INTRODUCTION.



India has been doing well lately in the economic field. The signs of a good future are there in the distant horizon. The growth rate index jumped up last week to almost 8.5%. Technological advances are taking place at a breathtaking speed. India is now a nuclear power and is in a commanding position amidst the comity of nations. Monsoons have been good and the crop position is comfortable. We have been doing well in the trading organizations. Politicians are upbeat about the achievements. Technocrats are also happy and they predict a strong India by 2020. It is projected that we would land on the Mars in a decade from now.



All these and more must make every Indian proud of his country and it’s pre-eminence in the world today. On the darker side is another India of poverty, squalor, hunger and illnesses. No country will be happy until the last man has had his basic needs met. “For the master spirit of the earth shall not sleep peacefully upon the wind till the needs of the least of you are satisfied.” wrote Kahlil Gibran in The Prophet. If monetary prosperity and technological advances are the measures of people’s happiness, United States of America should have been the happiest nation in the world. The reality is that America is the one country in the world where neither the rich nor the poor are, in fact, happy.



The rich are afraid of the poor and find life so uncertain that they are not sure of getting back home in the evening. The poor suffer all their lives not knowing where their next meal comes from. This gulf between the rich and the poor is widening by the day in a country which enjoys eighty-five per cent of the world’s wealth with just over fifteen per cent of the world population. The remaining fifteen per cent of the world resources are shared by the rest of the world. Despite this the two most important epidemics that plague the US are suicide and divorce.



It would be naive to equate prosperity and happiness with the betterment of the monetary economy alone where the inverse care law operates always-money is all there with the rich and the wants are there with the poor. The plastic card economy of buy now-pay later works as double edged sword for the middle and the lower middle class. Not having to pay on the spot makes them spend recklessly and buy things that they do not need at that point in time and push them to commit suicide when the debtor comes for the kill. What needs to be concurrently developed is the over all holistic health of the common man. The word health here is not used in the narrow sense of physical health. Health simply means creativity and enthusiasm to positively contribute to society’s progress by individuals where physical, psychological, emotional, spiritual, and societal dimensions of man’s existence on this planet must all be properly balanced. India of the distant past had such an egalitarian society which was advanced even in science, technology, the fine arts and many other forms of human pursuits. It had Universities of excellence attracting students from all over the world while the west was still roaming the forests.



This book looks at that kind of holistic health in India in the next half a century where development is not lop sided but balanced in every direction. We would analyze the malady that is afflicting the present day India and suggest ways and means to change all that for better with every Indian sharing both in its fruits and the struggle to achieve that goal.





“Where the mind is without fear and

the head is held high;

Where knowledge is free;

Where the world is not broken up

into fragments by narrow domestic walls;

Where words come out from the depth of truth;

Where tireless striving stretches

its arms toward perfection.

Where clear stream of reason has not lost its way

into the dreary sand of dead habit;

Where the mind is led forward by thee

into ever widening thought and action-

Into that heaven of freedom,

My father let my country awake.”

Rabindranath Tagore.





That is the kind of India we will have to build in the next half a century-the India that leads the world economically and spiritually as it did before the twelfth century. Monetary economy bereft of moral values will be as good as no progress at all. All this philosophy will fall on deaf ears as long as the majority in our midst do not know where their next meal is coming from and have only the blue sky for their roof and mother earth as their bed to sleep on come rain or shine. All progress starts with the bare minimum needs of the lowest of the low met. If they do not have three meals a day with clean and nutritious food and clean water to drink how will they be able to contribute to the country’s progress? Health is wealth and to that extent a healthy mind and a healthy body are the two basic needs of human progress and prosperity. Even a journey of thousand miles starts with the first step. The first step of a country’s progress is the total healthy development of its citizens.



“The difficulties of life are intended to make us better and not bitter.”

Anon.







HUMAN BODY’S INTELLIGENCE.





Prof. B. M. Hegde,

Vice Chancellor,

MAHE University,

Manipal-576 119.





Human beings have lived on this planet for well over 9,00,000 years in 50,000 generations! Man should have been extinct like the dinosaurs long ago; if what we hear today about drugs, preventive screening of the apparently healthy population and technology keeping people alive on this planet were to be true; as the latter have been operational at best for little over half a century!



Many studies have been looking at the reasons why we are still here despite the absence of modern hi-tech medicine being available to our forest dwelling ancestors over thousands of years of their existence on the planet. Evolution of man does not simply follow the naïve Darwinian laws. Environment, in addition, has a lot to do with our evolution. That is seen in many other species as well. One example would suffice. There is a type of butterflies which, when pregnant, accidentally coming in the close viscinity of a killer reptile, tries to escape from danger. In addition, it tries to so mutate the offspring’s genes that enable the foetus to develop much larger wing span, making it possible to get away from danger more effectively. The mother butterfly simultaneously mutates the genes of its offspring to be able to smell the enemy scent from a longer distance, by enhancing the child’s olfactory mechanism!



Similar evolutionary changes, based on our environment, kept us going for so long without the assistance of any hi-tech stuff. Let us call this “the intelligence of the body”. Time was when man lived in the forests and the causes of death then were primarily senility or predation. To keep man going despite injury in the likely event of an attack by larger animals, genetic mutation helped to develop the sympathetic system. This could keep one going in an emergency, say bleeding, by redistributing the circulation to supply blood to the vital organs in preference to the non-vital parts and also to help the blood to clot and the bleeding vessels to constrict, arresting blood loss. This friend of man could become his own enemy if used on a long-term basis, as happens in clinical heart failure!



The renin-angiotensin-aldosterone system was another boon to the hunter-gatherer man in the forest, who did not eat extra salt in his food. This prevented his blood pressure from falling to shock levels after injury and bleeding. Over the years, the same system has become our curse in the last ten thousand years, with lots of salt added to our diet, resulting in a novel disease, high blood pressure! In Nature extremes are detrimental. Whereas low sugar-high sugar, low blood pressure-high blood pressure, and low cholesterol-high cholesterol are all bad, constant fluctuations of all these parameters are a must. Stationary levels obtain only after death!



