Welcome to the Silver Jubilee celebrations of the Perfect Health Mela

This year, we are celebrating 25 years of the MTNL Perfect Health Mela, scheduled to be held from 23th October to 27th October 2018 at the Talkatora Indoor Stadium, New Delhi. The theme for the Mela this year is “Affordable Healthcare”.

This year, the Mela promises to be bigger, better and more exciting for everyone as we have introduced many new features such as the ‘Evening Conclaves’, ‘Mini Melas’ and ‘HCFI CSR Awards’.

The Evening Conclaves are thematic conclaves, which will bring together experts from various fields for panel discussion on relevant issues such as antimicrobial resistance, IVF, Indoor pollution. The panel discussions will be followed by entertainment programs like a comedy night, concert night, qawwali and others.

Mini Melas are melas within the main Mela with five different themes each day of the Mela such as Math Mela, Art Mela, female adolescent health.

The HCFI CSR Awards, under various categories, will honor the best CSR initiatives by organizations and individuals that have revolutionized the way healthcare and other social initiatives are delivered.

The Mela will also undertake campaigns on two issues – “Indoor air pollution” and “Make in India” - to raise awareness on the fact that indoor air pollution can affect health as much as outdoor pollution; and to realize the goal of affordable healthcare through the Make in India for Cure in India movement.

We often talk of pollution outside our homes. Indoor air pollution often goes unnoticed and can be a major health hazard even in urban areas. However, indoor air pollution is an equally urgent issue that needs attention because a major part of our life is spent indoors in homes, schools, colleges, offices etc.

Make in India is imperative for Cure in India and it must be promoted to ensure that no one lacks access to timely treatment. This covers medical devices as well. The aim is to achieve the overall goal of affordable health care for all by making all critical and lifesaving medical devices available and accessible at affordable prices.

The Mela will showcase its usual activities across categories such as free health check-ups, entertainment programs, lifestyle exhibitions, lectures, workshops, CPR training, inter-school competitions (Harmony and EcoFest), a unique competition for specially-abled children (Anmol),  inter-college competitions (National Youth Fest) among others.

Entry to the Mela is free for all.

Join us as we celebrate the silver jubilee celebrations of the Perfect Health Mela.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Follow the four principles of Gandhian philosophy

The 150th birth anniversary of Mahatma Gandhi starts today and gives us an opportunity to recall the four fundamental principles that Mahatma Gandhi taught: Truth (satya), non-violence (ahimsa), welfare of all (sarvodaya) and peaceful protest (satyagraha). These principles can hold people together and hence form the backbone of dharma, which means “to hold together”.

Satya means oneness in your thoughts, speech and actions. Gandhi believed that “there is no religion higher than truth”. The Yoga-shastras as well as the Yoga Sutras of Patanjali propagate truthfulness as one of the main components for living a disciplined life.

Gandhi preached the concept of “experimenting with truth”, a phrase that also formed the subtitle to his autobiography. He taught how to learn through trial and error, often admitting to mistakes and changing one’s behavior accordingly. Non observance of truthfulness is the root cause of any corruption in the society.

Ahimsa teaches us the path of non violence. It should be practiced not only in actions but also in thoughts and speech. Ahimsa also forms the basis of Jainism and Hinduism as a religion.

The third principle is sarvodaya or welfare for all. The basic fundamental teaching of the Vedic science is also based on sarvodaya. It talks about “bahujan hitay-bahujan sukhay” - “the good of the masses, the benefit of the masses”. Gandhi found in it a composite concept of social welfare and economic justice. Any action, which is aimed and seems to be aimed at the welfare of the people will be accepted by all.

Satyagraha is protest based on satya (path of truthfulness) and non violence and includes peaceful demonstrations, prolonged fasts etc. i.e. a non violence-based civil resistance. It is based on the law of persistence. Satyagraha is formed by two Sanskrit words satya (truth) and agraha (holding firmly to or firmness). Gandhi said “Satyagraha is a weapon of the strong; it admits of no violence under any circumstance whatsoever; and it ever insists upon truth”. He said that if you are firm in the truth in the long run you are going to win.

