(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying there. You can subscribe here to get the newsletter in your inbox.)
Some times, the local is global and the global, local. Particularly during disasters. A disaster at home is not something to get over easily… And with climate change a reality, natural disasters seem to be sitting at our doorsteps, awaiting the slightest shower, the mildest snowfall, a harsh summer to enter and wreak havoc in homes, cities, suburbs, crippling entire communities. Cyclone Michaung which swept through northern Tamil Nadu and Andhra Pradesh last week was such a storm, that not only pummelled land with rainfall for hours, but also led the catastrophe to homes. Last week we saw how COP28 in Dubai was the first such conference to make sure that a health component was centre-staged. Sophie Robinson, Rebecca Patrick, Arthur Wyns, Annabelle Workman, and Kathryn Bowen write health is finally on the agenda – but there’s more to do as we face continued climate extremes. It is clearer now than ever before that climate change cannot be seen in isolation, as it gathers with power, much like a tornado lifting homes, cows and tin roofs, into its fold, multiple aspects all of them impacting on the lives and livelihoods of people. It also generates a ripple effect, that impinges on allied sectors, not directly related, and generations.
Increasingly, it is clear that government systems must be prepared for the particular and general challenges that every natural disaster that throws a spanner in the works. The ‘One Health’ perspective that is gaining increasing traction, is aimed at taking a 360 degree view of health care, one that is not necessarily anthropocentric. This approach must be ushered in with great urgency, as we realise that rains impact us, not only with flooding and temporarily disable us, but also hygiene and sanitation issues that might cause infections and diseases, cause scarcity of water and essentials, long-standing inundation also affects livestock, causes temporary disruption to jobs, and has an effect in the long term, on the ecology and sociology of a community.
There are plenty of lessons to learn from Cyclone Michaung — not only for Chennai, or Tamil Nadu, but also for other cities in India and States too. The number of floods, landslides, flashfloods, and earthquakes across the country in recent times are a wake up call, to take action before it is too late.
Here, read the compilation of our stories on Cyclone Michaung, presenting a range of issues that were encountered on the field.
Houses submerged at Yamuna Nagar, Nasarathpettai Panchayat in Tiruvallur district, after in the wake of Cyclone Michaung that brought in continuous rains to Chennai. | Photo Credit: Jothi Ramalingam B.
R. Sujatha writes on how one can prepare for the floods, at least health wise.
300 mobile medical units flagged off for Chennai and neighbouring districts.
Director of Public Health urges Chennai Corporation to stock medicines.
Water from flooded areas in north Chennai yet to be drained, say residents.
108 ambulance team creates its own boats to rescue people.
T.N. Health Department issues post-flood advisory.
Over 90,000 persons screened in mobile medical camps held in flood-affected districts.
NDRF team, private hospital help woman from Madipakkam deliver baby during the floods.
Talking of climate change, we can scarcely afford to ignore the perils of pollution and how it touches everyone. In this article, V. Kamalakara Rao says the perils of pollution are forcing people to beg for relocation from a once-green land. Tadi village, located adjacent to the Jawaharlal Nehru Pharma City (JNPC) industrial park, nourished by the abundant supply of the Godavari river waters through the Yeluru canal, once produced vegetables like tomato, ladies’ finger, ridge and bottle gourd, which were in high demand in Visakhapatnam. Today, however, severe industrial pollution plagues the village.
In West Bengal, there are concerns too, reports Shiv Sahay Singh. Doctors and civil rights group issued a health advisory to combat Kolkata’s air pollution. With the onset of winter as Kolkata is grappling with air pollution, a group of civil rights activists, and medical professionals have issued a health advisory. The advisory calls for the role of citizens and educational institutions along with the government. It also mentions that prolonged exposure to pollution levels can contribute to chronic respiratory and cardiovascular illnesses, lung cancer, and premature mortality. It also calls for the government to ban 15-year-old vehicles, recommends waste segregation, and a ban on single use plastic as well as the creation of clean air zones across schools and hospitals.
And in distant Pakistan, the situation is similar. Soaring pollution in Pakistan’s Lahore is filling wards with sick children. Lahore, known historically as a city of gardens, is now choking with toxic smog that placed it as the world’s worst for air quality last year. As cooler temperatures took hold in November, air quality levels spiralled. Twenty-four of the last 30 days had ‘hazardous’ or ‘very unhealthy’ air quality, according to Swiss group IQAir.
