FEATURE
How to save an 800gm @ birth
Swapna Majumdar
Prematurely born, little Babu weighed just 800 grams at birth. Considering that over three-fourth of neonatal deaths occur among infants who are born with low birth weight - weighing less than 2.5 kilo at birth - and that the state of Bihar, his birthplace, sees about 250 neonates die everyday, his chances of survival were bleak. Neither his mother, Kajal Devi, a resident of Vaishali district, nor her family, thought he would make it. In fact, his case was a big challenge for Dr Martin Parvez and the team of nurses at the sick newborn care unit (SNCU) in Vaishali.
Baby Babu, however, beat all the odds. Severely anemic, he had to be given blood transfusion twice, his body was too frail for the ventilator so he had to be given ambubag care with oxygen round the clock. In ambubag care self-reinflating bag is used during the resuscitation for artificial ventilation.
Call him a regular little fighter or a miracle child, but Babu was lucky enough to get timely specialised care that saw him through the tough times. “The chance of survival of a child who is less than one kilogram is very poor. He (Babu) was lucky that there is SNCU in Vaishali and he was able to come here,” says Dr Parvez.
What’s so special about the SNCU? For starters, it’s a facility that is not affected by power cuts because there is back up in the form of generator. And the biggest advantage, according to Dr Parvez, is that it has oxygen concentrator that make oxygen directly from the atmosphere. So there is no need to wait for the refilling of oxygen cylinders. “This is why we could also keep Babu in the SNCU for one-and-half months till he gained weight and was healthy enough to go home,” he adds.
So had it not been for the SNCU at the Maternal and Child Health (MCH) Unit in Hajipur, Vaishali, Babu would have become another statistic in Bihar’s high neonatal mortality – or the probability of dying in the first month of life. Around 90,000 children die every year within the first month of their birth in the state.
Because the maternal and child care facilities have been abysmal – contributing to the state’s high mortality rate – the SNCU, that is part of the Comprehensive Newborn Care Initiative (CNCI) developed by the Bihar government with technical support from UNICEF and the National Neonatology Forum, has been set up.
And the SNCUs have proved to be a boon for critically sick newborns. The number of children in the age group 0-2 months, admitted in these units has almost doubled from 53,987 in 2009 to 90,236 in 2010. While the number of SNCUs in the state has gone up from four to eight, the number of neonatal deaths declined in the corresponding period.
In Hijapur, where the first SNCU was set up as a pilot project, the number of admissions to the unit rose from 1,200 in 2008 to 2,500 in 2010. There has also been a small drop in the percentage of newborn deaths from 10 percent in 2009 to nine percent in 2010.
According to Dr Parvez, in Vaishali this has been possible because of people like Parbati Devi, a ‘dai’ (midwife). Surprised? Don’t be, because Parbati helps the nurses at this SNCU and keeps a hawk’s eye on all the newborns admitted. She is always around to ensure every child is breathing properly and, if something is wrong, she calls the nurse or doctor immediately. Parbati’s contribution may be invaluable but she is modest about her role, “I feel very bad when I see these babies struggling for life. I don’t think I am doing anything special by looking after them. After all, I am mother too”.
According to Patna-based Sanjay Kumar, Executive Director, State Health Society (SHS), the SNCUs have contributed towards a decline in state’s infant mortality rate (IMR). Bihar has reduced IMR from 56 per 1,000 births in 2008 to 52 per 1,000 in 2009 (SRS 2009) and is now only two points below the national average of 50 per 1,000 live births.
Moreover, Kumar contends that the CNCI has the potential to save up to 60,000 newborn lives every year as it provides for newborn care at every level. The initiative adopts the integrated management of neonatal and childhood illnesses (IMNCI) approach comprising a newborn and child health package of preventive, promotive and curative interventions.
Now, all newborns in Bihar receive home visits, thanks to IMNCI, in the 24 IMNCI districts. In fact, Bihar is the first state in India to integrate the facility based care package with the IMNCI to manage referred sick children in hospitals. A pool of 76 facilitators has been created and 400 MOs (Medical Officers) trained so far.
