Hospitals may examine Patients for HIV/AIDS without Permission
This is terrible! I cannot believe clinics and doctors are allowed to do this especially as there seems to be no scientific rationale behind the argument.
The clinics suggest that blanket testing for HIV prevents health care workers from getting infected. Surely, health care workers should probably be aware of HIV transmission pathways which includes transmission by infected blood, unprotected sexual intercourse,mother-to-child either by breast feeding or during delivery. Which of these are these clinics worried about?
If you are really worried about infected needle stick injury, that could happen accidentally when you are taking a blood sample. So, you have to take precautions anyway prior to the HIV test result being known. Existing standards in clinical practice expect medical workers to take precautions to reduce needle stick injury or contamination with blood products as routine.
There are rather obvious confidentiality issues and patient rights that are being violated and while the article mentions these issues, the article fails to highlight the poor clinical standards that forms the basis of this policy and the possibility of a dangerous,covert problem of discrimination.
1. If clinics are having to test patients for HIV to avoid infection of their workers, this could only happen if current practices preventing HIV transmission do not exist in these clinics. This is even more worrisome especially if private clinics charging patients exorbitant fees and claiming the best current medical practice are presently not enforcing simple,cheap HIV and infected blood transmission prevention measures.
2. Clinics believe they need to take special precautions if a person is HIV+. This is on the slippery slope to overt discrimination. Where would these special precautions end? Would private clinics treat HIV+ patients differently? Could private clinics refuse treatment to patients who are HIV+? Would clinics be allowed to test for any disease? See this story about HIV discrimination by hospitals.
The entire idea of having universal precautions against infected blood precautions is to avoid this sort of discrimination. Although we know that such discrimination exists, health workers must lead the fight to abolish such discrimination not reinforce it by such ludicrous policy.
Of course, the article does not tell us who has legislated this policy, who ratified it, where it is applicable. But, even if such a policy does not exist, the very thought of such a policy should make us shudder.
Showing posts with label India. Show all posts
Showing posts with label India. Show all posts
Monday, September 24
Wednesday, August 15
Avahan Interview HIV in India
Health Affairs Blog
This is a very interesting interview of perhaps India's best funded AIDS program. Ashok Alexander was a McKinsey consultant and now has become involved in NGO work. I was quite interested in reading his views about the epidemic and prevention.
The first question about prevalence estimates of HIV is very interesting because the Indian authorities have consistently argued that the WHO estimates have been inflated and wrong. I must admit that that I did not believe the Indian figures as I never trust the Indian government, but they seem to have come out on the right side of this argument and have found that the numbers are much reduced.
As an aside, there are some seriously weird people in the world. When this preliminary report based on the national Family Household survey was made public there were some civil society interest groups who believed this was a conspiracy between pharma companies and the Indian government to allow pharma companies to patent drugs and reduce the Indian government's spending on AIDS drugs. Here is their point of view and all I can say is considering what happened to Novartis quite recently I cannot see how these intelligent, educated people can make such absurd accusations.
I digress. Returning to this interview, the other interesting observation that Mr.Alexander makes regards the apparent North-South divide regarding HIV prevalence. The southern states have much higher HIV prevalence and he attributes this to greater economic development which leads to increased migration to these states, more slums, sex workers and human mobility. I think thats an interesting argument although I would also argue that your data from the Northern states are probably not very accurate and better education in the south would probably lead to better reporting and surveillance.
He also states "I would go so far as to say India has one of the most balanced and holistic national programs. Now one the biggest challenge is to implement it at scale and with quality. That remains to be done."
The greatest stumbling block in India's public health system is size and therefore I think we are looking at a difficult task in trying to scale up the problem. Take some basic health system indicators and you will realise the problem. USA has 730,000 physicians at a density of 2.65/1000 people while India has 645,000 at a density of 0.6/1000 while China has over 1 million physicians at a density of 1.06/1000. My point is that almost 90% of our doctors are concentrated in the urban areas so in essence you are probably only getting about 1 doctor per 10,000 people in the rural area and thats a conservative estimate. So, there is almost no way you are going to be able to reach the required people simply by using the already existing health set up. It is arguable that you do nor really require physicians for behavioural interventions. I agree and would be even more worried if you look at the numbers of health workers the government has recorded. It is close to 82 for every 10,000 people. This number is almost too small to be able to control, undertake surveillance,educate and implement a health program.
I would argue the way to manage our health system is in effect to break in down into local systems. Alexander alludes to this in the interview indicating the reason why Avahan's prevention program has been so successful. He gives two reasons - community participation and a "basic common policy" which is adapted at the local level. If we are to push our prevention programs forward and scale it up to the national level, perhaps we should try and break every metropolis into smaller sections each having its own unique millieu, issues and social dynamics that need to be understood, leveraged and encompassed for the success of the program. Similarly, the same needs to be done in towns and districts.
