Ensuring that a vaccine you depend on is not a dud

Dr Giridhara Babu has done us a service pointing out that a valuable indicator which should be on vaccine packs is often not there.

Visit

Visiting private clinic for immunization?

Dr Giridhara R Babu, April 08, 2015, DHNS

http://www.deccanherald.com/content/470363/visiting-private-clinic-immunisation.html

He points out that you may be worse off if you get a vaccine shot at a private hospital. Government hospitals usually use vaccine that are guarded by a printed image named the Vaccine Vial Monitor. If the vial is not kept at specified low temperatures all the way from the factory to the place of use, the image changes its shape/color and warns you that the contents cannot be relied upon. Vaccines at private clinics do not necessarily use the VVM device.

I have myself taken expensive “flu shots” in private hospitals and I can assure you that there was no VVM on those packages. Why not? What prevents the government from banning the sale/use of vaccines not protected by VVM?

More information can be found on VVMs, including a very descriptive image, at

http://www.path.org/blog/2014/07/5-billion-strong/

Dr Babu's article goes beyond protecting vaccines through cold chains. There is another point he makes about an unethical medical practice that is unrelated to vaccines. However, that is also worth thinking about and protesting against. 

The role of the World Wide Web in promoting transparency

I found a Times of India item on the Web today about medical colleges which show to the regulatory agencies fake lists of professors they claim to have on their faculty. The professors appear on campus miraculously on the day any inspecting committee turns up. Visit

http://timesofindia.indiatimes.com/india/On-the-trail-of-ghost-faculty-in-private-medical-colleges/articleshow/46810529.cms

Incidentally, it is unfair to focus only on “private medical colleges” here. There have been reports in the press of government medical colleges using “short-term transfers” to make up for non-existent faculty too! Visit

http://www.thehindu.com/todays-paper/tp-national/tp-kerala/kerala-loses-350-mbbs-seats/article7009287.ece

I have a simple suggestion. The regulatory agencies should ask the colleges to have permanently on the websites a list of faculty, giving the dates indicating the period they served the institution and details such as qualifications, department and designation. There should be enough information for anyone to figure out if the professor named is a real one or a ghost!

Prof R Narasimhan Memorial Lectures - International Conferences in India can get grants for inviting speakers

Tata Institute of Fundamental Research has designed a poster for 2015 to publicize Prof R Narasimhan Memorial Lectures. Visit
http://www.tifr.res.in/~endowment/prof-r-narasimhan-lecture-award.htm
This endowment offers a grant annually to a selected international conference in India in the area of computer science and technology to cover travel costs of an invited speaker.

You can ask the TIFR
Public Relations Officer <pro@tifr.res.in>
to send you a copy of the colorful poster for display at your institution. 

Untangle India

I took this picture recently on the streets of Coimbatore. You can take such pictures anywhere in the country. The practice of putting up with shoddy wiring exemplifies the “chalta hai” (it will do!) attitude to construction and maintenance. Our engineers may be great in publishing new algorithms, but when it comes to wiring by technicians, they will put up with anything that works for the moment. The worst mess in India is made by cable TV service providers. There is no regulation of their wiring, which jumps across streets, spans distances no engineer would dream of, and even invades tree branches in parks.

The phone and Internet connection of a resident in our building was cut last week by mistake when somebody was reconnecting wires in the junction box in the electrical room. He was there with the phone company’s technician when wires were re-connected. The junction box was a complete rat’s nest of wires, tangled and intertwined with one another. It's easy to see how someone could make a mistake and cut the wrong wires since nothing is labelled or cleanly visible. It is not uncommon to hear your phone ring and hear a technician asking you your flat number! That is often the only way he can figure out which wire goes where. No one seems to have heard of any wiring standards.

India is proud to have over 18 million wired Internet connections and 28 million wireline telephones. You are lucky when they are working. Any day a small change has to be made to accommodate new connections near your residence, there is a good chance that your connection will stop working!

Swachh Bharat (a clean India), yes! Let us also have an untangled India, in which wiring follows some discipline and can be maintained without messing around.

Appeal to architects – Design buildings to be smart phone friendly

I was visiting a relative in a hospital today. My tablet could not pick up 3G signals in the waiting room and in the patient’s room. Why? They have metal grills covering the glass windows even on the fifth floor! The grills are large and cover a lot of the external wall area. They will surely keep burglars from breaking and entering! But, I don’t think burglars want to steal intravenous feeding stands by coming in through the 5^th floor window! Not in a hospital which is bustling with hundreds of people all the time.

I believe that professors of architecture should emphasize the importance of cell phones and smart phones in peoples’ lives today. These devices have to be used in the busiest of places – hospitals, airports, railway stations, and company as well as government buildings open to the public. Students of architecture should learn about the permeability of building materials to electromagnetic waves. They must know how Wi-Fi systems work and learn to design buildings which will allow Wi-Fi and cell phone networks to most of the built-up area.

Know-how about electromagnetic signal propagation will also help architects to prohibit cell phone usage where necessary, in a natural way. Places of worship, courts, and some government offices are best served by walls with embedded wire mesh! Such walls will automatically disable cell phone usage!

