Tribute to Dr Samuel Hahnemann

Jana Swasthya
(People’s Health)
2nd Issue, May – June 2023

Digital Magazine of Medical Service Centre

(MSC)
Odisha
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 Index

1) Health Budget 2023 – A Critical Analysis – Dr S.S. Senapati

2) History of Medicine – A Brief Outline – Dr Prajna Anirban

3) Noise Induced Hearing Loss – N. C. Biswal

4) Oral Care in Pregnancy – Dr Manoranjan Mahakur

5) Hand Wash or Hand Hygiene – Nasim Parvej

6) Prevention of Heat Stroke

7) Press Release by MSC on Health Budget 2023

8) Press Release by MSC on Rajasthan Right to Health Bill 2022

9) From the Print Media

10) From Pages of Journals

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 From the Editorial Team

Dear Friends,

We have received bouquets of positive feedback and encouragement from all sections of people for
our first issue of “Jana Swasthya” from all over the country.

WHO observes 7th of April as ‘World Health Day’. The constitution of WHO came into force on 7 th
April 1948. WHO was founded with the aim to promote health and keep the world safe and healthy,
so that everyone, everywhere can attain the highest level of health and well-being. WHO is
observing its 75th anniversary this year. The slogan for this year is “Health for All”.

The programs and aims of WHO are lofty and ideal, but the sincerity of the member countries to
achieve the goals envisaged is doubtful. The Covid 19 pandemic showed us how the rich countries
and their pharma corporates behaved. There was a need for all countries to come together and pool
their resources to fight the pandemic, to develop medicines and protocols jointly, to vaccinate the
major proportion of the world’s population at a fast rate. The vaccine nationalism, not sharing
technology with poor countries and profit motive show how far we are from the goal of “Health for
All”.

Health is a commodity which is beyond the reach of the poor and middle class in every country.

We are dedicating this issue as a tribute to Dr Samuel Hahnemann, the founder of the alternative
system of medicine called Homeopathy.

We solicit feedback and suggestions from all of you to further improve the quality of our digital
magazine. Please share the magazine in all forums to reach a wider audience.

Editorial Team

Contact us at: -
Email id: mscodishajanaswasthya@gmail.com

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 HEALTH BUDGET 2023 – A CRITICAL ANALYSIS

The last Covid 19 pandemic played havoc throughout the world and more so in our country. Our
health system almost collapsed. The WHO and scientists of the world predict that such pandemics
will be frequent events in future and admonish that we should prepare our health system to meet
such exigencies in future, with lessons that we learned from the past pandemic. The citizens of our
country, health professionals, economists had expected that the Union Health Budget will address
the needs, aspirations, and expectations for health of the common man in consonance with the
lessons learned from the pandemic.

Does the Health Budget 2023 reflect the health needs of the country? Have we learned anything
from the last pandemic? Does the Health Budget 2023 meet the expectations and wishes of citizens
of our country?

What is Budget?

Budget is presented by the State and Union Government every year. It shows the income and
expenditure of the Government for the next financial year. The income of the Government comes
from the taxes collected, both direct and indirect taxes. Every citizen pays taxes, even a common
man pays taxes on every item he buys from the market. The Government presents, how they will
spend the money collected as taxes, in the next financial year. It is our money that the Government
spends. So, it is the responsibility of every citizen of the country to know how their money is being
spent.

The different sectors like education, health etc. are allocated different amounts in the budget.
Budget estimate for the current financial year for a particular sector shows the overall wishes of the
Government or the fund-raising estimate. This is not the final commitment of the Government.
Revised estimate shows that how much was possible to allocate to the sector in the last fiscal year.
The Budget estimate and Revised estimate may not be the same. The amount actually spent for the
sector may be different from the revised budget. The actual amount spent for health sector in
financial year 2023- 2024 will be only known when the budget for FY2025- 26 is presented.

We will critically examine the Health Budget 2023-24.

Total Health Budget –

BE 2022-23 RE 2022- 23 BE 2023- 24

86201 79145 (-8.2%) 89155 (+3.4%)

Figure -1 – Total Health Budget 2023-24 including Health research in Crores of Rupees (Times of
India 5th February 23) (Change in % calculated by us)

A glance at the total Health Budget (including research) of this year and last year, shows that there is
a slight increase in total BE of 2023 from that of 2022, that is from 86201 crores to 89155 crores
(3.4%) (Fig 1). In nominal terms there is a slight increase. Economists compare any two budgets on

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real terms that is by taking into account rate of inflation, GDP growth and population growth. We all
know the rate of inflation was very high during last year, that is from 5 to 12% and the RBI is worried
about this high rate of inflation. Experts have calculated that in real terms there is a 6% reduction of
BE of 2023 in comparison to that of 2022 in total health budget.

Fig 1 shows that the Revised Estimate (RE) of 2022 is significantly less than the Budgeted Estimate
(BE) of 2022, that is from 86201 to 79145 crores (7056 crores), 8.2% reduction. This is something
unusual which was never seen in the past. Government says that it is because of reduction of
expenses for vaccine and Covid 19 care. If so, the RE of 2023 will be much less. Where will this
money go? This amount could have been used for Health infrastructure development. We do not
know the actual expenditure in health during 2022, which we will only know in 2024.

Finance Minister during her Budget speech painted a rosy picture saying that there is an increase of
13% in total health budget from previous year. She compared the BE of 2023 with RE of 2022, which
is wrong. We have already shown the comparison of BE of 2023 with BE of 2022, there is a 6%
reduction in real terms.

The total Health Budget of 2023 is 1.97% of the total Budget and it is only 0.31% of the GDP.