The story of man’s immune system being able to cope with adversity is also based on the experience of any hostile environment through genetic mutation. History of man in the New World is a good example. When Europeans landed on the American continents the virgin population of that landmass did not have any immunity against the diseases the Europeans were heir to, like small pox. Large chunks of the Natives died of such scourges that the white man brought with him, rather than his guns!



Medical world is learning the hard way the need to respect this capacity of the body and not to interfere too much too soon, hurting the native wisdom of the body and its in-built protective mechanisms, in our enthusiasm to intervene with modern gadgets and powerful drugs. Some examples would reveal the secret. Our present mindset of “a pill for every ill” and the “quick fixes” has to give place to our understanding that there is a self-regulatory compensatory phase inside the human body for every single alteration or accident!



Studies of sex workers in Nigeria and SanFrancisco have shown that there are many of them in the trade, on a regular basis, housed in the designated areas having “good business” who keep very good health, despite having more than 50% of their clientele with either full blown AIDS or, at least, the presence of the virus in the blood or semen! But the sophisticated classes of sex workers who operate from five-star outfits as and when they need an extra kick or buck do not enjoy this immune protection! The same calamity befalls the hapless victim of accidental exposure to AIDS virus! Oxford University has embarked on studies of the Nigerian prostitutes and the healthy ones from SanFrancisco to see if some sort of vaccine could be produced from the knowledge gained from such sex workers.



Children of migrant workers in Dakshina Kannada district originally from Northern Karnataka, whose parents have lucrative jobs to give them good food, mostly live on makeshift dwellings on the road side literally eating from the dirt, resist most of the communicable diseases much better than their cousins in clean and rich households! Extra clean surrounding might endanger children’s health by exposing them to new risks from ordinarily innocuous germs. Epidemics of viral appendicitis in British primary schools are one such example.



Caucasians exposed to falciparum malaria are likely to die most of the time, if not properly protected by drugs for prevention, as they had not been exposed this germ earlier. This is due to the lack of racial immunity. Similarly, when Europeans first come to the third world countries they would not be able to tolerate the drinking water that we all take without any harm.



Hostile environments make us acquire the capacity to genetically produce immunity against many adverse situations. The same mechanism could work against us under special circumstances. East Africans living there have very little, if any, autoimmune diseases! The same people, who form the bulk of American blacks. There they live in a much cleaner environment without exposure to killer germs like malaria, filaria and others like in Africa. The one hundred-fifty odd genes situated in the long arm of the ninth chromosome exclusively looking after anti-body production against invading germs, at times, feel jobless in their new clean surroundings! They could unwittingly manufacture anti-bodies against body’s own cells, resulting in a very high percentage of killer autoimmune diseases in American blacks of East African origin! Strange are the ways of Nature!



Another glaring example is study of the death rate variations in grievously injured soldiers in the Vietnam War vis-à-vis the Falklands war. Whereas helicopter evacuations and immediate blood transfusions and warming were very common during the Vietnam War, during the wintry war in the Falklands those facilities were absent and the wounded soldiers were sometimes left to fend for themselves for long stretches of time in the cold! Curiously, the per capita death in the two groups showed that a much larger number of them survived the wounds in Falklands compared to Vietnam! One would not easily believe this, but this is the bitter truth.



While the body’s compensatory mechanisms, discussed above, helped wounded bleeding soldiers in South American Island front, effectively, the cold weather helped lower the basal metabolic rate thereby lessening the demand for oxygen to the tissues. In Vietnam the early human intervention with blood transfusion enhanced bleeding by displacing the clot and reducing vasoconstriction, the warmed up body increased the oxygen demand! This kind of mistakes occur many times in some other disease states in the intensive care settings.



Physiological heart failure is another good example. With its onset the sympathetic system remodels the heart and redistributes circulation, but chronic stimulation makes the same system destroy the heart muscle and enhance failure. If we use blocking drugs at the beginning to knock off the sympathetic system patients could die, but later use of the same drugs, when the body’s own protective mechanisms are exhausted, as in clinical heart failure, could save a lot of lives! One could go on and on. Every single intervention by man at the wrong time ends up killing more people than saving them.



It is high time that many of the hi-tech early interventions are properly and meticulously audited in the field before being sold in the market. One would be shocked to know that this does not happen most of the time because of the hype and greed. Newer interventions are touted as the new avatar of life saving God’s in technological form and are let loose on the gullible and demanding patients. It is better to remember the dictum that while it is the bounden duty of the medical profession to do its best for the suffering humanity, even when knowledge in that field is inadequate, it is a crime to intervene in the healthy segment of the population with newer technology or untried drugs, with the fond hope and assurance of averting long term danger when the latter interventions are not properly audited in that setting.



Times change and knowledge is bound to change, but wisdom lingers on. Study of this prayer of a wise physician of yore, Sir Robert Hutchinson, reveals it all. It is as relevant today as it was then.



God give me deliverance from:



* not letting the well alone.

* treating suffering humans as cases, and

* making my treatment worse than his suffering!









WHAT IS HEALTH?



Health is not the mere absence of physical illness. Health is the overall wellbeing of an individual that takes into account his/her physical, mental, spiritual, societal aspects of life into consideration. With this broad definition of health, most of what happens to society or a nation depends on individuals being healthy. Even the present malady of terrorism is due to loss of a balanced view of life. The whole problem could be solved if one could try and understand the terrorist’s motivation and try to modify that with psychotherapy. It is also connected to the economic health of the individual as most terrorists come from the poor socio-economic background. Even the few that come from the affluent society do so because of abnormal psychological reaction to the goings on in society-oppression, suppression and denial. Individual health is related to social health and vice versa.