A friend who reviewed this note said “Perhaps the grill is to prevent people from jumping out of the windows”. I think that can be prevented by hospital sending the patients' bills through burly security guards and having them keep watch till the bills are paid!

Flu shots for Indians

For five years now, my wife and I have been taking our annual flu shots regularly on the basis of a niece’s advice – she is a doctor in the US. We have been going to some big time hospital or other in Bangalore because flu shots were rarely available in other Bangalore pharmacies. We had talked to Indian doctors and found that it was not the practice in India to ask people to take annual flu shots.

In the US, the government recommends that everyone who is six months or older be given a flu shot. Visit http://www.niaid.nih.gov/topics/Flu/understandingFlu/Pages/seasonalVaccine.aspx
This site says that over the last 31 years, the number of influenza-associated-deaths in the U. S. have ranged from 3000 to 49,000 per year. 90% of these deaths have been among those above 65 years of age.

It had always puzzled us why Indian medical practice has not insisted that at least those above 65 should take a flu shot regularly.  It is well-known that immunity to flu does not last very long because the virus mutates fast and an annual immunization is necessary.

Things are changing this year. A domestic who works for us told us that some people living near her place are paying Rs 800 each to get some injection that is expected to protect them from swine flu. Should she take it? It is a difficult question to answer, not because of the money, but because whatever she gets has to be authentic. We would hate to see her being cheated by some hack giving her a vitamin injection and charging Rs 800 for it. Do government hospitals give flu shots? Are they stocked with adequate supplies? Which hospital should we contact?

A Web search took me to a website that lists hospitals authorized to treat swine flu cases: http://vaccineindia.org/index.php?option=com_content&view=article&id=395&Itemid=361

Later on in the day, we heard from a relative who was to get admitted today into a big hospital for a procedure tomorrow. However, admission this evening was impossible because of the pressure on hospital rooms from patients suspected to be suffering from swine flu. The patient has been told to fast at home and turn up tomorrow for the procedure.

Public health authorities, obviously, have a difficult task on their hands this year. The reason I write this post is, however, a concern for the long term. Unless reliable flu shots made in India become available in adequate quantity and unless Indian medical practice ensures that high-risk groups get immunization, we could have a major problem on our hands. H1N1 is not a new strain on the scene. It has been around for many years.  

Christian Medical College, Vellore

I had gone to Vellore to help a relative get medical care for a fractured hand. We visited the famous hospital at CMC, Vellore http://en.wikipedia.org/wiki/Christian_Medical_College_%26_Hospital

The experience left indelible memories and made me read up a little about what motivated the founding of such a great institution. One place that summarizes a lot of what is relevant is the Wikipedia article mentioned above. That article describes the moving experience that made Ida Scudder decide to earn a medical degree and come back to work in India.

I understand that the hospital treats approximately 7,000 patients a day. They come from all parts of India and speak all the national languages in this small town. It is not any freebie they come for; they pay what it costs, as far as I can observe. The credibility of the hospital and its reputation have gone far and wide; it gives them what they really need - a hospital they can trust, a hospital that does not rip off, a hospital that has treated generations of doctors whose behavior constantly reminds you about the values they have imbibed.  

Many Christian missionaries have contributed to education and healthcare in India. The idea of recognizing service to humanity as an important principle of religion has been a great development in human history. It is not my concern here whether this great idea originated in a single religion or if it existed in many religions simultaneously. 

Great Indian thinkers have taught us to adopt this principle. Gandhiji had written "If India adopted the doctrine of love as an active part of her religion and introduced it in her politics, Swaraj would descend upon India from heaven". According to Vivekananda, an important teaching he received from Ramakrishna was that Jiva is Shiva (each individual is divinity itself). So he stressed on Shiva Jnane Jiva Seva, (to serve common people considering them as manifestation of God). According to Vivekananda, man is potentially Divine, so, service to man is indeed service to God. (you can find both these quotes in the Wikipedia).

Coming back to CMC, I should mention the significant economic contribution it has made to district of Vellore and to the State of Tamil Nadu, through the number of jobs it has created directly and indirectly.

It is also worth noting that there is a CMC, Ludhiana, again founded by a woman, Dame Edith Mary Brown. Founded in 1894, CMC Ludhiana has contributed a lot in training women doctors during a critical time in Indian history. 

Undoubtedly, there are other institutions in India and elsewhere that contribute very significantly to education and healthcare. They are not limited to a single religion. 

I conclude this note with three thoughts: 

I wish that all religions will emphasize service to humanity as a major principle, and take effective steps to progress in that direction. Our instincts as human beings incorporate this basic principle; emphasizing it as a part of education is essential for the survival of our species. 

The notion of profit is said to be fundamental in economics, but a visit to CMC tells me that great hospitals do not necessarily have to be profit-oriented institutions. Not being profit-oriented is possibly a blessing for a teaching hospital. 

When we wish to build something in memory of a great soul, it is worth thinking if it could be in the form of a self-sustaining hospital and medical college. It could transform the economy of a district, in addition to providing education and healthcare. 

Srinivasan Ramani