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Symbiosis Health Times

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ISSUE : MAY 09

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Index

1. FOREWORD _________________________________________________________ 01

2. FROM THE EDITOR'S DESK ____________________________________________ 02

3.

HIGH COURT DIRECTS MUNICIPAL CORPORATION TO DEPOSIT RS 5 LAKHS

IN MISSING BABY CASE _______________________________________________ 33

7.

NEW PARADIGMS IN HEALTHCARE DELIVERY ____________________________ 03

4. GREEN BUILDING IN HEALTHCARE _____________________________________ 06

5. RECIPE FOR DISASTER OF 'CHILDHOOD' ________________________________ 09

6. SURROGACY & LAW __________________________________________________ 10

7. FUSION IMAGING - A CURRENT SCENARIO IN RADIO IMAGING _____________ 13

8. A STUDY ON THE USE OF INDIAN SYSTEMS OF MEDICINE AND

HOMEOPATHY AMONGST THE PATIENTS OF A SERVICE HOSPITAL. __________16

9. KEEP YOUR HEART TICKING......? ______________________________________ 20

10. HEALTHY WORK ENVIRONMENTS THROUGH

TRANSFORMATIONAL LEADERSHIP ____________________________________ 23

KNOWLEDGE BANK

1. SUPREME COURT ISSUES NEW GUIDELINES FOR DECIDING MEDICAL

NEGLIGENCE CASES ________________________________________________ 27

2. HIV, AIDS POSE SERIOUS RISK TO SOUTH ASIA: WORLD BANK _____________ 28

3 'CYBERKNIFE' TO TREAT CANCER _____________________________________ 30

4. TRANSPARENCY HAS STARTED COMING IN INDIAN MEDICAL FIELD ________ 31

5. PFIZER TO SET UP 600 SMOKING CESSATION CLINICS IN 2 YEARS __________ 32

6.

IRDA GUIDELINES FOR HEALTH INSURANCE _____________________________ 34

8. WHO LAUNCHES GLOBAL CAMPAIGN TO IMPROVE HOSPITAL SAFETY ______ 35

9. ORGAN DONATION SCENARIO IN MAHARASHTRA ________________________ 36

FOREWORD

Symbiosis Health Times - 09 01

It gives me immense pleasure to present the commemorative

issue of the Symbiosis Health Times. This journal is one of the

periodicals of the Symbiosis Centre of Health Care that publishes

articles, which are related to the Health Care sector and to the

various subsectors like IT, Pharma, Health Insurance, NGO's,

Hospital, Fitness, Medicolegal, Medical technology etc.

Healthcare is a complex & multidimensional issue. It is a service

provided by a coordinated and committed group of professional

people. Healthcare services are being provided as team effort basically aimed at relieving

pain and sufferings of the customers so called as 'patient'.

Symbiosis Health Times thus covers a gamut of topics ranging

from Management Issues in the Health Care Sector especially Hospitals, Medico Legal

Issues, New Paradigms in the Healthcare, Green building hospital concept etc.

An interesting and useful addition is the “Knowledge Bank”, wherein we have complied

articles on important and current issues.

I believe that this issue will enlighten all of you and give you an insight on the topics

covered in it.

Happy reading.

Dr. Rajiv Yeravdekar

Director, Symbiosis Centre of Health Care.

Dear Reader,

I am delighted to release the commemorative issue of Symbiosis Health

Times. This is a special issue, in the sense; we have given opportunity to

the budding professionals in the interdisciplinary area of Health

including Pharma, Insurance, Information Technology, Hospitals, NGO's

and Health Law to contribute articles.

This edition focuses on issues like 'New paradigms in healthcare

delivery'

wherein special emphasis is given to retail healthcare, medical malls, daycare surgery centers,

senior assisted living facilities, rehabilitation centers and boutique healthcare.

In an article on 'green building in health care', issues like benefits of green building in hospitals &

factors that discourage a hospital from going green building concept are discussed.

An article on 'Surrogacy & Law' raises issues about need, benefits etc. for enacting law which

will regulate surrogacy matters in India. 'Keep your heart ticking' talks about advantages & risks

of exercise, precautions and some important tips of exercise. Article on 'Fusion Imaging'

enables us to know the current scenario in Radio-Imaging.

Some of these are the burning issues of debate all the time and are of great practical utility in

modern era.

We have included a 'Knowledge Bank' section, which is primarily a section where views,

recent trends on same subject & its effects on growing Health Care sector are being discussed.

These issues are like 'Guidelines issued by Supreme Court for Medicolegal Cases', 'Cyberknife

for treating cancer', 'World Bank report on HIV/AIDS', 'Setting up of 600 smoking cessation

clinics', 'IRDA Guidelines for Health Insurance', 'WHO's global campaign for improving Hospital

safety' and many more………….

Happy Reading.

Best wishes,

Adv(Dr) Salunkhe Milind

BHMS;DHA;MBA;LLB.

FROM THE EDITORS DESK



Medical treatment has advanced exponentially over the last two decades. However, the packaging

and delivery of treatment has not shown the same improvement and growth over the time frame.

This has left the consumer struggling with scattered and inconvenient healthcare delivery systems.

The present systems lack transparency and are difficult to access. Overall, the existing systems are

providing sub optimal levels of experience and returns for consumers, payers and suppliers.

While hospitals will continue to be the mainstay of treatment for episodic acute care we see a

fundamental shift in the nature, mode and means of delivery of care. Preventive and chronic care

are best treated in an ambulatory environment close to the place where the patient resides. This

transformation is already evident and shall continue to grow.

The new paradigms of healthcare delivery are:

1. RETAIL HEALTH CARE

Medical clinics co- located with retail outlets in varying sizes and service mix offer a more

convenient option for accessing medical care. The existing customer base of the retail outlets in

question would almost naturally gravitate to such healthcare options being offered in the same

location. As retailers look for newer growth strategies healthcare seems the most logical and

exciting option. It has been proved internationally that the healthcare providers and retailers grow

synergistically in which there is a classic win-win paradigm: convenience and accessibility for the

consumer; increased footfalls for the retailer, easy entry and sharp growth for the provider.

AMARTHMBA(Hospital and Health Care Management)

NEW PARADIGMS IN HEALTHCARE DELIVERY

RETAIL HEALTHCARE

MEDICAL MALLS

DAYCARE SURGERY CENTERS

SENIOR ASSISTED LIVING FACILITIES

REHABILITATION CENTERS

BOUTIQUE HEALTHCARE

RETAILHEALTHCARE

REHABILITATION CENTERS

MEDICAL MALLS

DAYCARESURGERYCENTERS

BOUTIQUEHEALTHCARE

MODELS

ASSISTED LIVING FACILITIES

CONVENTIONALHOSPITAL

THE RANGE OF SERVICES AT A MEDICAL MALL

Retail Clinics

Rehabilitation Centers

Pharmacy Superstores

Beauty and ObesityClinics

Hospital InformationCenters

Health and MedicalInsurance Shops

Whole Sellers for Pharmacy Drugs (Cash and Carry Format)

Alternative Healthcare Chains(Ayurveda, Homeopathy, Naturopathy

Clinics and Treatment Centres)

Dental Clinics

Gymnasiums

Wellness Centers and Spas

Medical Furniture Stores

Health Food Stores

Medical Conferences and Exhibitions

Physiotherapy andRehabilitation Centers

Personal MedicalEquipment Stores

Pain Management Clinics

Sports and fitness Stores

Yoga Centers

Diagnostics Centers


Internationally, healthcare retail is taking place in the following settings:

Pharmacies (such as CVS)

Mass merchandisers (such as Wal-Mart)

Local Grocery stores (such as Kroger)

2. DAY CARE SURGERY CENTERS

Traditionally, surgery has required the healthcare provider to meet inpatient requirements.

however, inpatient facilities are expensive, inconvenient and less then savory to most patients.

technological advances over the last two decades have helped address this gap. a large number of

surgeries can now be performed without the patient having to be admitted at all. This has spelt vast

advantages for both healthcare providers and consumers. Surgery in an outpatient setting has

become a global trend and is expanding throughout the world. It is estimated that by 2020, 75% of

all surgical operations will be carried out in ambulatory surgery centers/units. Today over a quarter

of the surgeries are contributed by ophthalmic procedures. the cost advantage of day surgery is

best achieved in free-standing centers or totally free-functioning units within hospitals. Day care

surgery is now a popular and preferred mode of treatment for most surgical patients. in the united

kingdom, 55% of elective surgery is carried out in an ambulatory setting. Over 50% of NHS

hospitals have self-contained day surgery units and the ministry of health is targeting over 70% of

elective surgery on an ambulatory basis by 2010.

3. MEDICAL MALLS

Medical Malls would offer the

widest array of medical services

and provide a convenient, one

stop environment designed for

the healthcare consumers it

serves. It would also serve as an

effective platform for interaction

a n d c o m m e r c e b e t w e e n

professionals in the healthcare

arena – doctors, healthcare

providers, medical equipment /

D e v i c e m a n u f a c t u r e r s ,

pharmaceutical companies,

medical insurance providers ,

etc. The medical malls would

also provide an ideal setting for

healthcare conferences and exhibitions.


4. ASSISTED LIVING FACILITIES

An Assisted Living Facility (ALF) provides care for seniors who need some help with

activities of daily living, yet wish to remain as independent as possible. A middle ground between

independent living and nursing homes, Assisted Living Facilities aim to foster as much autonomy as

the resident is capable of. These facilities are to provide all day supervision and many other support

services with maximum levels of privacy, space and dignity. An Assisted Living Facility differs from a

Nursing Home in that it is for permanent residential occupation. It provides social and other

amenities besides primary healthcare. The focus of an ALF is on providing a productive lifestyle for

senior citizens.