Scientific studies have shown that any kind of dependence leads to psychological problems-even religious fanaticism could lead to personal and societal ill health. This is precisely the reason why it is important to have a healthy nation for all rounded development at any time. Mere economic development would be counter-productive, as we have seen in the industrialized countries in the last century. While they have physical comforts and easy access to all the material wealth, they are not healthy nations what with all social ills damaging the moral fabric of the nation. The rich exploiting the poor is a daily affair in their idea of development! Making money has become their religion and money is their God. Affluent nations have been destroying the entire God given resources of this world with their greed and proclivity for comfort. They would, one day, have to realize that money can not be used to buy happiness as also that money can not be used as a substitute for food. Healthy nation is a happy nation; consequently, a happy nation would be healthy.



Every creature in nature is built to last as long as it is supposed to last. Nothing could be immortal in nature. The human system is very robust and can withstand most of the day-to-day insults using the immune system and the autonomic nervous system. This was needed when man was a hunter-gatherer in the forests where the only cause of death used to be predation, in addition to old age. Man has existed on this planet for well over 9, 00, 000 years in fifty thousand generations. Without the above mentioned built-in repair mechanisms mankind should have been extinct millions of years ago like the dinosaurs. This simple truth tells us that man could live happily as long as he lasts.



However, modernity has made man’s environment much more dangerous for man to live compared to the forest life of yore. The present social and environmental degradation is such that the inbuilt repair mechanisms are stretched to their limits every day. To cap it we have created for ourselves the monsters like junk food, fancy beverages, tobacco products in deadly form and the much touted alcohol that is being sold as a health tonic by the market economy. All these put together bring on illnesses despite the fact that the repair mechanism tries its best to keep diseases at bay.



Over crowding, because of high birth rate and acculturation to larger cities for economic reasons, has helped our friendly germs to become deadly and invade us. Industrialization has added to the burden by polluting all our water sources and the air we breathe. Agriculture, by uprooting the soil, has forced the innocent soil germs like the TB germs to get air borne and become violent. Domesticating animals for farm labour as also for milk etc. has brought in its wake the curse of communicable diseases. Most communicable diseases have come to us from animals-common cold from the dog and SARS from the monkey. Overcrowding helps the germ to be more powerful in defeating our immune system. Pollution levels in some of our larger cities have reached such dangerous levels where children below five can not even survive. Thank God, our villages still have very clean atmosphere.



The solution to all these is to make the village economically more attractive to reverse the acculturation process from the cities that are bursting at the seams. One would now realize how important it is to understand holistic village development as the be all and end all of a healthy nation. Overall development of the village would lead to better agriculture and more food helping the starving millions to regain their health and happiness. Innovative cheap technologies would help make life of a villager better than of a town dweller. Electricity from solar power, waterless latrines to avoid hookworms, clean water supply which gets filtered through novel filters using simple local waste products like burnt bricks to filter deadly arsenic in deep well water, cooking gas from manure would avoid millions of cancer and pneumonia deaths due to cooking smoke coming from dry leaves and twigs, would make life enjoyable in the village. Good village roads with efficient rural public transport system should allow villagers to commute to nearby towns for better jobs. Making the village self governing would hit two birds with one stone. While it makes the villagers totally self dependent, it would take away large number of government jobs in larger cities lessening the population burden there.



Adult education in the village would help improve their health status. Educated people are comparatively healthier as they are able to access health tips from others as also to follow them. Good schools in villages would encourage girls to be busy with studies to postpone early marriage bringing down the birth rate. Village schools should also have the primary health centre associated with them in the same campus. The school could be the nucleus of spreading health message, immunization, and hygiene advice as also to get the adults educated about these matters through their wards. Village school teachers must double as health workers. Village schools should have the best brains as teachers. Eighty per cent of the population is still in the villages and village is the place where healthy India should have its foundation. I would even go to the extent of saying that the best boys and girls should be chosen for primary school teaching and the latter included as a central service IES having the same pay and perks of other central services. If the primary education is of the best variety this country would be the leader in the world. It is at the primary level that one prepares the future good citizens.



The primary teachers could be given regular training in health care (not medical care) with health education as a major subject for children between 5-15 years of age with the village as the laboratory where the young teachers and their students could innovate research methods in health care. We could have roughly the following special programme for school children, aarogydarshana.


AAROGYA DHARSHANA



(Heath Awareness Programme for School Children)



* This could be an additional subject of instruction to boys and girls in the 8th through 10th classes. No examinations and ranks at the end, though. The children could get a certificate, if needed.

* It is a comprehensive holistic wisdom of physical, psychological, social, spiritual (secular), emotional, and ecological health awareness programme.

* It is audiovisual, assisted by trained teachers. Suitable to be aired through DD on the UGC educational network. Could be broadcast on AIR also.

* Based on most recent research data* on mind/body medicine done both in India and abroad.

* The main points are:



1) Holistic Definition of Heath, stressing that even social health is as important as physical health-spiritual health of sharing and caring, while keeping society tranquil would improve personal health to a great extent.

2) Simple rules of healthy foods and eating habits.

3) Simple hygienic rules to avoid infections.

4) Vaccination principles.

5) Family Planning ideas: a) For girls the need to keep studying up until the 25th year of age before marriage, to reduce fertility rate and , for boys the simple truths in this context, coupled with giving incentives to village barbers to put peer pressure on men who come for haircut. Peer pressure is the best way to influence our rustic wise, but illiterate people.

6) Principle of Yogic breathing. If one knows how to breathe properly, healthy body and mind will automatically result from that.

7) How to avoid unnecessary drugs.

8) The twin menace of alcohol and tobacco, the two great enemies of man, not to forget other drugs abuse.