These are basic principles that doctors should also follow as doctors not only need to be scientifically and legally correct, they also should be morally and ethically correct. Non-maleficence (do no harm) and beneficence (do good) are the pillars of medical ethics

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

The Board of Governors taking over was inevitable

The Niti Aayog had always wanted to change the structure of MCI for long. However, it was getting postponed either by pressure from the medical community including IMA or by the opposition political parties.

The NMC Bill had been put before the Parliament twice but had not been passed. It may not get passed in the winter session too. After that it will be National election time.

The bureaucracy is very adamant in making this change. The term of the MCI was getting over on 5th November. If the govt. had started the MCI re-election period, this would mean being elected for five years.

The Supreme Court had already consented to an overarching control of a 5-member committee.

So, the best way for the government was to not continue with the MCI beyond 5th November and run it with a 5-7 member Board of Governors as the Congress had done in the past with the same members who had been running it for the last one year with additional two members.

Most of these members nominated to the Board of Governors have proven integrity. Dr Sanjay Shrivastava, who has been appointed the Secretary General has a wide experience of the MCI.

The whole procedure has been advanced by one month with an idea that by the time the next parliament sits, they will have had enough time to adjust. The government is hoping to get the NMC Bill passed in November. If not, continue with the Board of Governors for the next one year.

Till the NMC comes, the present infrastructure and staff of MCI continues.

MCI Take-over: Malafide and Scheming (Team IMA 2018)

In an emergency session in Mumbai, the IMA Action Committee condemned the supersession of the Medical Council of India (MCI).

This action of the Government, at a juncture when the election to MCI has been announced, is unwarranted and malafide. The composition of the Board of Governors (BOG) itself is unacceptable. Directors of major National institutions would scarcely find time to administer more than 450 medical colleges and their UG and PG courses. Moreover, there is no representation to women and Registered Medical Practitioners.         

                                     

The Indian Medical Association (IMA) is convinced that supersession of MCI is only a smoke screen and ploy to prepare the ground for NMC and sabotage the democratic process of MCI. Why the Government was in a hurry to scuttle a democratic process needs an answer.     

                                        

 IMA’s concerns remain. Bringing MCI directly under the government control seems to be the plan to implementation of Bridge Courses, crosspathy and registration of non medical persons.

IMA demands that the BOG should refrain from taking any major policy decisions or amendments changing the character of the IMC Act.

IMA also demands that the election process in progress in MCI should be allowed to continue.   

    

IMA will continue its resistance to NMC Bill. Any intentions of the NMC Bill implemented through the appointed BOG will be fought with determination. 

• This is the fourth time that BOG is being appointed. All the previous attempts were an abject failure. 
• The eminent clinicians appointed have little exposure to the day-to-day administration of MCI. 
• The Government has not cited any reason for superseding MCI.                     
• MCI Election process is on.  It was inappropriate for the Government to supersede at this stage. This betrays a malafide intention. 
• BOG should conform to the basic tenets of IMC Act and refrain from tinkering with its fundamental structure. 
• Crosspathy, registration of non medical persons, bridge courses and mixing of syllabi are core concerns. The fidelity, identity and the privileges of the profession will be defended at any cost.       
• 184 private medical colleges are awaiting recognition due to strict norms of the outgoing MCI team.  IMA, media and the people should keep vigil in this regard.
• IMA foresees a highly difficult period ahead when checks and balances have been removed.
• A generation of substandard doctors will be the legacy of this action.
• IMA will keep its tryst with destiny and redeem the profession from dark forces. Every single challenge thrown at the profession will be repulsed with single minded. 