Insurance Schemes & Private Hospitals –

Budget Head BE 2022-23 RE 2022-23 BE 2023-24

CGHS 1850 1945 2220
CGHS Pensioners 2645 4640 3846
Ayushman 6412 6412 7200
Bharat
Total 10907 12998 13226 (+21.3%)

Figure 2 – Funds Allocation to Insurance Schemes in Crores of Rupees (Times of India 5 th

February’23) (Change in % calculated by us)

There is a jump in total allocation to different insurance schemes for health. The BE for 2023-24 has
increased from 10907 to 13226 crores (2319 crores) that is a whopping 21.3% increase from
previous year (Fig2). Where does this money go? The bulk of the amount goes to private hospitals
and private insurance companies. Government data itself shows major portion of it goes to coffers
of private sector, that is private hospitals and private insurance companies.

The official data shows that 46% of empaneled hospitals under Ayushman Bharat scheme are private
hospitals, but hospital admissions in the scheme in private hospitals is 54% and we all know the
charges of private hospitals are much higher than that of the Public Health facilities. Then again, the
money ultimately goes to the insurance companies, and majority of players in Health insurance are
private companies. So, the bulk of spending for health insurance goes to the coffers of private
companies (private hospitals & insurance companies). We all know the main motive of private
hospitals and private insurance companies is to reap maximum profit. This sector cannot meet the

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health needs of people. The pandemic proved the need for strengthening the Public Health system.
The present budget shows that the revenue generated by heavy taxation of the common man is
being diverted to the private sector.

Health Infrastructure spending

Budget Head BE 2022-23 RE 2022-23 BE 2023-24

NHM 28860 28974 (+0.05%) 29085 (+0.08%)
PMABHIM 5157 2167 (-58%) 4846 (-6%)
HR for Med Ed 7500 4083 (-46%) 6500 (-13.3%)
Tertiary Care 501 327 (-34.7%) 290 (-42.1%)
PMSSY 10000 8270(-17.3%) 10200 (+2%)
Total 52017 43882 (-15.6%) 50921 (-2.4%)

Figure 3 – Allocation for Public Health Infrastructure in Crores of Rupees (Times of India 5 th
February’23) (Change in % calculated by us)

If we look at the above table (Fig3), the total outlay for Public Health infrastructure has been
reduced even in nominal terms by 1200 crores (2.4%). In real terms this will be much more, around 8
to 10% reduction. The Revised estimate for 2022-23 on these heads was less than the BE, from
52017 to 43882 crores (8135 crores), a reduction of 15.6%. This is again an unusual phenomenon if
we compare budgets of last 5 years. We do not know what will be the RE for 2023-24 and the actual
expenditure.

All the above schemes are infrastructure schemes, whose main aim is to improve the existing health
infrastructure in both rural and urban areas. NHM (National Health Mission) has two components
Urban and Rural. The main objective of the program is to strengthen Health system, Programs for
Maternal & Child Welfare, Program for control of Communicable and noncommunicable diseases. It
was expected that this head would get a major boost in this budget, but the increase is merely
0.08% in nominal term and in real terms a reduction. PM-ABHIM aims to strengthen grassroot health
institutions, creation of Wellness centers in rural areas, Integrated District Public Health Labs and
Critical Care Hospitals. There is a 6% reduction of Budget in this head.

If we compare the BE and RE of 22-23, NHM gets a small increase of 0.05%, but in all other heads
there were drastic cuts ranging from 17% to 58%. This was never seen in budgets of previous years.
We will know the RE for 23-24 only after one year.

All those concerned with Health of the country had expected huge spending in Public Health
infrastructure, learning the lessons from the last pandemic. The Health Budget has failed in giving
importance to Public Health and on the other hand has given priority to Insurance schemes which
will only benefit the Private Insurance companies and Private Hospitals.

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Health research –

The budget for health research has been slashed from 3200 crores (2022-23) to 2980 crores (2923-
24), that is by 220 crores. Health Research has once again been neglected. The finance minister
stated that the prestigious government research laboratories like ICMR will now be open to private
sector in PPP mode. Who will be benefitted by it and whose interest they will serve? Once again the
private sector will gain at the expense of the public sector and the integrity of reputed research
institutes will be at stake.

New Nursing Colleges –

The Budget 23-24 has declared to open 157 new Nursing Colleges with dedicated hospitals. This is a
welcome step, as there is shortage of 8 lakh nurses at present.

We have at present 900 Nursing Colleges, out of which 70% are private ones. The main concern of
Nursing education is the absence of dedicated hospitals, number of beds, quality education and
training, lack of faculty, low wages, long working hours, workplace violence etc. which should be
addressed.

Sickle Cell Anemia to be eradicated by 2047

This budget claims to eradicate Sickle Cell Anemia by 2047. There is no specific allocation for this
program in the budget; however, the Ministry of health has clarified that it will be covered under
NHM.

There is no mention of any specific program for eradication. Sickle cell anemia is a genetic disease
affecting mainly the tribal population and some other castes. The strategy should be screening for
the disease, creating awareness and counselling. We all know the condition of our tribes and how
they are neglected. They neither have basic facilities for livelihood nor accessible Health facilities.

The feeling of many experts is that this program will have the same fate as that of Leprosy, Filariasis,
Kala Azar, TB and Blindness prevention.

National Heath Policy 2017

The National Health Policy 2017 was enacted by the same Government as the present. Let us visit
some of the recommendations of that policy and examine how far they have been implemented in
subsequent Health Budgets.

In the section, Health Finance it says, Allocation to Health will be 2.5% of GDP by 2025. Are we
anywhere nearer to it? It was 0.37% last year and 0.31% of GDP in present budget.

The NHP 17 had envisaged elimination of Leprosy by 2018, Kala Azar by 2017, Filariasis by 2017, TB
by 2025. The years targeted have been revised now. The elimination of these diseases is a faraway
dream.

It further says out of pocket expenditure for health expenses will be reduced to 25% by 2025. Out of
pocket expenditure is the routine medicines we take on daily basis. The out-of-pocket expenditure is
55% at present as per experts in the field. There is no mention about it in the present budget.

