Health Matters | Staying on the mental healthcare treadmill

(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.)

Many a times in health care or medicine it seems as if we are running on a treadmill — we do the same things again and again, encounter the same diseases, spend energies on combatting them again and again, allocate resources to fuel awareness and prevention programmes. It can get a tad monotonous, but then, the belief that these acts, done again and again, chip away at the old block of misconceptions, and reduce stigma, is the reward for doing it all over again, another day. This past week, with World Suicide Prevention Day falling on September 10 and Alzheimer’s Day falling on September 21, the wheel of action spun unceasingly on addressing mental health issues. Though ideally, awareness building is a year-long exercise, the reality is that these days provide occasions to make as much noise as possible, with the hope that its echoes last until the next year.

Afshan Yasmeen, in this story, ‘India needs to gear up for the emerging dementia epidemic, say experts’, articulates the opinion that a national action plan is needed to tackle rising cases of Alzheimer’s. India’s elderly population is expected to touch 20 crore in 2031, and estimates from a recent study recent multi-centric study reveal a dementia prevalence rate of 7.4% among those aged 60 years and above, translating to nearly nine lakh Indians currently living with dementia. From an estimated 88 lakh in 2016, the prevalence of dementia is projected to increase to 1.7 crore by 2036. The glaring lack of a national plan will leave the nation vulnerable with rising costs of care, and the burden of a health condition that has no known cure. Alzheimer’s is the most common form of dementia which can impair memory and significantly lower quality of life.

Former World Health Organisation chief scientist and current chairperson of the M. S. Swaminathan Research Foundation Soumya Swaminathan raised the need for more data on dementia, trained caregivers for persons diagnosed with dementia, and research on interventions and the prevention of dementia, at an event over the weekend in Chennai.

Sunday also marked World Suicide Prevention Day and news pages were replete with information on helplines and events that aimed at increasing awareness, and offering support. In Chennai, again, a massive run organised by Sneha, a 24-hour hotline for people in distress (044-2464 0050) took place on Sunday, in an attempt to holler out the prevention message, so more people know what to do, the options they have to reach out to, in case there is a need, or refer other people to. In Tamil Nadu, Sneha and the State Government’s health helpline 104, in addition to Tele-MANAS (14416), have been providing counselling to those in distress, and have proven to be of great assistance, particular after exams and before exam results are announced.

Clearly, this type of intervention works. Read about how a particular intervention through the USHAS project helped over 2,800 persons in five government hospitals in Bengaluru to reduce suicide intent and future attempts. Even incremental steps help towards achieving the larger goal, as every person who is prevented from taking the final step is a definite win. Meanwhile, a new helpline from Madurai Speak2Us (9375493754), has started outreach services to provide much-needed emotional support. And in Hyderabad, Siddharth Kumar Singh writes about Roshni, a local suicide prevention helpline that is offering hope and healing in the darkest moments, one call at a time.

Another important effort involves the setting up of the Suicide Loss Survivors forum, and interactive platform for care and support. Shekhar P. Seshadri, former Senior Professor at the Department of Child and Adolescent Psychiatry at NIMHANS, said the feelings that arise during the loss of a loved one to suicide — the confusion, the guilt, the stigma, the shame — often go unattended and unheard. “Postvention helps these survivors of suicide loss to address this predicament that they are going through,” he explained.

There’s the quotidian in health, and then there is the serendipitous. Multiple inventions and discoveries were made thanks to the serendipitous meeting of minds, or chemicals or elements, or simply the right circumstances. Here, Bindu Shajan Perappadan recounted how researchers discovered that Monkeypox surveillance helps identify variants of the virus causing chickenpox. The Indian Council of Medical Research-National Institute of Virology (ICMR-NIV) has for the first time found the presence of Clade 9 variant of varicella zoster virus (VZV) in India. Monkeypox disease symptoms are frequently mistaken for VZV, as their clinical presentations often closely resemble each other. There is a need for clinical differentiation between mpox and VZV for accurate diagnosis, said the study.

Doctors in urban centres across the country have been warning of a rash of viral fevers for a while now. Outpatient departments of government and private hospitals are filling up with patients suffering from flu-like illnesses and fever. Here is a sample, from Hyderabad, where the number of cases is between 300-400 overall, but doctors have just cautioned vigilance, and have emphasised that there is no need to panic.

Quality will continue to be an issue that will require health managers of the country running hard to stay in the same place. In a case that grabbed the headlines this past week, the drugs regulator issued an alert after pharma firm Abbott India recalled antacid syrup Digene Gel. The drug controller’s notice said the company initially withdrew one batch of its product available in mint flavour and four batches in orange flavour after receiving a complaint about a product that was white, had bitter taste and pungent smell early August. Within a week the company recalled all batches of its Digene syrup sold in mint, orange, and mixed-fruit flavours manufactured at its Goa facility.

