Time will heal, so will Sidha


Sidha healers residing in the mountains are usually picturised wearing saffron dhotis with uncombed voluminous hair falling all over their face. The chief healer of Kolli hills, Mooligai Selavaraj’s image does not concur with any of it.

He zooms around in his bike, participates in all the cultural extravaganza during festivals and weddings, pets two dogs and a kitten, indulges in gardening and to top it all, walks around in his white dhoti, a casual checked shirt and a red cap.

Aged 49, he admits to have been in the profession of Sidha since he was just 24. His ancestral inclination towards medicine did not leave him many options.

He grew up running through the Kolli forests, smelling and spotting the medicinal herbs. This explains much about his eloquent rendering of all possible scriptures which have reference to health and medicine.

“There is no disease without a cure,” he says with a confident smile.

Selvaraj is a busy man. Ignoring the continuous buzz on his phone, he shows us a pamphlet with the names of all Sidha Rasams (medicines) used for curing diseases ranging from a simple knee pain to the fatal ones like Cancer and Aids.

He frankly admits that only 75% of the cases he attends succeed. Cases fail when the patient does not take the medicines as prescribed or when the medicine simply does not suit the patient.

“One should have patience while the medicine acts on him,” says Selvaraj. “Most importantly, one should be kept detached from ones family and in complete care of the healer,” he adds.

The trend of allopathy medicine has invaded Kolli as well. But Selvaraj is not against it. He says that for an emergency, allopathy is always advisable.

However, what disappoints him is that villagers opt for Sidha medicine when nothing else works on them. “Most of the cases cannot be cured because they come one hour before their death,” he says.

While he is not attending to patients, he is busy training researchers from all over Tamilnadu. In the two month training, charged at Rs 2000 per head, he practically shows them how to prepare the medicines – the ingredients of which he fearlessly obtains from the sacred forests – an act which could sin him, according to the natives.

Determined to keep the Sidha tradition alive, he says, “I am ready to impart my knowledge to anyone who is ready to receive it.”

 

Kolli Sheds Calories


The change in the socio economic needs among the Malayalis, the local tribe of Kolli, Tamil Nadu, has brought a shift in the indigenous agriculture. As a sign, food crops are being replaced by cash crops. While it serves as a quick money minting method, the question of food security remains blotted.

Dhanpal, a villager from Sellipatti, was offered one lakh by the Government under the Indra Awaz Yojna scheme that provides housing for rural people. However, this amount was insufficient for construction and he ended up taking a loan of 2.5 lakhs from others.

Unable to repay, his paddy fields were taken away.

He worked for four months in the fields of Erode and Salem, and brought home 40% of the produce – which should last his family until the next harvest.

This story pertains to most of the farmers in Kolli.

Dhanpal made meager profits through pig rearing and started poultry for self consumption. He raised goats and sold its milk to Aavin Milk Corporation in exchange for rice and pulses.

Saroja, the Kaveriamman women’s self help group representative said, “Only kids until the age of three consume milk here. No one travels 3 km to the milk corporative society just to fetch a litre of milk from the corporation.”

The papaya fruit which grows in Dhanpal’s garden is neither sold, nor eaten. “We are bored of it,” he sighs. The Guava, orange, bananas and Jackfruits which are grown in house gardens are never consumed by the villagers. Instead they are sold to middlemen at a marginal price.

The intake of proteins among villagers has decreased over the past 10 years with the shift in cultivation from Ragi to Tapioca. “Tapioca provides for immediate income, but not for sufficient nutrients,” said Kateshwari, a nutritionist working with M S Swaminathan Research Foundation (MSSRF)

Probably not a direct result of shift in cultivation, but “monthly health check camps conducted in Primary Health Centres showed that most children are underweight, the women are anaemic and majority of them suffer from Calcium and Iodine deficiency,” she said.

Malayali women take less than 50 grams of meat a month. “As per the tradition, a woman eats only after her whole family is done eating. There are times when we do not get enough,” said Senthamarai from Alavadi village.