9) Toilet use to eradicate the major killer in India-hookworm. The so-called “Toilet Plus” scheme. Teaching children the dire need to use toilets when provided. Model toilets must be built in every school.

10) How to avoid cooking smoke in village homes.

11) Personal hygiene, bath, nail health, etc.

12) Relation between germs and man-suggestions as to how to keep bugs like AIDS virus at a distance. Incidentally, without going into mundane details, this part gives the child a judicious dose of sex education stressing on the importance of emotional long-term relations in marriage compared to quick-fix free sex.

13) Stressing the need for social harmony to keep one’s health and indirectly conveying the importance of co-existence and co-operation rather than competition.

14) Stress on the major role played by negative feelings like anger, greed, jealousy and hatred as the most important causes of killer diseases like heart attacks and cancer.

15) To stress that a healthy society needs all kinds of people to keep society going. All of them are equally important. A cobbler is as important as a Minister is, for example. Dignity of labour, taught to children, aims to remove the greatest stress for diseases-frustration.

16) Awareness that poverty is the mother of all illnesses-need for sharing is stressed.

17) Clean drinking water and how to get that.

18) Preserve the environment to remain healthy-symbiosis.

19) To learn to live and let live.



We have been doing this in a small way around here with good results. We would be happy to share this with the millions of future leaders of this country, so that we could hope to have a more tranquil and healthy society that might even get rid of narrow mentality and fissiparous tendencies. Children are very intelligent. That every generation is better than the previous one is a genetic truth. They need to be put into the right path in the midst of the multitude of noise that they get daily from their surroundings, especially the electronic media that has invaded their environment in a big way. Earlier we do this the better for them. Teach them to pick the wheat from the chaff.





























School is also the place to spot congenital diseases for early correction. One could easily inculcate healthy habits in children at this age-healthy food habits, exercise habits, social health, sexual health, their moral obligation to society and, also their societal dharma. Children at this age are still non-converts and could easily be converted to acquire these healthy habits unlike older adults and adolescents that are already converts. Primary children could also be used to educate their parents in healthy habits. We have done this successfully in some villages in the past.



The school could be associated with the local Panchayat where the child learns the basic rules of civic responsibilities. The local leaders could, in turn, help run the school better. If one has read the PROBE report of the primary schools in the four large states of north India one would understand the need to change the character of the village school to that of the center of activity in the village. The village and the school should be interdependent with the latter being the centre of major happenings in the village.



Villagers should have all the amenities that a city dweller has and this is possible now with the electronic and wireless revolution. This would attract a lot of people to the villages reducing congestion in cities. Best schools including some of the posh residential schools could be encouraged to go to villages where the total environment is more conducive to learning and healthy living. Cottage industries should be encouraged in villages. Local talent could be tapped to look after the health needs of the villagers. We will see later on in this book that the future medical education would be in the community for better patient care. This again brings the village to the centre of medical education. Community educated doctors would love to settle in villages to practice removing the biggest hurdle in this area in the medical field today. Better villages would lead to better health of the nation. We could achieve all this in the next quarter century to usher in a new, healthy, and dynamic India, showing the way to even the developed countries.















HEALTH PROMOTION





Prof. B. M. Hegde,

hegdebm@yahoo.com



“For the master spirit of the earth shall not sleep peacefully upon the wind till the needs of the least of you are satisfied.”

Kahlil Gibran





We seem to have a distorted view of health care in India. We have the health ministries that mainly look after ill health. We abuse the term health care when we, in fact, are talking about medical interventions. This brings to mind the old saying of Mark Twain: “The difference between the right word and the almost right word in a given place is the difference between lightning and the lightning bug!”

Neither doctors nor hospitals are needed for health promotion. They are both essential for looking after people who have, unfortunately, lost their health resulting in disease. Diseases are accidents and at any given day there could be a couple of million who are ill, but daily there are more than a thousand million Indians who need health care. If the latter is done correctly we could bring down the illness rates to negligible levels.



In fact, eighty per cent of the gut diseases would vanish and thousands of deaths averted if every Indian gets clean drinking water. If one gets three square balanced meals a day not contaminated by human and/or animal excreta another few thousands would not meet their maker prematurely. Smokeless houses in the villages would save thousands of women from dying of heart attacks and cancer of the lungs. An equal number of children, below the age of five, die of smoke related pneumonias. Seventy per cent of Indian children today have less than fifty per cent haemoglobin in blood mainly because of hookworms that are ubiquitous due to lack of toilet facilities for the poor. This would result in the younger generation not being able to compete in sports as also in intellectual pursuits. Recent data shows how the early development of that part of the brain looking after memory function etc., the hippocampus, needs good iron supply for its proper growth in the mother and the new born. Iron deficiency is the main cause of slow brain development and many other long term health problems.



We get worked up and go mad if there is an epidemic like SARS. Millions suffer and thousands die daily in this world for want of clean water and good food and no one bothers about that. We need some scare to wake up from our slumber and then go to sleep again only to awaken at the next pandemic. Daily deaths do not count at all. SARS did not even kill a single Indian. We seem to have some kind of racial immunity against that virus. But the epidemiologists produced a very big scare and many would have suffered stress related illnesses because of the scare. Instead of scaring the public and lowering their immune levels making them succumb to infections, the epidemiologists should work silently to quell the threat when there is a real one. We could save millions of Indians if we could look after the following in all our villages where nearly eighty per cent of Indians live.



* Clean drinking water to every one.

* Clean food as three meals a day.

* Smoke free house.

* Toilet for every house.

* Economic empowerment of women.

* Educate the village barber to put peer pressure on all men to practise family welfare schemes.

* Every village school must be the primary health centre for the village; the present PHCs could be dispensed with and replaced by village health workers that report any illness to the Taluka hospitals from where ambulances could be dispatched to transport patients when needed.

* One doctor, the same doctor, should visit every school once a week and look after the health status of the children and do the needful. Children will, in turn, educate their parents.