Health care system Vs Disease care system. (Peace Vs War)
Prof. B. M. Hegde,
hegdebm@gmail.com
“Fill your paper with the breathings of your heart.”
William Wordsworth 1770-1850
Health is defined by Richard Smith, the former editor of the British Medical Journal,
as that state where one has “enthusiasm to work and enthusiasm to be compassionate”. This would fit in with the definition of health by Sigmund Freud as “work and love.” The conventional Alma Ata definition, a real utopia, is humanly unattainable. The above definition does take into account the physical, mental, ethical, and spiritual dimensions of health. Spirituality, in essence, is sharing and caring, which, in short, is the enthusiasm to be compassionate. Rest of the definition deals with physical, psychological and ethical dimensions. “It is time” writes Mary Tinnetti, a professor of medicine at Yale, “to abandon the concept of disease in medical care delivery as the present concept with its attendant therapeutic strategies is, at best, inappropriate and, at worst, dangerous.”
This makes sense in the background of my recent visit to the USA. In the last twenty four hours that I have been here, the media, of all hues and colour, was awash with only one news-Obama’s health care reforms bill! While the whole saga is about the various strategies for sharing the booty from human misery, there was nothing about health in that. Health is not just managing illnesses or even absence of disease. Health is much more than those. Health is that state where the human being has enthusiasm to work and be compassionate to others. In that sense the majority in the society, is unhealthy today. Health has very little to do with doctors, hospitals and the pharmaceutical industry; as such it is not covered in the Obama drama. MacFarlane Burnett once said that the concept that doctors and hospitals keep society healthy is plain rubbish. This has been now proven by the 14 industrialised countries’ study which showed that countries like Germany and the US, where the doctor-patient ratio is very high, have the highest disease load and shorter longevity compared to countries like Japan where the ratio is much lower. Of the 14 countries, Japan stood first with highest longevity and lowest disease load. Japan also has very, very few specialists compared to the US where the majority of doctors are specialists. In the past several instances of doctors going on strike decreasing human mortality and morbidity adds credence to this theory.
In this debate about health care most of the stake holders-politicians, doctors, pharmaceutical cartels, medical insurance industry, the media, and Para-medical personnel are involved but the common man is not represented at all. His voice should have been heard first. It is the wearer of the shoe that knows where it pinches and not the seller, the broker or the manufacturer. Let us examine the nitty-gritty of disease care in its present avatar.
Scientific base of modern medicine:
“Science is simply making models, mostly mathematical constructs, which, with verbal jargons, are supposed to work”, wrote Jon von Neumann, an American scientist of Hungarian origin. Modern medicine uses the reductionist, linear, and static mathematical model in a holistic, non-linear, and dynamic human body which naturally becomes a square plug in the round hole. In that sense modern medicine’s scientific foundation is totally flawed. The bench mark of evidence based medicine (EBM), the cliché these days, is the RCT (randomized controlled trial), which is unscientific, to say the least. Archives of Internal Medicine of 26th October, 2009, in a scathing editorial in page 1737 of volume 169, mourns that the adverse events in RCTs are “neglected, restricted, distorted, and silenced”. This is serious charge after my continuous fight against RCTs in the last four decades. Naturally, audits of healing outcomes in modern medicine have been disappointing. Medical fraternity, chemical molecules called drugs, many of the heroic surgeries, with over investigations and over treatment have resulted in the whole establishment being the leading cause of human misery and death followed by cancer and heart attacks in that order of preference!
Statistical science of medicine is its bane. Predicting the unpredictable future of a dynamic system using linear mathematics has been the curse of modern medicine. While time evolution in any dynamic system depends on the total initial knowledge of the organism, the latter is unattainable with the human system. Altering the initial state even slightly might have unexpected catastrophic long term outcomes. No intervention, howsoever hi-tech it exotic zoonotic ones as well. Greening the earth to have more forests to stabilize the weather would also be needed.