Fish, a major source of Vitamin A and proteins, has never been a part of their diet. As an MSSRF initiative, several varieties of fishes were released in the community pond and steps are being taken to educate women on how to cook fish.

As a quick fix to the problem, the agriculture department introduced rice varieties from the plains. According to Balakumar, an agricultural scientist working with MSSRF, this was a failed plan since those “did not suit the soil here and hence gave low yield.”

“The rising expenses, increasing population, deforestation and lack of interest among the young to learn the indigenous agroforestry system are a threat to food security of Kolli,” he added.

 

 

 

TB cure initiatives lack patients


Less than one fifth of the population in India remains unaware of the free medical treatment provided by the Government for Tuberculosis( TB) as it continues to remain in the top spot, putting the other diseases like HIV Aids, Sexually Transmitted diseases , Malaria, Leprosy and Tropical diseases behind,  in killing the maximum number of people in India every year.

The president of India, Pranab Mukherjee, in his message on the occasion of world tuberculosis day ( March 24th, 2013) said that “ Since 1998, due to the successful implementation of the DOTS strategy; more than 14.2 million people across India have accessed treatment (for TB).”

World TB day - 2013 themePicture Source : wikinewstime.com

World TB day – 2013 theme
Picture Source : wikinewstime.com

However, according to a Knowledge, Attitude and Practices (KAP) study done by the Akshaya Project, though 37% of the people knew about 6-8 month treatment to cure TB, only one-third of them visited a health facility for seeking an examination.

While there can be several reasons for this inhibition, the poor financial status of the families cannot be excluded. Directly Observed Therapy- Short Course(DOTS), under the auspices of Government, provides for free tests. “This unfortunately, as is evident from the figures, is not availed by the people,” said Ramya Ananthakrishnan, Medical Director of REACH – an NGO working in TB control.

The free tests given in the Government clinics include Sputum microscopy, a gold standard technique, which uses a phlegm indicator. The patients are asked to spit out the phlegm and the infection is confirmed by spotting the rod-shaped bacilli, using the indicator.

However, “If the Lab staffs test your blood (Mantoux test) and say that you have TB, then you are being taken for a ride,” said Ms Ananthakrishnan. These tests only say whether a person is infected. It doesn’t concur the prevalence of a disease.

If the sputum tests appear positive, then drugs are administered for 6 to 8 months ensuring a supervised, uninterrupted treatment. The first line of treatment includes the drugs – Rifampicin, Ethambutol, Pyrazinamide and INH. If these do not cure the disease, the second line of drugs are given, which include the (Multi Drug Resistant) MDR-TB  drugs. These are to be taken for another 18 to 24 months.

TB is caused by the bacteria – rod-shaped cells called Mycobacterium – which spread through air, when an infected person coughs. This sets up home in ones lungs and later reaches other parts of the body through the bloodstream.

Rod-shaped Bacterium(causes TB)Picture Source : jpkc.njau.edu.cn

Rod-shaped Bacterium(causes TB)
Picture Source : jpkc.njau.edu.cn

Ms Ananthakrishnan in her presentation emphasised on the need to cover ones mouth while coughing in public spaces and on the necessity to dispose the sputum carefully to avoid spreading to others.

She added that special care should be taken if a person is a smoker, a diabetic or a HIV positive patient, since in such cases the immunity is low.

Debunking the idea of TB being hereditary, Ms Ananthakrishnan said, “ anyone can get TB”. Her best advice is to seek medical help in case of a two-week cough as that is a typical symptom of TB which is sadly ignored by many. Other symptoms include Pneumonia, Cavities, Diarrhea, Fibrosis, swollen bones or spine depending on the type of TB and the part it affects.

According to a WHO report, 2009, India carries one fifth of the world’s TB burden, recording a shocking rate of two TB deaths every 3 minutes – A data which supports the statement of it being the TB capital of the world.