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Saving a death when we cannot save a life in the intensive care unit

There are several situations and/or elective interventions in medicine where the patient is made unconscious, given anesthesia, surgery or sedation especially in terminally ill patients. In these situations, there is a chance that the patient may not wake up. Even though the intervention may have been necessary, it deprives them of their chance to share few last words with their families.

In the June 2018 issue of JAMA International Medicine, Michael E. Wilson - a critical care doctor - has written an account of a woman in intensive care in “Saving a death when we cannot save a life in the intensive care unit”, who was electively intubated for a procedure and then died, without ever having had the opportunity for her loved ones to say goodbye.

This can be somewhat likened to soldiers being sent off to war by their families with a puja and tika or families sending off their loved one on a pilgrimage or tirth yatra with a tika in ancient times as they may not come back alive.

This gives them an opportunity to talk to their families and express their wishes that they want to be fulfilled, knowing that this might be their last chance to hold this conversation.

When I was in Malaysia for the CMAAO general assembly, we went to the Port. There were three temples where fishermen prayed before going out to the sea and also when they returned.

The ritual of performing Shradh is to satisfy the unfulfilled, known or unknown, wishes and desires of the deceased person by the eldest son in the family. Shradhs are also for the unknown unfulfilled desires of our ancestors; unknown to the present family but maybe were known to the past family. These unknown wishes come back as dreams to their descendents through qualia or tanmatras. A mahashradha is performed when all the wishes of the ancestors are fulfilled. Once a mahashradha is performed, then there is no need to perform Shradh rituals thereafter.https://ssl.gstatic.com/ui/v1/icons/mail/images/cleardot.gif

 According to the Vedas, every individual has three debts to be paid off, firstly, the Devtas (Dev Rin), secondly of Guru and teachers (Rishi Rin) and, thirdly, of Ancestors (Pitra Rin). Devtas represent people with Daivik qualities; teachers the ones who have taught us and Pitra represent the three generations of our ancestors.

Therefore, it is always better to allow patients some time alone with their families and express their wishes, before any such intervention, or say goodbye in the worst case scenario.

 “My intubation checklist now includes this step…It’s a way to avoid stealing last words from a person”, as Michael E Wilson writes.

Always write down your wishes for your family…

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Ordinance cleared to set up committee to run MCI until Parliament passes NMC

Just like it was 5 years back, a Board of Governors has taken over the MCI. Dr VK Paul has taken charge of MCI today evening.

The present MCI gets dissolved with immediate effect.

Proposed NMC is in Parliament and has nothing to do with present ordinance.

The ordinance is as below:

The Gazette of India

New Delhi, Wednesday, September 26, 2018/Asvin 4, 1940 (Saka)

MINISTRY OF LAW AND JUSTICE
(Legislative Department)

New Delhi, the 26th September. 2018/4svina 4, 1940 (Saka)

THE INDIAN MEDICAL COUNCIL (AMENDMENT)

ORDINANCE, 2018

No. 8 of 2018

Promulgated by the President in the Sixty-ninth Year of the Republic of India.

An Ordinance further to amend the Indian Medical Council Act. 1956.

WHEREAS Parliament is not in session and the President is satisfied that circumstances exist which render it necessary for him to take immediate action;

NOW, THEREFORE, in exercise of the powers conferred by clause (1) of article 123 of the Constitution, the President is pleased to promulgate the following Ordinance:-

1. (1) This Ordinance may be called the Indian Medical Council (Amendment) Ordinance, 2018.

(2) It shall come into force at once.

2. In section 3A of the Indian Medical Council Act, 1956,- --

(a) in sub-section (I), for the words, brackets and figures "Indian Medical Council (Amendment) Act. 2010", the words, brackets and figures "Indian Medical Council (Amendment) Ordinance, 2018" shall be substituted;

(b) in sub-section (2), for the words "three years", the words "one year" shall be substituted;

(c) in sub-section (4), for the words "and medical education", the words "and medical education or proven administrative capacity and experience" shall be substituted;

(d) after sub-section (7), the following sub-section shall be inserted, namely: — "

(7A) The Board of Governors shall be assisted by a Secretary General who shall be appointed by the Central Government on deputation or contract basis and he shall be the head of the secretariat in the Council.".