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What experts say about the budget –

K. Sujatha, former Health Secretary says – “most boring budget as far as the health sector is
concerned. Oxfam India says – “The Union Budget has missed yet another opportunity in addressing
the growing inequality in India.” Jan Swasthya Abhiyan, an NGO in health says – “health budget falls
flat because it has completely overlooked the lessons of Covid19 and fails to allocate the much
needed in allocation for Public Health System.”

Health economist Indranil Mukhopadhyay of OP Jindal University states – “While appearing to be a

marginal increase, adjusting inflation, there is actually a decline.” K. Srinath Reddy of Public Health
Foundation states – “allocation signals health is not a priority.” Prof Arup Mitra, economist opines –
“Health allocation in budget must lay emphasis on revamping the public health care system and
technology.” Prof Amartya Sen says, “India wants to be superpower by neglecting its health and
education.”

The concerns of a panel discussion on Health Budget 23 by CHDD (Centre for Human Dignity &
Development) were same as that of ours – Health Budget as a proportion of total budget has
decreased from 2.2% to 1.97%. The spending in health is way below that was envisaged in NHP2017.
Primary care at grass root level, access to health, and equity in health not addressed in the budget.
Out of pocket expenditure for health has reached 55% which is alarming. The push for privatization
in health should be stopped.

The Headlines from Print media rings the alarm bell. “No effective rise for Health Department (The
Wire).” “No major announcements in health front.” (Financial Express) “Health continues to be on
backburner.” (Money control) “No Amritkal for health sector.” (Quint) “Stagnation of healthcare
activities.” (Telegraph India)

Stand Of Medical Service Centre – (MSC)

Medical Service centre has all along fought for Right to Health or Health for all, and condemned
encouragement of private sector in the field of health. MSC has been against insurance schemes in
Health as it cannot solve health problems of the country and has always reiterated the demand for
strengthening the Public Health System.

MSC has always demanded that Union Health Budget should be 10% of total Central Budget and
15% of total State Budget.

Conclusion –

total health budget 2023 is only 0.31% of the GDP which is much below the 2.5% of GDP envisaged
in National Health Policy 2017.

In real terms taking into consideration the rate of inflation, the total health budget is reduced by 6%
in comparison to previous year.

Allocation for health as a proportion of total budget has been decreased from 2.2 % to 1.97%.

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No importance has been given to strengthening the Public Health infrastructure, but more
importance has been given to insurance.

Our concerns on Health Budget have been corroborated by economists, health experts, health
journalists and the media.

It seems that the health budget has forgotten the lessons from the Covid 19 pandemic and the
health expectations and aspirations of the common man has been belied.

Dr S.S. Senapati

MD (Paediatrics)

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 HISTORY OF MEDICINE – A BRIEF OUTLINE
Prologue:

"History cannot give us a program for the future, but it can give us a fuller understanding of
ourselves, and of our common humanity, so that we can better face the future." 
- Robert Penn Warren
Medicine is both a science and an art. In the daily din and bustle of seeing patients, treating and
managing complications and intervening, we often tend to forget the chequered history of this noble
profession and the toil and labour that has gone behind shaping Medicine as we see it today. It is
important that we visualise the wonders of modern medicine through the lens of history. A historical
perspective could perhaps be a beacon of light to the difficult times the profession finds itself in. But
are we ready to go back in time and ponder over the glorious history of this ancient science?

The Beginnings:

The history of medicine as we know it today has its humble beginnings in the prehistoric times.
Perhaps medicine is one science that has walked hand in hand with human evolution and
civilisational advancement. There was nothing called medicine. In those times, when there was no
science and people lived in ignorance, when there was no concept of hygiene and nutrition, they
started observing – natural phenomena and events and probably formed their opinions. So anything
that could not be explained on the basis of the then existing knowledge and logic was ascribed to a
supernatural entity. As people gradually accumulated experiences and as their observations
widened – perhaps noticing the medicinal properties of some plants and herbs or watching someone
exsanguinate to death – their opinions began to change and develop bit by bit. Around 5000 BC, we
find the first evidence of trephining of the skull – a procedure that was done in those times to try to
cure someone of lunacy or a headache that would not go! Much of the practices at that time would
seem to us barbaric now. But that is how human history is!

The Dawn of Civilisation:

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With the advent of civilisation, mankind began to look for something more than just the fulfilment of
the basic needs of life. And that is when science was born. However, even then there was no
distinction between rational science and superstition. There were no doctors. There were only
priest-doctors! To cure illnesses, medicines were prescribed along with chants and incantations.
Illnesses were ascribed to the doings of ghosts. The “Diagnostic Handbook” written in Mesopotamia
prescribes a combination of these remedies to cure ailments. We have Imhotep in Egypt who was a
philosopher, author, physician, priest, magician and god – all rolled into one! The Atharvaveda in
India also has similar hymns and chants for illnesses. The discovery of the Edwin Smith papyrus is a
landmark event in decoding the history of medicine. This papyrus describes 48 cases of injuries,
fractures, wounds, dislocations and tumours in a systematic manner. This was an attempt to
approach disease through knowledge, truth and science. A dichotomy is clearly visible here. When a
disease appeared mysterious to them and could not be explained on the basis of external factors, it
was ascribed to magic and incantations would be used. In this regard, the teachings of two Indian
medicine men need to be emphasised – Charaka and Sushruta. Charaka made an honest attempt to
explain the occurrence of diseases based upon the imbalance among the three doshas – vatta, kapha
and pitta. The Charaka Samhita describes the traits of an ideal medical student. In India, the
evolution of the science of medicine is starkly different from that of grammar, astronomy and
geometry in the sense that the former is marked by a radical departure early in its journey from
magico-religious therapeutics to rational therapeutics; in the words of Charaka himself, “from daiva-
vyapashraya bhesaja to yukti-vyapashraya bhesaja.” However, physicians had to face the wrath of
the priestly class as a result of this. The respectable position which doctors enjoyed in the Rigvedic
period soon gave way to abuse and slander in the early historical period. Sushruta was a surgeon par
excellence. It is even more important to realise the contributions of surgeons to the science of
medicine. Surgeons sought to interfere with and alter the anatomical structure which was divinely
ordained and thus had to face stiffer resistance. However, the very nature of surgery made them
free, to a large extent, from the priestly bias to which physicians were not totally immune. Sushruta
laid particular emphasis on the anatomical description of bodily structures. His elaborate texts on
surgical procedures is testimony to the advances medicine was making in those times.
Medicine also developed in other regions – China and Egypt – based on herbal medicine,
acupuncture, massage and other forms of therapy. The development of the Greco-Roman civilisation
marks an important chapter in the history of medicine. Akin to Dhanvantari, Asclepius was the Greek
god to whom temples were built and patients cared for by physicians. The advent of Hippocrates –
considered to be the Father of Medicine – marks an important departure from supernatural
medicine to rational medicine. The Hippocratic Oath that is still followed to this day, was perhaps,