When wisdom is gone


“They just wanted to be a part of my body, and I said, ‘No! Get out!’ I didn’t mean it. You can come back if you want,” sobbed Abbie Kritz, a 19-year-old, who turned hysterical after her wisdom tooth was removed, according to a report in ABC news (March 2013).

Ask a person who has suffered the bouts of pain with the wisdom tooth trying to pierce its way out, or randomly growing in different angles, the story will be different. Though it isn’t sure whether it would be story of pain and torture, but sympathy would be the last emotion it would invoke.

Wisdom tooth, the late comer, plans to grow when a person is already in his or her late teens or early twenties with the other 28 teeth neatly aligned and comfortable. Now, asking for space to include four fat molars in the jaw, is asking too much. No wonder, it grows in weird angles, sometimes peeping halfway out or sometimes pushing its neighbour away so as to become a part of the alignment. This tooth has a name -‘impacted’.

NHS choices, United Kingdom’s biggest health website explains the different types of impactions depending on the position of the emerging tooth. It is as Mesial impaction if the wisdom tooth grows at an angle facing the front of the mouth. If the tooth grows straight,but then is unable to pierce out because it is stuck to the tooth which is immediately beside it, then it is called vertical impaction. When it grows horizontally, it is called horizontal impaction and when it grows somewhere distant from the immediate tooth, it is distal.

ImpactionPhotosource : www.esteticadental.com

Impaction
Photosource : http://www.esteticadental.com

It is the most natural thing for someone to hesitate meeting a dentist. While one may ignore the partial growth, or the abnormal twist in its position, it is important to note that these hideous molars, if ignored, can lead to serious problems in the long run.

Dr Ravindran, BDS, M.D.S., Oral & Maxillofacial Surgery  says, “With the tooth-brush hardly able to pamper the deposits in the interiors, the wisdom teeth are mostly left with the food particles and bacteria which fester the growth of plaque.”

Plaque, like the locust affecting the fields, slowly breaks up the surface of the tooth and imparts the cavity to the adjacent tooth as well. It also releases toxins that affect the gums, making them red and swollen. In few rare cases, the wisdom tooth which still hasn’t burst through the gum can produce cysts.

While many of the problems mentioned could be treated by antibiotics and antiseptic mouthwash, there are cases where the removal becomes mandatory, according to a report in NHS choices.

In such cases, an appointment with the doctor might follow a X-ray, with an appointment for the surgery in a week or two. After the sedatives are given, the patient is allowed to lie down in the chair and wait till the area around the wisdom tooth is numb. If the tooth has still not emerged out, then the bone immediately surrounding the tooth is cut. Also, the visible area of the tooth is cut into small pieces for easy removal. A significant amount of pressure is applied to finally take the molar out.

Mani K G, a 30-year-old patient, who recently underwent the surgery says, “The whole process took an hour to complete, after which I found myself with a swollen cheek, with the flesh around the removed area stitched with a dissolving suture and a cotton stuffed into the now empty space where the tooth once resided.”

Though one wouldn’t experience significant pain, the swelling might prevail for a couple of days to a week’s time.

According to a study by Cochrane in 2005, the number of extractions could be reduced by 60 percent if they were done only when patients were in pain or developed a condition related to wisdom teeth. The group also said there is “reliable evidence” that suggests that removing wisdom teeth does not prevent or reduce crowding of front teeth.

Opposing this, the “Oral surgeons have long argued that if you don’t have your wisdom teeth removed at a young age, you are simply postponing the inevitable”, as mentioned in report in The New York Times (September 2011).

Dirk Van Tuerenhout, the curator of anthropology at the Houston museum was quoted saying in the Red Orbit (August 2007)that in a few years time “Our little toes were once vital for climbing trees, but might soon disappear, along with our appendices and wisdom teeth, vestiges of our vegetarian past”

Now, that would be a solace to the Homo sapiens who have to endure the pain of birth and removal of something which is absolutely unessential for survival.

 

Picking on ‘Rag Picking’


With the urban areas spreading their boundaries to the rural areas, there are more people who are out of jobs. These people are unskilled, uneducated and illiterate. The easiest way which they find to support their life is by rag picking which is a self-employed job without any specific work timings.