* Health education should be a compulsory subject in the age group of 5-15 years.

* Pregnant mothers should get special attention and more nutritious food especially during the first trimester to prevent major killer diseases in the adult population in later life as all the organs are properly made during the 12-16th weeks of gestation inside the mother’s womb. If the mother’s nutrition is poor the organs are defective. These are the children that get major killer diseases precociously in later life.

* Having done all these, vaccination to prevent communicable diseases will work well. Vaccination will not be effective in children with very low blood protein levels.



As has already been pointed out above doctors and hospitals do not promote people’s health; in fact, a recent study showed that a surfeit of hospitals of the hi-tech variety and increase in the number of interventionalists would result in higher than expected deaths in society. An audit of European countries and Japan showed that those countries with the higher number of doctors per unit population compared to countries with less number of doctors had lower health status and higher morbidity. When doctors went on strike in Israel and no intervention on the apparently healthy was carried out death rates plummeted down only to go back to the original levels when doctors resumed full duty.



I have been writing about this for the last four decades but it seems to fall on deaf years and the powers-that-be seem to have selective blindness for this kind of information. “Truth influences but half a score of men in a century while false hood and mystery will drag millions by the nose”. This saying of Aristotle is true even today.



India needs a very strong health promotion set up, may be, headed by a health promotion powerful ministry that has jurisdiction over food supply, water supply as also other infrastructural needs of the people. Large part of the present “so called” health budget could be shifted from hospitals to health care. We need a full department of health promotion. Medical schools should teach health of the public (Public Health) to students for all the five years as a doctor is trained to look after the health of the public in the first place. Unfortunately, today we teach medical students advanced diseases in a five-star technology oriented set up and make them believe that the be all and end all of health care is hi-tech intervention. Students must have their training in the community as also in the villages to learn the real time medicine.



Medical Care:



This needs hospitals, but the future hospitals must incorporate complementary systems, mainly Ayurveda to widen the net to help more patients and also save billions of rupees spent on some of the useless hi-tech stuff offered today. Majority of illnesses (80%) are but simple minor illness syndromes and they could be helped by complementary medicines and some of the chronic illness get better with Ayurveda with much less cost and less discomfort to patients.



Wellness Clinics:



Life style changes, healthy diet advice, yoga and meditation, life style modification advice, alcoholism and smoking advice, could all be done in the new concept of the wellness clinics where healthy people regularly attend, not to get themselves checked up but to get themselves trained in the above methods that would keep diseases at bay for very long time even one were eventually get an illness later on. In the latter event the wellness clinic experience would hasten healing.

These two new concepts must be a part of all Indian hospitals sooner than later for the common good.













HEALTH CARE Vs MEDICAL CARE





"The difference between the right word and the almost right word in a place is like the difference between lightning and the lightning bug."

Mark Twain.





Health care is a word mostly misunderstood and used in place of palliative medical care. The two are poles apart. It is very important, both for the lay man and the administrators, to make a clear distinction between the two, lest there should be mal-administration of health strategies in society.



Health is a state of holistic wellbeing of man, enabling him to be enthusiastic to be creative in society for his own good as well as for the good of others; the latter more important than the former in the social context. On the contrary, palliative medical care is trying to fix the broken pieces of a healthy man into a whole again. There is further confusion here in that it is sometimes called curative medical care, in place of palliative care. Cure, we rarely, if ever!



If one follows the holistic classification of diseases the following classification, suggested by me, would be more practical.



* Emergency Medicine (10% of the sick population)

* Minor illness syndromes (around 30%)

* Doctor-thinks-you-have-a disease (10%)

* Patient-thinks-he-has- a disease (10%)

* Chronic illness syndromes. (remaining 25-30%)

* Drug or Doctor Induced (iatrogenic) diseases (10-15%)



In this scenario only the first ten per cent of the sick population does need modern hi-tech medical and surgical care. Rest of them could make do with conventional traditional systems of medicine coupled with change in the life style. Modern medicine becomes prohibitively expensive when used for all the one hundred percent of the sick population; it could strain the budget of even the richest nation. America is feeling the pinch. Whereas more than sixty percent of the upper middle class Americans can not afford good health insurance cover as the premia are sky high, thanks to the charges of the star-performers!

The National Health Service of the UK is broke and the story repeats everywhere, but if one were to follow the dictum mentioned above one could have equitable medical care for the really needy. While the American hospitals have been reducing their beds, the new idea of HMOs to replace hospital expenses have been declaring chapter eleven one by one.



Action plan for India for the next century:



It is true that the population growth in our country is still not arrested while in many western countries it is either decreasing or is, at least, not increasing. They envisage a large chunk of their population in the next millennium to be in the above sixty category (70% of the population). Naturally, they could expect to see degenerative diseases go up exponentially there. That would be their real problem. Our scenario would be totally different.



More than sixty per cent of our population in the next millennium would be in the second decade. We would have totally different type of problems of adolescence viz.: aids, drug addictions, infective diseases, nutritional disorders, violence, tobacco and alcohol related diseases, and road accident deaths in place of their load of degenerative diseases.



Modern medical wisdom comes in handy here for us to avoid any future threat of degenerative diseases should they show up when our present generation of children grow to the sixth and seventh decades in the third world. Most, if not all, degenerative diseases get born in the mother’s womb in the first trimester of her pregnancy. It is there that the foetus forms its heart, blood vessels and pancreas, to name a few. These structures, if not formed well, could encourage the onset of heart diseases, high blood pressure, diabetes and other vascular accidents in adult life! It is known now that mother’s nutrition in the first trimester of pregnancy is of vital importance to avoid this menace.



The next period in life when these diseases get their encouragement is childhood and adolescence when bad food habits, alcohol and tobacco could further ensure the progress of degenerative diseases in later life.



