Thailand ups diabetes prevention and education on World Diabetes Day 2009





In Thailand, more than 3 million people are living with diabetes. There is an urgent need to scale up the diabetes prevention and education, says Wittaya Kaewparadai, Minister of Public Health, Thailand.
According to the International Diabetes Federation (IDF), diabetes education and prevention is the World Diabetes Day theme for the period 2009-2013. The World Diabetes Day campaign calls on all those responsible for diabetes care to understand diabetes and take control.
"We have to educate Thai people to prevent getting diabetes by reducing the risk and modifying lifestyles and consumption

behaviours," says Wittaya. "More than 980,000 health volunteers are sent by the Ministry to conduct surveys and provide diabetes-related education to encourage people to reduce consumption of food that
increases their vulnerability to diabetes, like sweets. There is a need to pay more attention to healthcare and healthy lifestyles," says Wittaya.

"For those people who are living with diabetes presently, we
provide special care to manage
diabetes. There is regular screening for people with diabetes, especially for those who may be at risk of diabetes retinopathy, which is one of the major preventable cause of blindness" informs Wittaya, Minister of Public Health, Thailand.

"We received financial support from Denmark when HRH Crown Prince Frederik of Denmark and HRH Crown Princess Mary came to celebrate 150 years of Thai - Denmark relationship in Bangkok in
November 2008. In addition to this financial aid, with the support of the World Diabetes
Foundation (WDF), we started the mobile car units providing diabetes scanning, consultations and diabetes retinopathy treatment to the populations in Thailand. These two cars will also
provide services to people one day before World Diabetes Day, 14 November, at Nakhon Sri
Thammarat and Surachthanee (in Thailand)" further added Wittaya.
Diabetes claims 4 million lives every year and is a leading cause of blindness, kidney failure, heart attack, stroke and amputation. According to International Diabetes Federation (IDF), if the current rate of diabetes growth continues unchecked, the total number of people living with
diabetes worldwide will exceed 435 million in the next 20 years.

"The world needs to invest in integrated health systems that can diagnose, treat, manage and prevent diabetes," said Professor Jean Claude Mbanya, the new IDF President. "Governments also need to invest in actions outside the formal health sector, particularly in promoting healthier diets and physical activity, to reduce obesity and the risk of type-2 diabetes. Without effective prevention diabetes will overwhelm health systems and hinder economic growth" further added Mbanya.

"It is estimated that 50,000 - 60,000 of people living with diabetes in Thailand would develop blur vision or blindness. Instead of waiting for them to come to hospital which sometimes becomes too late to provide effective prevention and cure, we move ahead to reach out to them and prevent or treat as required. There are ophthalmologists and specialists with well-equipped advanced diagnostic and therapeutic facilities, to treat patients in faraway villages free of cost. We expect that by next World Diabetes Day 2010 we will prevent 4,000 people from blindness" said Dr Sriwanna, Head of Academic Department, Public Health Ministry, Thailand.

In many high-burden diabetes countries like India, China and USA, there are efforts to educate people to reduce consumption of junk food. There are regulatory laws to check misleading advertisements as well. "We still don't have any law to check the amount of sugar in snacks, or to regulate the TV advertisements yet, but we have been asking the companies or entrepreneurs to reduce the sugar in their products and if they cooperate then they can mention it on the label as healthy food/snack. I understand that if we seek cooperation and give education to people, every company will finally follow. We also provide statistics and information about what kind of food/beverage are unhealthy to people" informs Wittaya. "We are also campaigning in schools and giving rewards to school which do not sell junk food to children" said Wittaya.

"Growing numbers of Thai people especially from middle-income group are buying more healthy food, pesticides-free vegetables, brown rice, among other healthy food products. 'Khon Thai Rai Pung' campaign to raise awareness about obesity and to encourage Thai people to reduce their weight by having more physical activities is also giving encouraging results" said Wittaya.
"In cooperation with the Food and Drug Administration (FDA), we are opening pesticides-free markets like Sam Yan Market, where there is an officer from the FDA to check every entrepreneur and certify the quality of food product" informs Wittaya, the Thai Public Health Minister.

"This year we are also promoting Tambon Health Stations to become Tambon Health Promotion Hospital at about 2,100 places around the country" informs Wittaya. "Besides providing treatment, these centres also provide health promotion services" says Wittaya.

"This year we received great support because everyone already realized that Diabetes is a growing public health challenge for Thailand," said Professor Wannee Nitiyanant, Vice President, Diabetes Association of Thailand under the Patronage of Her Royal Highness Princess Maha Chakri Sirindhorn.
"There will be campaigning and activities on diabetes education
and prevention, free diabetes and health check up on how at risk you are, and facilities to cater to other related health problems such as high blood pressure at Lumpini Park" says Professor Wannee.

According to the International Diabetes Federation (IDF), the key messages of the World Diabetes Day (November 14) campaign are:
* Know the diabetes risks and know the warning signs
* Know how to respond to diabetes and who to turn to
* Know how to manage diabetes and take control

Thailand seems to be gearing up to improve diabetes prevention and education to prevent diabetes and diabetes-related complications, alongside scaling up quality care and services for people living with diabetes.