SERVICES PROVIDED BY AN ALF

Health Services (medications, nursing care)

Physiotherapy Community Activities (social events, outings, golf, etc.) Support Services (laundry, F&B, housekeeping, etc.) Regular specialist screenings

5. REHABILITATION CENTERS

Medical Rehabilitation deals with functional restoration of a patient's normal physical

abilities. Medical rehabilitation provides restorative services to people who acquire functional

inability due to various ailments like Neurological, Orthopedic, Cardiac, Oncology, Pulmonary,

Diabetic, Pain, Disability, etc. to pace recovery to an active and productive lifestyle. These services

are provided in a variety of settings, including acute hospital–based rehabilitation units,

freestanding rehabilitation hospitals, and, increasingly, alternative settings such as sub acute care

units, outpatient rehabilitation centers, skilled nursing facilities and at home.

WHAT'S DRIVING MEDICAL REHABILITATION?

A changing disease profile necessitating more surgical interventions

An Aging population Desire for an active and productive lifestyle Better and cheaper access to services outside hospitals Technological advances enabling quicker and painless recovery Makes available inpatient beds for more acute cases in hospitals

6. BOUTIQUE CENTERS

Boutique Healthcare offers a more comprehensive “wellness” approach to the luxury customer.

Round-the-clock Availability, Home and Office Visits, Same Day Appointments, Unhurried Visits

Concierge Care, Specialist Liaison Services, Increased Level of Follow-up Care, Prescription

Services.

Enhanced coordination of specialist, referrals and treatment, Travel medical services

BOUTIQUE HEALTHCARE

COSMETOLOGYCOSMETICSURGERY

WELLNESS & &LIFESTYLE

?Weight Loss

?Diet/Nutrition

?Antioxidants

?Exercise

?Self Examination

?Warning signs of disease

?Stress Management /

Relaxation

?Age related problems

?Personal Aesthetician

DENTISTRY

?Dental Implants

?Cosmetic Dentures

?Smile Design

?Smile Makeovers

?Porcelain Veneers

?Teeth Whitening

?Non-Metal Restorations

?Laser Dentistry

?Breast Enlargement

?Breast Reduction

?Breast Lift

?Breast Reconstruction

?Tummy Tuck

?Body

?Contouring/Liposuction

?Facelift

?Eyelied Surgery

?Eye Brows / Forehead Lift

?Chin / Cheek Implants

?Nose Surgery

?Ear Surgery

?Male Breast Reduction

?Injectible Fillers

?Laser Hair Removal

?Laser Vein Removal

?Laser Red Spot/Redness

Removal

?Laser Brown Spot/Age Spot

Removal

?Laser Facial Rejuvenation

?Botox to remove facial

wrinkles

?Restylane & Juvederm to fill

deep lines on the face and

enchance lips

?Advanced Acne Treatments

?Chemical Peels

?Microdermabrasion

?Sclerotherapy Vein Removal

?Skin Care-General

Dermatology

?Acupuncture

?Massage

?Facials

Editor's Note :This is futuristic thought process which needs to be deliberated over period of few

years to visualise real scientific, technical, ethical & economic advantages to the stake holders. In

developing country like India where primary Health Care by the stake holders is far from

satisfactory, such innovative ideas need to be implemented after due deliberations and

discussions.



GREEN BUILDING IN HEALTHCARE

Maj(Dr.) Ashwin Sudheer Devanahalli MBA, (Hospital and Health Care Management)

Green building is the practice of increasing the efficiency with which buildings use resources –

energy, water and materials – while reducing building impacts on human health and the

environment, through better site, design, construction, operation, maintenance, and removal i.e.

the complete building life cycle.

THE NEED FOR GREEN BUILDING

Today the world shows fast paced progress and development. The world has also begun to realise

that this development has been achieved at a very high price, a price so high that it threatens the

very survival of humans in the eras to come. The global surface temperature has increased by

almost one degree Celsius in the last century. New research indicates that the global climate in the

coming century will be 2 – 4 degrees warmer than today and the ocean could rise by almost a

meter, threatening the existence of many minor islands in the Pacific Ocean (Science Daily, Jan 11,

2009). The Intergovernmental Panel on Climate Change(IPCC) in its latest report observed that

greenhouse gases like carbon dioxide, methane and nitrous oxide have increased markedly as a

result of human activities, the levels far exceeding the natural range of the last 650000 years

leading to larger drought affected areas coupled with more common heavy precipitation events

leading to increased flood risk, the resilience of many ecosystems is likely to be exceeded this

century, many millions of people are projected to be affected by flood every year due to sea level

rise . The IPCC report goes on to state that the perceived reduction in GDP in stabilizing

atmospheric greenhouse gases would be substantially offset by benefits to health as a result of

reduced air pollution and that there would be further cost savings from other benefits such as

increased energy security, increased agricultural production, reduced pressure on ecosystems as

well as, in certain countries, balance of trade improvements, provision of modern energy services

to rural areas and employment. The IPCC opined that to achieve reductions would require a large

shift in the pattern of investment, although the net additional investment required ranges from

negligible to 5-10%. They also concluded that it is more cost effective to invest in end-use energy

efficiency improvement than in increasing energy supply. They were in high agreement and much

evidence that, despite many barriers (particularly in developing countries), new and existing

buildings could reduce emissions considerably and that this would also provide other benefits in

terms of improved air quality, social welfare and energy security.

GREEN BUILDING IN INDIA

With the rising awareness about the environment, the Green Building Concept was mooted as a

measure to reduce the carbon footprint of a building. In India the Indian Green Building Council as


the leading organisation that represents the entire building industry on environmental building

matters. A not-for-profit organization, it provides the industry with tools necessary to design, build

and operate buildings that deliver high performance inside out. The council has developed industry

standards, design and construction practices and guidelines, operating practices and guidelines,

policy positions and educational tools that support the adoption of sustainable design and building

practices. The IGBC has set up the Leadership in Energy and Environmental Design (LEED) India

Core Committee to focus on indigenising the LEED rating to suit the Indian context and has come

up with the LEED India Green Building Rating System. The rating system is organized into five

environmental categories: Sustainable sites, Water efficiency, Energy and Atmosphere, Materials

and resources and Indoor Environment Quality. An additional category, Innovation and Design

Process addresses sustainable building expertise as well as design measures not covered under

the five environmental categories. LEED is a measurement system designed for rating new and

existing commercial, institutional and residential buildings. It is a performance oriented system

where credits are earned for satisfying criterion designed to address specific environmental

impacts inherent in the design and construction. Different levels of green building certification are

awarded based on the total credits earned. The points are divided as follows;

a) Sustainable Sites : 14 points

b) Water Efficiency : 6 points

c) Energy and Atmosphere : 14 points

d) Materials and Resources : 11 points

e) Indoor Environment Quality : 11 points

f) Innovation and Design Process : 5 points

Marked on each aspect the buildings are then certified as LEED – Certified ( 23 – 27 points), LEED

– Silver ( 28 – 33 points), LEED – Gold ( 34 – 44 points), LEED Platinum ( 45 – 61 points).

BENEFITS OF GREEN BUILDING IN HOSPITALS

Though building new facilities and retrofitting old ones to be eco friendly pose economic and

operational challenges, studies have shown benefits not only for the environment and health but

also for workers with reduced stress, patients with shortened stays and the bottom line with lower

energy bills.

The green building protects the immediate health of the occupants i.e. the patients, staff and

visitors by improved quality of indoor air which is dependent on physical and mechanical design, the

choice of building materials, building operations and maintenance. It also helps protect the health of

surrounding community as local air and water quality is significantly affected by construction

practices, building materials, construction equipments, and HVAC systems( Heating, Ventilation

and Air Conditioning) directly emit VOCs ( Volatile Organic Compounds), particulates and other

materials that can cause allergic attacks, respiratory problems and other illnesses. Land use and

transportation planning, landscape and water management on the grounds and water conservation

efforts within the building will influence the amount of toxic emissions released to the water and air

throughout the life of the building. Protection of health of larger global community and natural


Documented energy savings

50%

Reduced waste/cost

41

Improved indoor air quality

34

Improved staff satisfaction 32

Reduced waste streams 30

Improved or extended equipment life 26

Improved patient satisfaction 22

Improved community relations 19

Documented water savings 19

Increased savings from green materials/systems

16

Improved patient outcomes 12 Received award recognition 11 Reduced

liability

8

Increased philanthropy

5

Source:

Health Facilities Management /ASHE 2008 Green

Design & Construction Survey

MAJOR CHALLENGES

According to a survey conducted by Health Facilities Management and American Society for

Healthcare Engineering, the biggest issues that discourage a hospital from going green are

Higher initial (first) cost 78%

Increased cost over traditional materials/systems 73%

Competing investment/spending priorities 72%

Perceived lack of immediate return on investment 47%

Lack of information/evidence on benefits of green construction 28%

Lack of knowledgeable service and product providers 25%

Lack of senior management support 24%

Limited range of environmentally friendly building products and materials 22%

Source: Health Facilities Management/ASHE 2008 Green Design & Operations Construction Survey

resources is also achieved as the production of building materials can result in the release of

persistent bioaccumulative toxic compounds, carcinogens, endocrine disruptors and other toxic

substances. These compounds threaten communities where the materials are manufactured, and,

because of the long life of some of these compounds, can risk the health of communities and

ecosystems far from their release. Climate change resulting from burning fossil fuels is expected to

increase the spread of disease vectors far from their current regions and destabilize ecosystems,

threatening worldwide nutrition. Loss of rainforests from unsustainable forestry can result in the

loss of medicines and important genetic information that could help fight disease. Moreover,

release of CFCs and HCFCs damages the stratospheric ozone layer, allowing increased levels of

ultraviolet rays on Earth resulting in heightened potential for skin cancer.

According to Health Facilities Management/ASHE 2008 Green design and Construction survey the

biggest payoff in hospitals going green is in energy savings. Below are the percentages of hospitals

saying that they have seen improvements in the specific areas:-


But the point to be noted is that a $4 investment (per square foot) in green buildings nets a $58

benefit (per square feet) over 20 years (according to US Environmental Protection Agency). An

upfront investment of two per cent in green building design, on an average, results in lifecycle

savings of 20 per cent of the construction costs — more than ten times the initial investment.

