CNS

The Last Lesson

Mrs Bimla Misra

On 12th September 2013, former Principal of Kasturba Gandhi Balika Vidyalaya Mrs Bimla Misra (84 years) bid farewell to this world - but not before teaching another lesson: as per her wish, her body was donated to the cause of medical education to King George's Medical University (KGMU) sans rituals. Mrs Misra taught her students most of her life till mid-August 2013.

Anatomy, the study of the structure of the human body, is one of the most important courses in the medical education. The need for human bodies is pressing and no doubt Mrs Misra's gift will be valued and honoured.

Affectionately addressed as 'Mamma' by most of us, she always stood as a living example of empowerment and living life with dignity and grace. Mother of CNS Executive Director Shobha Shukla, she could not have given a more powerful example when it was the time to go by donating her body and rising above traditional customs and rituals to support the cause of science.

As her daughter and CNS head Shobha Shukla said, let us celebrate the years she lived...

Go well 'Mamma'....

Citizen News Service - CNS family
September 2013

Integrated TB and HIV care in Myanmar gives hope

Bobby Ramakant - CNS
[Images] There is no doubt that tuberculosis (TB) and HIV care should be integrated at different levels, particularly in high burden settings. Being part of the UNITAID mission to report from the global launch of the largest-ever roll-out of Gene Xpert MTB/RIF machines in Yangon, Citizen News Service - CNS got an opportunity to witness an inspiring work done in Myanmar since 2005 where TB and HIV care services are getting increasingly integrated at different levels, with support from the International Union Against Tuberculosis and Lung Disease (The Union) and partners.

[हिंदी] Just when it appeared that Samajwadi Party government had handled the 84 Kosi Parikrama incident quite well and had emerged as a hero in the eyes of Muslims, Muzaffarnagar has happened. It has painted the government in a very bad light, said a statement jointly issued by Socialist Party (India), Rihai Manch and National Alliance of People's Movements (NAPM).

Okeoghene Oghenekaro, Nigeria
(First published in National Mirror, Nigeria on 3 September 2013)
The incidence of tuberculosis and HIV seem to be rising in Nigeria, as it has been recorded that more than 3.4 million people are now infected. More agonising is the fact that those diagonised with the diseases are constantly stigmatised in the society. This piece examines efforts being made to mitigate their effects.

Bobby Ramakant - CNS
[Images] Diagnosing tuberculosis (TB) and also getting to know with accuracy about resistance to one of the two most powerful anti-TB drugs (Rifampicin) within two hours is increasingly becoming a reality on the ground. The largest-ever roll-out of Gene Xpert MTB/RIF machines in countries most severely hit by drug-resistant TB was launched on 10th September 2013 at the National Tuberculosis Reference Laboratory in Yangon, Myanmar, with support from UNITAID, an organization whose 70% funding is raised by innovative financing mechanisms such as levying a small fee on airline tickets.

Shobha Shukla - CNS
Some years ago, 30 years old Tanveer (name changed), a noted tabla percussionist, sustained a fall that lead to a spinal fracture and complete paralysis of both his lower limbs. Although orthopaedic surgeons fixed his spinal bony fracture, he continued to have paraplegia.

HIV patients vulnerable to TB

Chhatra Karki, Nepal

(First published in Kapan, Nepal)
Tuberculosis (TB) and HIV co-infection is now emerging as a big threat in the health sector around the world. As people living with HIV (PLHIV) gradually lose their immune power, they become more vulnerable to the infection of TB. As per a report, there are 34 million PLHIV around the world; and 11 million of them have been affected by severe forms of TB.

Shobha Shukla - CNS
40 years old Rukmini lives close to the Civil Hospital of BJ Medical College in Ahmedabad. She used to sell fruits to supplement her daily wage earner husband’s meager income till tuberculosis struck her in 2010. She has a 17 year old daughter and an elder son who is married. Rukmini is illiterate but has managed to educate her children up to elementary level.

Carolyn Kavita Tauro, India
Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) – can we continue to tackle these separately? According to the Global TB Report (2012), in 2011, out of 8.7 million people who developed TB worldwide 1.1 million (13%) were HIV positive. An approximate of 0.4 million HIV-associated TB deaths took place in 2011 and TB is the most common opportunistic infection among people living with HIV (PLWH). HIV increases chances that latent TB infection can become active TB disease and also increases the risk of death due to this.