Jittima Jantanamalaka
[The author is the Director of Jay Inspire Inc and produces radio programmes for FM radio stations in Thailand]

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Prof Rama Kant takes charge as PRESIDENT of Association of Surgeons of India (ASI), UP

Prof Rama Kant takes charge as PRESIDENT of Association of Surgeons of India (ASI), UP

Lucknow's noted Surgeon and Head of Surgery department at CSMMU - Professor (Dr) Rama Kant - took charge as President of Association of Surgeons of India (ASI), UP Chapter, at the closing ceremony of the 35th Annual Conference of ASI, UP Chapter (UPASICON 2009) which concluded in Lucknow. Prof Rama Kant was already the President of the Lucknow College of Surgeons (LCS) since past many years. He has also served as the national secretary of Indian Association of Endocrinal Surgeons, Association of Surgeons of India, more than a decade back. ASI is the largest and most reputed network of Surgeons in India.

"In my tenure as President of ASI, UP, I envision to enhance the team spirit among surgeons of UP state, strengthen academic interactions between surgeons all across the state on pragmatic approaches to surgical management of major health concerns in UP that demand effective and affordable surgical interventions, and transfer knowledge and help build skills in state-of-the-art operative techniques through continuing medical education (CME) programmes conducted by stalwarts from around the world" said Prof Rama Kant, who took over as President of ASI, UP. “I wish to reach to our members at their place through physical, electronic or printable communications and will try to ensure to work as a bridge between young surgeons aspiring for training and National and international trainers” said Prof Rama Kant.

It was a momentous occasion indeed when the baton of presidentship of the UP Chapter of the Association of Surgeons of India was passed on to the much revered Prof (Dr) Rama Kant. Earlier, historic Surgeons from Lucknow have led the august body of ASI, UP - including Prof PC Dubey and Prof NC Misra who are undoubtedly noted doyens from Lucknow in chronicles of Surgery in the world.

While ASI UP outgoing leader Dr Rajeev Sinha reaffirmed his faith in the dynamic leadership of Prof Rama Kant, the latter accepted his new responsibility in all humility and promised to take UPASI to new heights, by working in close contact with all the members of the association and by acting as a facilitator to expose them to the latest surgical techniques. He vowed to bring back the team spirit for making the association stand tall and not fall down as a divided house. He expressed confidence in able and dedicated Honorary Secretary of ASI-UP Dr SK Mishra who was instrumental in achieving the target of this chapter being declared as Best Chapter of the ASI.

Prof Rama Kant, who is also the World Health Organization (WHO) Director-General's Awardee (2005), will officiate as President of ASI, UP for 2009-2010. He was also the Chairman of the 35th Annual Conference of Association of Surgeons of India, UP Chapter which brought over 500 surgeons and noted International experts from around the world and hosted rich academic exchanges between surgeons during 6-8 November 2009 which also included a live operative workshop.

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UPASICON 2009 ends with updates on cutting-edge laparoscopic and endoscopic surgeries

UPASICON 2009 ends with updates on cutting-edge laparoscopic and endoscopic surgeries

The three-days surgeons' conclave - 35th annual conference of Association of Surgeons of India (ASI), UP Chapter, (UPASICON 2009) entered its third day on Sunday, 8 November 2009. UPASICON 2009 is being organized by Department of Surgery (General), CSMMU in collaboration with Society of Endoscopic, Laparoscopy Surgeons of India (SELSI), UP, under the leadership of ASI-UP President-elect and UPASICON 2009 Chairman Professor (Dr) Rama Kant, Secretary Dr HS Pahwa, and Joint-Secretary Dr Suresh Kumar.

The last day of the Conference saw the presentation of more Video Workshops and very informative guest lectures. It gave an opportunity to the participating surgeons to interact directly with noted experts, to understand the various aspects of laparoscopic and open surgical procedures.

Prof Dr E Fukuma (Japan) a pioneer in the field of endoscopic breast surgery and cryosurgery, gave an insight on hybrid skills with such surgeries for breast cancer. This lecture ably augmented his Video Presentation on Oncoplastic Breast Surgery With Endo videoscopic Approach, given yesterday.

In keeping with his passionate involvement of management of trauma, Dr Mohammad Zubair Ansari from Sandville Hospital, Birmingham, UK, spoke on ATLS – Advance Trauma and Life Support. He also conducted a trauma workshop for surgeons.

Other informative lectures enlightened the medical fraternity about the Mess Created By Hernia Meshes, Cost Effective Laser Ablation of Varicose Veins Treatment, Management of Urinary Tract Obstruction in Children, Management of Acute Pancreatitis and treatment of male infertility.

Video presentations, touching upon a vast range of topics, proved to be as lively and educative as of the day before.

Dr S.K.Mishra of Kanpur gave a video presentation on ‘Complications of Laparoscopic Cholecystectomy, while ‘Points of Technique of Radical Cholecystectomy’ were discussed by Dr Sonkar.