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the first document along with the teachings of Charaka and Sushruta, to lay emphasis on the role of
ethics in medicine. The major achievement of Hippocrates was to systematise medicine. “Disease is
not a punishment inflicted by the gods but rather the product of environmental factors, diet and
living habits”, proclaimed Hippocrates. There is no mention of a single mystical illness in the entirety
of the Hippocratic Corpus! As with Charaka, Hippocrates too, explained the occurrence of diseases
based on the theory of humourism. An able successor to Hippocrates, Galen was called the Prince of
Physicians. His teachings had such an impact that for the next 1500 years, Galen was virtually
unchallenged in medicine – like Aristotle in philosophy. Galen had to struggle a lot in his quest to
learn human anatomy. Since dissecting cadavers was prohibited, he dissected monkeys and pigs.
Galen was severely criticised by other physicians because of his radical teachings. He would cut open
a squealing pig and cut the nerves of the vocal cord proving thus that they controlled phonation!

The Middle Ages:

The significant progress made in medical science in the early periods were offset to a large extent
during the Dark Ages of the Medieval Period where not much advancements were made barring,
perhaps, the rise of medicine in the Arabic world. Paul of Aegina who lived in Constantinople is
known for writing the earliest medical books which are remarkable for their accuracy. The Arabic
world had a significant influence not only in medicine but also in the realm of science and arts.
Medicine in the Islamic world was heavily influenced by Indian, Persian, Greek, Roman and
Byzantine medical systems. Almost all of Galen’s works were translated into Arabic. In fact, Galen’s
insistence on a rational and systematic approach to medicine set up the template upon which
medicine in the Islamic world developed. Foremost among the giants in medicine during this period
was Al-Razi, also called Rhazes. He was a polymath, physician, philosopher, logician and astronomer.
He pioneered the development of ophthalmology, described the pupillary reflexes and
conceptualised psychology and psychotherapy. Al-Razi questioned the theory of humourism and laid
stress on evidence-based medicine. To pick a hospital’s location, he suggested having fresh meat
hung in various places throughout the city and to build the hospital where meat took the longest to
rot! The other important figure in medicine during this period was Ibn Sina. He summarised all
hitherto known medical knowledge in his ‘Canons of Medicine.’ He described novel concepts like
drug delivery, targeting the organ, site of action, wound healing etc. It is an irony that not much
happened during the Dark Ages in the Indian subcontinent. Although Siddha and Unani medicine
flourished in Southern India, this could not match up to the giant strides that had been made during
the early historical period.

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Renaissance and Beyond – Emergence of Modern Medicine:

The period of Renaissance brought in fresh ideas, thoughts and concepts to the world of medicine,
as it did to literature, science, humanities and different other aspects of civilisation. Mondini de Luzzi
– famously called the Restorer of Anatomy – declared that human beings are superior to all other
creatures because of their intellect, reasoning ability, tool-making abilities and upright stature.
Medicine began freeing itself from the shackles of primitive thoughts and obscurantism. The
invention of the microscope by Leeuwenhoek, the advancements in anatomy by Vesalius and the
discovery of blood circulation by Harvey heralded the march of modern medicine. Vesalius was
punished and tortured for his revolutionary achievements – he corrected more than 200 mistakes
made by Galen. Harvey turned upside the concept of circulation, placing the heart at the centre of
blood circulation. Harvey was also vocal in denouncing the evil practice of labelling women ‘witches’.
The Stormy Petrel of medicine, Paracelsus, openly criticised the teachings of Galen and Ibn Sina and
disproved their theories and declared that the ‘patients are your textbooks, the sickbed is your
study.’ This was the spirit of Renaissance which permeated society and life during those times. One
must mention the contributions of Michelangelo and Leonardo da Vinci -who described human
anatomy in extreme detail, having laboriously dissected cadavers in the face of severe opposition
from the Church. The period of Renaissance also saw the creation of medical schools. While the
Universities of Padua and Bologna were one of the earliest universities, Guy’s Hospital was built
during the Renaissance which was a major seat of medical education and teaching.
The emergence of modern medicine was complemented and supplemented by rapid and
revolutionary advancements in basic sciences. Clinical medicine immensely benefitted from these
landmark inventions and discoveries. The proposition of Cell Theory by Theodore Schwann, Koch’s
postulates by Robert Koch, Germ Theory by Louis Pasteur and the concepts of Vaccination and
Immunology put forward by Edward Jenner and Paul Ehrlich respectively changed the very dynamics
of understanding of the human body and treatment approaches. Complementing these
advancements were two landmark discoveries in the natural sciences – Theory of Evolution by
Charles Darwin and the Laws of Genetics by Gregor Mendel. These two discoveries which were
heavily attacked and criticised at that time changed our understanding of our history on this planet
once for all. The achievements of Madam Curie, who died of leukaemia while experimenting with
radioactive substances, in chemistry, opened newer vistas of application of radiation in medical
science. Clinical medicine also developed side by side. Laennec invented the stethoscope – a basic
instrument in every physician’s hand today – and that changed the paradigm of clinical examination
of a patient, especially examination of the respiratory and cardiovascular system. The concept of
handwashing, first put forward by Ignaz Semmelweis drastically reduced maternal mortality. It is a