Action Plan:



1) The comprehensive village development plan should include water supply, toilets, education about common foods available in the village, and also some methods to uplift the economic condition of the villagers. Smokeless choolas should be supplied to all houses.

2) Pregnant mothers should get special attention regarding their diet, more so in the first trimester. Proper nutritional advice should avoid undernourishment during that crucial period in the life of the foetus.

3) Compulsory breast feeding education to be given to all mothers. In case the breast milk is inadequate other human milk, if available, is good enough but not cow’s milk! Instead the baby could be given fruit juices and cereals in an easily digestible form. This could avoid many other diseases in later life, like the autoimmune diseases.

4) Effective education, to keep tobacco and alcohol at bay, aimed at the adolescents using different methods suitable to different set-ups, should be started.

5) Our primary education should change in such a way that it inculcates the essence of Indian education of the yore-humility. Humility begets better life habits. Anger, pride, jealousy, hatred, and ego get suppressed to give place to love, compassion, and camaraderie. The former are now known to be important risk factors for major degenerative diseases.

6) Proper health education of children in school about the dangers of alcohol, tobacco, and also sexually transmitted diseases will go a long way in reducing the future problems of drug addiction and AIDS, which are going to be our big problems in the next millennium.

7) Better roads and stricter licensing procedures should decrease road accident deaths. Coupled with a war on alcohol this should yield better results. The only truly avoidable deaths are accidental deaths. Punishment for careless driving should be more stringent to persuade rich kids from rash driving in larger cities.

8) Family planning should be pursued on war footing. In the villages, where the bulk of India lives, men are at fault. The best way to educate the men in the village is to catch the village barber. The latter is an incessant talker and also has a lot of influence on all the men in the village. If we could properly educate the barbers and then give them an incentive, that could work wonders in addition to the conventional methods followed.

9) Screening whole populations for high blood pressure, heart disease and diabetes to get them under the net of doctors, drug companies, and instrument manufacturers to fix the defect would look good on paper. It can work in the laboratory, but it does not work in the population, and it is definitely not cost effective.

10) In addition, screening apparently healthy populations could even be counter-productive. “It could seriously damage the health of the population”. Past experience has shown that screening increases sick absenteeism in society making more people sick! It also increases false positives.

11) Screening a population of one billion is not feasible. Screening only the urban elite is also not going to help. This would certainly net more people into the system for treatment and also get more hapless victims for intervention in the present top heavy hi-tech medical field, but would not change the scenario as far as the imaginary threat of the degenerative disease epidemics, as predicted. Predicting the future is impossible. “We have been predicting the unpredictable”.

12) Reliable studies even in the West have shown that the so-called epidemic rise of certain degenerative diseases and their subsequent fall has been spurious and flawed heavily.

13) Life style modifications have been palpably more effective in containing these diseases even in the West. While the effect of life style modifications has been 59.4% effective in reducing the incidence of coronary artery disease, interventional methods have only been effective to the tune of 3.4%. The story is not different in the field of drug therapy, either. The famous MRC study of mild to moderate hypertension treatment, which has 85,000 patient years of experience, clearly showed that to save one life from stroke we have treat 850 apparently healthy people in society with anti-hypertensive drugs unnecessarily.

14) These speak volumes about the very effective role of life style modifications in altering the future incidence of degenerative diseases.

15) Coupled with the prohibitive cost of population screenings and their attendant dangers to human health it makes lot of sense for third world countries to concentrate all their efforts in modifying the life style of their populace to contain these dreaded diseases even if they were expected in the next millennium.

16) Here the role of tobacco and alcohol has to be stressed. We have to fight the powers-that-be that try and push these two evils on society with all our might.

17) Another area is the field of diet for our adolescents. Indian vegetarian diet has a lot to recommend it to them in place of the modern junk non-vegetarian food, which seems to be invading the world of the young in a big way. Nutrition based education should start in the elementary school itself.

18) Need to have physical exercise is the next area to be stressed. This could be done in many ways aimed at the younger generation.

19) The need to keep the human mind filled with universal love to avoid hostility and depression-the two most important risk factors for heart and vessel diseases in addition to cancer –has to be stressed right from day one in school.

20) Economic empowerment of our masses is of vital importance to avoid future epidemics of vascular degenerative diseases.



The need of the hour is the courage to implement these right away and keep the pressures on population screening and mass drugging only to the symptomatic in society, thus bringing down the cost of curative medicine to affordable limits.



Would someone listen please?



I’m sick of gruel, and the dietetics,

I’m sick of pills, and sicker emetics,

I’m sick of pulses, tardiness or quickness,

I’m sick of blood, its thinness and thickness,-

In short, within a word, I’m sick of sickness!



Thomas Hood, `Fragment’, c. 1844.



VILLAGE SCHOOL AS THE PROMOTIVE HEALTH UNIT

(PHUs)



Prof. B. M. Hegde,

hegdebm@yahoo.com





Healthy India would certainly be a wealthy India with its all round progress. Rounded development of an individual, and consequently of the whole society, depends on his/her total health. The latter could be defined as the enthusiasm to be creative in life to live and let others live with physical, mental, social, emotional, societal, and spiritual wellbeing. The foundation of this kind of growth should be laid in childhood. The parents and the home environment are as important, if not more, than all the education that the child gets in life outside the home. Village schools are the ones that train the bulk of future India. There are well over six lakh villages in India where more than eighty per cent of Indians live. Unless the village school, where the future India is being brought up, is given due respect and importance the country has no future, despite all the fanfare of the Sensex rising and India shining.