While Dr Kureel taught the audience How To Do A Proper Colostomy, Dr Rawal of Rajiv Gandhi Cancer Research Institute presented techniques of various permanent Urinary Diversions.

Dr Anant Kumar of Apollo Hospital, gave a video presentation on ‘Laparoscopic Radical Nephrectomy’.

The curtains were drawn on the conference with the Valedictory Function.

UPASICON 2009 more than succeeded in its aim to provide an excellent platform for all practicing surgeons of various streams (gynaecologists, paedriatic surgeons, gastro-surgeons, urologists) interested in advanced laparoscopic procedures; as well as surgeons and residents aspiring for trauma care – a vital component of medical education.

Shobha Shukla

(The author is the Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)

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Cutting-edge surgical techniques for management of breast surgery, cancer, piles at UPASICON 2009

Cutting-edge surgical techniques for management of breast surgery, cancer, piles at UPASICON 2009

The three-days surgeons’ conclave - 35th annual conference of Association of Surgeons of India (ASI), UP Chapter, (UPASICON 2009) entered its second day on 7th November 2009. UPASICON 2009 is being organized by Department of Surgery, CSMMU in collaboration with Society of Endoscopic, Laparoscopy Surgeons of India (SELSI), UP, under the leadership of ASI-UP President-elect and UPASICON 2009 Chairman Professor (Dr) Rama Kant, Secretary Dr HS Pahwa, and Joint-Secretary Dr Suresh Kumar.

The second day of the Conference could aptly be called a day of Video Workshops and Enlightening Orations. It gave an opportunity to more than 500 participating surgeons to interact directly with globally acclaimed experts to understand the various aspects of cutting edge surgical techniques, particularly laparoscopic and open surgical procedures.

The star presentation of the day belonged to Prof Dr E Fukuma from Japan, the ‘land of the rising sun’, who has done pioneering work in the field of endoscopic breast surgery. He gave a Video Presentation on Oncoplastic Breast Surgery With Endo videoscopic Approach. This is the latest technique in the field of Mastectomy and is yet to begin in India. It leaves no injury on the whole breast, and can become a single standard method for breast-conserving surgery, wherever a cancer is situated.

A Video presentation on Surgical Management of early breast cancer was given by Prof Dr Gaurav Agarwal, Endocrine Surgery Department, SGPGIMS, Lucknow.

Prof Rama Kant, Head of Surgery Department, CSMMU, delivered a guest lecture on “Journey from Piles to Smiles.” A very recent technique for the treatment of Piles, called Doppler Guided Haemorroidal Artery Ligation (DGHAL) and Recto Anal Repair (RAR), was presented by Prof Kant. This requires hospital stay of a few hours only, and the patient can go back to work the very next day.

'Laparoscopic Hemicoleectomy' and 'Duodenal Perforation' video presentations were the specialized domains of the stalwarts Dr Rao and Dr Puntambekar respectively.

Dr Amit Srivastava presented ‘A Novel Approach For Management Of Lower One Third Uretric Calculus’. Dr Maurya, the renowned laparoscopic surgeon from Agra, showcased ‘Laparoscopic CBD Exploration in Minimal Access Surgery’.

The medical names for these minimal access surgical interventions might sound very high brow for the common person, but then these are big names for procedures that make small cuts (or no cuts) in the patients and make their pain smaller and life easier.

Besides these lively video presentations, there were several informative lectures on a wide variety of topics ranging from ‘Common Surgical Procedures In Breast Disease’ by Dr Sandeep Kumar, to Basic Management of Fistula, by Dr Ashok Kumar.

The gold standard technique of Laparoscopic Cholecystectomy in difficult situations was discussed alongside with the current approaches to follicular malignancy of thyroid.

The participants, though advocators of single PORT and E PORT surgeries, did not neglect conventional open surgery procedures, which are still practiced in general hospitals, probably due to the lack of requisite instruments and gadgets. The doctors of CSMMU spoke at length on the management of common cancer in general surgical set ups for carcinoma of Breast, Oral Cavity and Gall Bladder. Queries related to the symptoms, confirmatory tests and treatment options for these types of cancers were dealt with in a lucid manner.

Shobha Shukla

(The author is the Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)

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Diabetes in Zimbabwe: It’s Not All About Sugar

Diabetes in Zimbabwe: It’s Not All About Sugar

GROWING up in Zimbabwe, diabetes (a polygenic disease characterized by abnormally high glucose levels in the blood) was something that the old people always talked about, and the fear of the disease grew over me like a giant baobab.

To describe a person with diabetes, the old people would say in local parlance “Ane shuga”, which literally means: “He/she has sugar”. Essentially, it meant that the affected person has a disease associated with sugar.

To my childhood fancy, I thought that the people who were affected with the diabetes ate a lot of sugar only to discover later it was the common understanding.

Most people in Zimbabwe associate diabetes with a high intake of sugar, particularly in tea.