A day-long Advocacy Training Workshop on WHO Framework Convention on Tobacco Control (FCTC) Article 5.3 will be held in Lucknow, India, on Saturday, 7th September 2013. Several civil society and government representatives implementing the domestic tobacco control law are likely to participate.

Photo credit: CNS, January 2010

Shobha Shukla - CNS
[Hindi] 48 years old Deepak, was leading a happy normal life with his wife and 3 children. He was working in a government job as a driver in the police department in Ramgarh district of Uttarakhand when, way back in 1997, he suddenly vomited blood one day. The doctor diagnosed him with pulmonary TB on the basis of a chest X-Ray and put him on a 6 month Anti TB Treatment under DOTS (Directly Observed Treatment Shortcourse). Deepak was presumably cured and remained okay for a year and a half. Meanwhile he had been transferred from Ramgarh to Uttar Kashi. There his problem recurred and he vomited blood again.

Alice Tembe, Swaziland
‘I had to choose between being deaf and being dead’, this is what Dalene von Delft, a Medical Doctor from Stellenbosch University in South Africa, said in her testimony at a two-day Southern Africa meeting held recently to strengthen and scale up TB /HIV responses in the workplace. The meet was supported under the TB Care II program by University Research Company in collaboration with USAID. In the meeting, Swaziland, Namibia, South Africa were represented by their government, workers and employers’ organizations working in the field of TB.

Diana Esther Wangari - CNS
Lying in bed at Kenyatta National hospital, Joshua Lule stared at the ceiling lost in thought. The hospital had been his home for the past three months and while the rest of the patients prepared to see their friends and relatives at half past noon every day, Joshua remained in his recumbent position. No one would be coming to visit him; in fact no one had visited him in the past two months. He had remained hopeful during those first few weeks but as days passed by his hopes of seeing a friendly or family face dwindled. The grim reality that they had all given up on him gradually dawned on him.

Shobha Shukla - CNS
Meena (name changed), a 35 years old mother of 3, comes from a village in district Gonda of Uttar Pradesh, India. She is living with HIV and has suffered from TB also. I met her at the antiretroviral therapy (ART) centre of a Government Hospital in Lucknow and was instantly struck by her infectious smile and cheerful disposition. Three years ago, both she and her husband were diagnosed with HIV. She was immediately put on ART, but not her husband as the doctor did not find his CD4 count below the critical level. Ironically, her husband died six months later of a fall, but Meena is still up and about.

(First published in THE HINDUSTAN TIMES on Tuesday, 6th August 2013)
Diabetes has proved itself a silent killer disease. Today in the world maximum numbers of the patients are suffering from this disease, and moreover they are passing through the complications too. The World Health Organisation estimated that in the year 2000, 150 million people had diabetes mellitus, and it is predicted that this number will rise to 366 million by the year 2030.The life style, diet and addictions are adding fuel to fire. Evidence prove that the patho-physiological process of diabetes have put the foot at increased risk for tissue damage. As soon as tissue damage has occurred,the foot is at risk for end stage complication including gangrene and amputations.

Paidamoyo Chipunza, Zimbabwe
(First published in The Herald, Zimbabwe on 8 August 2013): GOVERNMENT has been urged to create 100 percent smoke-free environments to help reduce the risk of contracting cancer. The calls come amid chilling revelations that more than 4 000 chemicals are found in tobacco smoke, from which at least 250 are known to be harmful and more than 50 known to cause cancer. Ministry of Health and Child Welfare deputy director for the department of mental health and drug abuse Mrs Dorcas Sithole said while current laws forbid anyone to smoke in public spaces such as in buses, commuter omnibuses, airlines, halls, schools and public offices, people still do so.

Okeoghene Oghenekaro, Nigeria
(First published in News Agency of Nigeria, on 6 August 2013): Bidemi, a widowed petty trader, feels her life is crumbling because all her children frequently go down with cold. Joshua, her five-year old son, has just been discharged from the hospital after treating a debilitating cold. After medical tests, the doctor said Joshua had a respiratory tract infection the symptoms which Bidemi’s three other children are already having. She then wonders what could have caused this.