13
matter of regret that he was ridiculed for his opinions and confined to the asylum. History is replete
with such instances when pioneers have been insulted and harassed and even put to the sword for
speaking the truth. Philippe Pinel spoke out against the inhuman practice of chaining psychiatric
patients and advocated a rational and humane approach towards such patients. Ivan Pavlov
conducted his famous experiments and pioneered the concept of conditioned and unconditioned
reflexes which helped in development of neurophysiology. Ronald Ross, in India, braved the
elements and proved that mosquitoes transmitted malaria.
William Halsted, William Osler, William Welsh and Howard Kelly were the founders of modern
clinical medicine and introduced the concept of “rounds” at Johns Hopkins Hospital which is a
routine clinical practice today. “He who studies medicine without books sails an uncharted sea, but
he who studies medicine without patients does not go to sea at all” – this aphorism by Osler stands
true to this day.
Humankind has seen several pandemics – the Black Death of the Middle Ages caused by bubonic
plague, the Spanish Flu of 1918 and the diseases unleashed by great wars. It is to Alexander Fleming,
Waksman, Subbarao and others that mankind owes a debt for the monumental discovery of
antibiotics and chemotherapeutic agents. The discovery of insulin by Banting and MacLeod saved
millions of diabetic patients from sure death. When Banting was asked to patent this great invention
of his, he simply replied, “Insulin belongs to the world, not to me.” Similarly, Jonas Salk who invented
the first polio vaccine refused to patent it saying, “…..there is no patent. Can anyone patent the
Sun?”

Ethics in Medicine:

One interesting character about whom we must know is Norman Bethune, Canadian thoracic
surgeon, inventor of surgical instruments, innovator of the first mobile blood transfusion unit in the
world, soldier in the battle against injustice and untruth, poet and pioneer of medical ethics.
Bethune advocated socialised medicine. His position on medical ethics was revolutionary.
“Medicine, as we are practising it, is a luxury trade. We are selling bread at the price of jewels…. Let
us take the profit, the private economic profit, out of medicine and purify our profession of rapacious
individualism…. Let us say to the people not ‘How much have you got?’ but ‘How best can we serve
you?’ ” Today we have reached stratospheric heights in medical practice. We are blessed to live in an
era where we can almost do anything at the drop of a hat. But what about ethics and morality in our
practice? It is apparent that medicine has also fallen victim to the dark forces of our times – all-out
commodification and corporatisation of all services and amenities. Will we be able to save our
profession from the tentacles of this vicious octopus? Perhaps this is where our knowledge and

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realisation of the history of medicine will help. It is a long and arduous history, dotted with sacrifices,
suffering and torment. We are now enjoying the fruits of other people’s labour. We don’t feel it but
it would serve us well to remind ourselves of that great legacy.

\
Conclusion:

The history of medicine is too vast and too convoluted to be covered in a single essay. It is stupid to
even contemplate doing that. This is just an outline. Each chapter in the enormous compendium of
medicine needs to be researched and discussed in detail. The contributions of Samuel Hahnemann,
Florence Nightingale and many other crusaders who tried their best to alleviate suffering and misery
of the people needs to be told in detail. There are many books to be written and many stories to be
told. It is our bounden duty to do justice to the great heritage we have inherited.

Epilogue:

“History does nothing, it ‘possesses  no immense wealth’, it ‘wages no battles’. It is man, real, living

man who does all that, who possesses and fights.”
- Karl Marx

The history of science and of medicine is the story of the struggle of mankind against the elements
aided by knowledge and wisdom accumulated through contradictions and social interactions. There
were a few who gave everything they had in order to discover the unknown for the greater benefit
of mankind. It is our turn, young doctors and physicians, to at least try to emulate a part of that
heroic struggle so that we leave behind a better society for the generations to come.

Dr Prajna Anirvan
DM (Gastroenterology)

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 # (1755-1843)

NOISE INDUCED HEARING LOSS

What is noise-induced hearing loss /NIHL?

An unwanted acoustic signal is otherwise known as noise. Noise is one of the most prevalent and
common factors responsible for hearing loss in each and every country of the world. In India
about 22.9% deafness is due to noise-induced hearing loss, also called as NIHL. It is a permanent
type of hearing loss caused by prolonged exposure to high levels of noise. The hearing
deteriorates gradually from constant noise exposure. It can, in some cases occur suddenly (a
sudden hearing loss) after exposure to very loud noise for a short duration such as an explosion
or other loud noises. In these cases, you often very clearly notice that you have lost some of your
hearing. When you have a noise-induced hearing loss (NIHL), the hair cells in your inner ear are
damaged by the exposure to noise. The hair cells’ ability to pick-up and transmit sound to the
brain is therefore reduced. Hence there will be sensorineural hearing loss which is basically of
two types. They are: temporary threshold shift (TTS) and permanent threshold shift (PTS). TTS
Improves after 16 hours whereas PTS does not improve at all (irreversible).

Permissible noise levels in India:

Prescribed noise level by Central Pollution Control Board effective from 22.2.2022 is as follows:
Residential areas – 6 am to 10 pm – 55 dBA
10 pm to 6 am – 45 dBA
Commercial areas – 6 am to 10 pm – 65 dBA
10 pm to 6 am – 55 dBA
Industrial areas - 6 am to 10 pm – 75 dBA
10 pm to 6 am – 70 dBA

Violation of above criteria warrants a fine from Rs 1000 to Rs 100000 or a jail term up to
one year. Repetition of the same offence will warrant an extra fine of Rs 5000 per day.

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Symptoms of noise-induced hearing loss

When a noise-induced hearing loss develops gradually, it is harder to perceive. Symptoms and
signs, like many other types of hearing loss, are:

• Trouble hearing what other people are saying, like people are mumbling.

