(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying there. You can subscribe here to get the newsletter in your inbox.)
The noblest of acts, arguably, is the donation of organs post-brain death, to aid transplantation of organs; no less significant is a living donor transplant. For many people forced onto their last length of life, thanks to end-stage diseases that severely impact the function of organs, an altruistic organ donation is a literal lifesaver. As incredulous as it sounds, accurate data on the exact numbers of people with end-stage disease/organ failure is still elusive. A study by G.K. Modi and V. Jha, way back, put the average crude and age-adjusted incidence rates for end-stage-renal disease at 151 and 232 per million population, respectively. With the association between diabetes and kidney failure now an established fact, given the large epidemic of diabetes India is currently witnessing, the number of people awaiting transplants is likely to grow much more unless attention is paid to good control of blood sugar, experts have said.
As per a 2016 study, different chronic liver diseases and cirrhosis accounted for 2.1% of all deaths in India in the year 2016. Add to this the relatively smaller number of patients in line for a lung or heart transplant, the burden is indeed huge for India.
With a waiting list of over three lakh patients and at least 20 persons dying each day waiting for an organ, India’s paucity of organ donations, especially deceased donations, has been exacting a steep toll. According to the Health Ministry’s own data, the number of donors (including the deceased) only grew from 6,916 in 2014 to about 16,041 in 2022. Bindu Shajan Perappadan underlines the seriousness of giving the country’s deceased organ transplantation a much-needed fillip.
The other reality is that performance is patchy across the country, with some of the southern States performing much better in terms of organ donation, equitable sharing of organs and capacity to perform cutting-edge transplant surgeries. At a recent event in New Delhi, Tamil Nadu received the award for the best State Organ and Tissue Transplant Organisation from the National Organ and Tissue Transplant Organisation. Since the commencement of the Organ Transplantation programme in the State in 2008, there have been 1,706 donors. A total of 786 hearts, 801 lungs, 1,566 livers, 3,047 kidneys, 37 pancreas, six small bowels, two stomachs and four hands have been transplanted. A total of 3,950 minor organs and tissues have been transplanted, according to official data. Earlier in the Health Matters column, we learnt of Telangana marking significant achievements in deceased organ donation, and in Karnataka, for the second consecutive year, cadaveric organ donations in Karnataka have crossed the century mark. Last year, the State recorded the third-highest number of donations in the country with a total of 151, the highest ever, says Afshan Yasmeen.
Organ donation rates in India remain abysmally insufficient at 0.8 per million population, by any standards. When compared to Croatia’s 36.5, Spain’s 35.3, and the U.S.’s 26 per million, respectively, and when evaluated from the point of view of serving its vast population with end-stage disease, requiring organs. Improved awareness, better facilities to take of brain stem death, certifying brain death and upskilling to address transplant surgical needs are the need of the hour.
In other news, a very significant conference was held in Chennai last week at the Dr. M.S. Swaminathan Research Foundation, on a topic that has implications for the future of healthcare, how we approach health and make it multi-dimensional - One Health. In One Health, public health is not seen in merely human terms alone, having arisen as a response to zoonotic diseases making a species crossover, but as one that involves many more elements. According to the One Health Initiative Task Force, it involves “the collaborative efforts of multiple disciplines working locally, nationally, and globally, to attain optimal health for people, animals and our environment.”
With World Breastfeeding Week being observed last week in the country, the usual blitzkrieg of information about the benefits of breastfeeding for both the mother and child, here’s a less popular version of, but very significant aspect, of breastfeeding that lactating mothers experience by Christianez Ratna Kiruba, a physician. She writes of mothers who have problems with breastfeeding and feel judged by their doctors. Lactation consultants and antenatal counselling can, in a way, address this, but until the judging and guilt-tripping stops, mothers are going to continue to feel overwhelmed and underappreciated during a tough patch in their life. Even as health managers orient themselves with this point of view, there’s a pressing need to improve maternal and childcare services in the country. Though India has notched up substantial improvements in reducing maternal and child mortality over the decades, much more remains to be done in terms of bringing more people into institutional systems, reducing anaemia and inequity in healthcare. Here, I write about how while a public perception survey indicated flagging levels of confidence in delivering good care to pregnant women, the raw data - maternal mortality, neonatal mortality and infant mortality - is sobering. The country does constantly have to endeavour to bring down the numbers, never mind the substantial gains of the past. There is no room for complacency here.
Do you know people around you that seem to have suddenly developed lactose intolerance in adulthood? If you’ve been wondering about the curious case of rising adult lactose intolerance, then you’ve come to the right place. C.Maya lays it out for you: The body needs an enzyme called lactase which is produced by the cells lining the small intestine, to digest lactose. If one is deficient in lactase, the undigested lactose passes on to the colon, where it produces extra gas and water, resulting in bloating, cramps and diarrhoea. Lactose intolerance thus produces symptoms which can be uncomfortable, but it is never dangerous. It is often also mistaken for other gastric conditions.