Lop sided technological development and economic growth are not as important as the emotional and ethical growth of the populace. While aping the west we should be careful not only to imitate the worst in their culture, we would do well to concentrate on the best that they have. Monetary economic growth alone would eventually take man into the valley of moral nihilism and extremism, as has happened in the west today. Monetary development must be combined with healthy human development, as defined above. We, in India, have had a hoary past of a great culture. Indian culture depended on what every Indian did when no one was observing him/her. Indian culture demanded that we walk our talk. Indian culture, combined with the good points in the western economic growth, would make India the world leader once again. It all depends on India’s greatest asset-its man and woman power.



Even the journey of a thousand miles starts with the first step. The first step for the growth of a strong India in the next few decades is to change the face of the village primary school. This should be the nucleus for village development, nay the country’s development. The prevailing scenario is anything but conducive to this kind of human growth. The recent PROBE report made very sad reading about the appalling conditions of village schools in the four large northern states of UP, MP, Bihar and Rajasthan. The earlier we do something to change this, the better for the nation. Good life depends on good health to begin with. Health depends on man and his surroundings. Health does not depend on doctors and hospitals. The latter are needed only by those who are not healthy. If we try to preserve and promote positive health, the need for doctors and hospitals would automatically go down.



Education for healthy living:



Educated people, especially those that receive correct guidance to live and let live, have been shown to live longer and better than those that do not have education. Education and health promotion are inseparable parts of human growth. It makes good sense to make the primary school in every village also the village health promotive unit. The present concept of a primary health centre in villages is not only a waste of resources, it is counter productive. The PHCs, as they are conceived now, are fashioned more like mini hospitals without the capacity to do even minor surgery, not to speak of the doctors presence in the first place. Doctors in India today are trained within the four walls of a hi-tech modern hospital where they get to see a microscopic minority of serious terminal illnesses. Such training, which stresses the use of gadgets and scanners for every diagnosis, would be an anathema in a village set up to assess and diagnose illnesses as they present in society. The young doctor, not exposed to this kind of medicine in his medical school, feels like a fish out of water in a village and feels guilty. This is the reason why our doctors do not want to go to villages.



Village school teacher as a health promoter:



In the new concept the village school teacher is trained for a year with a teaching diploma in school health promotion (TDHP) to replace the village doctor. Every medical school could be made to train certain number of selected bright village teachers, free of charge, with a special curriculum to equip them with enough know how to look after the holistic health of the children and their parents in the village. They should be provided with communication facilities to inform the Taluk hospital about any sick child or adult in the village to be shifted there for treatment. They should be trained to spot trouble and inform the doctor and the hospital to do the needful. The money being spent for the PHCs could be diverted to develop this new concept along with the village school. The teacher/health promoter would look after sanitary needs in the village like toilets for every household, clean drinking water, smokeless houses, and clean meals for all, and assist the villagers to live like a large family in the village. In due course people would look up to them for all kinds of guidance. The idea is to develop a cadre of village teacher who becomes the friend, philosopher, and guide of the villagers.



In the school these teachers have added responsibility to see that children get proper nutritious meals, they develop healthy habits, clean dress and are made to wash hands before eating. Children should be trained to use the toilet and teach their parents in turn at home. Children should be taught to respect all life on this planet as we are all inter-dependent. These teachers are responsible to see that children get proper immunization at the right time. They could help children to develop a healthy social outlook with universal compassion, sharing and caring. Healthy living should be one of the important subjects in the curriculum but without the conventional end year examination. However, those who excel should be given a special certificate as also some incentive by way of a prize or so. Children could be encouraged to think for themselves to develop curious healthy citizens for science training in later life. Catch them young should be the motto. My friend, Dr. Solomon Victor, a famous cardiac surgeon of Chennai, has a model for teaching school health. That could be supplemented to make a special curriculum for the subject of health promotion in school, as also expanded to make the curriculum for the teaching diploma mentioned earlier.



Village School as the cultural centre of the village:



Rounded education needs an overall development of human personality. Arts, humanities, behavioural methods, community living etc. could all be promoted through regular festivals in schools periodically where the villagers use local talent to entertain others with the help of the teachers and students of the school. This could be a good medium for spreading health messages like AIDS awareness, family welfare etc, through dance, drama and songs. Folk arts could be promoted here. Creative writing, story telling, poetry reading etc. could be arranged in addition. Neighboring village talents could also be tapped in the bargain. The stress in all these should be communal harmony and community living and letting others live. The school should be the place where all special occasions of all religions should be celebrated to show the oneness of all human beings-the fatherhood of God and brotherhood of man. Village school teachers could wear the cap of village counselors in their spare time. For all these one will have to make the village teacher happy with comfortable living standards where he/she does not have to depend on a side business for living. It would be better to tap the best brains with right qualifications for the village teachers job. Bright young men and women should shape the future of India. They would do well in this area rather than in central services or in IITs, where they may do well for themselves. As a village teacher one builds a new India that will be the world leader, not only in monetary terms but in human terms.



Family Welfare and the Village Barber:



Another area where our planning has gone astray is the family welfare. If we are able to control our population we will be able to build better village schools. The village barber is the friend of every male in the village. Males are the usual culprits in the failure of family planning. The barber meets every man at least once a month for about half an hour. Barbers are incessant talkers. Peer pressure is the best influence. If we could train the barber and motivate him to convey the message of family planning in his own rustic terms to every male in the village, I am sure our family planning would be a lot better in future. The village teacher/health promoter could be used to train and give continuing education to the village barber to replenish his knowledge. The credit for this idea should go to a friend of mine, Late Dr. H.K. Ranganath, a noted writer who told me to try this method while I was trying to help develop a few villages with the help of money from a generous patient of mine, Shri Durgadas Mandelia.



School Children to help develop the village atmosphere:



We have been able to get the children in village schools to help grow more trees and also help keep their surroundings clean. They could be the best influence on their parents in following good healthy habits. Children should be given prizes for growing tress and gardens in their own homes instead of giving prizes for mugging g up textbooks! In short, the village school could be the nucleus for the great future for this country. May the future India develop a healthy tradition which could be the model for the whole world? The present school scenario in the west is so bad that our children should not even know what is happening there. There have been eleven thousand serious crimes against teachers in schools in the US in one year and eleven teachers were shot dead by their own students. School children use their parents’ guns to settle daily quarrels with their peers and/or teachers! When one ponders over these facts, one realizes the significance of what is written above.









