Challenges in Health Sector

By Dr Rajagopal Soondron

Our health, which we soon realize is so important, unfortunately escapes good definition; each individual, influenced by the media, has a biased and different concept of what good health is

New ideas crop up in the mind of researches and scientists, but the question is how many of these ideas materialize.

In the field of health care, one can witness the tremendous progress made in the new concept of care delivery – how robotic surgery, telemedicine via internet and the decades old pin-hole surgery have displaced the old manners of dealing with patients that we learned some four decades ago. The advantage is that patients have less pain post operatively, and they are discharged from hospital earlier. And echography, MRI and scan investigations have longed peeped into every nook and corner of the living body in three dimensions to offer fast diagnosis. Add to that the inclusion of Artificial Intelligence to shift through the thousands of data about a patient that a doctor will have difficulty to do. In 75% of cases, it could predict whether patients would be seeking medical help again within the following 24 to 48 hours – after analyzing their medical files. Looking at the eye fundus of a diabetic patient, AI could pick up cardiac events to happen in the five years to come.

It’s common sense – the longer we keep patients in hospitals the more complications arise – so many centres have now instituted day-care surgery; patients come in the morning, are seen by the respective doctor and surgery carried out – and within three to six hours they are discharged to go home. Any complications that may arise are taken care for by a fast track special module attached to the hospital. In so doing a lot of advantages accrue to the treating institutions; patients feel more comfortable in the familiar surrounding at home than hospital and recover quicker.

And as digital apparatuses come on the market, many of them would become cheaper and more miniaturized – ready to be attached to any patient with major problems. These could monitor the patients 24 hrs over 24 and relay the information to a central station in the health institutions where the results could be scanned and analyzed to come up with a diagnosis. Such patients do not have to go in hospitals – and could be seen in a peripheral unit. Or still patients can correspond through video and audio facilities with a pool of medical or nursing staff to discuss their symptoms, the seriousness of each case assessed and the patients advised and directed to the proper clinic.

For centuries, the act of operating on patients has always taken the toll off the surgeons and anaesthetists; it was fraught with complications and dangers; it has been the stressful locus by excellence in a hospital. So doctors have been trained to pay 100% attention to the surgical procedures in operation theatres. Now it is being suggested that doctors be trained to take the patient in toto from the day he walks into the hospital for surgery until he walks out – so that he receives both 100% care pre- and post- operatively. By so doing a lot of complications could be avoided, and the cost effectiveness of a procedure would be worthwhile. Of course, new ideas and idealistic approaches to the patient is being propounded, but the cornerstone of such venture is the availability of adequate staff and funding to look after the patients.

Many of us would remember old Indian pictures where the actress, falling ill, would be treated at home in a room… And that’s where the actor, generally a doctor, would meet her first… and all sorts of drama and romantic scenarios would be dreamt of by the producer to promote his film. Someone has suggested that rich people when building their house should include a special room at home where any sick member of the family could be treated. Being at home has multiple advantages. After all, no one of us feels comfortable in the strange, austere, rigid, disinfectant smelling environment in health institutions. If this idea catches up in society, the government could start thinking how to subsidize it, plan for nursing and medical staff to visit these private houses. In so doing there would be decongestion at the central health institutions.

Prevention

However, it is a fact that there is no frustration greater for the medical personnel than to realize that their job – dealing with human suffering – seems never ending; hence the idea arose that if we could prevent people from becoming sick – we’ll gain on both humanitarian and financial sides. And all the panoply of vaccinations, of diets, of exercise, of moderation, of proper social adaptation, of religious and philosophical concepts creep in… just to make the healthy individual remain healthy.

There was a belief that by treating as many infections as possible a lot would be achieved. But suddenly news is coming that infective bugs are coming back with a vengeance and are determined to be around till the end of time. Mumps, tuberculosis and measles are there to remind us of that danger.

We must not insist too much on 100% cleanliness. We must build our immune system by allowing ourselves to be exposed to some sorts of microbes now and then.

Thus the latest edition of New Scientist is quite telling about:

Phorphyromonas Gingivalis

Received wisdom told us of non communicable diseases like diabetes, hypertension and cognitive decline, heart disease are non-infective – and are caused by our lifestyle. But the latest is that all these are just communicable diseases – the result of infections – which have their origin in our mouth where the bug Phorphyromonas Gingivalis… plays havoc with all our systems. Causing inflammation for years and decades this bug or its derivatives is being found in the walls of hardened arteries, in the heart, liver and brain all leading to what we had considered as non-communicable disease!!!

Are we up against the bugs for eternity, pitching our human organism in a never ending tug of war? Must we redefine our basic conception of health? That’s what some experts believe. We just have to tackle the problem of Phorphyromonas Gingivalis and we would be free from Parkinsonism and Alzheimer… and many other problems in health sector. But the medical jury is still out and debating.

Are we not being made aware of the problem of cholesterol, of the feasibility of eating too many eggs? Every month we have a contradictory report about the food we have to eat; of sticking to fibre containing food, of staying away from too much sugar and fatty diets. All sorts of supplements are being promoted by Big Pharmacological boxes and the latest scientific report says that all the news about diets are not supported by proper scientific research.

There has been too much publication bias – where those foods with positive effects have been blown out of proportion. There are so many factors that could affect our health while taking our food that no one knows what the truth really is. Cholesterol is no longer considered so bad for our heart; all research done has found that only people with some deficiency symptoms could benefit from some pharmaceutical supplements – but healthy people would be wasting their money to take them.

The golden rule is that you can eat whatever you want – but do it in moderation; the problem arises when you cross the limit. Of course, if one is diabetic, one must necessarily diminish sugar and fat intake; those with hypertension must limit salt intake. It’s well known that pregnant women must be given folic acid. Apart from that, most experts are of the view that food products are being manipulated by most big industries and promoted as superfood just for profit; they rely on sugar and salt to ensnare the people into their unhealthy products, while knowing quite well these are the culprits.

It looks as if we now and then have a lot of doubts about the rationale of what we have come to believe to be the truth. Our health, which we soon realize is so important, unfortunately escapes good definition; each individual, influenced by the media, has a biased and different concept of what good health is.


* Published in print edition on 6 September 2019

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