To conclude, traditionally hospitals have never been considered green, with incinerators giving out

noxious fumes, HVAC equipments running 24/7, mass quantities of plastics and other harmful

substances (e.g. mercury sphygmomanometers) to the extent of some observers even citing

hospitals a source of alarm. But rising awareness and more importantly economic concerns have

brought about drastic changes in Hospital practices. Health Executives have now begun to

acknowledge Green practices as not just an add-on but also as a key responsibility. In India, the

movement is gradually picking momentum with more and more projects registering with the Indian

Green Building Council. This positive trend is sure to have far reaching benefits for both the

organisation and the country.


Dr.Vijaya.DateyMedical officer for Disaster Mangement,Symbiosis Institute of Health Sciences

Recipe for Disaster of 'Childhood'

Take a happy baby-

Weigh him down with disposable nappies and baby food formulas.

Tie him to a Toddler Walker and force him to watch Idiot box.

After a year or so,

Transfer him to a huge Utensil/playgroup/prenursery.

Surround him with mounds of plastic toys.

Later soak him with coke, pizzas, lays.

Cover him properly to see that he does not come in contact with fresh Air, sunshine etc.

After a few months, put him in K.G

Add some alphabets, some strokes, schoolbags and plastic water bottles. Mix Nursery Rhymes

with TV jingles and computer jargon.

Let this simmer for a year.

Then take 8 -10 carrots of different classes –

Singing, Drawing, Origami, Abacus, foreign languages, Pottery, Salsa, jazz, Karate, Instrumental

music classes. Grate these fine and mix the above ,stirring all the time.

Cook well till his hands pain, body aches and his dreams die.

Now add dollops of competitions, Races, Reality shows with generous heaps of rivalry and hatred

for co –participants.

Add donkey load of books and tuition studies.

Cook well to see that the twinkle in his eyes vanishes.

Turn the flame to 'High' and roast for many months.

This roasting should burn down Dreams, Love Fantasy and Innocence to charcoal. This would give

Ashy flavour.

Take off the flame.

Garnish it with chopped Rules.

Take care to remove all Moral Values From these Rules.

The 'well done' 'cooked' 'minced' child is now ready to serve the society.

“Jai Ho”

Total cost of the Recipe:

Baby's right to enjoy his 'Childhood'.


Surrogacy & Law

Adv(Dr) Salunke Milind HOD- PGDHHM & PGDMLS

After years of trying and treatment, US-based couple Jason and Nancy were finally proud parents

of a healthy baby girl; and their tiny bundle of joy, Tara, was delivered by Ashaben through a

surrogacy arrangement at a Hospital in Gujarat.

An Israeli couple experienced similar joy when, at Mumbai's Hospital last September, they

'fathered' twins through a surrogacy programme.

In another case an abandoned ten-day-old Japanese baby born to an Indian surrogate mother

finally has some hope. The doctors who are taking care of her are considering legal recourse to

claim her custody till her biological father legally adopts the baby.

Child's Japanese parents got separated a month before she was born. Even though her father still

wants to claim her custody, a string of legal hurdles prevent him doing so. India's laws prohibit the

child's divorced father from taking custody of her.

Both Indian and Japanese laws will have to be taken into account in order to allow child's father to

take her home.

There are specific laws in India for surrogacy issue but Indian Council of Medical Research (ICMR)

has given a general guideline which mentions that any child born through surrogacy must be

adopted by genetic parents.

There is provision in the guideline, which states that in case of a divorce during the gestation period,

the law of land pertaining to normal conception applies. In this case, the child was born in India so

the child is an Indian citizen. But because her father is Japanese, both Indian and Japanese laws

apply !!

Surrogacy is one of the well- accepted methods of assisted reproduction that benefits patients who

can't conceive or carry a pregnancy to term. "Such people can take the help of surrogates, who

carry their child in the uterus and then hand it over to the genetic parents, post-delivery.

Of late, there has been a growing demand for Indian surrogate babies from foreigners, infertile

couples in India and even single mothers - making the country a preferred destination for such a

service. As per the Indian Council for Medical Research (ICMR) estimates, due to the upward spiral

in the number of surrogacy cases, the reproductive sector in India is expected to rake in a whopping

US $ six billion this year!!


After IT services, it's now the turn of babies to be outsourced from India. In these times of

globalization and market-driven economies, there's considerable demand for this service.

Indeed and fuelling the demand is a slew of factors, including low medical costs and a competent

workforce. The total cost of renting a womb in India works out to around US$10,000 as compared to

about US$50,000 in the West. In the US, expert claim that surrogate mothers are typically paid

US$15,000, while the agencies claim another US$30,000. In India, however, fertility clinics charge

in the realm of US$2,000 to US$3,000 for the procedure, whereas a surrogate is paid anything

between US$3,000 and US$6,000 - a fortune in a country where the average annual per capita

income is a mere US$500!!

But, despite the demand, surrogacy has its share of critics in India due to the moral, legal and ethical

debate that swirls around it. If surrogacy becomes an avenue by which women in richer countries

choose poorer women in our country to bear their babies, then it is economic exploitation, a kind of

biological colonization.

A factor that has contributed to the negative feeling is the lack of a definitive legal framework to deal

with surrogacy and related issues. While commercial surrogacy is banned in many countries -

including Italy, Australia, Spain and China - and permitted with restrictions in the US, France and

Germany, the Indian government is yet to formulate any laws. In fact, the only guidelines, which

regulate surrogacy - and the clinics that provide ART (Assisted Reproductive Techniques) - are the

ones framed by the ICMR and the Ministry of Health and Family Welfare in 2005. But these, point

out experts, are nebulous and patient - and doctor - unfriendly.

For instance, Section 3.10 of the ICMR guideline states, "No relative or person known to the couple

may act as a surrogate." This, experts believe, is ludicrous as it propels childless couples

needlessly towards commercial surrogacy. In fact, in-vitro fertilization (IVF) in 90 per cent of the

surrogacy cases in India, the mother is related to the childless couple while only in five per cent

cases, the surrogacy is altruistic and in the remaining five per cent, commercial. So, infertile

couples are forced to think twice before going in for it due to the costs involved, which is unfortunate

as India is home to 14 per cent of the world's estimated 80 million infertile couples.

Then there is ambiguity about a surrogate mother's rights. The guidelines are skewed and

thoughtless. There's very little to protect the interests of the surrogate mothers. The guidelines state

that "a surrogate should be younger than 45 years" without mentioning the minimum age. So does

that mean an 18-year-old, or someone even younger, can become a surrogate mother?

Also, what happens after the baby is born? The biggest problem arises after the baby's birth.

Foreigners are unable to get legal assistance when it comes to taking the child back home.

According to the ICMR guidelines, a child born through surrogacy “must be adopted by the genetic


(biological) parents.” But Genetic parents will have to establish, through genetic (DNA)

fingerprinting, that the child is theirs. The only option left open to them is to 'adopt' the baby - which is

a very lengthy and cumbersome process in India.

The regulations don't provide legal protection to Indian parents, either. The only legal recognition of

the child's parentage is the birth certificate, and it's only the birth mother's name that can be used for

this purpose. Consequently, if the birth mother decides not to hand over the baby after birth, there's

nothing the intending parents or the doctor can do about it.

Not surprisingly there for, with such ambiguous regulations in place, surrogacy in India has become

a lucrative playing field for unscrupulous middlemen who entice and push uneducated and poor

women into surrogate motherhood. This practice also encourages the misuse of a surrogate child

for prostitution, terrorism or unethical genetic engineering research.

India can take a few pointers from the US, which has strict regulations in place - the law there

mandates that surrogate agreements be meticulously drawn out to delineate the responsibilities of

intending parents as well as the surrogate. "But in India surrogacy has a high potential for abuse as

the monetary stakes are high. When anything is influenced by economics, there's invariably a dark

side to it.

Basic problem is that people are not well informed about surrogacy and its related issues. For

example, a surrogate's health is not given due priority. Fertility doctors are allowed to implant up to

six embryos in a donor's womb - in other countries it's limited to three - which creates the risk of

multiple pregnancies and can lead to severe complications, stillbirth or even the surrogate's death.

In many cases, the surrogacy option is used even when it is not necessary. Sometimes patients

have had repeated IVF failures or recurrent miscarriages. Usually, a simple egg donation is enough

rather than a more complicated surrogacy option.

Doctors agree that a mass awareness campaign is key to making the treatment more accessible to

all. Many sensitive, surrogacy-related issues, too, need to be tackled on a priority basis. Who

ensures that the woman's unused eggs or embryos are not harvested/stored and then sold to

couples who want fair-skinned children? Or to couples who don't have viable eggs/sperms?

Moreover, some questions need urgent answers, such as: what happens if the surrogate dies

during childbirth, is there due compensation for her motherless children in that case; and what

about the postpartum psychological and emotional support for poor women surrogates?

There's also the issue of money. As the treatment is expensive and huge amounts of cash are

involved, perhaps there should be a regular audit to oversee the funds distribution to the

surrogates.


All transactions between surrogates & Genetic parents, emotional & practical, are regulated by an

Agreement which has entered in-between the parties called as Surrogacy Agreement. While

drafting an Agreement all the possibilities shall be considered from legal point of view. After

successful birth of surrogate child, Genetic parents will be given such surrogate child in adoption.

An adoption procedure will be regulated by Adoption Laws existing in India. Before the procedure of

adoption, Genetic parents have to prove that they used their ovum & sperms for the birth of

surrogate child, by conducting certain DNA testing.

Due to infertility problems, Genetic parents ‘hire’ the womb After the birth, if surrogate mother

denies to give surrogate child in adoption to the Genetic parents then there are no legal provisions

in existence which will force mother to give child to Genetic parents. Up to certain extent such points

can be considered while drafting surrogacy agreement. Any contravention of terms & conditions of

surrogacy agreement shall invite liability of paying huge compensation & other party will be entitled

to get such compensation; if compensation or penalty clause is incorporated in an agreement itself.

If male partner of the genetic parents is suffering from male infertility & such parent receives sperms

from any donor & if such couple goes for surrogacy, in such complicated case it is very difficult to

establish genetically that the surrogate child is of their own. Law is not clear on such complicated

issues of surrogacy.