Bobby Ramakant - CNS
[Online poster image gallery] [हिन्दी] Over a hundred poster exhibits made on "Lessons From Japan" theme by Lucknow youth had sent a strong message on Hiroshima Day, 6th August 2013 in favour of low carbon and no-nuclear energy. Using nuclear energy for power generation is a very dangerous and expensive option with serious risk of irreparable and/or long term damage to environment and human life, argued the activists. This Lessons From Japan poster exhibition was organized at Daffodils Convent Inter College campus in Lucknow by Vote For Health campaign, CNS, Asha Parivar and National Alliance of People's Movements (NAPM).

Dr Ram Puniyani
A friend with dogged determination to show that the BJP is a lesser culprit of communal violence and that Congress is the major party to be blamed, listed the major communal riots in India and showed that most of the time when violence took place, it was Congress which has been the ruling party. He asks, so why get stuck with one episode of Gujarat violence and put it as a major point against Narendra Modi or BJP for that matter?

The International Management Development Programme (IMDP) of the International Union Against Tuberculosis and Lung Disease (The Union) ) has joined hands with the World Health Organization (WHO) TBTEAM network to support health systems strengthening by delivering accredited health management training courses. TBTEAM, the Tuberculosis Technical Assistance Mechanism, whose secretariat is hosted in the WHO Global TB Programme, is a global coalition of partners, countries and funding agencies, which aims to build up the national capacity of countries and focuses on assisting national TB programmes and other stakeholders in improving implementation of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund).

[Report is online here] CNS with support from Lilly MDR TB Partnership visited 14 sites of Programmatic Management of Drug-resistant Tuberculosis (PMDT) in India and conducted key informant interviews on four key themes (counselling, infection control, diagnostics and laboratory services, and treatment and care services) and came up with specific recommendations. Those interviewed included patients of multidrug-resistant TB (MDR-TB), extensively drug-resistant TB (XDR-TB), cured MDR-TB patients, their family members, nurses, laboratory technicians, scientists, physicians, home-based care workers, counsellors, among others. The report, was submitted to Planning Commission; Central TB Division of Government of India; among other authorities. It was also disseminated at 8th World Conference of Science Journalists (WCSJ 2013) in Helsinki. Fifth part of this report also includes personal stories of MDR-TB and XDR-TB patients currently on treatment and cured MDR-TB patients.

5 years survival after lung cancer treatment remains low

Bobby Ramakant - CNS
Lung cancer is lurking around along with known risk factors such as tobacco smoke. Although with recent advancements in medical science 5 years survival rate for other forms of cancer has increased considerably yet the same remains as low as 14% for lung cancer patients since past two decades. Professor (Dr) Rajendra Prasad, Director of Vallabhbhai Patel Chest Institute (VPCI) was speaking to Citizen News Service - CNS before a lung cancer update in Delhi.

Alice Tembe - CNS
The impact of indoor air quality, on airborne infections is often ignored or unknown even though it relates to the health of our lungs—one of the most vital organ of or bodies. Indoor air pollution arising out of inhaling solid cooking fuel smoke directly caused 3.5 million premature deaths in 2010 and 1.3 million children under 5 years of age died from pneumonia in 2011 according to UNCEF Reports of 2012. The WHO report of 2011 further confirms that three types of lung diseases have been shown to have a strong association with solid fuel smoke: acute lower respiratory infections (ALRIs) in children, chronic obstructive pulmonary disorder (COPD) in women, and lung cancer in women exposed to coal smoke.

Bobby Ramakant - CNS
Three billion people around the world still cook their daily meals with wood, charcoal, coal and other forms of solid fuel. According to the latest Global Burden of Disease update released in December 2012, resulting health impacts lead to four million deaths annually which after high blood pressure, alcohol and tobacco is the greatest killer in the world. In India at least over a million people died each year due to health impacts of using solid fuels for cooking (25% of the global burden) which is quite alarming and a significant problem in the country" said Sean Bartlett, Senior Communications Officer, Global Alliance for Clean Cookstoves.

Carolyn Kavita Tauro - CNS
As we stand at a pedestrian crossing or walk by a bridge, and a vehicle passes by, letting out a cloud of smoke in our face, our immediate reaction is to fan it away with our hands. We are also quick to give the driver of the vehicle a stare and even make a comment about how unclean and unsafe the air in the atmosphere around us is.