Little to no other foods are associated with the onset of this condition. Put simply, very few people know that eating too much of carbohydrates, fats, proteins can increase the incidence of diabetes.

I discovered later that diabetes mellitus occurs when the pancreas does not make enough or any of the hormone insulin, or when the insulin produced doesn't work effectively. In diabetes, this causes the level of glucose in the blood to be too high.

According to experts, the number of people with diabetes in Zimbabwe is growing. In 2003, Zimbabwe recorded more than 90 000 cases of diabetes, an increased of 3 000 from the 1997 figure.

The Diabetes Association of Zimbabwe estimates that around 400 000 people in the country have the disease but many are unaware on their condition.

“About 50 percent of Zimbabweans are living with diabetes but are not aware of the condition, so many people are suffering from diabetes but do not have any knowledge about it,” a Zimbabwe Diabetes Association official was quoted in The Herald newspaper.

"It is sad that a lot of people have died because of this disease without knowing it, and only relatives will know about it after a post-mortem has been conducted," added the official.

With all the attention on high profile diseases such as AIDS and TB, it is not surprising that little to nothing is talked about diabetes. Yet with a little investment in information dissemination on how to prevent diabetes, many lives would be saved.

There is need for advocacy on proper dietary habits. Information can be disseminated through schools, hospitals and community health centres. The involvement of traditional leaders in the dissemination of information on diabetes can also lead to a better uptake of the message.

In addition, parents must be educated to take care of their children dietary habits. According to experts, the promotion of traditional Zimbabwean diets can also be a portent tool in the fight against diabetes. The value of exercise needs to be emphasized within the population.

There is also need for information that debunks the myth which makes people associate diabetes with high sugar intake in tea. In other words, there is need for accurate, scientific, and evidence-based information about the disease.

All in all, greater investment in prevention efforts can save government, communities and individuals a lot of money in diabetes treatment costs.

If anything, it is critical to let the majority of people in Zimbabwe know that diabetes is not all about sugar, and that its possible to prevent the disease.

Chief K.Masimba Biriwasha

(The author, born in Zimbabwe, is a children's writer, poet, playwright, journalist, social activitist and publisher. He has extensively written on health and is presently based in France. His first published book, The Dream Of Stones, was awarded the Zimbabwe National Award for Outstanding Children's Book for 2004)



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Spotlight on big surgeries with minimal or no incisions at regional Surgeons' Conclave

Spotlight on big surgeries with minimal or no incisions at regional Surgeons' Conclave

The three-days regional surgeons' conclave - 35th annual conference of Association of Surgeons of India (ASI), UP Chapter, (UPASICON 2009) began on 6th November 2009. UPASICON 2009 is being organized by Department of Surgery (General), CSMMU in collaboration with Society of Endoscopic, Laparoscopy Surgeons of India (SELSI), UP, under the leadership of ASI-UP President-elect and UPASICON 2009 Chairman Professor (Dr) Rama Kant, Secretary Dr HS Pahwa, and Joint-Secretary Dr Suresh Kumar.

"The Live Operative Workshop on Single Port Total Hysterectomy; Single Port Cholecystectomy; and Laparoscopic Hernioplasty, held on the first day of the conference, exposed over 500 delegates to the latest advancements made in the field of Minimal Access Surgery. It was not only the surgeons’ delight to be a part of the revolutionary changes sweeping the field of conventional surgery, but also the attention bestowed on the common patients by the uncommon doctors" informed Prof (Dr) Rama Kant.

The conference began on a very practical and professional note, with renowned surgeons showcasing their skills and expertise in performing ‘big operations with minute or no incisions'. The star performer was none other than Dr Prashant Rao, aptly called the “Father Of Single Port Surgery”. He performed Single Port Cholecystectomy (no perforation) on a female patient.

Dr Shailesh Puntambekar of Pune, did Single Port Hysterectomy. Laparoscopic Hernioplasty was done by Dr M.C.Misra of AIIMS, Delhi. Dr S.D.Maurya from Agra, showed his expertise in Non Descent Vaginal Hysterectomy.

A very recent technique for the treatment of Piles was performed by Prof (Dr) Rama Kant, Head of the Surgery Department of CSMMU. It is called Doppler Guided, Haemorroidal Artery Ligation (DGHAL) and Recto Anal Repair (RAR). This requires hospital stay of a few hours only, and the patient can go back to work the very next day.

“The main thrust of the workshop is to bring the state-of-art surgical techniques to the aid of the common people. With more and more doctors honing their skills in this direction, and with the people becoming more aware of the overall benefits of Minimal Access Surgery, these surgical procedures are likely to replace conventional open surgeries in a big way, and become available to all strata of society, irrespective of their social status” said Dr HS Pahwa.

Even though the direct cost of such surgical interventions, may be slightly higher than conventional surgery, but the overall gains are far too many. Dr Pahwa informed that there is less tissue trauma, chances of post operative infections are minimised, recovery is faster, and duration of hospital stay is reduced. All this adds up to be more patient friendly and more economical in the long run.