Global warming might bring back the black rat into the northern hemisphere to help deadly plague make a come back! Pollution control, population control, reduction in unemployment with poverty alleviation are urgently needed for making the world healthier. Poverty is the mother of all ills of mankind. The poverty pandemic should have been declared by the WHO long back. More than three fourths of the world population suffers from some degree of malnutrition. India alone has a load of 47 million children with severe nutritional immune deficiency syndrome. (NIDS) Disturbed minds of extremists, in every walk of life, are a mighty danger looming large. Tranquility of mind is the need of the hour and we might have to include gurus and mystics to use yoga, meditation, as also many others in those areas. Not knowing where one’s next meal comes from is a great risk factor for killer diseases. Wealth generation and equitable distribution is, therefore, a part of health care. This would make it clear that health care has nothing to do with the medical fraternity or the pharmaceutical industry.
Conclusions:
Just as peace is incompatible with war, is health incompatible with disease. The stake holders for peace and those for war are poles apart. So are the stake holders for health and disease. Knowing the details makes all the difference between life and death. Weapons industry and politicians with disturbed minds are the stake holders for war while authentic, humane, empathetic, and compassionate people hold the brief for peace. Latter are also needed to awaken the sleeping conscience of the well meaning people to see the writing on the wall. Future of mankind depends on a sturdy health care system in the world and not the zillion dollar disease care system that benefits only a handful of rich business houses. If we succeed in putting together a proper health care delivery system we would be able to raise the health expectancy of the new generation. Health expectancy is the number of years a new born child could expect to live without help from doctors and pharmaceutical drugs. Politicians, the media and the common man must know the truth. The knaves in politics and the media help spread the false canard against natural healing methods while there are honest people even in the media who could help to spread the truth. Unfortunately, “truth is bitter and could influence only half a score of men in a century while falsehood and mystery will drag millions by the nose.”
“For I have learned to look on nature, not as in the hour of thoughtless youth, but hearing oftentimes the still, sad music of humanity
William Wordsworth 1770-1850
Swapna Majumdar
Prematurely born, little Babu weighed just 800 grams at birth. Considering that over three-fourth of neonatal deaths occur among infants who are born with low birth weight - weighing less than 2.5 kilo at birth - and that the state of Bihar, his birthplace, sees about 250 neonates die everyday, his chances of survival were bleak. Neither his mother, Kajal Devi, a resident of Vaishali district, nor her family, thought he would make it. In fact, his case was a big challenge for Dr Martin Parvez and the team of nurses at the sick newborn care unit (SNCU) in Vaishali.
Baby Babu, however, beat all the odds. Severely anemic, he had to be given blood transfusion twice, his body was too frail for the ventilator so he had to be given ambubag care with oxygen round the clock. In ambubag care self-reinflating bag is used during the resuscitation for artificial ventilation.
Call him a regular little fighter or a miracle child, but Babu was lucky enough to get timely specialised care that saw him through the tough times. “The chance of survival of a child who is less than one kilogram is very poor. He (Babu) was lucky that there is SNCU in Vaishali and he was able to come here,” says Dr Parvez.
What’s so special about the SNCU? For starters, it’s a facility that is not affected by power cuts because there is back up in the form of generator. And the biggest advantage, according to Dr Parvez, is that it has oxygen concentrator that make oxygen directly from the atmosphere. So there is no need to wait for the refilling of oxygen cylinders. “This is why we could also keep Babu in the SNCU for one-and-half months till he gained weight and was healthy enough to go home,” he adds.
So had it not been for the SNCU at the Maternal and Child Health (MCH) Unit in Hajipur, Vaishali, Babu would have become another statistic in Bihar’s high neonatal mortality – or the probability of dying in the first month of life. Around 90,000 children die every year within the first month of their birth in the state.
Because the maternal and child care facilities have been abysmal – contributing to the state’s high mortality rate – the SNCU, that is part of the Comprehensive Newborn Care Initiative (CNCI) developed by the Bihar government with technical support from UNICEF and the National Neonatology Forum, has been set up.