• Problem in hearing children and women’s voices.

• Problem in hearing at meetings and social gatherings.

• Problems hearing in noisy surroundings, like in a restaurant or a market.

If people say that your TV is tuned up loud or say that you speak too loudly, this can also be a
sign of a noise-induced hearing loss.

A noise-induced hearing loss is often accompanied by tinnitus – a ringing, whooshing, roaring or

buzzing sounds in your ears, also more commonly known as ringing ears.

Some with a noise-induced hearing loss may also experience pain in their ears and imbalance when
exposed to noise.

What causes noise-induced hearing loss/NIHL?

Noise induced hearing loss is caused by exposure to excessively loud noise for longer periods e.g.,
in the workplace or listening to loud music at concerts or on your smart phone or it may be caused
by acute, high intensity noise such as gunshots, air horns or fireworks.

A noise-induced hearing loss usually affects both ears. In some rare cases, it can also occur in one
ear only – this is called a unilateral hearing loss. This can occur if you experience, a sudden very
loud sound close to one of your ears.

Who can get noise-induced hearing loss?

We can all get a noise-induced hearing loss. If we expose ourselves to prolonged loud sounds and
noises or experience a sudden very loud sound such as an explosion, we are at risk of getting a
noise-induced hearing loss.

People who have a noisy job are particularly at risk, especially if they work in noise for a longer
period of time and do not use hearing protection. Adults above 40 and persons with general
debility or chronic diseases are more prone.

Occupational risk…

In India, 8hrs weighted average is 90dBA which means a person Working in a factory for 8 hours

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daily for six days in a week should avoid noise level more than 90dBA which is also called as
damage risk criteria. Followings are noise levels in different industries.

1. Textile – 102-114dBA
2. Printing – 93-114dBA
3. Saw mills – 90-102dBA
4. Mining – 110-139dBA
5. Fertilizer plants – 90-102dBA
6. Metro rail – 70-111dBA
7. Air traffic – 90-112dB

Concert goers, DJs, and musicians are also at high risk. High decibel music during festivities,
in pubs and hotels do cause hearing loss. They must remember to wear earplugs or other
types of hearing protection.

Military personnel are at risk of a noise-induced hearing loss due to the explosions from grenades
and other loud noises, like from heavy vehicles.
Finally, people who use noisy tools in their leisure time and do not use hearing protection are also
at risk. Using earphones to listen to music for a longer period can be hazardous too. More so
when you go to sleep with earpieces in place. As a result, you get up with a hearing loss in the
morning which is an emergency situation.
A cross sectional study in India shows that tractor driving farmers had a higher frequency of
hearing loss compared to non-tractor driving farmers.

Prevention of noise-induced hearing loss

As discussed earlier you can prevent a noise induced hearing loss/NIHL by turning down the
volume, reducing the time you are exposed to the loud noise and/or using hearing protective
device like Earmuffs, Ear plugs, Ear canal caps etc. Besides, steps can be taken by management of
industries to maintain the machines regularly, insulate them and regulate susceptible personnel
to less high-risk areas at a periodic interval.

Compensation for NIHL

NIHL is a compensable disease under the ESI act (1948) and the workmen’s compensation act1923.
In India, it was in 1996 that the first case got compensation and about 250 workers are receiving
compensation approximately per year.

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Fig 1 – Audiogram of early Noise Induced Hearing Loss – showing typical notch at 4K Hz

How do you treat noise-induced hearing loss?

If you experience a sudden hearing loss you should contact a doctor or an ENT specialist or an
audiologist as soon as possible as the critical period of intervention varies from 24 hours to 48
hours. By doing a pure tone audiogram, an Audiologist can diagnose it by looking at the notch
from the audiogram as given in Fig 1. There is chance of improvement to some extent within one
month of the incident. Beyond that hearing loss is most often treated with the use of hearing aids
or with hearing implants such as cochlear implants if the hearing loss is very severe. In progressive
hearing loss hearing aid is the solution. It is desirable to have early diagnosis and necessary
intervention to prevent permanent hearing loss.

Symptoms like Tinnitus due to NIHL can be treated with Tinnitus retraining Therapy or Hearing aid
with Tinnitus Masker if medication fails.

What are the consequences of noise-induced hearing loss?

Just like any other type of hearing loss, NIHL can have negative effects on a person’s quality of life.
People with a Noise-induced hearing loss often have problems of following conversations in groups
or noisy places and may experience problems communicating with friends, family or colleagues in
the workplace. This may lead to avoiding social gatherings and even the loss of social contacts.
Sometimes Reeling of Head and Tinnitus associated with hearing loss can cause other psychological
problems. In a nutshell, NIHL has far reaching consequences on human body, mind and environment
as a whole.

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 N. C. Biswal
MASLP
Audiologist and Speech Pathologist

ORAL CARE IN PREGNANCY

Pregnancy is not a disease, but is a physiological state of women’s life. During pregnancy, women
become more careful and anxious about their foetus inside and take least care about their general
and oral health. The changing hormone levels in pregnancy directly affect gum health, and indirectly,
cause tooth decay. So neglected oral health care may lead to detrimental effects like premature
delivery, low birth weight baby, pre-eclampsia, gingival tissue ulcerations, pregnancy granuloma,
gingivitis, pregnancy tumours (epulis gravidarum), loose teeth, mouth dryness, and dental erosions.

Why Pregnant women are prone for gum disease?