As 60-70% of the patients coming to hospitals like CSMMU are poor, this workshop should go a long way in making the latest technologies affordable. Dr Rama Kant was very optimistic about the outcome of the conference and rightly believed in Thinking Big in order to Achieve Big.

Shobha Shukla

(The author is the Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)

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Turn off the Diabetes Tap - Turn Media on!

Turn off the Diabetes Tap - Turn Media on!



Diabetes is one disease that can be influenced by the consumption of unhealthy foods. There are approximately 285 million or roughly 7% of the world’s adult population affected by diabetes. The use of media tools on health care promotions and campaigning is growing but much more needs to be done to ensure that more positive messages reach a greater number of people in the world. The media can be used as a tool to spread disease prevention messages.

"Either we spend all our time mopping the floor, or we get up and turn off the tap," said
Professor Jean Claude Mbanya, the new president of International Diabetes Federation (IDF) during the 20th World Diabetes Congress held in Canada.

The most effective way to turn off the flowing diabetes tap from flooding all over is to give education to people as the slogan of World Diabetes Day this year focusing on 'Understand Diabetes and Take Control', says. There is a need to influence people to be concerned about what they eat so that they can prevent the onset of diabetes.

It has to be a big poke to get all attention. The fastest way is turning the mass media spotlight on the disease. However, in Chiang Mai, Thailand, as in many parts of the world, the media often fail to give adequate attention to the problem of diabetes.

Apichai Mathavaphan, a senior radio announcer and news reporter of MCOT Broadcast Chiang Mai FM 100.75 Mhz. explained that, "There are 13 main Radio Stations in the Chiang Mai, 13 FM stereo and 2 AM, which belongs to Government. And under the new Institution Law 1997 - there are 329 new community radio stations registered in Chiang Mai, 80 - 90 of them are broadcasting radio program daily at the moment."

"The benefit of this is Chiang Mai people can have more choices to listen to what they really like, on the other side some people might not be able to reach the good programmes because there are too many on the radio" said Siripong Wattanapaiboon Director of GSSM Radio Station Broadcast, FM 91.75 Mhz.

"When there are too many radio stations broadcasting at the same time, sometimes it interrupts the other channels and the problem is lack of quality control," said Rattanaporn Suvagodha, Vice Director of Voice of Mass Communication Chiang Mai University FM 100 Mhz.

Despite the fact that Chiang Mai has so many open channels to communicate with audiences including newspapers, television stations, radio stations and other media, many of the outlets lack funding and depend on sponsorship from businesses. As a result, they give very little attention to health-related issues.
"There is not enough health programmes on radio. The DJs themselves don't have deep knowledge about diseases. They are not doctors. They might read something from the newspaper, search online or invite the experts," said Siripong. "When diabetes and other non-communicable diseases which are causing many deaths each year are now increasingly perceived as major issues in society, the media is turning to new diseases such as 'Virus H1N1'. That is how real issues impeding people's health like diabetes have been forgotten" he added.

"In the past, often the media have focused on diabetes campaign a week or two before start of an event without giving continuous education or updating people on prevention efforts. We often talk about things when it's too late. Considerable damage has been caused already by then," said Yanyong, the Head of Radio National of Thailand, Chiang Mai, Thailand. "This way it's like 'building the fence for the lost cow" said Yanyong.

According to Nopniwat Krailerg, Editor of LannaThai-news newspaper in Chiang Mai, media organizations were not in touch with health organizations which campaign on diabetes-related issues.
"We do not often receive any updated information from government or organizations themselves on health issues, if you send something good to us that I find interesting why will I not share it with other people" he said.

"I've been working on health radio program for 8 years and 9 months. I could say that changing people's consumption behaviour is very hard," added Apichai. "In the next few years Thailand will have more elders in society than ever before, because the number of elders is going up to 20% of our population, owing to increase in life expectancy and decline in birth rates among other factors. We have to ask the government and policymakers how much they are prepared for this eventuality" he added.

"The challenges in our work is funding," said Yanyong Somchit, Director of National Radio Thailand (Chiang Mai) while Jareat Hommak, Head of Siang Sam Yod Radio Station also express his concerned at the same point, "The government and policy makers should support the media sector much more than this, people especially with low incomes still listen to radio for information but I think the government doesn't give enough importance to media yet."

"I think we need to make people understand that actually diabetes and non communicable diseases are not far from them, and we should use all media to give education to people, also set up campaign or activities in the community and school to support as well," said Sayomporn Ano the Head of Rajchabhat Collect Radio Station Chiang Mai. "Whoever have media on their hands and know how to use it efficiently their work would be easily successful." he said.

Media and health organizations need to work together to provide more information about diabetes. The use of media can potentially assist many people to know about the disease, ways to prevent it and existing services and approaches to take better care of people living with certain conditions like diabetes.


