Health Matters | Health care in a war zone

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Murder most foul is afoot in Gaza. In violation of all conventions that bind humanity at war, Israeli troops are bombing Shifa Hospital where patients are stranded without any care, newborn infants in need of support are flailing, and staff, patients and the displaced who had sought refuge in the hospital are moving out. Let’s make that ‘force to move out.’ What is unfolding in Gaza is probably the worst humanitarian crisis in recent history. Israel’s reason for bombing hospitals is that Hamas militants are hiding inside. Even if that might be the case, and proof for that emerges, it takes great skill to remove the gossamer veil off a bush of thorns. It’s unacceptable that basic health facilities are being denied to those injured in the blasts, many of them rendered amputees, where doctors are forced to work under the illumination of mobile phone flashlights, and operate without anaesthesia. Premature babies who need neonatal intensive care did not receive the assistance, some were lucky to be evacuated, for transfer to Egypt.

Further horrors in terms of availability of clean drinking water, and hygienic health food have already ridden the Gazan strip, making life hell for those who have managed to survive the bomb blasts. Battle upon battle ensues as these people struggle to even meet the basic requirements for living. It seems as if plenty of outrage is not sufficient to ensure that this situation is reversed, not commensurate to force a ceasefire and complete restoration of basic necessities to the people of Gaza, and the health care that they need and deserve. We have a series of reports this week stressing the aspects of threats to health care in Gaza, do read below:

Saumya Kalia talks with Dr. Samah Jabr, head of the Mental Health Unit at Palestine’s Ministry of Health, about authentically defining and measuring the trauma that Palestinian bodies and minds face. She explains what makes PTSD a Western concept, why clinical mental health systems fail people facing oppressive policies and colonial injustice, and the urgent need to build communal forms of care that address Palestine’s collective trauma: Understanding Palestine’s colonial, intergenerational trauma from a mental health perspective.

At least 30 premature babies evacuated from Gaza’s main hospital and will be transferred to Egypt.

Shifa Hospital patients, staff and displaced leave the compound as Israel strikes targets in south.

Israeli forces battle militants around another Gaza hospital as babies evacuated to Egypt.

Israeli forces raid Gaza’s largest hospital, where hundreds of patients are stranded by fighting.

The bugs are always at the foot, sniping and yelping. A global world with interconnects never even imagined, that has, unwittingly expanded risks, as it has opportunities, to the entire world. As we saw during the pandemic, the global nature of trade, commerce and movement between nations are all vehicles that microbes ride on, to spread diseases across the world.

Antimicrobial resistance is the one that is feared the most, bugs that cannot be wrestled down by medicine, are indeed the most deadly. The WHO has warned again, on the occasion of World AMR Awareness Week, between November 18 and 24, that antimicrobial resistance is a significant threat to global public health. The South-East Asia regional office of the World Health Organization (WHO) warned that antimicrobial resistance (AMR) is directly responsible for approximately 1.27 million deaths annually across the world, with current estimates placing the number of casualties in South Asia at 3,89 000.

Meanwhile, there are always dollops of good news in the healthcare sector, not mere gloom and doom. I record the USFDA approval for the first Chikungunya vaccine in the U.S. If you were wondering how was the first vaccine for chikungunya approved, then, hit the link. Here’s a short preview: On November 9, the world’s first vaccine for chikungunya was approved by the Food and Drug Administration (FDA) in the U.S. The vaccine has been developed by European vaccine manufacturer Valneva and will be available under the brand Ixchiq, and has been approved for administration in people who are 18 years or older, and are at increased risk of exposure to the virus. It was approved using the Accelerated Approval pathway, which allows the FDA to clear certain products for serious or life-threatening conditions based on evidence of a product’s effectiveness that is likely to provide clinical benefit.

R. Prasad writes a very important story on how U.S. data underscore the benefits of chickenpox vaccination. 25 years of data (1995-2019) from the U.S. show a sharp drop in the incidence of chickenpox and shingles in children; in adults, shingles cases did not increase as feared and the rate of shingles is expected to decline.

Meanwhile, a global report indicated a 43% increase in global measles deaths from 2021 to 2022. Experts blamed it on dropping efficiency in vaccinating children against measles. The number of measles deaths globally increased by 43% from 2021-2022, following years of declining vaccination rates, according to a new report from the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC). Measles is preventable with two doses of vaccine. While a modest increase in global vaccination coverage occurred in 2022 from 2021, there were still 33 million children who missed a measles vaccine dose, according to the global health body. Of the 22 million children who missed their first measles vaccine dose in 2022, over half live in just 10 countries: Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Madagascar, Nigeria, Pakistan and Philippines, it said.

Nearly expectedly for those following these issues, the Union Health Ministry issued a statement denying reports claiming 11 lakh children missed the first measles vaccine in 2022 ‘inaccurate’. “These reports are not based on facts and do not reflect the true picture. These reports are based on the estimated number reported under the WHO UNICEF Estimates National Immunisation Coverage (WUENIC) 2022 report which covers the time period from January 1, 2022 to December 31, 2022,” the statement countered. Only 21,310 children missed their 1st dose of Measles Containing Vaccine [MCV] in 2022-23, it contended.