Up to the age of 5 years, minor child shall be given in the safe custody of mother only. But may be

due to divorce, just before the birth of surrogate child, if genetic mother is not interested in the

custody & adoption procedure of such surrogate child then existing Indian Law does not allow

Genetic father to take surrogate child in adoption. In such case who shall take the responsibility of

such surrogate child? Genetic mother is entitled to take child into adoption but she does not want to

do so. Genetic father is interested to take surrogate child in adoption but Law is not allowing him to

do so.

It's time the Government seriously considers enacting a law to regulate surrogacy and related

IVF/ART technologies in India to protect and guide couples going in for such an option. Without a

foolproof legal framework, patients will invariably be misled and the surrogates exploited.


FUSION IMAGING - A CURRENT SCENARIO IN RADIO IMAGING

Dr. Sammita Jadhav, Programme Head, Medical TechnologyMs. Swati Soni, Faculty imaging sciences,Symbiosis Institute of Health Sciences

RADIOLOGY

Radiology is the Study of images of the human body. Although radiology began with the use of X –

Rays and large flat sheets of photographic films, the modern Radiologist now has a variety of tools

for '' taking pictures'' of living patients. Many of these newer tools create an image with a computer

(CT – computed tomography) and some do not use any X – Rays, nor radiation of any kind - such as

MRI and Ultrasound.

Conventional techniques performed are Plain radiographs, Fluoroscopy, Computed Tomography

(CT), Magnetic Resonance Imaging (MRI), Angiography, Nuclear Medicine imaging techniques like

Positron Emission Tomography (PET), Single Photon Emission Computed Tomography (SPECT),

Ultrasound and Radiation Oncology.

FUSION IMAGING

In simple words, fusion Imaging is the marriage of two modalities to provide a combined enhanced

image, amalgamating structural and functional information into a single output. This marriage

solemnized with either hardware or software union requires that the two modalities establish

several common reference points so that programmes can overlay one image on the other.

However, hardware images produce both types of images sequentially on a single equipment

platform.

Now a days fusion imaging of two modalities is becoming very popular.

For e.g.:- Positron Emission Tomography (PET) / CT, PET /MRI

Combination of PET / CT –

PET scans are increasingly read alongside scans, the combination ("co-registration") giving both

anatomic and metabolic information (i.e., what the structure is, and what it is doing biochemically).

Because PET imaging is most useful in combination with anatomical imaging, such as CT, modern

PET scanners are now available with integrated high-end multi-detector-row CT scanners.

Because the two scans can be performed in immediate sequence during the same session, with the

patient not changing position between the two types of scans, the two sets of images are more-

precisely registered, so that areas of abnormality on the PET imaging can be more perfectly

correlated with anatomy on the CT images. This is very useful in showing detailed views of moving

organs or structures with higher anatomical variation, which is more common outside the brain.


Risks

Ø The doses of the radioactive tracer isotope administered for diagnostic examinations are

small, so diagnostic nuclear medicine imaging procedures result in low radiation exposure.

Hence compared with the potential benefits, the radiation risk is very low.

ØNuclear medicine has been used for more than five decades, and there are no known long –

term adverse effects from such low - dose exposure.

ØAllergic reactions to radiopharmaceuticals may occur but are extremely rare and are usua l l y

mild. Nevertheless, the patient should inform the nuclear medicine personnel of any a l le rg ies

he may have or other problems that may have occurred during a previous nuclear m e d i c i n e

exam.

ØInjection of the radiotracer may cause slight pain and redness which should rapidly resolve.

ØWomen should always inform their Physician or Radiology technologist if they are

breast feeding their baby.

What are the limitations of Positron Emission Tomography – Computed Tomography

(PET/CT)?

Procedures are time consuming and the resolution of structures of the body with nuclear medicine

may not be as clear as with other imaging techniques, such as CT or MRI. However, nuclear

medicine scans are more sensitive than other techniques in a variety of indications, and the

functional information gained from nuclear medicine exam imitations is often unobtainable by any

other imaging techniques.

PET scanning can give false results if chemical balances within the body are not normal example in

diabetes patients.

CT imaging uses special X –ray equipment, and in some cases a contrast material is used to

produce multiple images or pictures of the internal structure of the body. These images can then be

interpreted by a radiologist on a computer monitor as printed images. CT imaging provides

excellent anatomic information.

Today, most PET scans are performed on instruments that are combined PET and CT scanners.

The combined PET/CT scans provide images that pinpoint the location of abnormal metabolic

activity within the body. The combined scans have been shown to provide more accurate

diagnoses.

PET and PET/CT scans are performed to:

Detect cancer

ØDetermine whether tumour metastasis has occurred

ØAssess the effectiveness of a treatment plan, such as cancer therapy

ØDetermine the recurrence of tumour after treatment

ØDetermine the blood flow to the heart muscle

ØDetermine the effects of a heart attack - myocardial infarction on areas of the heart

ØIdentify areas of the heart muscle that would benefit from a procedure such as angioplasty or

coronary artery bypass surgery (in combination with a myocardial perfusion scan)

ØEvaluate brain abnormalities, such as tumors, memory disorders and seizures and other

central nervous system disorders

What are the benefits vs. risks?

Benefits

ØThe information provided by nuclear medicine examination is unique and often unattainable

using other imaging procedures.ØFor many diseases, nuclear medicine scans yield the most useful information required to

make a diagnosis or to determine appropriate treatment, if any.ØNuclear medicine is less expensive and may yield more precise information than exploratory

surgery.ØBy identifying changes in the body at the cellular level, PET imaging may detect the early

onset of disease before it is evident on other imaging techniques such as CT or MRI.

Combination of PET & MRI –

Its common knowledge that two imaging systems are better than one, but what happens when two

of the most advanced systems available are fused into one machine ?

Following in the footsteps of other hybrid technologies, such as PET/CT and SPECT/ CT , the novel

PET/MRI imaging system in which brain tissues might be salvageable after a stroke, has emerged

Working in two different levels, the fusion of PET and MRI images has granted a more

encompassing view of the body's internal workings. The PET system tracks the movement of

radiotracers through the body, targeted to specific organs, bones or tissues, providing precise

pictures of the area of tissues of the body and molecular images of the body's biological functions.

However, since PET does not image soft tissue as well as MRI, or have the same degree of flexibility

in providing functional and physiologic information, the subsequent MRI scan effectively fills in the

gaps in the anatomic scan.

Challenges

Problems in composite images arise when researchers attempt to correlate data from PET and

MRI, as images obtained on separate systems must be aligned using software that looks for

identical landmarks on the two images.

This can be challenging when it comes to organs in the thorax and abdomen, which can easily be

displaced or change shape when a patient is moved between scanners.



A STUDY ON THE USE OF INDIAN SYSTEMS OF MEDICINE AND HOMEOPATHY AMONGST THE PATIENTS OF A SERVICE HOSPITAL.

Dr. Dhiraj Saini MBA (Hospital and Health Care Management)

KEY MESSAGES:

Ø

patients.

Ø About one third of patients utilised both allopathic and ISMH as preferred form of treatment.

Ø Reasons for use included fewer side effects and better results.

ABSTRACT

Complementary and Alternative medicine or Traditional Medicine is rapidly growing worldwide. In

India also, there is resurgence of interest in Indian Systems of Medicine. People are becoming

concerned about the adverse effects of chemical based drugs and the escalating costs of

conventional health care. Keeping in view the rising use of alternative medicine globally, the

introduction of Indian system of medicine and Homeopathy as part of the health care system of the

country, and the increasing acceptance by the population, it was decided to carry out a study on the

use of Indian system of medicine and Homeopathy by the clientele of a service hospital.

A questionnaire to determine the extent of utilization and felt need for Indian System of medicine and

Homeopathy was distributed to a sample of 400 patients attending the OPDs of a service hospital.

The study revealed that 5% of the population utilized alternative medicine as the preferred form of

treatment and 32.25% utilized both allopathic and alternative medicine as the preferred form of

treatment. It was seen that alternative medicine was maximally utilized because it showed better

results, fewer side effects (25%) and had easy accessibility (24.5%). 74% of the sample population

felt that in addition to allopathic (modern medicine) alternative type of therapy (Ayurvedic,

Homeopathy, Unani, Yoga and Naturopathy, Siddha) should also be provided in the hospital.

INTRODUCTION

WHO defines Traditional medicine as “the diverse health practices, approaches, knowledge and

beliefs incorporating plant, animal and/or mineral-based medicines, spiritual therapies, manual

techniques and exercise, applied singularly or in combination to maintain well-being, as well as to

treat, diagnose or prevent illness. “

Complementary and Alternative Medicine or Traditional Medicine is rapidly growing worldwide. In

India also, there is resurgence of interest in Indian Systems of Medicine. People are becoming

concerned about the adverse effects of chemical based drugs and the escalating costs of

There is increasing acceptance of Indian System of Medicine and Homeopathy (ISMH) amongst


Preferred Choice of treatment amongst clientele of a service hospital.

S.No. Preferred form of Treatment % Distribution 1 Allopathy 62.75% 2 Alternative system 5% 3 Both 32.75%

conventional health care. Longer life expectancy and life style related problems have brought with

them an increased risk of developing chronic, disease such as heart disease, cancer, diabetes and

mental disorders. Although new treatment and technologies for dealing with them are available, more

and more patients are now looking for simpler therapies for improving the quality of life and avoiding

iatrogenic problems.

Keeping in view the rising use of alternatives medicine globally, the introduction of Indian system of

medicine and Homeopathy as part of the health care system of the country and the increasing

acceptance by the population, it was decided to carry out a study on the use of Indian system of

medicine and Homeopathy by the clientele of a service hospital, the reason for its use amongst the

patients and determine if there was any felt need for the Indian System of medicine and Homeopathy

amongst the patients attending the OPD of service hospital.