Jittima Jantanamalaka
[The author is the Director of Jay Inspire and produces radio programmes for FM radio stations in Thailand]

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Punishing success in tackling AIDS: Funders’ retreat could wipe out health gains in HIV affected countries

Punishing success in tackling AIDS
Funders’ retreat could wipe out health gains in HIV affected countries

A retreat from international funding commitments for AIDS threatens to undermine the dramatic gains made in reducing AIDS-related illness and death in recent years, according to a new report by Médecins Sans Frontières (MSF) "Punishing Success? Early Signs of a Retreat from Committment to HIV/AIDS Care and Treatment."

The MSF report highlights how expanding access to HIV treatment has not only saved the lives of people with AIDS but has been central to reducing overall mortality in a number of high HIV burden countries in southern Africa in recent years. In Malawi and South Africa, MSF observed very significant decreases in overall mortality in areas where antiretroviral therapy (ART) coverage was high. Increased treatment coverage has also had an impact on the burden of other diseases, for example tuberculosis cases have been significantly reduced in Thyolo, Malawi and Western Cape province, South Africa.

"After almost a decade of progress in rolling out AIDS treatment we have seen substantial improvements, both for patients and public health. But recent funding cuts mean doctors and nurses are being forced to turn HIV patients away from clinics as if we were back in the 1990s before treatment was available," says Dr Tido von Schoen-Angerer, Director of MSF’s Access to Essential Medicines Campaign.

International support to combat HIV/AIDS is faltering as reflected in significant funding shortfalls. The board of directors of the Global Fund, a key financer of AIDS programmes in poor countries is unable to respond to countries’ needs and will next week in Addis Ababa vote whether or not to suspend all new funding proposals in 2010; and PEPFAR, the US AIDS programme is flatlining funding for two more years.

"The Global Fund must not cover up the deficit caused by its funders”, says von Schoen-Angerer. “The proposed cancellation of the 2010 funding round and other measures to slow the pace of treatment scale-up are punishing the successes of the past years and preventing countries from saving more lives."

In 2005, world leaders promised to support universal AIDS coverage by 2010, a promise that encouraged many African governments to launch ambitious treatment programmes.

"What about the promise made to people with AIDS? We gave them hope and life. We have to be there for them, we all knew from the beginning that this treatment was for life," says Olesi Ellemani Pasulani, MSF Clinical Officer in Thyolo District Hospital, Malawi. "Passing on the bill for treating AIDS to very poor countries would be a colossal betrayal."

Reducing funding at this time will leave people in urgent need of treatment to die prematurely and can lead to dangerous interruption of treatment. In Uganda, cuts have already begun to hit home with some facilities forced to stop treating new patients with HIV. Other countries are backing away from their earlier treatment coverage targets. In Free State, South Africa, past funding problems that have now been resolved led to disruption of treatment and a moratorium on treating new patients which resulted in an estimated 3,000 deaths.

The report provides evidence that, particularly in high HIV-prevalence settings, treating AIDS has a positive impact on other important health goals, in particular maternal and child health.

"A stronger commitment to other health priorities must happen, but this should be in addition to, not instead of, continued, increased commitment to HIV/AIDS," adds von Schoen-Angerer.

At present, over four million people living with HIV/AIDS in the developing world receive antiretroviral therapy. An estimated six million people who are in need of life-saving treatment, are still waiting for access. MSF operates HIV/AIDS programmes in around 30 countries and provides antiretroviral treatment to more than 140,000 HIV-positive adults and children.

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"Greater the surgeon, smaller the incision": UPASICON 2009

"Greater the surgeon, smaller the incision": UPASICON 2009

Lucknow, the erstwhile 'City of The Nawabs' will be host to the 35th Annual Conference of the Association of Surgeons of India (ASI), UP chapter (UPASICON 2009). The surgeons' conglomerate is being organized by the Department of Surgery of CSM Medical University (upgraded King George's Medical College - KGMC) in association with the Society of Endoscopic & Laparoscopic Surgeons of India(SELSI), UP Chapter, under the dynamic leadership of Professor (Dr) Rama Kant, Head of the Surgery Department and President-Elect of Association of Surgeons of India (ASI), UP.

"We have come a long way from the days of 'greater the surgeon, bigger the incision' to 'greater the surgeon, smaller the incision'. And now we are progressing from Multiple Keyholes to Single Port Laproscopic Surgery" said Prof Rama Kant.

He added that all this is developed with utmost precaution so that the safety of patients is not compromised. Laproscopic surgeries lead to minimum post operative pain, and a very early 'back to normal' recovery.

This mega event will be an occasion to interact with around 500 doyens of surgery, especially laproscopic surgery, from around the world, from 6-8 November 2009, to learn, update and keep abreast of the moving jet set technology in the field of surgery.

The stalwarts who have consented to grace the conference include Dr Fukuma from Japan, Dr Mohd Ansari from UK, Dr Prashant Rao of Mumbai, Dr Shailendra Puntambekar of Pune, Prof SD Maurya from Agra and Dr SK Mishra from Kanpur.

Prof Rama Kant is indeed happy to bring this conference back to Lucknow after a gap of 12 years and treat the medical fraternity to the latest techniques in the field of minimal invasive surgery, as well as take part in a broad based scientific programme, covering most of the important issues of surgery.