It is estimated that there are at least 15 lakh scrap and waste collectors in India alone.

The flexibility of it even encourages the women folk to enter into this profession as they can strategically decide on the time when they have to work and when they have to take care of their family. This explains the higher percentage of women employed in this profession.

Ragpickers constitute a huge informal sector which works in an organized way. They have different groups within the community who segregate specific items. While few focus on copper, few others would pick plastics, and few glass, metallic pieces, rubber products, e-waste and so on. These components when sold to a client would fetch them money depending on the market force then. For example, in Kodingyur, iron was prices at Rs 18/kilo, copper at Rs 350/kilo, Aluminium at Rs 60/kilo, bottles at Rs 35/kilo and Masalas (Tin and plastic) at Rs 30/kilo. The money received would be enough to just about keep their family from starving and get the basic necessities.

Trash industry as a whole in itself is worth $410 million worldwide per year.In 2005, SAAHAS, a Bangalore based Waste Advocacy group estimated that gold extraction alone from Bangalore budding e-waste recycling industry was worth $1 million.

It is said that the landfill emissions are projected to increase to nearly 75% in 2050. With the segregation process done by the rag pickers, the materials like plastics and other materials which can’t be disposed are removed from the heap of waste. This is turn reduces pollution when the heap is burnt in open or in incinerators.

According to the 2010 UN Habitat Publication, the waste pickers perform 50% to 100% of all ongoing waste collection with no cost to the city budget. Thus, the intervention of Garbage collectors brings in huge amounts of profits for the official garbage collection committee.  In Delhi alone, it saves the Municipal Corporation Rs 600000 in daily waste disposal costs.

Picture Source : www.zimbio.com

Picture Source : http://www.zimbio.com

However, for the amount of work they do there is no official recognition given by the Government. There is no insurance provided and no option of pensions in their field of employment. Also, there is no guarantee on a stable monthly income as the prices of the components which they pick change depending on the market force and are further manipulated by the clients or scrap dealers they work for. On an average they receive Rs 100 to Rs 150 for 8 hours of work.

With no footwear or gloves used while working, the ragpickers are susceptible to all sorts of diseases ranging from the respiratory problems to the heart ailments. There have been accidents, garbage avalanches which remain to be unspoken about or even urged for a solution. In 2001, Ragpicking was included among the hazardous occupations banned under Child Labour(Prohibition and Regulation) Act, 1986.

Children as young as 4 years old assist their parents in the job to supplement income for the family. This deprives them of the basic education which in turn deprives them of a better livelihood in the future. Without any footwear or health precautionary measures, they suffer from diseases which later aggravate and result in the low life expectancy levels in the community as a whole. This form of child labour is a usual sight in the landfills.

Children grow up without being aware that there are better opportunities outside the life they lead. Even though their parents work hard to ensure that at least their kids are rescued from falling into taking up this job, the meager income pressurizes every member of the family to contribute.

It is also observed that the rag pickers are usually from the lower castes. No Brahmins or upper caste people can be seen taking up these professions. Thus, there arises a question of caste discrimination and equality. If this is an impact of the rigorous caste issues which our country has been having for centuries, isn’t it time we erase it?

 

An innocent kill


668..670..672, she muttered to herself , now safe in the darkness of her room. 674..676..678..the sweat drops glistening on her forehead flowed down to her neck and were now forming dark patches on her cotton shirt. 680..682..684..the voices grew closer. There was a thud on the door and then a sharp turn of the handle – Amina shrieked, shivered and swooned.

 

Amina had woken up that morning to the sight of four strange men in suits, looking at her.  Her parents stood in a corner like the curators of a museum where she was the only showpiece.

She scorned at the men while they smiled. She collected her bed cover closer to her body and reclined to the farthest corner possible.

One of the men moved closer, “Hey Kiddo, isn’t it a fine morning?” She inserted her tiny fingers into her ears, deep enough to touch her ear drums.