And the SNCUs have proved to be a boon for critically sick newborns. The number of children in the age group 0-2 months, admitted in these units has almost doubled from 53,987 in 2009 to 90,236 in 2010. While the number of SNCUs in the state has gone up from four to eight, the number of neonatal deaths declined in the corresponding period.
In Hijapur, where the first SNCU was set up as a pilot project, the number of admissions to the unit rose from 1,200 in 2008 to 2,500 in 2010. There has also been a small drop in the percentage of newborn deaths from 10 percent in 2009 to nine percent in 2010.
According to Dr Parvez, in Vaishali this has been possible because of people like Parbati Devi, a ‘dai’ (midwife). Surprised? Don’t be, because Parbati helps the nurses at this SNCU and keeps a hawk’s eye on all the newborns admitted. She is always around to ensure every child is breathing properly and, if something is wrong, she calls the nurse or doctor immediately. Parbati’s contribution may be invaluable but she is modest about her role, “I feel very bad when I see these babies struggling for life. I don’t think I am doing anything special by looking after them. After all, I am mother too”.
According to Patna-based Sanjay Kumar, Executive Director, State Health Society (SHS), the SNCUs have contributed towards a decline in state’s infant mortality rate (IMR). Bihar has reduced IMR from 56 per 1,000 births in 2008 to 52 per 1,000 in 2009 (SRS 2009) and is now only two points below the national average of 50 per 1,000 live births.
Moreover, Kumar contends that the CNCI has the potential to save up to 60,000 newborn lives every year as it provides for newborn care at every level. The initiative adopts the integrated management of neonatal and childhood illnesses (IMNCI) approach comprising a newborn and child health package of preventive, promotive and curative interventions.
Now, all newborns in Bihar receive home visits, thanks to IMNCI, in the 24 IMNCI districts. In fact, Bihar is the first state in India to integrate the facility based care package with the IMNCI to manage referred sick children in hospitals. A pool of 76 facilitators has been created and 400 MOs (Medical Officers) trained so far.
Health care system Vs Disease care system. (Peace Vs War)
Prof. B. M. Hegde,
hegdebm@gmail.com
“Fill your paper with the breathings of your heart.”
William Wordsworth 1770-1850
Health is defined by Richard Smith, the former editor of the British Medical Journal,
as that state where one has “enthusiasm to work and enthusiasm to be compassionate”. This would fit in with the definition of health by Sigmund Freud as “work and love.” The conventional Alma Ata definition, a real utopia, is humanly unattainable. The above definition does take into account the physical, mental, ethical, and spiritual dimensions of health. Spirituality, in essence, is sharing and caring, which, in short, is the enthusiasm to be compassionate. Rest of the definition deals with physical, psychological and ethical dimensions. “It is time” writes Mary Tinnetti, a professor of medicine at Yale, “to abandon the concept of disease in medical care delivery as the present concept with its attendant therapeutic strategies is, at best, inappropriate and, at worst, dangerous.”
This makes sense in the background of my recent visit to the USA. In the last twenty four hours that I have been here, the media, of all hues and colour, was awash with only one news-Obama’s health care reforms bill! While the whole saga is about the various strategies for sharing the booty from human misery, there was nothing about health in that. Health is not just managing illnesses or even absence of disease. Health is much more than those. Health is that state where the human being has enthusiasm to work and be compassionate to others. In that sense the majority in the society, is unhealthy today. Health has very little to do with doctors, hospitals and the pharmaceutical industry; as such it is not covered in the Obama drama. MacFarlane Burnett once said that the concept that doctors and hospitals keep society healthy is plain rubbish. This has been now proven by the 14 industrialised countries’ study which showed that countries like Germany and the US, where the doctor-patient ratio is very high, have the highest disease load and shorter longevity compared to countries like Japan where the ratio is much lower. Of the 14 countries, Japan stood first with highest longevity and lowest disease load. Japan also has very, very few specialists compared to the US where the majority of doctors are specialists. In the past several instances of doctors going on strike decreasing human mortality and morbidity adds credence to this theory.