In pregnancy, the progesterone and oestrogen levels increase in blood leading to hypervascularity of
gingiva. So gingiva becomes red and swollen and sometimes bleeding occurs too. The swollen

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gingiva favours more plaque deposition which subsequently results in pregnancy gingivitis or epulis
gravidarum, commonly known as pregnancy tumours (Fig 1) and can be seen very often. Pregnancy
gingivitis usually starts at the second month of gestation and reaches the highest level at the eighth
month, and heals spontaneously after birth with good oral hygienic practice. If it does not subside, it
may need surgical intervention. According to a WHO survey, 60 to 70% pregnant women are
affected with gingivitis. If gingivitis is untreated, gums also will be infected and the bone that
supports the teeth can be lost; it is called periodontitis. In periodontitis, the teeth will be loosened
and eventually have to be extracted. Again, periodontitis has also been associated with poor
pregnancy outcomes, including preterm birth and low birth weight. So, taking care of gum in
pregnancy is of utmost important for both mother and foetus.

fig 1

Why Pregnant women have more dental caries?

Pregnant women are more prone to dental caries, the reasons being –

1)-hormonal gingivitis,

2)- poor oral health care due to foetus stress,

3)- frequent snacking

4)- vomiting in pregnancy leads to erosion of enamel (Fig2).

So, increasing oral hygiene habits during pregnancy will help to prevent this problem. Studies show
that many pregnant women develop new cavity / dental caries during pregnancy and caries in
mother’s mouth is a source of infection to the new born. The child born to mother having dental
caries will develop more health problem and dental caries also.

fig 2

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Why oral health deteriorates in pregnancy?

 Vomiting in pregnancy is physiological but it leads to erosion of enamel and cavity

 Interest for carbohydrate food and frequent snacking
 Hormonal changes lead to gingivitis and subsequently to periodontitis
 Saliva flow reduces in pregnancy, leading to increased dental caries
 Dealing with foetus’ health, pregnant women neglect their own oral health care

How to take oral care in pregnancy?

During pregnancy period both personal and professional oral care is mandatory.

Personal care…

1- Daily two time brushing and flossing (morning and night) with fluoridated tooth paste
2- Thorough mouth rinse with warm saline after vomiting.
3- Avoid sugary snacking.
4- Avoid tea and coffee.
5- Continue prescribed vitamins by your gynaecologist
6- Visit dentist before pregnancy or in the first month of pregnancy to have thorough oral
examination

Professional care….

1- Thorough oral examination and conveying the importance of good oral health in pregnancy
2- Oral prophylaxis, if needed scaling and root planning
3- Teaching brushing technique
4- Pit fissure sealant
5- Restoration of cavity if any
6- Follow up

Conclusion

During pregnancy, oral and dental care is of utmost importance for better health of mother and
foetus as oral health is also a part of our general health. Again, poor oral health in pregnancy not
only affects the tooth or gum of mothers but also leads to serious problems like premature birth,
low birth weight infant, and pre-eclampsia. So pregnant mothers must follow some rules and
practice good oral care to protect their health and the baby’s health. Prevention is better than cure.

Dr Manoranjan Mahakur

MDS

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 HAND WASH OR HAND HYGIENE

Definition - Hand washing, also known as hand hygiene, is the act of cleaning one’s hand with the
help of soap or hand wash solution and water to remove virus/ bacteria/ microorganisms, grease,
dirt or other harmful and unwanted substances stuck to the hand.

Hand washing steps –

The World Health Organization (WHO) has published standard guidelines describing the situations or
opportunities when hand hygiene is indicated in healthcare sectors. The steps of handwashing are -

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Hand rub
Hand Rub Alcohol based (70-80% ethyl alcohol) and chlorhexidine (2-4%) based hand rubs are
available. The duration of contact has to be at least for 20-30 seconds.

Hand Wash –
Antimicrobial soaps (liquid, gel or bars) are available. If they are not available, then even ordinary
soap and water can also be used. The duration of contact has to be at least for 40 to 60 seconds.

Prevention of Diseases –

There are lot of germs in our hands and we frequently touch our mouth, nose and eyes with our
hand, and facilitate entry of the germs to our body. Germs from hands can contaminate food or
drinks, while preparing it or consuming it. They also can be transferred to other objects like mobile
phones, tabletops, handles etc. from hands. Hand wash with soap and water or hand rub with
alcohol kills these germs and prevents infection.

1) Reduces diarrheal diseases

2) Reduces Respiratory illness
3) Reduces infection of skin and eyes

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Global Handwashing Day –
It is observed on 15th October every year.

Remember the five steps –

Wet – Lather – Scrub (at least 20 seconds) – Rinse – Dry

When to Wash your hands –

- Before, during or after preparing Food
- Before and after eating Food
- After using the toilet
- After blowing your nose, coughing or sneezing

Nasim Parvez
Medical Student,
MKCG Medical College

TAKE CARE – THIS IS SUMMER TIME – PREVENT HEAT STROKE

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Prevention of heat stroke –

1) Limit outdoor time during summer – schedule outdoor activities to morning and evening
2) Wear loose fitting, lightweight, light-coloured clothes
3) Drink plenty of fluids
4) Protect against sunburn – Use umbrella, sunscreen SPF at least 15, sun glasses, hat
5) Never leave anyone in a parked car – When parked in Sun, the temperature inside car can
rise up to 20 degrees F in 10 minutes
6) Avoid Alcohol
7) Be cautious if you have increased risk
8) Take a cool shower

PRESS STATEMENT OF MSC ON HEALTH BUDGET 2023-24

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 PRESS RELEASE BY MSC
Sub: MSC ON CONTROVERSIES IN RAJASTHAN RIGHT TO HEALTH BILL 2022