RAM NATH KOVIND,

 President.

DR. G. NARAYANA RAJU.

Secretary to the Govt. of India

(To be published in the Gazette of India, Extraordinary, Part – II, Section 3, Subsection (ii)] MINISTRY OF HEALTH AND FAMILY WELFARE (Department of Health and Family Welfare) NOTIFICATION New Delhi, the 26th September, 2018-09-26 S.O. – Whereas the President promulgated the Indian Medical Council (Amendment) Ordinance, 2018 (Ordinance 8 of 2018) on 26th September, 2018, which came into force on the said date; And whereas, on and from the date of commencement of Indian Medical Council (Amendment) Ordinance, 2018 (Ordinance 8 of 2018), the Medical Council of India shall stand superseded and teh President, Vice President adn other Members of the Council shall vacate their office and shall have no claim for any compensation, whatsoever; And whereas upon the supersession of the Council and until a new Council is reconstituted, a Board of Governors is required to be constituted by the Central Government to exercise the powers and perform the functions of the Council under the said Act; Now, therefore, in exercise of the powers conferred by sub-section (4) of section 3A of the Indian Medical Council (Amendment) Ordinance, 2018, the Central Government hereby constitutes the Board of Governors consisting of the following persons as its Chairperson and Members, namely: - Dr. VK Paul, Member, NITI Aayog                                      - Chairman Dr Randeep Guleria, Director, AIIMS, New Delhi               - Member Dr Jagat Ram, Director, PGIMER, Chandigarh                     - Member Dr BN Gangadhar, Director NIMHANS, Bangalore             - Member Dr Nikhil Tandon, Professsor, Department of                        - Member Endocrinology & Metabolism, AIIMS, New Delhi Dr S Venkatesh, Director General of Health Services            - Member ex-officio Ministry of Health & Family Welfare Prof Balram Bhargava, Secretary, Department of Health       - Member ex-officio Research & Director General Indian Council of Medical Research, New Delhi Further, in exercise of the powers conferred under section 7A of the Indian Medical Council (Amendment) Ordinance, 2018, the Central Government hereby appoint the Secretary General to assist the Board of Governors to the following person, namely:- Dr Sanjay Shrivastava, Ex-Deputy Director General, Directorate General of Health Services, Ministry of Health & Family Welfare, New Delhi

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Diphtheria death toll in Delhi rises to 20: Anticipation and preparedness key to avert any outbreak

As many as 19 children have died of diphtheria at the North Corporation-run Maharishi Valmiki Infectious Diseases Hospital, one child died at the Delhi government-run Lok Nayak Hospital, taking the death toll due to diphtheria in the city to 20.  “From September 6-24, there have been 157 admissions, of which 128 were from UP. Rest of the cases are from Haryana and Delhi,” a senior North civic body official said. (HT, Sept. 25, 2018).

Diphtheria is a vaccine-preventable disease and is included in the Universal Immunisation Programme (UIP) in India as DPT vaccine. In 2014, the Health Ministry launched Mission Indradhanush as a special drive to vaccinate all unvaccinated and partially vaccinated children under UIP. Mission Indradhanush aims to increase full immunization coverage in India to at least 90% children by December 2018.

The very fact that there has been an increase in the number of diphtheria cases in the capital, this indicates the failure of the primary immunization program. This should be investigated and the unvaccinated children and those who have received incomplete vaccination, in both urban and rural areas, should be identified and covered under the Mission Indradhanush, as was its aim.

There is a shortage of antidiphtheria serum (ADS). We have been told that the facility to produce DPT group of vaccines at the Central Research Institute in Kasauli is undergoing renovation. This shows no anticipation and lack of preparedness on the part of the government.