While the temperature outside dipped, Amina’s body gave in to perspiration. She started counting numbers – multiples of two. This usually calmed her down. “It’s like being back in the womb,” she would say.

The men had now receded. It was the turn of the ‘curators’.

“Relax Ami. They have just come to visit you,” her mom said. Amina hardly paid attention and kept looking at the mosquito which sat on her mother’s wrist. Snap…It now lay smashed in a tiny patch of blood. For a second, she imagined herself in the insect’s place – limbs twisted at odd angles, broken teeth and hair smudged with blood. She quivered.

Amina was just nine – a fact that would appear as a joke to someone who saw her personal library. Stacked on the shelves were works of Srinivasa Ramanujam, Wu Wenjun, Andrew Wiles, Fibonacci and others – a collection that could boil the brains of any ordinary human.

But she was far from ordinary. A child prodigy, she had cracked the code to the most perplexing math and physics paradoxes and was now a research specimen for the biologists. Doctors say she has “savant syndrome” – something which her family read as “being utterly genius” syndrome ignoring the deficiency.

Picture source : tvtropes.org

Picture source : tvtropes.org

Amina was staged before people like a gorilla in chains, while her parents in their prettiest dresses, bowed, gleamed and flaunted their property. The audience sighed with admiration and later sniffed with sympathy.

That morning the cage appeared again – the cage that would take Amina to one of the wretched exposing lawns, where a million eyes would tear through her body to find an answer to why she is unique. She could already feel the bright neon lights blinding her. The applause at the end of it, which would remind her of axes trying to fell a tree.

The mosquito’s blood was now turning into a dark shade of maroon. Wiping it off, her mom said,” Now you should get cleaned too.”

“For what?”

“We have to go, another glorious moment for you.” said her mom, and left to get herself dressed.

Amina followed her. She stared while her mom chose the best of clothes, tried different accessories and rehearsed her laugh, walk and handshake in the mirror.

Surges of hatred consumed her. She took to counting. 2,4,6,8 ….

660, 662, 664, 666… Amina stopped.  Her eyes went to the pesticide near the bedroom window.

“Oh honey…..”

Unable to finish the sentence, her mom fell – unconscious and lifeless.

668..670..672, she muttered to herself , now safe in the darkness of her room. 674..676..678..the sweat drops glistening on her forehead flowed down to her neck and were now forming dark patches on her cotton shirt. 680..682..684..the voices grew closer. There was a thud on the door and then a sharp turn of the handle – Amina shrieked, shivered and swooned.

 

 

 

Generics: A promising era in Medicine


Arun Bharati, an 18-year-old from Bihar was diagnosed with Hodgkin’s lymphoma, a cancer that affects the lymphs, at All India Institute of medical sciences (AIMS) in New Delhi earlier this year. On learning that the drugs would cost him Rs 300000 per month, his dad, who was a farm labourer, committed suicide as he couldn’t afford the mammoth amount.

Arun’s tragic story speaks of millions others who, unable to afford the drug rates, opted to end their lives themselves than wait for the disease to nibble on them.

While the poor give up their hopes on getting a quality treatment, the middle class end up selling all their possessions, and drowning themselves in bankruptcy by the time they accumulate enough for the treatment.

And this is a phenomenon which is prevalent worldwide, not just in India. High drug prices are responsible for the deaths of more than one lakh people in the US, who cannot adhere to the costly medical prescriptions.

It is quite unfortunate how lives are lost in spite of having the medical facilities and technology to treat the diseases. Nothing could be more tragic than having the life saving technology in front of you and not be able to use it. This would almost measure to a cruel manslaughter.

So why is the system so skewed?

The answer is – Monopoly.

The way the drug companies operate today is almost like a monarchy where they decide the price and distribution of their medicines. The fulcrum of the weighing balance is in their hands. They can incline it to any side so as to stabilise the profits of their company by increasing the prices of drugs.

The pharma companies work with a sense of complete, almost possessive ownership of their product. This explains the concept of branding, wherein the same drug made by three different companies can have three different brand names and be sold at three different prices.