Of special interest will be the operations performed in the 'Live Operating Workshop' on the first day of the conference, which will focus on 'Single Port Laproscopic Surgery' NOTES (Natural Orifice Transluminal Endoscopy Surgery), Laproscopy in trauma, emergency, endocrine, thoracic, gynaecological surgeries. In a lay person's language, Single Port surgery is performed by making a single hole, instead of the normal four to five holes. This technique has been pioneered in India, by Dr Prashant Rao of Mumbai, who will demonstrate this revolutionary surgical procedure at UPASICON 2009.

The second and third day of the conference will showcase various Operative Master Video Presentations with emphasis on the practical aspects of Minimal Access Surgeries and Open Surgeries.

Dr Eisuke Fukuma, the Endoscopic Endocrine Surgery expert from Japan, purports be the star attraction on the second day. He will give a videoscopic presentation of Endoscopic Mastectomy - a technique which he has mastered. He and his group at Kameda Medical Centre, Chiba, Japan, has performed 385 such breast surgeries between 1995 and 2007. This type of mastectomy involves minimal scarring and post operative pains.

Apart from Video Presntations, there will be sessions of informative panel discussions, debates, symposia by faculties from all over the world, with special emphasis on the practical aspects of Emergency Care (in management of Melema, Bleeding Per Rectum,etc), basics of surgical suturing and surgical site infections, and Laproscopy in emergency (bowel perforation, appendix removal, abdominal trauma etc).

As if this was not enough food for the mind, there will be paper/ poster presentations, guest lectures, orations and a quiz for the resident doctors.

Last, but not the least, Prof Rama Kant will give a live demonstration of a unique non-surgical technique for the management of Piles called Doppler-guided haemorrhoidal artery ligation (DGHAL) and Recto-Anal Repair (RAR). The beauty of this procedure lies in the fact that the patient is discharged within a few hours and is back to work, the very next day.

So all ye Lucknowites, please brace up to welcome and reap the benefits of this international gathering of surgeons.

Shobha Shukla

(The author is the Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)

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Nationwide support to NBA's Indefinite protest fast against atrocities of Madhya Pradesh government

Nationwide support to NBA's Indefinite protest fast against atrocities of Madhya Pradesh government

Medha Patkar slams M.P. Govt: Charges contempt of Court

Thousands of displaced gathered today as well in Khandwa to lend solidarity and support to the jailed activists of Narmada Bachao Andolan and to condemn the malicious and brazen attempts of the Government of Madhya Pradesh to scuttle their lawful attempts to enforce the directives of the High Court. The displaced of Maheshwar, Upper Veda, Omkareshwar and Indira Sagar dams were joined by representatives of various people’s organizations from within and outside the state.

Even as the protest fast of activists Chittaroopa Palit and Ramkuwar Rawat inside the jail continued undaunted on the second day, the Government seemed to be investing all its energies and resources in hounding the activists, instead of respecting the High Court’s orders and speedily rehabilitating the displaced.

The NBA office was again searched today and shockingly, the police officials (instead of electricity officials!!!) slapped an additional bill of Rs. 15,149/- on the Andolan for electricity charges, terming it a ‘commercial establishment’, even though it is well-known that NBA is a people’s organization, working for the realization of the constitutional and human rights of the displaced. It is clear that the office is being targeted. While it was told that activist Alok Agrawal was being taken for interrogation; he was detained all through the night and was then framed in old cases. NBA is contemplating legal action against such annoying tactics of the State.

Citizens groups and eminent persons from across the country have extended support to the ongoing ‘sangharsh’ in the valley. Major Genl. (Retd). Sudhir Vombatkere wrote to the Prime Minister and Chief Minister, terming the arrests as repulsive to democratic resistance and demanded urgent release of the activists and justice to the displaced. Veteran Gandhian ideologue Raha Bhatt and Vasant Pandey of Uttarakhand Nadi Bachao Abhiyan, in a separate letter to the CM, demanded him re-establish the rule of law in the state. Prof. Kamal Mitra Chenoy,of Jawaharlal Nehru University, New Delhi also wrote to the District Collector and sought the release of the illegally detained NBA activists who are genuinely demanding for court-ordered rehabilitation.

Yesterday, activists Yogesh Diwam, Azam Khan, Sarika Sinha and others of Jan Pehal met the Chairperson of the State Human Rights Commission, Justice (Retd) Shri D.P. Dharmadhikary, in person and expressed serious concern on the erosion of democratic space in the state. The Chairperson later issued notices to the District Collector and Superintendent of Police and demanded a Report on the incident within 3 days.

The Government also drew flak from citizen’s groups in Bhopal, Indore, Jabalpur, Badwani and Harda where protetsts are taking place. The Indore Solidarity Group and People’s Union or Democratic Rights as well expressed vocal condemnation of the arrests in seperate releases and expressed solidarity with the Andolan. An online petition has also been circulated and more than 500 sensitive citizens and organizations have already expressed their support. The Asian Human Rights Commission also came down heavily upon the State Government and has issued an action alert for global support.