At a time when several key questions are decided in courts of law, we know that both the philosophy and procedure behind health decisions are decided within the haloed portals of courtrooms. Two such interesting questions came up before the courts in the country and mandate our attention. Krishnadas Rajagopal reported that the Supreme Court asks if unmarried women having children through surrogacy is against Indian society. On December 5, “A single woman bearing a child is an exception and not a rule in Indian society because our society says to have children within marriage. A single woman bearing a child is outside marriage… That is not the accepted norm of Indian society,” Supreme Court judge B.V. Nagarathna orally observed. The Bench, also comprising Justice Ujjal Bhuyan, was hearing a petition filed by a 38-year-old single and unmarried woman to become a mother through surrogacy. The petitioner, represented by senior advocate Saurabh Kirpal, said she was “heavily diabetic” and pregnancy would pose a grave risk to her. The Surrogacy (Regulation) Act, 2021 allows a widow, a divorced woman between the age of 35 and 45 years, and an infertile couple to avail the benefit of surrogacy. With the judge saying: “we are keeping in mind the pulse of Indian society” and the counsel for defence responding that the court should “keep in mind the pulse of the Indian Constitution”, as of now, the matter stands with the court issuing a notice to the Centre. We’ll be keeping track of this, for sure.
It is astounding that women’s health forms a substantial percentage of the health issues that reach the courts for litigation, over all other subjects. Last week, the Kerala HC turned down a plea for medical termination of pregnancy. The High Court turned down the plea of the mother of a 14-year-old girl, seeking the medical termination of the pregnancy of her daughter, who was a rape survivor. The court, which had sought reports from a medical board, noted that there was no health risk to the victim’s child’s health on account of the pregnancy. No lethal foetal abnormalities were detected. The pregnancy was almost in its ninth month and the foetus was gaining weight and getting closer to its eventual birth weight. The vital organs of the foetus were almost fully developed, preparing for life outside the womb. Hence, the court cannot accede to the request of the petitioner though it was in full empathy with the condition of the girl and her family, Justice Devan Ramachandran held. It will be a long while before an essentially patriarchal society will grant that women have autonomy over their own bodies, and the right to bear children or not.
Just when we thought we were past the nightmare of an organ trade scam, here’s some bad news. Bindu Shajan Perappadan writes on the ‘Cash-for-kidney’ scam where the Health Ministry orders a probe against Apollo Hospitals. The Health Ministry’s National Organ and Tissue Transplantation Organisation (NOTTO) initiated an inquiry into allegations of cash-for-kidney scam against Indraprastha Apollo Hospital, after the British newspaper The Telegraph published an article alleging that the hospital was involved in a racket where people from Myanmar are being enticed to sell their organs for profit. Sources in the Ministry on December 5 said that the State Organ and Tissue Transplant Organisation (SOTTO) will start looking into the matter immediately. It truly is disheartening to see news of organs being sold for profit from time to time, at the heart of it is the certain link with poverty that entices people to sell their own organs, fully cognisant that it could go bad for them.
Following up on the cough syrup quality controversy do read this important piece: 6% of cough syrup samples fail export quality test. Recent data from the Central Drugs Standard Control Organisation (CDSCO), shows that at least 6% of cough syrup samples from 54 Indian manufacturers failed a mandatory quality test for export. This was until October this year. The CDSCO is the regulatory body for cosmetics, pharmaceuticals and medical devices. “Testing is an ongoing process and is a standardised method to weed out substandard products. Testing before export is now mandatory,” said a Health Ministry official. Given that India is a global leader in generic medicines and commands a 20% share in global supply by volume, it is important to zone in on quality issues and ensure strict standards are adhered to.
I write on the hope that was generated recently, as at least four improved drug regimens for Tuberculosis to cut the treatment time were announced at the Paris Lung conference. After a drought of nearly no development in TB care over five decades, the roll out of effective and safe diagnostics and therapeutics that score over conventional technologies is a huge source of jubilation in the sector, and among patients and their families.
More on pharma, last week, the Indian Pharmacopoeia Commission (IPC) issued an alert for painkiller mefenamic acid, writes Bindu Shajan Perappadan. The Pharma standard body issued a drug safety alert for commonly used painkiller mefenamic acid, popularly sold under the brand name Meftal. In its alert, IPC said that healthcare professionals and consumers are advised to closely monitor the possibility of adverse drug reactions with the use of the drug. “The adverse drug reaction found during preliminary analysis was eosinophilia and systemic symptoms called DRESS syndrome,” the alert noted. Mefenamic acid is a nonsteroidal anti-inflammatory drug used to treat mild to moderate pain. It may also be used to treat menstrual cramps and other conditions as determined by a doctor, and is available only with a doctor’s prescription.
Staying on the drugs question, Dinesh S. Thakur, and Prashant Reddy T. flag the worrying issue of fixed drug combinations (FDC) in India. A group of academics from India, Qatar and the United Kingdom recently published a worrying new study in the Journal of Pharmaceutical Policy and Practice on the volume of unapproved and even banned fixed dose combination (FDC) of antibiotics that are being sold in India. Using sales data of the pharmaceutical industry, the study documents that in the year 2020, 60.5% FDCs of antibiotics (comprising 239 formulations) were unapproved and another 9.9% (comprising 39 formulations) were being sold despite being banned in the country. That so many of these unapproved or banned FDCs contain antibiotics is alarming because of the increasing prevalence of antibacterial microbial resistance (AMR) in India.