MARERIAL AND METHOD

The study was conducted as a prospective study for period of one month in a tertiary care service

hospital. Perusal of OPD records of past 12 months of the hospital revealed that on an average, the

average daily OPD of the Hospital was 555. This figure covered the entitled personnel and their

dependents. It was decided to exclude the patients attending psychiatry OPD from the study. A

questionnaire to determine the extent of utilization and need for Indian system of medicine and

Homeopathy was distributed to a sample of 400 patients attending Medicine, Surgery, Eye, ENT,

Dermatology, Paediatric and Gynaecology OPDs as well as Medical Inspection room(MIR) in

proportion to average daily attendance in these OPDs.

RESULTS

It was noted that the maximum number of respondents belonged to the age group 15-45. The male

to female ratio was 1.7:1. Maximum number of the respondents were serving personnel (52.75%);

11.75% were ex-servicemen and 7% were dependents of ex-servicemen.

Out of the 400 sample population, 62.75% utilized Allopathic as the preferred form of treatment, 5%

utilized alternative medicine as the preferred form of treatment, and 32.25% utilized both allopathic

and alternative medicine as the preferred form of treatment.

Preferred Choice of treatment amongst clientele of a service hospital.

Amongst those who utilized alternative medicine either as the preferred form of treatment or along

with allopathic; 43.4% used Ayurvedic as the choice of treatment, 43.4% used Homeopathy, 8.5%

used Unani form of treatment and 4.6% used Yoga and Naturopathy as the choice of treatment.


Type of Alternative system used.

S.no. Alternative system used % Distribution 1. Ayurvedic 43.4% 2. Homeopathy 43.4% 3. Unani 8.5% 4. Yoga and Naturopathy 4.6% 5. Siddha -----

The morbidity profile for which these systems of medicines were sought included respiratory

diseases, gastrointestinal diseases, skin diseases, obst. and gynaecological diseases, viral

diseases injuries and other miscellaneous diseases. It was seen that the these alternatives

systems are maximally sought for bone and joint diseases like arthritis, spondylitis, and low back

aches; CVS involvement like asthma and bronchitis, skin diseases like dermatitis, vitiligo.

Morbidity Profile.

S.No. Group of diseases % of Patients 1. Diseases of Musculo- skeletal system 33.5% 2. Diseases of Cardiovascular system 20.7%

3. Diseases of Skin 15.5% 4. Diseases of Respiratory system 10.35% 5. Diseases of GIT 10.35%

6. Obstetrics & Gynaec. diseases 5,1%

7. Diseases of CNS 4.35%

It was seen that maximum respondents choose alternative system because of perception of better

results (28%), fewer side effects (25%), and easy accessibility (24.5%). The other reasons

included, to avoid illness being reported to auturities. The details are as per following table.

Reasons for use of alternative medicine.

S.No. Reasons for use of alternative medicine No. of responses

% Distribution

1. Modern Care not available 17 6.1% 2. Alternative medicine is cheap 04 1.4% 3. Alternative Medicine is easily available 65 23.5% 4. Alternative Medicine has fewer side effects 69 25% 5. Was not getting relief from allopathic medicines 43 15.4% 6. It shows better results 78 28.1% 7. Other Reasons 01 0.4%

As regard efficacy of these alternative systems, 3.2% of the users found results of to be

unsatisfactory, 10% partially satisfactory, 67.9% satisfactory and 19% found it to be highly

satisfactory. None of the users of this form of treatment had reported to have suffered any ill effect.

Of the sample population studied, 74% felt that in addition to allopathic (modern medicine)

alternative type of therapy should also be provided in the hospitals.

The study revealed that, if both forms of therapy would have been available in the hospital, 45.5%

respondents would have chosen to use allopathic, 3% would have chosen Alternative medicine and

51.5% said that they would have used both systems of medicine.

DISCUSSION

The study reveals that 3.5% of the study population prefer to use alternative medicine as the

preferred form of treatment. The findings are on the lines of a study by the department of AYUSH

which had shown that about 10% of the Indian population solely depend on Homeopathy for their

health care needs.

About a third (32.25%) of study population prefers to use both allopathic and alternative medicine

as the preferred form of treatment. Study conducted by International Institute of Population

Sciences revealed that 15% of patient attending homeopathy clinic in Primary Health Care Units (of

Govt.) used both allopathic and alternative form of therapy. This shows that acceptance for

alternative systems were higher in study population.

Study reveals that leading cause for preferring alternative medicine was better results in 28%

followed by fewer side effects (25%), and easy accessibility (24.5% ). This is similar to the results of

Study done by Majumdar et al in Cooch Behar and Jalpaiguri districts of West Bengal. The study

revealed that 16% of the people in the rural category preferred Homeopathy for treatment. Most of

them preferred Homeopathy as it was 'cheap' and as it was perceived 'good for children', and also

for 'permanent cure'. According to Srivastava and Bhandri who studied utilisation pattern and

demand for Central Government Health Scheme(CGHS) Ayurvedic dispensaries in Delhi the

reasons for choosing Ayurvedic system were' lasting cure', 'no ill effects', 'more effective', and 'tried

allopathic earlier'.

Hans studied perception and utilisation of Ayurvedic medical care by rural community in Aligarh,

Uttar Pradesh. He reported that great importance is attached to Ayurvedic institutions despite the

availability of the allopathic services through primary health centres. The reasons for preferring

Ayurvedic system was inexpensive medicines.



Keep your heart ticking......?

Amruta MBA (Hospital and Health Care Management)

We've heard it time and again that there is a crucial relationship between exercise and

cardiovascular health.

In today's stressful and sedentary lifestyle it is essential for us to follow a scientific exercise and diet

pattern to save ourselves from the adverse cardiovascular events that these factors can cause.

Over the past many years, numerous scientific reports have examined the relationships between

physical activity, physical fitness, and cardiovascular health. Expert panels set up by organizations

such as the Center for Disease Control and Prevention (CDC), the American council of exercise

(ACE) the American College of Sports Medicine (ACSM), and the American Heart Association

(AHA), have reinforced scientific evidence linking regular physical activity to various measures of

cardiovascular health. The main view in these reports is that more active or fit individuals tend to

develop less coronary heart disease than their sedentary counterparts. Even if heart disease

develops in active or fit individuals, it occurs at a later age and tends to be less severe.

Cardiovascular diseases are amongst the leading causes of deaths worldwide and it is no longer

the disease of the developed nations alone. It has been on the rise in developing nations as well.

This can be mainly attributed to lack of regular physical activity. In addition, studies have

documented the positive & protective effects of physical activity for a number of non-

cardiovascular chronic diseases, such as diabetes, hypertension, osteoporosis, and colon cancer.

In contrast, we see a higher rate of cardiovascular events and a higher death rate in those

individuals with low levels of physical fitness. Even midlife increases in physical activity, through

change in occupation or recreational activities, are associated with a decrease in mortality. Despite

of this knowledge there is still a lack of motivation amongst people and the death toll due to heart

attacks and strokes is rising. In addition to this, there is an increase in morbidity due to diabetes,

hypertension and obesity.

Is it necessary to exercise at all?

The heart is a muscle and also requires regular exercise. Regular exercise has a favorable effect on

many of the risk factors for cardiovascular disease. Exercise promotes weight reduction and can

help reduce blood pressure. Exercise can reduce "bad" cholesterol levels in the blood as well as

total cholesterol, and can raise the "good" cholesterol. In diabetic patients, regular activity favorably


affects the body's ability to use insulin to control glucose levels in the blood. Although the effect of an

exercise program on any single risk factor maybe small, the effect of continued, exercise on overall

cardiovascular risk, when combined with other lifestyle modifications (such as proper nutrition,

smoking cessation, and medication use), can be dramatic.

Some benefits of regular exercise:

ØPromotes weight loss and helps control weight.

ØPromotes endurance, strength and flexibility.

ØNormalizes blood pressure.

ØPrevents heart disease : Increases “Good cholesterol”

ØRegulates blood sugar.

ØPromotes bone density. Prevents Osteoporosis.

ØSupports body structure. Counteracts sarcopaenia.

ØImproves joint range of motion especially in arthritis.

ØAids sleep.

ØBoosts the immune system.

ØStimulates the endocrinal system.

ØIncrease in exercise tolerance .

Although the benefits of exercise are categorical, it is important to understand that exercise

programs alone for patients with heart disease have not convincingly shown improvement in the

heart function.

With regards to heart disease, it's better to be fit— even if you're overweight—than to be skinny and

sedentary, according to a study published in the Journal of the American Medical Association.

Regular physical activity increases blood flow to the heart and strengthens the heart's contractions

so it pumps blood with less effort. Immediate benefits include improved mood due to the release of

endorphins, increased energy level and better sleep patterns—all of which help control the stress

that could play a role in cardiovascular disease.

Some tips before starting exercise

ØPerform/undergo routine health screening.

ØObtain Physician's clearance, especially if above 40 & unaccustomed to exercise & + history.

Ø Become / make aware of any unusual signs or symptoms that may indicate a problem.

ØPAR Q Form(Physical Activity Readiness Questionnaire ).

ØFeedback evaluation (Ongoing).

How Much Exercise Is Enough?

The benefits mentioned above will generally occur by engaging in at least 30 minutes of modest

activity on most, preferably all, days of the week. Modest activity is defined as any activity that is

similar in intensity to brisk walking at a rate of about 3 to 4 miles per hour. These activities can

include any other form of occupational or recreational activity that is dynamic in nature and of similar


intensity, such as cycling, yard work, and swimming. @ a minimum scale an individual should

workout 1hour for 4 days in a week.

It has been shown that repeated intermittent or shorter bouts of activity (such as 10 minutes) that include occupational and recreational activity or the tasks of daily living have similar cardiovascular and other health benefits if performed at the moderate intensity level with an accumulated duration of at least 30 minutes per day. People who already meet these standards receive additional benefits from more vigorous activity.

Greatest gains in terms of mortality are achieved when an individual goes from being sedentary to becoming moderately active. Studies show that less is gained when an individual goes from being moderately active to very active.

F I T T Principle

ØFrequency : About 4 to 6 days a week. At least 3 sessions per week.

ØIntensity : Moderate intensity physical activity. Exercise between

60% to 90% of your maximum heart rate. Your maximum heart rate is 220 minus your age.