At this point in time, it is probably pertinent to ask: How safe is our personal health data with the Indian government? as Zubeda Hamid did in the In Focus podcast, this week. Health data consists of sensitive, personal information and once stolen, can increase the risk of digital identity theft, online banking thefts, tax fraud and other financial crimes. India was ranked fourth across the world in all malware detection in the first of 2023, as per a survey from Resucurity. This American cyber security firm, said that the personal information of 815 million Indians was being sold on the dark web. This included details such as Aadhar numbers and passport details. The persons selling this information claimed that it was from the Indian Council of Medical Research or ICMR, the country’s premier scientific research body.

This week we also investigated the value of food – its nutritive benefits and what safety and hygiene standards food we buy needs to conform to. R. Sujatha quotes a study that stopped just short of delivering a verdict, though it took up the question: Is it better to eat plant-based foods than rely on meat? A recent issue of BMC Medicine analyses the evidence that substituting animal-based with plant-based foods does lower risk of cardiovascular diseases, and type 2 diabetes besides mortality.

Here, Serena Josephine M. examines the health and hygiene norms to be followed while ordering food or eating outside, in order to stay safe and out of hospital with a food/water infection: In food we trust: laying out health and hygiene norms. If ordering out or eating out is your family’s norm, as is the trend these days, do spend a few minutes on this story.

Moving from the body to the mind. A.S. Jayanth speaks to experts to say mind and skin, there is a link between the two. Dermatologists suggest that dermatologists need to closely examine people with skin problems and check their symptoms and medical history to find out if they have any mental health issues. The importance of mental health care cannot be underestimated. Recently, the WHO declared loneliness as a pressing global health threat, reported Bindu Shajan Perappadan. The organisation has now launched an international commission on the problem to address loneliness as a pressing health threat, promote social connection as a priority and accelerate the scaling up of solutions in countries of all incomes. “Running for three years, it will analyse the central role social connection plays in improving health for people of all ages and outline solutions to build social connections at scale,” noted a release issued by the WHO.

Once again, we return to the issue of quality of drugs. N. Ravi Kumar reports the development: Kilitch Healthcare recalls eye drops amid U.S. FDA investigators finding unsanitary conditions. There have been multiple instances in the past of the WHO and other nations flagging issues of quality among drugs made in India, causing disease, aggravating an existing disease and disability, even death on consuming these drugs.

In context, do not miss Dr. K. R. Antony’s piece on the quality of drugs: Branded, generic and the missing ingredient of quality. He argues that the prevalence rate of spurious and “not standard quality” medicines (NSQs), stands at 4.5% and 3.4 %, respectively, as shown by two national drug surveys in the last 10 years using thousands of samples from retail chemists across India. In safeguarding a patient and enabling complete healing, drugs must be 100% quality test-passed. Having even 5% of medicines failing to pass quality tests is simply unacceptable.

Further he recommends that the government must ensure the quality of medicines produced, procured, and supplied through its Universal Health Coverage system as well as the private health-care network. For this, there has to be periodic lifting of samples for testing. Batches of medicines that fail the quality test must be banned, with punitive action taken against manufacturers. This will eliminate repeat defaulters from the supply chain. The mechanism and systems are in place but are not implemented in earnest.

Bindu Shajan Perappadan writes on an important development: NMC tightens rules for new medical colleges, aims to weed out ghost faculty, while Jayanth R. notes something that might come in handy for medical seat aspirants: NMC reduces NEET 2024 syllabus, cuts 9 chapters from chemistry and six from biology.

Tail piece

Two stories automatically land this slot this week: D.P. Kasbekar’s report on a new study, where researchers have explored how paramutations – one of nature’s more closely guarded secrets – work. The unusual ‘mutations’ that protect humans from viruses. This is going down to the basics, finally. A mutation is any change in the sequence of bases in the DNA of a chromosome. A paramutation is a small chemical modification of a chromosomal protein: it flips a nearby gene into a silenced state. So the active and silenced versions of a paramutated gene share the same DNA sequence but their associated proteins have different modifications.

The second is the one by Sridhar Sivasubbu and Vinod Scaria: The Chimaeras of nature and their promise to grow human organs. In a recent landmark study published in the journal Cell, scientists reported the successful generation of a live chimaera in non-human primates – species that are actually evolutionarily close to humans. This is the first time scientists have succeeded in producing a live infant chimeric monkey. In studies with long-tailed macaques. researchers extracted embryonic stem cells from one-week-old embryos. They modified the DNA in these cells to include a green fluorescent protein (GFP). These GFP-marked embryonic stem cells were then injected into recipient embryos that were implanted into surrogate female monkeys, which delivered six full-term offspring.

Using detectors, the researchers located the GFP signal in the tissues of one aborted male foetus and in one live-birth male. The latter signal originated from the donor cells that had been injected into the recipient’s embryo. The chimeric monkey had to be euthanized after a few days, but the technique is undeniably simply pregnant with possibility and needs to be explored further, to see if it can fulfill the great demand for organs for transplant among humans.

From the Health page

If you have a few extra minutes, also read the following stories:

How can India monitor air pollution-related illnesses effectively?

Dentists advocate caution in root canal treatment among children.

Indira Gandhi Peace Prize presented to COVID-19 warriors.

Rajeev Jayadevan on COVID-19: new brain damage mechanism uncovered.

Health Ministry releases draft National Pharmacy Commission Bill.

1.3 million lives lost every year to cancers caused by tobacco smoking in seven countries, shows a Lancet study.

Free cancer care alone won’t help India fight cancer, explains Parth Sharma.

For a rich compilation of our regional content, do see:

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Health Matters | Health care in a war zone
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