There’s good news on the mental health front. Modern antidepressants can reduce the risk of depressive relapse for bipolar patients, according to a NIMHANS-University of British Columbia study, we record here. The findings, published in the New England Journal of Medicine on August 3, challenge current clinical practice guidelines, and could change how bipolar depression is managed globally, a researcher commented. Also, Serena Josephine M. recounts how the Tele-MANAS mental health helpline has been of great assistance to callers.
The question of ensuring strict quality control in drugs remains a vexatious issue. Once again, the WHO has flagged the issue of contaminated Indian-made cough syrup in Iraq. The product was found to have unacceptable amounts of diethylene glycol and ethylene glycol, both of which can cause severe problems to humans and can even be fatal. Earlier, 300 children were estimated to have died from consuming India-made cough syrup across three countries.
In this podcast, Zubeda Hamid speaks to Prashant Reddy about the new Jan Vishwas Bill, passed recently by both Houses of Parliament, and the larger issue of substandard drugs. The drug law changes have sparked a controversy: health activists have said that it essentially decriminalises the manufacture of drugs that are not of standard quality, allowing manufacturers to get away with a fine, with no imprisonment.
In this context, the Health Ministry’s move to set a deadline for the Indian pharma industry to get their WHO-GMP certification, assumes crucial significance, though the government has not quite articulated its position on the cough syrup issue, apart from making testing of cough syrup before export mandatory. Meanwhile, counterfeit medicines of about ₹2 crores from leading manufacturers were seized from Kolkata.
In this hard-hitting opinion piece, Siddhesh Zadey and Lokesh Krishna argue that India needs evidence-based, ethics-driven medicine as a studied response to the recent push to integrate ‘AYUSH’ medicinal systems into mainstream health care to achieve universal health coverage and ‘decolonise medicine’. Meanwhile, Union Minister of Ayush Sarbananda Sonowal said, at a meeting in Kerala that the government had allocated ₹1,200 crore to develop infrastructure facilities of the Ayush institutions across the country in 2023-24,
And yet another question of ethics is examined here, in the piece by Francois Baylis and Jocelyn Downie over the move to use synthetic human embryos (embryo-like structures) that would allow expansion of research beyond the 14-day limit, but also bring with them a load of questions. As scientific advancements expand the scope of what we can do, it’s mankind that needs to be cognisant of the ethical implications of rolling out cutting edge technology in research.
For our interesting tailpiece this week, learn about prenuptial seizures. The same thing that Jhanvi Kapoor has in her recent Bollywood flick Bawaal, seizures can occur in known epilepsy patients before or after their wedding, due to a bunch of factors, including stress, anxiety, sleeplessness, forgetting to take the pills. Siddharth Kumar Singh here, finds out from doctors about the ways in which such seizures can be prevented.
From the Health pages
If you have more moments to spare than you had originally planned for, do stop by at the following stories:
Keralite doctor’s single pill strategy to combat cardiovascular diseases gets WHO’s nod.
In a humanitarian gesture, Health Ministry’s e-portal seeks to avoid delays in transporting human remains.
A study by doctors from the Sri Jayadeva Institute of Cardiovascular Sciences and Research has found late presentation to hospitals by women with severe coronary artery disease to be a major factor for higher mortality.
In TB detection, smear microscopy’s share still holds sway, says R. Prasad.
More regional content for you:
CM asks officials to focus on eradication of malnutrition and anaemia reports G.V.R. Subba Rao.
High Court notice to Centre on petition challenging exclusion of disabilities from National Family Health Survey.
A rapid survey in Karnataka showed lack of access to free medicines in government hospitals.
Climate change impacts various aspects of the United Nation’s Sustainable Development Goals, as per a report presented at Think20 Summit in Mysuru.
Four districts of Karnataka part of National Family Planning programme’s pilot on introduction of new contraceptive option.
Timely CPR saves 52-year-old who collapsed at work.
Antimicrobial resistance committees to be formed in all Kerala health blocks.
Nurses association urges intervention of CM in assault case.
Kerala Health Minister says all hospitals to be mother-and-baby friendly units.
Emergency loading dose for heart attack patients stocked at 10,999 rural health facilities: T.N. Health Minister.
Healthy diet, exercise and good sleep essential to avoid vascular ailments, say doctors at webinar.
Pain clinic at govt. super speciality hospital sees uptick in patients, doctors say more awareness needed.
Government should provide millets in PDS and create facilities for people to exercise.
Telangana sees rise in conjunctivitis cases; students face brunt of outbreak.
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