ØTime : An accumulated 30 minutes or more.

ØType : Strength training + Aerobic exercises + Feminine exercises

Risks of exercise

During exercise, there is a transient increase in the risk of having a cardiac-related complication (for

example, a heart attack or serious heart rhythm disorder). However, this risk is extremely small. For

adults without existing heart disease, the risk of a cardiac event or complication ranges between 1

in 400 000–800 000 hours of exercise. For patients with existing heart disease, an event can occur

an average of once in 62 000 hours. Importantly, the risk of a cardiac event is significantly lower

among regular exercisers. Evidence suggests that a sedentary person's risk is nearly 50 times

higher than the risk for a person who exercises about 5 times per week. Exercise is therefore

considered to be extremely safe. Nevertheless, it is a good idea to be aware of the warning signs or

symptoms that may indicate a problem: chest discomfort (pain or pressure in the chest, jaw, or neck,

possibly radiating into the shoulder, arm, or back), unusual shortness of breath, dizziness or light-

headedness, and heart rhythm abnormalities (sensations of heart beat skipping, palpitations, or

thumping). If one of these symptoms occurs, medical attention should be sought immediately.

Precautions

If above 40, unaccustomed to exercise, prior medical clearance is a must, especially if you have:

ØHistory of heart disease

ØHistory of chest pain diagnosed as angina

ØCardiac dysrhythmia or conduction defects

ØHistory of stroke

ØUse of medications for the heart or blood vessels


Stop Exercising if you experience:

ØDizziness or lightheadedness

ØAbnormal heart rhythm

ØRetro sternal chest pain with radiation

ØPain in the knees, feet, or ankles

Where to begin?

First, if you currently have heart disease or are over 45 years of age and have 2 or more risk factors

(immediate family member with heart disease before age 55, cigarette smoking, high blood

pressure, abnormal cholesterol levels, diabetes, sedentary lifestyle, or obesity), you should consult

your physician before starting any type of exercise. If one cannot exercise, it is advisable to work

more activities into the day by taking the stairs rather than the elevator, or try walking rather than

driving a short distance.

Exercise is fundamental in maintaining a healthy body and an active lifestyle.

Ø Lifelong commitment.

ØLifetime priority.

Ø Get Started: Today, Now, Age no bar

ØCompliance is vital

Catch hold of a qualified fitness Professional and get “STARTED”…

The most important thing is to get started…


Prof. Joshi S. G. (Symbiosis College of Nursing)

HEALTHY WORK ENVIRONMENTS THROUGH TRANSFORMATIONAL LEADERSHIP

INTRODUCTION

The success of any organization depends upon the quality of its leaders. Determining the

objectives of the organization, designing methods to achieve them, directing, coordinating the

activities of various departments can be successfully performed only if there is able leadership.

According to Peter Drucker, “ Leadership is the lifting of one's vision to higher sights, the raising of

one's performance to a higher standard, the building of one's personality beyond its normal

limitation”

Nursing is science profession whose core mission is nurturing of human beings in health and

illness. Nurses not only provide direct care to clients but also coordinate and manage the

environment in which all providers deliver client care. Thomas (1983 PG 66-67) Care provider's role

is primary focus of nurse. It is most important and valuable aspect of nursing. Care management

role is integration of skills of nurses.

Increasing technological complexity and rapid change with high workloads in nursing, traditionally

more emphasis is given on psychomotor skills than micro level of individual nurse-client

relationship. This is not sufficient for quality care. The effectiveness of an individual staff nurse is

dependent partly upon the creation of facilitating environment. The nurse leader's combines'

clinical administrative financial and operational skills to solve problems in care environment so that

staff nurses can provide cost effective care in a way that is satisfying and health promoting for

clients.

Together, we can ensure that health care workers contribute to building healthy work environments.

This is central to ensuring quality patient care. Let's make health care providers and the people they

serve the real winners of this important concept.

Most of the health care organizations provide excellent work environment, perks and benefits,

recreation facilities, multi cuisine restaurants, fitness centre, crèche facilities these are great

strategies to keep employees happy and contented. Many organizations are focusing on

management excellence as fundamental strategy to address employee retention. Equipping

leaders with necessary skills so that they can connect and converse with employee in the right way.

Creating healthy work environments is both an individual and collective responsibility. Successful

uptake of these guidelines requires a concerted effort by Administrators, Managers, Supervisors

and other Staff. If this guideline is shared with members of the team then there is much we can learn

from one another.


Achievement of healthy work environments for nurses is critical to the recruitment and retention of

nurses. There is a growing understanding of the relationship between nurses' work environments,

patient/client outcomes and organizational and system performance. A number of studies have

shown strong links between nurse staffing and adverse patient/client outcomes. Evidence shows

that healthy work environments yield financial benefits to organizations in terms of reductions in

absenteeism, lost productivity, organizational health care costs and costs arising from adverse

patient/client outcomes.

Transformational leadership is a leadership style that defines as leadership that creates voluble

and positive change in the followers. A transformational leader focuses on "transforming" others to

help each other, to look out for each other, be encouraging, harmonious, and look out for the

organization as a whole. In this leadership, the leader enhances the motivation, moral and

performance of his follower group.

In this theory leader and follower have same purpose; they raise one another to higher level of

performance. The central task of transformational leader is to create a vision and build social

architecture that provides meaning fir employees. The great attention was given to those leaders

who effectively transformed structures, human resources and profitability. These components are

balanced with quality. Leader attends needs and motives of the follower's so that motivation and

morality builds. Leader displays optimism, provides intellectual stimulation and encourages

follower creativity. The transformational leadership is a value oriented relationship which can only

occur within a climate of trust and mutuality.

A healthy work environment for nurses is complex and multidimensional, comprised of numerous

components and relationships among the components. A comprehensive model is needed to guide

the development, implementation and evaluation of a systematic approach to enhancing the work

environment of nurses. Healthy work environments for nurses are defined as practice settings that

maximize the health and well-being of the nurse, quality patient/client outcomes, organizational

performance and societal outcomes.

The five Transformational Leadership Practices:

ØBuilding Relationships and Trust is a critical leadership practice that provides the foundation

upon which the remaining practices rest. Leader behaves in a way that is trustworthy. Leader

achieves highest level of performance of subordinates through building on strength rather than

entrapment of poor performance. Follower develops trust in leader.

ØCreating an Empowering Work Environment depends on respectful trusting relationships

among members of the work setting. An empowered work environment entails having access

to information, support, resources, and opportunities to learn and grow within a setting that

supports professional autonomy and strong networks of collegial support

ØCreating an Environment that Supports Knowledge Development and Integration involves

fostering both the development and dissemination of new knowledge and the instillation of a

continuous inquiry approach to practice within the work setting. This knowledge is used to


inform efforts to continuously improve both clinical and organizational processes and

outcomes

ØLeading and Sustaining Change involves taking a proactive and participative approach to

implementing change that results in improved clinical and organizational processes and

outcomes. The change should be communicated and explained again and again

ØBalancing Competing Values and Priorities: values are inner force that gives purpose, direction

to life priorities. The mission and philosophy inculcated in its members influence decision

making and priority setting. Peoples also manifests their values through behavior. Advocating

values and priorities for necessary nursing resources to ensure high quality patient care while

recognizing the multiple demands that must be addressed in organizational decision-making

Recommendations

ØNurse leaders use transformational leadership practices to create and sustain healthy work

environments.

Nurse leaders should

ØBuild relationships and trust.

ØCreate an empowering work environment.

ØCreate an environment that supports knowledge and integration.

ØNurse leaders balance competing values and priorities.

ØOrganizations provide supports for effective nursing leadership..

Organizations should

ØDemonstrate respect for nurses as professionalsØDemonstrate respect for nurses as individuals.ØProvide opportunities for growth, advancement and leadership.ØSupport a culture of empowerment to enable nurses to have responsibility and demonstrate

accountability for their practice.ØProvide access to information/decision support systemØPromote and support collaborative relationships.ØProvide workplace Health, Safety and Well-beingØNurses leaders continually develop their personal resources for effective leadership.ØNurse leaders exhibit a strong professional nursing identity.ØNurse leaders reflect on and work to develop their individual leadership attributes.Ø Educational programs provide formal and informal opportunities for leadership

development for Nurses


Bibliography

ØBass, B. M. (1985). Leadership and performance beyond expectation. New York: Free Press.

ØBass, B. M. (1990). From transactional to transformational leadership: Learning to share the vision. Organizational Dynamics, (Winter): 19-31.

ØBurns, J. M. (1978). Leadership. New York: Harper & Row

ØHealthy Work Environments Best Practice Guidelines Project Toronto, Ontario, Website: http://www.rnao.org/projects/hwe.asp

ØHenderson, A. (2003). Nurses and workplace violence: Nurses' experience of verbal and physical abuse at work. Canadian Journal of Nursing Leadership, 16(4), 82-98.

ØStanhope, M., & Lancaster, J. (2000). Community and public health nursing. St. Louis: Mosby.


Knowledge Bank

SYMBIOSIS HEALTH TIMES


Supreme Court Issues New Guidelines For Deciding Medical Negligence Cases

Police and courts — both criminal and consumer — must establish “prime facie guilt” before

proceeding against a doctor accused of medical negligence, the Supreme Court has ruled. The

Supreme Court stepped in to check harassment of doctors in medical negligence cases. A division

bench of Justice Markandey Katju and Justice G S Singhvi held that consumer and criminal courts

would have to seek the opinion of a doctor or a panel of doctors before issuing a notice to a medical

practitioner or a hospital in a case alleging negligence.

Taking the cue from a 2004 judgment, the bench passed stern directions, which it felt was

“necessary to avoid harassment to doctors who may not ultimately be found negligent”.

Sometimes despite their best efforts, the treatment of a doctor fails. This does not mean that the

doctor or the surgeon must be held to be guilty of medical negligence, unless there is some strong

evidence to suggest that he is, the Supreme Court of India observed while setting aside a National

Consumer Commission order dated February 23, 2002.