Meanwhile, addressing a press conference in Khandwa, today evening, Medha Patkar along with Rajkumar Sinha of Bagri Dam Displaced and Affected Organiation and others stated that the actions of the State Government tantamount to contempt of Court, which it will have to answer. She said that the administration is tarnishing its own image by leveling false allegations against the activists.

Yesterday, a delegation along with Medha Patkar met the Collector Mr. Singh and pressed for the immediate and unconditional release of the activists and enforcement of the Court’s directives. He was also warned that any inaction from the administration will not be brooked anymore and all the displaced are even ready for a ‘Jail Bharo Andolan’, if their demands are not met.

Interestingly, the Staff Union at the Collector’s office also submitted a letter of solidarity with the displaced. Respecting their gesture, Medha Patkar conveyed that the struggle was not against the staff, but against the thick-skinned administration that has such disrespect towards the Constitution and the Court.

The struggle continues with some other activists joining in the fast today.

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Pneumonia kills more children than any other disease

Pneumonia kills more children than any other disease
Reinforce smoke-free laws to reduce pneumonia deaths in children

W o r l d P n e u m o n i a D a y
2 November 2009

Pneumonia kills more children than any other disease. Every 15 seconds it claims another child. Two million (twenty lakhs) children (less than 5 years) die of pneumonia every year. This is when diagnosis and treatment of pneumonia is widely available and affordable, says experts on the first-ever World Pneumonia Day on 2nd of November 2009.

"Pneumonia is the leading cause of death in children worldwide. Pneumonia kills an estimated 2 million children every year – more than AIDS, malaria and measles combined" says Professor (Dr) Rama Kant, the World Health Organization (WHO)'s International Awardee 2005 and Head of the Department of Surgery, CSM Medical University (upgraded King George's Medical College - KGMC).

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.

"Pneumonia can be caused by viruses, bacteria, fungi or chemicals. Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors such as enforcing smoke-free laws and patient-safety practices. Pneumonia can be treated with antibiotics, but according to the WHO, less than 20% of children with pneumonia receive the antibiotics they need" says Prof Kant. "Recently Ventilator Associated Pneumonia (VAP), Pneumonia in immuno-compromised states like diabetes mellitus and AIDS, has caused resurgence of this serious problem" adds Prof Kant. "This can occur at any age and is irrespective of gender. Nosocomial infections (hospital born) are most of the times resistant to antibiotics and have a high mortality. The infections in early stage in such situations might respond to recent, much broad-spectrum and expensive antibiotics but late Pneumonia are commonly resistant and have high mortality. Use of infected endo-tracheal tubes, oxygen masks and anaesthesia gas tubes can also be responsible for such grave situations. Here only patient safety practices can save patients" cautions Prof Kant, who is the former Chief Medical Superintendent of Gandhi Memorial & Associated Hospitals, CSMMU.

"VAP has become important because of use of ventilator in serious patients of trauma, burn, neuro-surgical problems and surgery for instance" says Prof Rama Kant.

According to the World Health Organization (WHO), Pneumonia is the single largest cause of death in children worldwide. "Every year, it kills an estimated 1.8 million children under the age of five years, accounting for 20% of all deaths of children under five years old worldwide. There are some 155 million cases of childhood pneumonia every year in the world. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. It can be prevented with simple interventions, and treated with low-cost, low-tech medication and care" says WHO site.

Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this has critical importance for treatment and prevention.

The symptoms of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia.

When pneumonia becomes severe, children may experience lower chest wall indrawing, where their chests move in or retract during inhalation (in a healthy person, the chest expands during inhalation). Infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.

While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.

Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.

The following environmental factors also increase a child's susceptibility to pneumonia:
* indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
* living in crowded homes
* parental smoking.

"In India, on 2nd October 2008, the smoke-free laws were implemented country-wide, in line with the Cigarette and Other Tobacco Products Act (2003) and also the global tobacco treaty (Famework Convention on Tobacco Control - FCTC) which India has ratified in 2005. The implementation of smoke-free laws has been far from ideal - and this needs to be implemented strictly - not only to harness tobacco control outcomes but also broader public health, environmental and social justice outcomes this law aims to deliver" says WHO's Director-General's Awardee on tobacco control for the year 2005 Professor (Dr) Rama Kant. Parental smoking is one of the key factors to increase child's susceptibility to pneumonia, says Professor (Dr) Rama Kant.

Pneumonia can be treated with antibiotics. These are usually prescribed at a health centre or hospital, but the vast majority of cases of childhood pneumonia can be administered effectively within the home. Hospitalization is recommended in infants aged two months and younger, and also in very severe cases.

Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.

Adequate nutrition is key to improving children's natural defences, starting with exclusive breastfeeding for the first six months of life. This is also effective in preventing pneumonia and reducing the length of the illness.

Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.

In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.

A very effective and important preventive method for pneumonia and other conditions too is proper hand washing, informs Prof Kant.

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