Non-communicable diseases such as cardiovascular diseases, diabetes, hypertension, stroke, cancer and respiratory illnesses are the top five causes for mortality and morbidity these days. Earlier, communicable diseases were the main causes of death.
The shift can be attributed to changing lifestyle, food habits and stress. Apart from these, anaemia, malnutrition, maternal/infant mortality are the other burning issues.
Unfortunately, budgetary allocation for health sector in India is only 2.5 per cent of GDP, a fraction of the allocation in the Western countries. The need of the hour is to address basic issues such as safe drinking water, proper sanitation, checking of environmental pollution, better connectivity and awareness about various health schemes.
To reduce infant and maternal mortality, intravenous iron therapy has to be popularised since compliance with oral tablet is very low. In rural areas, doctors need training in anaesthetic management so that deliveries are conducted with low mortality.
One of the biggest problems is very poor tertiary care — management in semi-urban and rural areas, doctors’ reluctance to work in villages due to interference, humiliation by local elected representatives and lack of infrastructure.
ICUs
District and taluk hospitals should have well equipped intensive care units which can be linked through telemedicine with tertiary care hospitals for consultation, treatment co-ordination and transfer of patients for further treatment.
This mechanism will allow optimal initial treatment during golden hour which will substantially reduce death rates.
Wherever possible, public-private-partnership (PPP) models should be encouraged to set up laboratory services, critical care units and tertiary care outlets.
Heart attack
Pre-hospital (in-ambulance) thrombolysis treatment for heart attack is important as the incidence of heart attack is steadily increasing both in urban and rural population affecting more younger patients in age group of 30-40. For every 30 minutes delay in treatment, the relative risk of death increases by 5 per cent. Although angioplasty is a superior treatment modality, it is not readily available and accessible in rural, semi-urban hospitals.
The alternative option is to initiate thrombolytic therapy (clot dissolving medicine) either in ambulance itself or nearby hospitals whichever is quicker — the ideal time is within the first six hours of heart attack. The treatment co-ordination can be done through telemedicine links with tertiary heart institution. Mobile phone technology can also be explored for transferring ECG from Primary Hospital with bigger centre in case of clinical dilemma and decision making.
After initial treatment with thrombolytic therapy, then patients have to be transferred to tertiary centres for angioplasty/other interventions, which will also improve outcomes.
However, in larger cities with catheter laboratory facilities, primary angioplasty should be encouraged and awareness has to be created regarding the benefit of this procedure within the first few hours. Quick mechanism for transfer of patients by ambulances, co-ordination and advance information at the receiving tertiary care hospital will avoid unnecessary delay in performing angioplasty. Hence, it is preferable to conduct primary angioplasty within 60 minutes after admission for maximum benefits.
CPR
Basic and advanced cardiac life support training programmes (CPR) should be conducted for doctors, paramedical staff, police and security personnel to attend and treat those in case of sudden cardiac arrest. CPR devices, including defibrillators, should be made available at bus stands, railway stations, airports, stadiums and high-rise buildings. This system can save many lives. Mobile ICU units can be set up during bigger events.