Sumita Thapar - CNS
Family planning is a key strategy for child survival, said Michael Stern, USAID India, in Delhi this week. “We look towards India as a development innovation hub,” he added. In Delhi this week, health practitioners, researchers and policy makers discussed how the Standard Days Method (SDM) for family planning fulfils an unmet need, specially in resource poor settings. The SDM is a simple fertility awareness-based method of family planning based on a woman`s menstrual cycle. Appropriate for women who usually have menstrual cycles between 26 and 32 days long, SDM identifies days 8 through 19 as the fertile days. To prevent pregnancy, the couple avoids unprotected sex on the fertile days.

Bobby Ramakant - CNS
If women and girls, and their male partners where possible, are aware of fertility cycle, then it is very likely to increase access to existing family planning services, improve communication between partners, and help them prevent unintended pregnancies and space childbirths. Natural fertility awareness methods such as Standard Days Method (SDM) have proven to be effective. SDM has 95% effectiveness which is comparable to other family planning options. Most importantly, SDM users highlighted that one of the reasons they prefer SDM is because it has no side effects.

Non-communicable diseases (NCDs) are causing two-third of deaths worldwide. There is no doubt that latest launch of a robust programme to help civil society work on improving responses to NCDs is a welcome step forward. The NCD Alliance launched a new programme, formally called "Strengthening Health Systems, Supporting NCD Action" at The Economist event "New Approaches to Non-Communicable Diseases" in South Africa, where experts discussed strategies to accelerate the prevention and control of NCDs.

Shobha Shukla - CNS
Air, water and food are the 3 basic essentials (in that order) to sustain human life. One can stay without water and food for long periods but not without oxygen laden clean air even for a few moments. So breathing fresh air is essential to let us live to eat and drink and be merry. While we have the wherewithal to monitor and control the quality of what we eat or drink by using boiled/filtered water and hygienic food for our individual use, we cannot carry with us our personal container of purified air to breathe. The air around us (whether good or bad) has to be necessarily shared with others. Yet the importance of keeping it clean for all of us seems to have taken a backseat.

Bobby Ramakant - CNS
[Images] Leave aside safe nuclear waste disposal, we are not even able to take care of domestic waste on our roads, said retired Justice Rajinder Sachchar while speaking at a book launch held in New Delhi on 12th July 2013. A Hindi language book, ‘Towards A Nuclear-free World’, penned by Magsaysay Awardee, scientist and noted social activist Dr Sandeep Pandey and published by Vani Prakashan, was also released by two women activists from Kudankulam anti-nuclear struggle, Ms Immaculate and Ms Maryaselvi at this Delhi meet.

Shobha Shukla - CNS
The fourth WHO Report on the Global Tobacco Epidemic 2013, which was released recently in Panama City, shows that one-third of the world’s population – 2.3 billion people (from 92 countries) – are now covered by at least one of the 6 life-saving policy measures to curb tobacco use. This represents an increase of nearly 1.3 billion people (and 48 countries) in the past five years. This year’s report focuses on complete bans on tobacco advertising, promotion and sponsorship (TAPS), which is a highly effective way to reduce or eliminate exposure to cues for tobacco use.

The Delhi Network of Positive People (DNP+) is calling on the Health Ministry and National AIDS Control Organization’s (NACO) Director General to urgently address the stock out of CD4 kits and/or reagents in Anti Retroviral Treatment (ART) centres in the North-East, UP, Maharastra, Delhi and other parts of the country. The never-say-die AIDS treatment activists are on an indefinite dharna (sit in strike) in front of the National AIDS Control Organization (NACO) office, New Delhi, from 9th July onwards till the CD4 laboratory services are resumed across the country. There seems to be a stock out of CD4 reagents in some North Eastern states of India.

Bobby Ramakant - CNS
[हिन्दी] The new World Health Organization (WHO) guidelines on HIV treatment and prevention which were released at the 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur do provide hope that more people living with HIV will be able to live healthy - only if these guidelines get implemented in letter and spirit on the ground. "These guidelines are a landmark in the fight against AIDS," said Mitchell Warren, Executive Director of AVAC. "But guidelines alone do not save lives - money, pills and smart programmes save lives. Investment and effective implementation will be critical."