The apex consumer forum had found Dr Martin F D'Souza of Mumbai's Nanavati Hospital guilty of

giving an antibiotic overdose, which resulted in the patient losing his hearing. The SC, however,

noted that the doctor had actually saved the patient's life, with the hearing impairment being the

drug's side effect. Life is surely more important than side effects. Hon'ble Supreme Court further

held that Courts and consumer fora are not experts in medical science, and must not substitute

their own views over that of specialists.

The matter before the SC pertained to a 17-year-old case filed by Union commerce ministry officer

Mohammad Ishfaq against a Mumbai-based doctor practicing at Nanavati Hospital.

The fresh guidelines stipulate that whenever a Consumer Forum or a Criminal Court receives a

complaint against a doctor, it should refer the matter to a panel of experts. Whenever a complaint

is received against a doctor or a hospital, the matter must be referred to a competent doctor or a

panel of doctors. Only after that doctor or committee reports that there is a prima facie case of

medical negligence, should the notice be issued, Hon'ble Bench held.

This is necessary to avoid harassment to doctors who may not be ultimately found to be negligent.

The courts and consumer fora are not experts in medical science and must not hold their own views

over that of specialists. It is true that the medical profession has to an extent become

commercialized and there are many doctors who depart from their Hippocratic Oath for their selfish


ends of making money. The law is a watchdog and not a bloodhound, and as long as doctors do their

duty with reasonable care they will not be held liable even if their treatment was unsuccessful. The

bench felt all doctors can't be accused of lacking integrity or competence “just because of some bad

apples”. However, the entire medical fraternity cannot be blamed or branded as lacking in integrity

or competence just because of some bad apples.

The court also warned police officials not to arrest or harass doctors unless the facts were in line

with earlier apex court guidelines. Otherwise the policemen will themselves have to face legal

action. Such act would amount to contempt of court and liable for fine and or punishment.

Medical Associations welcomed the judgment. It has to be understood that whenever a patient

agrees to go for medical treatment, there is a chance of multiple outcomes. If the patient does not

get cured, it cannot always be the doctor's fault. Every careless act of the medical man cannot also

be termed as 'criminal'.


HIV, AIDS pose serious risk to South Asia: World Bank

HIV and AIDS can pose a serious economic and social development risk to countries in South Asia

with about 2.6 million infected people, a lion's share of them in India, a new World Bank report says.

The report released argues that, even if the overall prevalence rate is low (up to 0.5 percent), there

is high and rising HIV prevalence among vulnerable groups at high risk for HIV infection, including

sex workers and their clients, and injecting drug users and their partners.

Unless prevention programme, targeting vulnerable groups at high risk of infection, are scaled up,

these concentrated epidemics can further escalate, says the report, titled "HIV and AIDS in South

Asia: An Economic Development Risk".

AIDS accounts for 1.5 percent of all deaths in South Asia and about 2 percent of all deaths in India.

These numbers of deaths are comparable to the numbers from diabetes, tuberculosis and

measles.

The report finds the impacts of HIV and AIDS in South Asia on the aggregate level of economic

activity to be small. For India, the effect on GDP (0.16 percent) corresponds to a one-off loss of

about 1.5 weeks of GDP growth.

However, the direct welfare costs of increased mortality and lower life expectancy are more

substantial, accounting for 3 percent to 4 percent of GDP in India and Nepal, respectively.

Even in the low HIV prevalence countries of South Asia, there cannot be any room for

complacency, opines World Bank HIV and AIDS Coordinator for South Asia.

While the impact of HIV and AIDS on economic growth is small in South Asia, the welfare cost on

households is by no means negligible.

HIV and AIDS also have an enormous disproportionate impact on vulnerable and often

marginalized people at highest risk of infection, and on poor households with less access to

information, preventive services and treatment.

The economic impact on individual households affected by the disease is substantial, the report

says.

In a household study on India, 36 percent of people living with HIV and AIDS who were able to

retain their employment nevertheless reported an income loss, which averaged about 9 percent.


Among those who lost their employment (about 9 percent), the income loss was severe, at about 66

percent.

India plans to target 3,000 HIV positive persons who need second line treatment as they have

developed resistance to the first set of medicines.

At the moment, the NACO (National AIDS Control Organization, the apex government body to

monitor and curb HIV/AIDS in India) is providing treatment only from two centers in Mumbai and

Chennai, but plans to open eight more centers in the country.

The second line treatment is being provided at Mumbai's J.J. Hospital and Chennai's Tambaram

ART centre.

According to estimates revised in 2007, India has an estimated 2.5 million people living with HIV.

Around 200,000 people are taking the first line treatment in the country, free of cost.

The cost of providing an affected person with the second-line treatment is phenomenal.

But providing money for the second line treatment would be at the cost of prevention programme

budget.

The second line treatment costs NACO Rs 40-50,000 per year per person. The NACO budget this

year is Rs 1,100 crore, of which 30 per cent is for the treatment.

The World Bank report highlights the fact that HIV and AIDS could pose a serious economic and

social development risk to countries in South Asia, including India, unless prevention programs,

targeting the vulnerable groups at high risk of infection are not scaled up.


'Cyberknife' to treat cancer

Doctors in Britain will for the first time use a robotic radiotherapy machine to treat cancer, this week.

The machine called Cyberknife is said to be worth 2.5 million pounds.

It maps the movement of a patient's breathing so that tumours can be targeted with greater

accuracy than is currently possible.

The novel device uses a robotic arm to deliver multiple beams of high-dose radiation from a wide

variety of angles. The CyberKnife works in conjunction with CT cancer mapping technology and

calculates how much radiotherapy a tumour needs to destroy all cancer cells without harming

surrounding tissue.

Having mapped the tumour in 3D, a patient will lie on a bed with the robotic accelerator delivering

radiotherapy doses from many directions all around the body. A separate camera monitors the

effectiveness of the operation and works with the robotic arm so that the arm moves with the

movement of the patient's breathing - ensuring an accuracy of delivery, never achieved before.

Cyberknife can treat tumours that were previously very difficult and sometimes dangerous, to treat

with direct radiotherapy – such as cancer of the spine. By targeting the tumour from all around the

body and from many different angles, the correct dose can be delivered without damaging the

spinal cord. A small tumour in an awkward place, under the liver or next to the kidney, then there's

really nothing better the Cyberknife!!

The patient's breathing is monitored with the aid of X-ray cameras, and the radiotherapy beam is

repositioned accordingly, to minimise damage to surrounding healthy tissues.

This, in turn, makes the therapy so accurate that even tumours in difficult positions and dangerous

to operate on, such as near the spinal cord, can be treated safely.

Apollo Hospitals in India expects to invest about Rs 80 crore in acquiring two cyberknife – a robotic

radio surgery system.

Ten people are lined up for treatment in the Harley Street Clinic in London, at a cost of 15,000 to

20,000 pounds per patient.


Transparency Has Started Coming In Indian Medical Field:

Want to know whether your friendly neighborhood doctor is actually a registered medical

practitioner or just an unqualified quack posing as a true blue physician?

Getting that vital knowledge, which could often spell the difference between life and death, is now

just a click away.

The Delhi Medical Council launched an addition to its website.

The latest list will enable all citizens to locate the right doctors in their localities. To know whether

the doctor next door to you is a registered practitioner, you just need to log on to the website where

you can locate that person by his name, address and his qualification.

The list, available on www.delhimedicalcouncil.nic.in, includes the names of all 40,000 Delhi

Medical Council registered doctors and provides an ideal guide to people seeking such

information.

The list that is available on website aims at checking medical negligence and quackery.

Although registration with the DMC is mandatory for practicing Allopathy system of medicine in the

National Capital Region (NCR), a large number of self-proclaimed doctors continue to practice

across the area.

The move is the latest in the Council's efforts to check the mushrooming of quacks. While it might

not end the problem altogether, at least it will help citizens take informed decisions.

The DMC, which receives hundreds of complaints against such 'doctors', has filed over 70 cases

against them in the last 2-3 years. On receiving complaints against unscrupulous practitioners, the

Delhi Medical Council gets in touch with the concerned Chief District Medical Officer and State

Health Officer, who in turn verify their presence.

To check the credentials of such practitioners, Delhi Medical Council asks them to appear before

with their testimonials, failing which cases are filed against them in courts.

Under powers vested with the DMC under Section 10 (a) of the Delhi Medical Council Act 1997, the

Council maintains a live register of qualified medical practitioners.

Those registered with the Council are also entitled to apply for entering additional qualifications

acquired by them.


Pfizer to set up 600 smoking cessation clinics in 2 years

Pfizer India plans to launch 600 smoking cessation clinics across the country in the next two years

in partnership with private sector hospitals and clinics. Pfizer has already tied up with 150 clinics in

17 cities, including Max Healthcare, and talks are on with more hospitals for partnerships. Pfizer is

also discussing with the government to use this as a treatment option in the 600 clinics that they

plan to set up. The Pharma firm will be providing literature and other written material to aid people

who want to quit smoking.

The Government of India had last year announced to launch same number of clinics. The

Government clinics will use nicotine replacement therapies (NRT) like chewing gum and patches,

along with counseling, to help people quit smoking, a method that doctors say has far less success

rate than medication which blocks the receptors in the brain absorbing nicotine. The government

plans to set up smoking cessation clinics across the country but it recognises the role of the private

sector to offer additional support.

The Government will shortly conduct a clinical trial of the Pfizer drug, Champix, to check its efficacy

and if satisfied it will become a part of the government's anti-smoking programme. The programme

costs about Rs 13,000. Champix for three months costs the smoker Rs 9,000.

Anti-smoking aids are scarce in India. Nicotine chewing gums and patches that are sold over-the-

counter (OTC) in developed countries are rarely available in the country. While select pharmacies

have started stocking nicotine chewing gums, patches that deliver the nicotine directly to the brain

without the add-on chemicals present in cigarettes, are available in the grey market.