Other Chapters:





* Industries and Human Health

* Are we barking up the wrong tree building five-star hospitals?

* Food Industry and Human Health

* Pharmaceutical Company’s role in Human Health

* Hi-Tech Medicine-a boon or a bane?

* Complementary systems in Medicine

* Trade Organisations and Health

* Landing in the neighbour’s house with a smile or Landing on the Mars.

* Health Promoting Indian Agriculture

* High, Medium, and Low Tech.

* Ancient Indian Wisdom in Healthy living.

* Vedic Wisdom and Health

* Bhagavadgita as a psychotherapeutic tool Vs Freudian school for India.

* Healthy Indian Infrastructure development.

* Eastern Science of holism Vs Western reductionism in medical care.

* Indianness in medical education for keeping the health of the public.

* Meditation and Health- Indian style.

* Secularism of the right type and good health of the society.

* Afterword.

























A PIECE OF MIND



Prof. B. M. Hegde,

hegdebm@yahoo.com



“Know thou this-that men

Are as the time is………..”

Shakespeare.



I shall give you a piece of my mind to help you get some peace of mind. All writings on esoteric matters like meditation, God and philosophy are shrouded in mystery and couched in unintelligible sesquipedalia verba. Nowadays they come packaged for sale, not to speak of their high cost in tune with the present trend in the market. They remind me of the popular junk food. I hope these methods are not as dangerous to health as are the junk food packets! Not a day passes without a new age guru appearing on the scene with his/her method of modified meditation, yoga and what have you.



The need for peace of mind started with the onset of the monetary economy, culminating in the new epidemic of suicides and divorces in the west. The plastic card economy would only enhance this need. Once a student reminded me that my efforts to make man tranquil would have to, per force, fail, since this universe is a combination of the opposites- good with the bad, yin with yang, positive with the negative, happiness with sorrow, elation and depression, etc. Even at the micro level, he said, the atom remains intact because of the protons, neutrons, and other quantum particles with opposite charges.



While I agreed with him, my submission was that the balance between the good and the bad- the bad arising out of oppression, suppression, and denial- has reached a flash point. If that were to happen to the atom the latter would have exploded by now. Before the macro world explodes we have to hasten to act. Otherwise, the saying of the poet “when the last tree is cut, when the last river is poisoned, and the last fish eaten, mankind would realize, for the first time, that money can not be the substitute for food and water,” would come true. Mankind then would have to follow the path shown by the mighty dinosaurs.



I have tried every one of the methods of meditation to get tranquility. While each one of them results in lower breathing and heart rates, I am not sure if there would be long term tranquility. I could draw a parallel from modern medicine. While blood pressure, sugar, and cholesterol lowering drugs get us better laboratory reports, almost all of them fail to translate into better health in the long run. The reason is not far to seek. Lowering the physical parameters alone will not translate into holistic health and longevity.



Be that as it may, let us look at common day to day human activities that bring permanent pleasure and lasting tranquility. Our scriptures have shown the path and the great science of Ayurveda has reiterated the same time and again for centuries. “Aaapthopasevi bhavet aarogyam”-treating everyone around you like your near and dear ones would give you positive health for certain, is the basis of Ayurvedic art of healthy living. I have been trying this experiment on myself for decades now with very good results. If I had a day when I did not get an opportunity to show some kindness to someone, do a good turn to others, give a smile to the needy, or wipe a tear from another’s eye, I get tired easily. On the other hand even when I was dead tired, if I got an opportunity to be of some use to another, my tiredness would vanish. Similarly, if I had inadvertently harmed someone, my body signals that all is not well by way of backache, pain in the neck, heartburn, sleeplessness, tension headaches, migraine etc.



Over the years I have learnt to analyze my body responses to my thoughts. Even when I think ill of others my breathing and heart rates hasten. When I help another I feel very tranquil and have peace within. Anger, hatred, jealousy, hostility, frustration, and other similar negative thoughts bring on discomfort immediately. This needs one to fine tune oneself to receive body signals. My post-meditation feeling is not comparable with the immense happiness that I get from sharing and caring that make me tranquil round the clock. I have come to realize that spirituality and meditation are nothing but sharing and caring. The joy of sharing is enormous when one cares for those that hate you. This is not easy, though. It requires lots of practice and understanding. If one could fill “the unforgiving minute with sixty seconds of distance run,” one could be really, really happy.



That said, I must hasten to add that the above simple message can not be packaged into a ready made recipe for all. No two individuals are alike, not even the uni-ovular twins. Each one will have to tailor this to his/her convenience. Perseverance pays dividends in the long run. Total health requires a holistic approach. I am not infallible. I, however, feel that I have described meditation in a more tangible fashion for the common man to understand. There are no easy short cuts in life. One has to work hard to get good results, but the results are better if one does not get too possessive about the outcome.



“Joy, temperance, and repose,

Slam the door on the doctor’s nose.”

H.W.Longfellow.













FOOD-GENE MISMATCH.



Prof. B. M. Hegde,

hegdebm@yahoo.com







We have been hunter-gatherers for millions of years before we settled down as groups (society today) on the fertile banks of rivers. Using the water way as the mode of transport to collect more food for members in the last ten thousand odd years, we have grown into larger societies and nations today. During our very long sojourn as forest dwellers we were depending on the hunted animals and the roots and fruits that we get for food. Naturally the food supply was not only erratic but uncertain. Mankind used to live long and the causes of death were predominantly predation and old age. Occasional deaths due to starvation must have been there.



This kind of life made the human bod