In this debate about health care most of the stake holders-politicians, doctors, pharmaceutical cartels, medical insurance industry, the media, and Para-medical personnel are involved but the common man is not represented at all. His voice should have been heard first. It is the wearer of the shoe that knows where it pinches and not the seller, the broker or the manufacturer. Let us examine the nitty-gritty of disease care in its present avatar.
Scientific base of modern medicine:
“Science is simply making models, mostly mathematical constructs, which, with verbal jargons, are supposed to work”, wrote Jon von Neumann, an American scientist of Hungarian origin. Modern medicine uses the reductionist, linear, and static mathematical model in a holistic, non-linear, and dynamic human body which naturally becomes a square plug in the round hole. In that sense modern medicine’s scientific foundation is totally flawed. The bench mark of evidence based medicine (EBM), the cliché these days, is the RCT (randomized controlled trial), which is unscientific, to say the least. Archives of Internal Medicine of 26th October, 2009, in a scathing editorial in page 1737 of volume 169, mourns that the adverse events in RCTs are “neglected, restricted, distorted, and silenced”. This is serious charge after my continuous fight against RCTs in the last four decades. Naturally, audits of healing outcomes in modern medicine have been disappointing. Medical fraternity, chemical molecules called drugs, many of the heroic surgeries, with over investigations and over treatment have resulted in the whole establishment being the leading cause of human misery and death followed by cancer and heart attacks in that order of preference!
Statistical science of medicine is its bane. Predicting the unpredictable future of a dynamic system using linear mathematics has been the curse of modern medicine. While time evolution in any dynamic system depends on the total initial knowledge of the organism, the latter is unattainable with the human system. Altering the initial state even slightly might have unexpected catastrophic long term outcomes. No intervention, howsoever hi-tech it exotic zoonotic ones as well. Greening the earth to have more forests to stabilize the weather would also be needed.
Global warming might bring back the black rat into the northern hemisphere to help deadly plague make a come back! Pollution control, population control, reduction in unemployment with poverty alleviation are urgently needed for making the world healthier. Poverty is the mother of all ills of mankind. The poverty pandemic should have been declared by the WHO long back. More than three fourths of the world population suffers from some degree of malnutrition. India alone has a load of 47 million children with severe nutritional immune deficiency syndrome. (NIDS) Disturbed minds of extremists, in every walk of life, are a mighty danger looming large. Tranquility of mind is the need of the hour and we might have to include gurus and mystics to use yoga, meditation, as also many others in those areas. Not knowing where one’s next meal comes from is a great risk factor for killer diseases. Wealth generation and equitable distribution is, therefore, a part of health care. This would make it clear that health care has nothing to do with the medical fraternity or the pharmaceutical industry.
Conclusions:
Just as peace is incompatible with war, is health incompatible with disease. The stake holders for peace and those for war are poles apart. So are the stake holders for health and disease. Knowing the details makes all the difference between life and death. Weapons industry and politicians with disturbed minds are the stake holders for war while authentic, humane, empathetic, and compassionate people hold the brief for peace. Latter are also needed to awaken the sleeping conscience of the well meaning people to see the writing on the wall. Future of mankind depends on a sturdy health care system in the world and not the zillion dollar disease care system that benefits only a handful of rich business houses. If we succeed in putting together a proper health care delivery system we would be able to raise the health expectancy of the new generation. Health expectancy is the number of years a new born child could expect to live without help from doctors and pharmaceutical drugs. Politicians, the media and the common man must know the truth. The knaves in politics and the media help spread the false canard against natural healing methods while there are honest people even in the media who could help to spread the truth. Unfortunately, “truth is bitter and could influence only half a score of men in a century while falsehood and mystery will drag millions by the nose.”
“For I have learned to look on nature, not as in the hour of thoughtless youth, but hearing oftentimes the still, sad music of humanity
William Wordsworth 1770-1850
Comments