Nicotine patches are not available in pharmacies because there are some procurement issues. So,

Doctors cannot prescribe this to smokers. Nicotine chewing gums, which are available now in

pharmacies, has problems with dosage. A smoker looking to chew gum to kick his smoking habit

has to chew 12 pieces of gum a day. That drug, however, gives better results and fewer cases of

relapses. Drugs block the receptors in the brain which absorb nicotine. So even if a person was to

smoke while on the drug, he won't feel the benefit. With a patch, the dosage for each person

becomes difficult to estimate.

Reports estimate that there are at least 120-million tobacco users in India and by 2010 one million

people will die each year from tobacco related illnesses. According to World Health Organisation

(WHO) reports, 80% of the eight million people who will die every year from smoking related

diseases will be from developing countries by 2030. With 120 million tobacco users in India, the

cessation clinics have their task clearly charted out.

The 'New England Journal of Medicine' in 2008 said smoking could soon account for 20% of all

male deaths and 5% of female deaths between the age of 30 and 69. It also said men who smoke

cigarettes in India shorten their lives by 10 years.


High Court directs Municipal Corporation to deposit Rs 5 Lakhs in Missing baby case

The Bombay High Court asked Municipal Corporation of Greater Mumbai (MCGM) to deposit

Rs five lakhs with the registrar general of the court in the Sion hospital missing baby case.

Court's direction came after municipal commissioner denied the responsibility to pay

compensation in affidavit.

The Registrar of the Bombay High Court will invest the amount in fixed deposit and monthly interest

will be paid to the parents, whose baby-boy was stolen from Government-run Sion hospital on

January 1.

Parents moved high court after police failed in tracing the unidentified woman, who stole the two-

days-old boy.

Earlier, division bench of High Court had asked how much compensation the corporation was

ready to pay to the parents for the lax security at hospital?

Municipal Commissioner has said in the affidavit filed that Corporation was not liable to pay as such

a precedent will encourage bogus thefts of children. Theft of ornaments, watches, cell phones from

patients admitted in hospitals are common.

‘Precedent of payment of compensation can encourage consensual temporary thefts through

friends or relatives with a view to claim compensation’, ‘No citizen has ever asked for a

compensation for stolen ornaments, cell phones or watches lost when he was on the municipal

premises’ & ‘It is primarily for an individual to protect his babies or property against theft’; these

issues have been alleged in affidavit.

Further it is stated in an Affidavit submitted by the Corporation that “maintaining a security force is

not an obligatory duty of the corporation under the Act. MCGM’s security force does guard

municipal hospitals, schools, offices...however, they are not expected to protect private property or

belongings of these individuals unless they themselves spot the crime or hear an alarm. The

corporation cannot accept responsibility for criminal acts committed by outsiders while they are on

the municipal premises”

It also said that if MCGM is liable to pay for child's theft, then "by the same logic" it will be liable to

pay for thefts of watches or cellphones too. Corporation took defense that the mother was negligent


in not protecting her child. Further Corporation raised the points like ‘Even in developed countries

like Canada, USA and Norwegian countries, there are instances of baby theft which happen even

annually’ & ‘a compensation policy once declared is very open to misuse’.

The Bombay High Court observed that it is “very unfortunate” for a man of his level to equate stolen

goods like cell phones and watches with children.

The court observed that the report raises hope that child may be found. Fact remains that the

parents have gone through this turmoil all these months. The judges then ordered the corporation to

pay a compensation of Rs 5 lakhs as an interim measure immediately with the Registrar of the court

who will provide the interest to the parents. The court has also appointed Senior Counsel as amicus

curie (friend of court) to assist the case.


IRDA Guidelines for Health Insurance

NEW GUIDELINES issued by the Insurance Regulatory and Development Authority (IRDA) made it

mandatory for an insurance company to renew a health insurance policy, irrespective of the payments

already made out in claims.

The elderly and those with medical conditions will now find it easier to renew their health insurance

plans. In response to court orders and recommendations of various committees, the insurance

regulator has changed the renewability rules of health insurance policies. There are large number of

complaints against health insurers that they avoid renewing policies of the elderly and those with

medical conditions if there is a break of even one day in renewing the policy. Until now there have been

several instances of insurers using the break in continuity as an excuse to reject renewals. No insurer

accepts a fresh proposal from a senior citizen over 70 unless it is under a special scheme.

These new rules will come in handy for the old and those with medical conditions as they faced a lot of

problem while renewing their health policies.

IRDA has made it clear that delays of up to 15 days from the renewal date will also need to be condoned

by the insurers and they have to cover benefits given for pre-existing diseases. The new regulations

make it mandatory for an insurance company to renew a health insurance policy, irrespective of how

much it has already paid out in claims. The new guidelines shall be applicable from June 1, 2009.

IRDA guidelines issued also make it clear that the renewal of a health insurance policy cannot be

rejected on arbitrary grounds. As per IRDA, the only exception for rejection of a health policy renewal

could be fraud or misrepresentation of facts.

IRDA also stated that a customer should not be compelled or forced to shift from one health insurance

policy to another insurance product, except where the policy was being upgraded or discontinued with

permission from the authority.

Henceforth, companies will have to disclose the maximum age until when the renewal will be available.

They will also have to disclose how their premium charges progress as the insured ages. The terms of

renewal must also state the procedure and terms for enhancing the sum insured or scope of cover.

Apart from the directive on renewals, the regulator has also increased the level of transparency on

health insurance. If the renewal premium being sought is higher than the existing premium, the

insurance company will have to give a note explaining the reasons for the increase and also how it is

consistent with the loading structure provided earlier.


In cases of group and tailor-made health insurance policies, Irda said the prospectus and policy

documents shall contain disclosures about the mechanism for continuity being offered by the insurer to

the individual members covered, in the event of the group policy being discontinued or not renewed.

It has also asked the insurance companies to provide complete details about terms of renewing a health

policy. IRDA said that the purpose of these guidelines was to enable the consumer to take an informed

decision.

Revision of premium structure or terms of insurance policies would be accepted only for “justified and

compelling reasons or if they are to the benefit of the policyholders”.

The regulatory body also told the insurance companies to state in clear terms if there are any changes in

the payment of premium by the consumer.


WHO launches global campaign to improve Hospital safety

The World Health Organization (WHO) launched a global campaign to improve hospital safety in

emergencies on World Health Day.

The campaign aims to protect hospitals, health facilities and the staff, patients and visitors who use

them, from all emergencies including natural disasters, conflict and disease outbreaks.

When an emergency or disaster occurs, most lives are lost or saved in the immediate aftermath of

the event. Judging by the state of our hospitals and their disaster fighting mechanisms or lack

thereof, it appears our health care structures are rather vulnerable to natural and man-made

disaster.

People count on hospitals and health facilities to respond, swiftly and efficiently, as the lifeline for

survival and the backbone of support.

The tragedy of a major emergency or disaster is compounded when health facilities fail.

Apart from causing increased suffering and loss of life, the failure of health facilities during an

emergency can provoke a public outcry, especially when shoddy construction or building code

violations are thought to be at fault.

To commemorate World Health Day this year, WHO is advocating a series of best practices that,

can be implemented, in any resource setting, to make hospitals safe during emergencies.

Apart from safe locations and resilient construction, good planning and carrying out emergency

drills in advance can help maintain critical functions.

Proven measures range from early warning systems to a simple hospital safety assessment, from

protecting equipment and supplies to preparing staff to manage mass casualties and infection

control measures. There are rules for ensuring safety for internal fires etc, but there are no

regulatory rules fortifying the hospital building for natural calamities like an earthquake or a

cyclone.

In 2008, a total of 321 natural disasters killed 235,816 people -- a death toll that was almost four

times higher than the average annual total for the seven previous years, according to the United

Nations Strategy for Disaster Reduction (UNSDR).


The increase was due to cyclone Nargist, which left nearly 138,000 people dead or missing in

Myanmar, and a major earthquake in southwestern China's Sichuan Province, in which more than

80,000 people were killed or missing, according to the UNSDR.

The May 12 quake in China's Sichuan province obliterated or damaged more than 11,000 health

facilities across the region. The 7.9-magnitude temblor was the country's worst in a generation,

leaving almost 90,000 people dead or missing and another 5 million homeless.

As climate change brings more frequent and more severe weather events, we need to anticipate, to

plan for and respond to a growing number of areas that will become disaster-prone.


Organ Donation scenario in Maharashtra

Doctors overseeing organ transplants across the state have found a worrisome detail: a large

number of kidney transplants in Maharashtra where the donor is not a relative of the patient involve

donation of the organ by a wife's parent or sibling.

“There are about 32 to 40 cases a year where male patients have a parent-in-law or a brother-in-

law or sister-in-law as donor” report of the Maharashtra state-level authorisation committee for

organ transplants says. The committee must give its nod to all transplants where the donor is not an

immediate relative.

This amounts to 40 to 50 per cent of cases where the donor is not a relative. In most such cases,

recipients bring certificates to the committee to prove that their biological parents are medically

unfit to donate.

Every year, Maharashtra sees 150 to 175 live kidney transplants, and approximately 80 of these

involve donors who are unrelated to the patient. The state authorization committee is entrusted the

task of finding the motive behind the transplant. While women's rights groups said it is alarming if

the numbers were accurate, the authorization committee says this is simply an observation, for

now.

Doctors began to see how common such a practice is when a recent suggestion from the

Maharashtra committee on amendments to the Transplantation of Human Organs Act (THOA),

1994, was turned down by the Centre. The suggestion had been to include uncles and aunts in the

list of “near relatives” who could be donors. Currently, near relatives — mother, father, brother,

sister, spouse, son and daughter — can directly donate organs at the hospital level without having

to approach the authorization committee.

The suggestion was rejected since experts felt it could expose the wife's family to undue pressure

for donating an organ to a recipient in the groom's family.

However there are many in-laws who are altruistic donors. Also, Indian families are very closely

knit. Some percentage of undue pressure should not stop the state from widening the ambit of near

relatives to uncles and aunts and even to in-laws with altruistic intentions. This would help reduce

the instances of commercial transplants.

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Senapati Bapat Road, Pune 411004. Maharashtra , (In dia)Tel. : +91-20-25655023, 25667164 Telex : +91-20-25678680E-mail : [email protected] Website : www.schcpune.org

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