Dr Bijnan K. Bera, General Secretary, Medical Service Centre, a national level socio-medical voluntary
organisation, in an appeal to the residents of Rajasthan and medicos in particular, in a statement
issued from Jaipur, said,
"Doctors as natural custodians of people's health are reaching out to the residents of Rajasthan at
large, to explain the surreptitious nature of the so-called RTH (Right to Health) Bill 2022. While
labelling Right To Health, actually it is paving way for shirking of government responsibility, opening
health sector, particularly individual practitioners and small non-corporate establishments in smaller
towns, tehsils and semi-rural areas to vandalism and arson engineered by anti-socials under cover of
any of the ruling parties in the name of demanding initiation of free emergency treatment as
becoming common in different parts of the country.
"The controversial issues in the Bill run as follows:
1] Who will determine emergency or accidental emergency in case-to-case basis, category of level of
health care offered/ permitted/ expected, and balance? [Clause 3. (c)]
2] Payment will be arranged later - a single line on state budget. [Clause 5. (b)]
What are the previous experiences, as in reimbursement of Chiranjeevi, or other insurances.
3] Elaborate arrangements for transfer (transport), insurance and treatment [Clause 3. (p) & (s)]
can only be arranged by the corporate. Hence individuals practising, and small institutions, non-
profit organisations [Clause 2.(m)] particularly in the district, tehsil and village levels will be forced to
sell out to the corporate.
4] Who will fix payments and who will ensure reimbursement with 6 monthly meetings [Clause 6.(i)
(3); [Clause 8.(1)]
5] District Health Authority is almost a non- medical body [Clause 9.(2)] which will add to the chaos.
6] Any decision by the Authorities cannot be challenged in the civil court of law. How can an act have
powers above the law of the land? [Clause 14, 15]
"MEDICAL SERVICE CENTRE on behalf of the medical fraternity and health-concerned
democratically-minded people of the country appeal to the doctors of Rajasthan to uphold the right
of people of Rajasthan to health, to actively take up the responsibility within the ambit of the
democratic movement to expose the covert nature of this Bill, lead the people to stand for the
public health system to achieve adequate manpower, infrastructure, medicines, reagents and usable
to ensure strengthening of the 3-tier healthcare system as per IPHS guidelines.
"The movement needs to concomitantly expose that with further shooting up of prices of medicine
from 1st April 2023, out-of-pocket expenditure is bound to further shoot up to make health further
inaccessible to the residents of Rajasthan as elsewhere in the country.
"Hence, the strike to make the Government of Rajasthan listen to the voice of the doctors should
exclude emergency services, and include parallel outdoors, voluntary clinics run on behalf of the
platform of movement at all cities, towns and even tehsils as doctors across the state are involved in
the movement. We have to actively take up programme to link up with the people to make the
people realise the surreptitious nature of the attack."
Circulated by
Dr. Ansuman Mitra
Secretary, MSC

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 FROM THE PRINT MEDIA

Ground Reality in Health & FW Department, Govt of Odisha

(Sambad, Dt 21/03/23)
Total Approved Filled posts Vacant posts
posts
Doctors in Health 10774 4591 6078(56.65%)
Services
Nurses in KBK 4552 2974 1578
Districts (13)
MPHS, MPHW, 2024
Statistical Asst
Medical Colleges – 290 101
Professor
Associate Professor 452 180
Assistant Professor 874 142
Tutors 164
Senior Residents 439
Junior Residents 121
Doctors on long 138
Leave

Status of Anganwadi Centers in Odisha (Sambad, Dt 3/4/23)

Anganwadi is the focal point for implementation of health, nutrition and early learning of all children
below 6 years in rural areas. They do also cover Health education, nutrition and immunization of
expectant and nursing mothers. NEP 2020 further aims to shift pre-school and primary education to
Anganwadis. What is the status of these Anganwadis?

Villages without Anganwadi Centers – 19%

Centers without Bathroom – 81%

Centers without safe water – 71.47%

Centers without own Building – 12.74%

Centers without kitchen – 31.19%

Rampant irregularity in supply of ration food items.

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 FROM PAGES OF JOURNALS

USE AGE, NOT WEIGHT TO SCREEN FOR DIABETES - American Journal of Preventive Medicine
(Matthew J. OBrien, et al. Screening for prediabetes and diabetes: clinical performance and
implications for health equity. Am J Prev Med. Published online March 24, 2023.
DOI:  https://doi.org/10.1016/j.amepre.2023.01.007

The paper published in the journal American Journal of Preventive Medicine advises universal
screening for prediabetes and diabetes of all adults in the age group 35 to 70 years old, regardless of
weight or BMI (Body Mass Index).

So, the recommendation is all adults of the age group 35 to 70 years old should undergo diabetes
screening test at regular intervals, which will help in detection of early diabetes and will not miss
cases where diabetes is present even though BMI is normal.

Walking 8000 to 10000 steps even twice a week reduces mortality – JAMA (Inoue K, Tsugawa Y,
Mayeda ER, Ritz B. Association of Daily Step Patterns With Mortality in US Adults. JAMA Netw Open.
2023;6(3): e235174. doi:10.1001/jamanetworkopen.2023.5174)

It is difficult for many adults to do regular exercise. This study shows, walking for even a couple of
days in a week provide meaningful benefits to adults. This was a cohort follow up study for 10 years
from USA. The study shows, persons who walked 8000 to 10000 steps even twice a week
significantly reduced their risks for all cause and cardio-vascular mortality within 10 years.

WHO – Strategic Advisory Group of Experts on Immunization (SAGE) recommendation for Booster
dose of Covid19 vaccine

SAGE recommends booster dose of Covid19 vaccine only for high priority group of adults, 6 to 12
months after the last dose of the vaccine.

High Priority group includes adults with comorbid conditions (for example diabetes and heart
disease), people with immune-compromising conditions (for example HIV or organ transplant
recipients), and frontline healthcare workers.

Air Pollution is a risk factor for Dementia: a meta-analysis – BMJ (Wilker  E

H,  Osman  M,  Weisskopf  M G.  Ambient air pollution and clinical dementia: systematic review and
meta-analysis BMJ    2023; 381: e071620  doi:10.1136/bmj-2022-071620)

This meta-analysis was based on 14 studies. They found association of dementia with the air
pollutants like particulate matter and nitrogen oxide, and no association was found with ozone.

“The findings support the public health importance of limiting exposure to PM2.5 and other
pollutants and provides a best estimate of effect for use in burden of disease and policy
deliberations” – the authors write.

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