Also, the Drugs Controller General of India directed the drugs controllers of all States and Union Territories to keep a strict vigil on the sale and distribution of falsified versions of two drugs, liver medication Defitelio and Takeda’s cancer drug Adcetris (injection), following alerts issued by the WHO that multiple versions of the drug were available in some countries, including India.

Again, having a vigilant drug control authority in place is a state’s best defence against spurious, fake or poor-quality drugs. Drugs Control Administration unearths spurious medicine racket in Vijayawada, writes Sambasiva Rao. The Delhi High Court upheld the Central Government’s decision to include all medical devices within the ambit of the term ‘drug’ under the Drugs and Cosmetics Act.

A contentious issue in recent times, with advertisements from one particular provider of Indian Systems of Medicine drugs flooding the market, is the question of regulating the claims and fantastic cures that some of these organisations promise. More recently, the Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) Ministry made a U-turn on its stance on regulating inappropriate advertisements of Ayurvedic, Siddha and Unani medicines and this has come under fire. Health experts have now approached the Ministry for urgent intervention and possible reversal of its recommendation. The Ayurvedic Siddha and Unani Drugs Technical Advisory Board has recommended the omission of Rule 170 which deals with controlling inappropriate advertisements and was previously brought into the amendment of the Drugs & Cosmetics Rules, 1945.

Food prices are on the rise, but are our earnings keeping up? | Data Point video

The messages on nutrition continue to be issued, given that September if being treated as nutrition week in the country. Watch this video by Sonikka Loganathan on how food prices continue to rise but the question to be asked is if earnings are going up to accommodate the inflation, continuing in the series on health, nutrition and affordability. Suruchi Singh discusses in this very important article about what will convey the message effectively to the people of the importance of taking a nutritious diet. People often lack knowledge of proper eating and feeding practices. Myths around food and increased accessibility to highly processed food have compounded the problem. Nutrition counselling can potentially be the answer to this problem, she says, highlighting the Bemetara experience from Chattisgarh.

If this is the question on your mind: What does a healthy breakfast do for you? then, here are some answers I find out from a nutritionist, particularly pertaining to children. In this bibliography of a bunch of books related to nutrition, The good food guide: building a healthy world for future generations, Soma Basu picks out the best advice that public health experts offer through their books. Millets also have a role to play in tackling lifestyle diseases, Kerala’s Health Minister says.

September 15 is Vaginismus Awareness Day, and utilising the opportunity, Soujanya Padikkal writes about providing support to women dealing with the unbearable pain of vaginismus. Vaginismus causes involuntary contractions of the vaginal muscles making penetration of any kind; sexual or otherwise impossible or accompanied by excruciating pain, irrespective of the woman’s desire. This has the potential to cause a great deal of embarrassment, shame, and a feeling of inadequacy, besides actual pain, and will have to be handled with a mix of interventions. Meanwhile, women, particularly those who have had early menopause or have had a hysterectomy, will do well to heed this piece of advice from cardiologists: Do not ignore symptoms of cardiac problems.

Here’s an anachronism, the way these things go. While awareness about adult vaccination is pretty high in several cities in India, the percentage of persons who get vaccinated is abysmal, a study conducted by the Association of Physicians of India (API) and Ipsos in 16 cities among adults aged 50 years and older. It appears as if the crucial vaccination falls between two stools, as doctors lay the blame on the fact that formal guidelines are not available to enforce adult immunisation, and that their patients did not welcome. The public reasons that their doctors do not make firm recommendations that they take their vaccines regularly.

Does vagus nerve dysfunction have a connection with COVID-19? asks Zubeda Hamid. In this explainer, she lists the functions of the vagus nerves, a pair of nerves, one on each side, that run from your brainstem, through the neck, to your chest and stomach. They form a key part of the parasympathetic nervous system, the system that is responsible for relaxing and resting your body after a bout of activity, and for a number of vital functions including your heart rate, blood pressure and digestion; it also plays a role in the immune system. They work bi-directionally, allowing the brain and body to communicate with each other. And so, researchers are increasingly looking at ways through which stimulation of these nerves, our ‘sensory superhighways’, thereby triggering the parasympathetic nervous system, may potentially help with various health conditions. And, yes, a connection has been established with long COVID.

Our tailpiece this week is a tale of hope, nearly miraculous, in the way it has altered the lack of basic sensory input - auditory. Senior ENT surgeon Mohan Kameswaran recounts the journey of this fascinating tool that was birthed on the cusp of technology and medicine - the cochlear implant - that has literally allowed the deaf to hear. The acoustic barrier has been surmounted with neural implants and more and more surgeries are being performed every year, to give little children a bionic ear that will allow them to hear the world, loud and clear.