The government should reimburse all those who have procured ADS from private sector or it should itself procure the same from local sources.

The overall case-fatality rate for diphtheria is 5-10%, with higher death rates (up to 20%) among persons younger than 5 and older than 40 years of age. These 20 deaths should not have occurred.

There is clearly a gap in immunization coverage rates as well as lack of preparedness of the government. As a result, the concerned authorities failed to mount the level of response needed to contain a probable outbreak of diphtheria, in this case, with 160 reported cases.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Universal health coverage: As I understand it

Dr KK Aggarwal

Universal health coverage is the need of the hour. Two weeks back I was in Malaysia for the CMAAO Assembly, where the Malaysian Medical Association (MMA) spoke about their 40:40:20 scheme. The entire population of Malaysia has been divided into three income groups: Lower income group bracket 40%, middle income group bracket 40% and top 20 income bracket 20%. Their government has said that they would pay for and look after the lower 40% income group bracket.

That is what the Modi government has decided to do. 

Under Article 21 of the constitution of India, right to health is a fundamental right and under Article 467 state directive principles, it is the primary duty of the state government to provide this as per their means and if they cannot provide, they need to enlist the private health sector under PPP model.

Under Ayushman Bharat, the government is paying for the insurance premium of 50 crore people. Everybody has a criticism that the premium is too low for five lakh insurance. But the reality is it is not five lakh insurance, the insurance is of approximately one lac as the packages have been capped with the maximum cap being around one lakh for tertiary care procedures. For one lakh insurance, the premium calculation is correct. 

What is required is honesty at every level in running the scheme.

Being a capped reimbursement policy, chances of manipulations are lower except for billing one surgical procedure as two procedures. This loophole needs to be checked.

Once the government has divided the community into two segments the poor (under Ayushman Bharat) and non-poor (personal insurance), every hospital also can and invariably will have two categories in their establishments (general ward for Ayushman Bharat and private wards for others).

In my medical college, we were taught affordable health care under the subject low-cost healthcare and we all need to revise this topic. For example, why should I go for full hemogram in routine cases when the same information can be gathered by looking at the peripheral smear and ESR.

This scheme will promote the Make in India program of the Govt. Devices, consumables, drug, reagents and/or equipments will take precedence and their use will increase; we need to find out indigenous ways to manufacture these at low cost. Use of generics will increase, use of antiseptics may increase to cut down infection rates, which will bring down antimicrobial resistance (AMR).

The scheme will open doors for Jan Aushadhi drugs, only essential investigations, minimum cross referrals and promotion of day care procedures.  

Being a doctor means we are different and are considered demi Gods. Those who believe in it should do 10% subsidized charity by choice. The charitable rates can be reimbursed by the Ayushman Bharat schemes.

Universal health coverage is incomplete without disease prevention and harm reduction. The budgets for road safety, universal immunization, antenatal care, rural health, Swachh Bharat, environmental protection, skill development, drug development, safe water, safe soil etc. should be calculated as extension of health budget.

Harm reduction is already in the fray with elimination of mercury by 2020, sequential phasing out of Euro 4 vehicles with an aim to go for Euro 6, gradually reducing the air pollution parameters, phasing out trans fats in commercial restaurants.

A major mistake of the government is not banning tobacco from the country. The govt. is neither banning tobacco nor allowing comparatively safer electronic cigarettes in the market giving the message that conventional cigarettes are the best.

Among people who cannot afford, all those covered by ESIC, CGHS, Defence (BSF, CRPF, ITBP), PSUs, State health insurance, municipal corporations etc will automatically get excluded as they are already covered under respective schemes.  

Will casual or contractual laborers be covered under Ayushman Bharat? Another major challenge would be rare diseases.

Issues such as these will keep on coming up as the scheme is being implemented.

The success of the scheme will depend on the number of "no claims", amount of claims more than one lakh and percentage of disorders requiring recurrent hospitalization.  

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA