Citizens' Issues
Prime Minister as the real Health Minister
What surprises me more is the capacity of our PM to understand the complexities of health care
 
I was thrilled to hear Prime Minister Narendra Modi asking doctors last week to try to be human and humane. It sounded like the lectures I used to take in the medical schools while I was in active teaching. The latest research shows what I used to teach for decades that healing is not due to our interventions with drugs and surgery but through the placebo effect, that underlies all interventions. (Science Translational Medicine 2013; 3: 70) If so, the doctor should earn (command) the respect and faith of his/her patients. As Oliver Wendell Holmes, a Harvard trained medical doctor who left medical practice to be a writer and poet, writes the following lines, which now have been proven scientifically right. “The two most powerful medicines doctors ever invented were the two kind words of a good doctor.” How true.
 
That being said what about the state of health care in India? Are doctors the only factor in health care? That is another unscientific myth that makes the round especially in political circles. Mac Furlane Burnet said something like this. “Doctors and hospitals do not keep society healthy.” When you talk to any politician worth his salt s/he thinks that India lacks in numbers of doctors to plug the doctor-patient ratio. There seems to be an obsession with the numbers game in the medical field that most politicians think that India needs more doctors! In fact, India has surplus doctors and the so called doctor-patient ratio is the best here if we consider all castes of doctors in the healing field as one bunch. If we take the MBBS doctors alone it might not be as good as some of the advanced countries. What is important is not the number of doctors but the number of humane doctors in any country. Several scientific studies have shown that even in the advanced west those countries with too many doctors per capita and when more number of the former are specialists, the health of the population was the worst and disease numbers were the highest compared to those countries whose doctor patient ratio was poor and most of their doctors were only family doctors. Japan with the worst doctor patient ratio was one of the best countries in the world for health statistics while US and Germany with the best ratios were the worst among the fourteen industrialised countries! (JAMA 2000; 284: 483). A very recent study done over a period of 10 years prospectively in thirty hospitals in the Massachusetts area showed that when senior interventionalists were away attending conferences, the death and disability rates among seriously ill patients admitted to their ICUs did better and death rates fell down significantly. (JAMA Internal Medicine 2015; 185: 237) Similar was the experience when doctors went on strike for longer than three months. (BMJ 2000; 320: 1561)
 
India does not have to worry about their doctor numbers; we could do well to reduce the numbers if needed. If some rationalists have doubts about the ability of the non-MBBS doctors to be effective one only has to look at that large study done in Thailand by the WHO some years ago where five different systems of healing arts are in vogue including quackery. This study did show that all doctors were equally effective in society in general. So we have to count all health care providers even in villages in India for our statistics.  Even if all Indian doctors abroad come back to their homeland, they will not go to our far-flung villages where the service will have to be provided by traditional practitioners only.
 
The PM almost echoes the sentiments expressed by the United Nations Industrial Development Organization (UNIDO), in 1998 that a country needs following basic needs for good health. Clean drinking water for the masses tops the list. Next comes three meals a day uncontaminated by human and/or animal excreta. Sanitary facilities like toilets, underground drainage systems, and environmental cleanliness come next. Cooking smoke, especially which emanates from burning dry leaves and twigs and some of our villages they even use cow dung cake, is the best stimulant of cancer and childhood pneumonia. Economic empowerment of village women will help remove her distress from seeing her children go to bed on an empty stomach, if the husband does not bring his earnings home, after spending most of it to drink alcohol and feed himself. Girl child education is a vital area for reducing the fertility rate, as girls above the age of 25 at marriage will have only half the usual rate. This is an indirect method of family planning. For some unexplained reasons our PM looks into all these areas and he is the true health minister. He could command the resources from all those concerned government departments that our conventional health ministers cannot muster. In short our conventional health ministers are just disease ministers. They are concerned about sicknesses and their management. Thank God, we have a thinking Prime Minister who works overtime to make is country healthy and prosperous. Health is the best wealth for any nation. Sick nation will be economically also sick. I have another thought for village health care. We could convert our village primary schools into health care centres! 
 

Primary schools double up as health centres:

 
In this new concept, the village school teacher is trained for 6-12 months with a teaching diploma in school health promotion (TDHP) to replace the village doctor. Every medical school could be made to train certain number of selected bright village teachers, free of charge, with a special curriculum to equip them with enough know how to look after the holistic health of the children and their parents in the village. They should be provided with communication facilities to inform the taluka hospital about any sick child or adult in the village to be shifted there for treatment. They should be trained to spot trouble and inform the doctor and the hospital to do the needful. They are never trained to handle drugs or treat any one. The money being spent for the PHCs could be diverted to develop this new concept along with the village school. 
 
The teacher/health promoter would look after sanitary needs in the village like toilets for every household, clean drinking water, smokeless houses, and clean meals for all, and assist the villagers to live like a large family in the village. In due course, people would look up to them for all kinds of guidance. The idea is to develop a cadre of village teachers who become the friend, philosopher, and guide of the villagers. In the school, these teachers have added responsibility to see that children get proper nutritious meals; they develop healthy habits, clean dress and are made to wash hands before eating. Children should be trained to use the toilet and teach their parents in turn at home. Children should be taught to respect all life on this planet as we are all inter-dependent. 
 
These teachers are responsible to see that children get proper immunization at the right time. They could help children to develop a healthy social outlook with universal compassion, sharing and caring. Healthy living should be one of the important subjects in the curriculum but without the conventional end year examination. However, those who excel should be given a special certificate as also some incentive by way of a prize or so. Children could be encouraged to think for themselves to develop curious healthy citizens for science training in later life. Catch them young should be the motto. My friend, Late Dr. Solomon Victor, a famous cardiac surgeon of Chennai, had a model for teaching school health. That could be supplemented to make a special curriculum for the subject of health promotion in school. I know that the vested interests will block these ideas as there is no business interest in this. Would some Godly person see that this message reaches our Hon. Prime Minister please? 
 
“The 1 to 2 billion poorest in the world, who don't have food for the day, suffer from the worst disease: globalization deficiency. The way globalization is occurring could be much better, but the worst thing is not being part of it. For those people, we need to support good civil societies and governments.” — Hans Rosling
 
(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.)
 

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COMMENTS

Prakash Bhate

1 year ago

Someone (Moneylife?) should arrange a talk by Dr Hegde in a company on his idea of utilizing village schools. Use of the company's CSR funds for initiating such an activity will be a natural outcome.

A S Bhat

1 year ago

As always, Dr. Hegde is right. Very well said sir! Thank you.

A.S. Bhat

D S Ranga Rao

1 year ago

Very practicable idea. But as Dr. Hegde rightly concluded:"I know that the vested interests will block these ideas as there is no business interest in this", will the medical mafia comprising the doctors, all sorts of health care professionals, hospitals, diagnostic centres, chemists, pharmas(merchants of death), the ministers, etc., be willing to forego their kickbacks, commissions and what not, so easily?

Narendra Doshi

1 year ago

Extremely well said, worth total or more applicable. Hegde sir, your thoughts are reborn for action. Moneylife and your contacts should continue their efforts in this direction, THIS REFORM IS A MUST.

REPLY

Shirish Sadanand Shanbhag

In Reply to Narendra Doshi 1 year ago

I full agree with Narendra Doshi's views on this article on health care.

Shirish Sadanand Shanbhag

In Reply to Narendra Doshi 1 year ago

I full agree with Narendra Doshi's views on this article on health care.

Nifty may struggle to go up – Tuesday closing report
Only a decisive close above 7,880 will signal that the market has come out of its recent trading range
 
We had mentioned in Monday’s closing report that Nifty, Sensex are in an uptrend and that Nifty has to stay above 7,800 for the uptrend to continue. However, in Tuesday’s trading, Nifty fell below the 7,800-level briefly and closed at 7,829. The major indices were weak throughout and closed with marginal losses. 
 
 
Market analysts felt that despite strong macro-economic data, investors remained cautious ahead of the upcoming decision on the US rate hike. Even the better-than-expected inflation and modest factory output data, which had cheered investors with hopes of a rate cut by the Reserve Bank of India, did not support buying in the markets.
 
India's annual inflation rate based on wholesale prices continued in the negative territory in August, falling to (-)4.95% from (-)4.05% in July. Another key macro indicator showed that India's factory output had grown by 4.2% in July against a marginal rise of 0.9% in the like month of last year. 
 
India's consumer price inflation for August eased slightly to 3.66% from 3.69% in July and a staggering 7.03% during the like month of last year. India Inc. expects that a better-than-expected WPI (wholesale price index) and CPI (consumer price index) will drastically improve chances of a rate cut during Reserve Bank of India's monetary policy review slated for September 29.
 
Higher interest rates in the US are expected to lead away the foreign portfolio investors (FPIs) from emerging markets like India. It is also expected to dent business margins as access to capital from the US will become expensive. It is estimated that the foreign funds and investors have sold around $3 billion since August 2015.
 
Sector-wise, only fast moving consumer goods (FMCG) and information technology (IT) index out of the 12 indices managed to stay afloat during the day's trade. 
 
The S&P BSE capital goods index plunged by 337.65 points, automobile index plummeted by 294.32 points, bank index receded by 188.28 points, metal index fell by 173.21 points and consumer durables index was lower by 162.90 points.
 
However, the S&P BSE FMCG index was higher by 60.44 points and IT index inched-up by 3.40 points.
 
Major Sensex gainers during Tuesday's trade were: Hindustan Unilever, up 1.15% at Rs.804.75; Sun Pharma, up 1.11% at Rs.866.70; ITC, up 1.09% at Rs.316.75; NTPC, up 0.68% at Rs.126.40; and Reliance Industries, up 0.52% at Rs.867.55.
 
Major Sensex losers were: Tata Steel, down 5.08% at Rs.229.05; Vedanta, down 4.06% at Rs.96.90; Tata Motors, down 3.69% at Rs.333.95; Hindalco Industries, down 3.05% at Rs.76.30; and Larsen and Toubro (L&T), down 2.92% at Rs.1,556.95.
 
Among the Asian markets, Hong Kong's Hang Seng inched down by 0.49%, and China's Shanghai Composite Index lost 3.55%. However, Japan's Nikkei inched-up by 0.34%.
 
The top gainers and top losers in the major indices are given in the table below:
 
 
The closing values of the major Asian indices are given in the table below:
 
 
 
 
 
 

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Snapdeal's FreeCharge launches digital wallet
Utility payments platform FreeCharge on Tuesday launched a digital wallet in partnership with Mumbai-based private lender Yes Bank.
 
Online e-commerce player Snapdeal had acquired FreeCharge in a deal believed to be worth around Rs.2,800 crore earlier this year and the launch of the new wallet could be seen as a challenge to digital payments player Paytm.
 
"With the launch of the FreeCharge digital wallet service, we are all set to transform the way people make payments. A secure, easy to use and feature-rich service, the wallet is equipped with state of the art technology and a robust partner network, making it a truly game-changing service that will bring value to consumers and our partners in the ecosystem," said FreeCharge co-founder Kunal Shah.
 
Freecharge, which has a volume of over 200 million transactions annually, claims that it is set to become the most used wallet within the next six months based on the ecosystem of 8.2 million daily unique users, 4 million monthly engaged hours, 15 million stored cards and a combined with gross merchandise value (GMV) of over $4 billion.
 
In addition, the company will partner with FINO - a payments bank licensee to build scale and ability to reach even the under-served.
 
"Our aim is to bring in efficiencies in payments using digital commerce to cater to every consumption need that a user may have. Consumer needs are constantly evolving and we feel it is the right time to launch a trusted and feature-rich digital wallet service," said Snapdeal co-founder Kunal Bahl.
 
"At Snapdeal we are building an ecosystem that powers billions of digital commerce transactions. With the launch of the FreeCharge Digital Wallet, we will now play an even more intrinsic role in our customers' lives," he added.

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COMMENTS

webkitendfullscreen

1 year ago

A wallet a day.. God only knows what market they are catering to.. Looks like another expedition to milk some silly investors of their money..

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