So how do the patients decide what to buy?

Unfortunately the patients make just pseudo consumers to the drugs. The real ones are the doctors who are made to strike a deal with different pharmaceutical companies via a medical representative who in turn gives a tempting commission to the doctor for endorsing the company he represents. The patients are left with no other option, but to buy the medicines prescribed by the doctor. Isn’t that a clever vicious cycle?

Dr C M Ghulati, Editor of Monthly index of Medical Specialities says that today in India, a pharma company spends nearly Rs 1,31,000 on one doctor per year. The whole money mongering industry of doctors and pharma companies to market the medicines amounts to Rs 1,2000 crores per year.

While it is a win-win situation for the doctors and the Pharma companies, the patients are left in a drain of manipulation, bankruptcy and suicides.

However, the world isn’t deprived of all hopes yet.

The industry of generic medicines has brought in a new ray of hope for those who thought drugs were a luxury.

The AIDS drugs was priced at $10,000 per person until 2001 when the Indian generic drug giant, Cipla started selling the drugs at a much cheaper rate of $150 per person.

The concept of generic medicines, which is gripping the market at present, requires all pharmaceutical companies to register for market license in the generic name and not the brand name.

Crocin, instead of its brand name will now be sold as paracetamol at much cheaper rate.

As far as India is concerned, the generic drug revolution had started in 1972 when a law was passed that could enable the emulation of any drug, even if under patent, unless the process isn’t the same. This gave Cipla the opportunity to make low cost drugs for the poor.

However, in 2005 India signed the Trade Related Intellectual Property agreement which was a major setback for a country with such a huge population. The agreement required the companies to keep the patent on new drugs for 20 years.

This gave the right manure for a monopolised structure. Though licensing was given by the government to few generic companies to copy the drug before the end of the patent period in case of public interest, it was a cumbersome process to get license from each company.

There has been a perennial argument between the Pharma giants and the poor sections of the society on the issue of patents.

While the companies insist on getting patents on the newly developed drugs as it would help in protecting the intellectual rights and also motivate in the development of new drugs in the country, the poor argue that if the patents are given the high prices would literally kill them.

The recent conflict between the pharma giant Novartis and the Indian Government over the drug, glivec is an accurate example of these arguments.

While the Generic medicines ensure the affordability of medicines to the weaker sections, the Medicines for Malaria Venture(MMV), a non-profit organisation, has taken an initiative to openly share the drug development data for the patients word wide through an open access portal called Malaria Box, a platform where any new research in the field can be shared by anyone.

India has now put a $5.4 billion policy to provide free medicines which is to be fully operational by 2014 for which sates would be providing 25% of the cost and the rest will be provided by the Central Government. The policy is aimed at covering 52% of the population by 2017 at a cumulative cost of 300 billion rupees.

Under this policy, the doctors are only supposed to prescribe generic drugs. They could land themselves in punishment if found prescribing the branded ones.

Generic makers, Dr Reddy’s and Cipla will be benefited whereas the global drug makers, Pfizer, GlaxosmithKline and Merck will be hit the most.

Earlier this year, Cipla cut prices of key cancer drugs by nearly 75%. Kidney cancer drug, Sorafenib, which was sold under brand name Nexavare by Bayer, will now be available at 6,840 per month, down from 28,000 per month. Similarly, Lung cancer drug Gestinib, which was sold by AstraZeneca as Iressa for Rs 10,000 will now be made available at Rs 4,250.

However, it is necessary to check the quality and efficacy of drugs produced by the generic industry. There is always the problem of having hundreds of generic versions of one drug. It is necessary to regulate the generics of a particular compound and ensure quality and bioequivalence to its pioneer drug.

Unfortunately, Central drugs Standard Control Organisation; the drug regulatory body in India, is understaffed and also lacks sufficient labs to check the quality of medicines. While this is an issue which needs to be tackled, other challenges would be the lack of awareness about generic drugs among the patients and a lack of doctors’ buy in.