We want to share the exciting news of CRISPR being allowed to be used for therapies by the US FDA, here. The U.S. Food and Drug Administration (FDA) on December 8 approved a pair of gene therapies for sickle cell disease, including the first treatment based on the breakthrough CRISPR gene editing technology. The agency approved Lyfgenia from bluebird bio, and a separate treatment called Casgevy by partners Vertex Pharmaceuticals and CRISPR Therapeutics. Sickle cell disease is a painful, inherited blood disorder that can be debilitating and lead to premature death. Not only is the excitement about finding appropriate treatments for a disease that otherwise meant doom, but also that gene editing will be used in real time therapeutics. The employment of a revolutionary idea down the line as working technology is exhilarating in the health sciences world, to say the least.
If you remember, we did have stories criticising the National Medical Commission’s attempt to rebrand itself, and change it’s logo. Union Health Minister Mansukh Mandaviya defended the change in NMC logo, justified it saying it is part of India’s heritage. The NMC is facing criticism for its new logo, which features a coloured image of Hindu god Dhanvantari, The minister, on December 11, said that the image was already part of the logo and it had recently only been made colourful.
R. Prasad writes that compensation to participants in human challenge studies should not incentivise risk-taking. The ICMR’s Bioethics Unit, which introduced a consensus policy statement on Controlled Human Infection Studies, says that payment should take into account the loss of wages and incidental expenses, and the time spent and efforts made while participating in CHIS. But it has made altruism central to participation. “The researcher must evaluate the true nature of altruistic motives to participate and select only altruistic participants that meet the selection criteria of the study,” the policy statement says. However, experts disagree. Wilbur H. Chen, who was the principal investigator of the Shigella study says: “Our approach to the compensation of research participants follows an ethical framework of the Wage-Payment model which provides a payment scheme according to what an unskilled labourer who engages in somewhat risky jobs (e.g., a day labour construction worker) might be paid.” A participant in a clinical trial says: The aim is to compensate participants for their time and effort, not to pay for the risk they are taking.
Tailpiece
This story pushed itself ahead of the pile for our tailpiece this week. Siddharth Singh wrote about a strange kind of demand from medicos, after the State elections in Telengana. Apparently, 15 doctors emerged triumphant during the recently concluded Assembly elections. This led to an intense drive to have doctor-led health deparments, replacing the current leadership of IAS officers. Triumph of medicos in Telangana polls has thus sparked calls for doctor-led Health Department. The Telangana Junior Doctors Association (T-JUDA) has coined the slogan, Marpu Ravali, Doctor Health Minister Ga Kavali, meaning Change in government, doctor should become Minister for Health. This will be one interesting stir to follow.
Sahana Venugopal’s story on whether ChatGPT can replace human therapists takes a look at what might happen when people begin to use the AI large language model as a therapist? Now that AI tools are getting overhauled in order that they are able to generate extremely personalised chat bots, this will also be something we will keep an eye on.
From the Health page
If you have a few extra minutes, do bookmark to read:
A very important move, one that will have a deep rooted impact on saving lives: Health Ministry launches nationwide campaign to train people to give life-saving CPR.
Ex-PM Boris Johnson apologises to families of U.K. COVID-19 victims.
Zubeda Hamid has a podcast on a subject we have discussed here over the last couple of weeks: Should India be worried by the new spike in respiratory illnesses in China?
Once again, heavy fighting across Gaza halts most aid delivery, leaves civilians with few places to seek safety.
D. Balasubramanian weighs in: Any activity is better for your heart than sitting.
Indian Medical Association to present National Health Manifesto 2050 in national meet.
For a smattering of stories from our regional bureaus, do spend a while on the links below:
Delhi
Bindu Shajan Perappadan finds pneumonia cases in AIIMS Delhi have no link to the recent surge in respiratory infections in children in China, says Health Ministry.
Alisha Dutta reports on the fake doctors’ racket, finding that the accused had performed surgeries elsewhere too.
Haryana
Haryana doctors threatened pen-down strike on December 9 over pending demands.
Karnataka
Experts stress early identification and intervention in treating hearing disorders.
460 vacancies of medical officers to be filled by MBBS graduates soon.
Health Department directs DHOs to seal down ‘fake’ clinics in Karnataka.
Afshan Yasmeen finds COVID-19 data missing in Karnataka’s weekly infectious disease reports due to technical glitch.
Kerala
e-health services now in 600 health-care institutions in Kerala.
Kerala PG medical student arrested for dowry-related death of classmate.
AMMOI seeks National Institute of Ayurveda in Kerala.
State Government issues gazette notification on Kerala Public Health Act 2023.
Lakshadweep
Nurses’ forum seeks action against surgeon at Agatti hospital.
Odisha
Odisha invokes ESMA to ban strikes by Health Department staff.
Puducherry
Manual on TB research released in Puducherry college.
Tamil Nadu
Though Tamil Nadu has excelled in healthcare services, there is still room for improvement, says official.
Expert stresses importance of community-based learning for medical students.
Telangana
Siddharth Singh reports Hyderabad faces surge in viral infections amid drop in day temperatures.
As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here.