I wonder how it is going to happen. If I were the GOI I would look at two national programs to learn my lessons. The polio eradication program which was a massive success and the national malaria eradication program which was a failure before embarking on another and I would argue even more important national health program. The strategy should encourage community participation and build a bottom-up approach.
This is a very interesting interview of perhaps India's best funded AIDS program. Ashok Alexander was a McKinsey consultant and now has become involved in NGO work. I was quite interested in reading his views about the epidemic and prevention.
The first question about prevalence estimates of HIV is very interesting because the Indian authorities have consistently argued that the WHO estimates have been inflated and wrong. I must admit that that I did not believe the Indian figures as I never trust the Indian government, but they seem to have come out on the right side of this argument and have found that the numbers are much reduced.
As an aside, there are some seriously weird people in the world. When this preliminary report based on the national Family Household survey was made public there were some civil society interest groups who believed this was a conspiracy between pharma companies and the Indian government to allow pharma companies to patent drugs and reduce the Indian government's spending on AIDS drugs. Here is their point of view and all I can say is considering what happened to Novartis quite recently I cannot see how these intelligent, educated people can make such absurd accusations.
I digress. Returning to this interview, the other interesting observation that Mr.Alexander makes regards the apparent North-South divide regarding HIV prevalence. The southern states have much higher HIV prevalence and he attributes this to greater economic development which leads to increased migration to these states, more slums, sex workers and human mobility. I think thats an interesting argument although I would also argue that your data from the Northern states are probably not very accurate and better education in the south would probably lead to better reporting and surveillance.
He also states "I would go so far as to say India has one of the most balanced and holistic national programs. Now one the biggest challenge is to implement it at scale and with quality. That remains to be done."
The greatest stumbling block in India's public health system is size and therefore I think we are looking at a difficult task in trying to scale up the problem. Take some basic health system indicators and you will realise the problem. USA has 730,000 physicians at a density of 2.65/1000 people while India has 645,000 at a density of 0.6/1000 while China has over 1 million physicians at a density of 1.06/1000. My point is that almost 90% of our doctors are concentrated in the urban areas so in essence you are probably only getting about 1 doctor per 10,000 people in the rural area and thats a conservative estimate. So, there is almost no way you are going to be able to reach the required people simply by using the already existing health set up. It is arguable that you do nor really require physicians for behavioural interventions. I agree and would be even more worried if you look at the numbers of health workers the government has recorded. It is close to 82 for every 10,000 people. This number is almost too small to be able to control, undertake surveillance,educate and implement a health program.
I would argue the way to manage our health system is in effect to break in down into local systems. Alexander alludes to this in the interview indicating the reason why Avahan's prevention program has been so successful. He gives two reasons - community participation and a "basic common policy" which is adapted at the local level. If we are to push our prevention programs forward and scale it up to the national level, perhaps we should try and break every metropolis into smaller sections each having its own unique millieu, issues and social dynamics that need to be understood, leveraged and encompassed for the success of the program. Similarly, the same needs to be done in towns and districts.
I wonder how it is going to happen. If I were the GOI I would look at two national programs to learn my lessons. The polio eradication program which was a massive success and the national malaria eradication program which was a failure before embarking on another and I would argue even more important national health program. The strategy should encourage community participation and build a bottom-up approach.
Thursday, June 14
India awarded Formula One race for 2009 | Reuters.com
India awarded Formula One race for 2009 | Reuters.com
I cannot believe it! Suresh Kalmadi has been able to sell India as a Formula 1 destination. I am very impressed, though I wonder where they are going to hold it?
There were talks a year or two ago coinciding with Narain's peek into F1 about a street race in Delhi or a F1 circuit in Bangalore. Street race in Delhi..you cannot be serious? Where?
Michelin will have a serious problem trying to design super-resistant pothole friendly tires while the engineers will be stuck with trying to figure out how to get downforce around roundabouts!!
Delhi traffic is a race in itself,with no quarter given and numerous obstacles to test your reflexes,the car's braking power and torque. Everyone waits for the lights to go and the race begins - people walking across the Ring Road tests your machine's braking power with cars slowing down in 3 seconds from 100kph to 30kph, evasive maneuvering to avoid the auto on one side and the truck on the other while making sure the car trying to overtake you does not get through and finally of course that much vaunted acceleration into a corner as you just make the crossing with the signal on amber!
So, I wonder where we are going to have a F1 race. I suspect this might also be good news for Narain as it might be difficult to muster a crowd without a local driver to attract some jingoistic spectators and add some excitement to the proceedings. Either way, I probably wont get to see it, so why am I complaining.
Good luck to those who deal with Delhi Transport Authority!!
I cannot believe it! Suresh Kalmadi has been able to sell India as a Formula 1 destination. I am very impressed, though I wonder where they are going to hold it?
There were talks a year or two ago coinciding with Narain's peek into F1 about a street race in Delhi or a F1 circuit in Bangalore. Street race in Delhi..you cannot be serious? Where?
Michelin will have a serious problem trying to design super-resistant pothole friendly tires while the engineers will be stuck with trying to figure out how to get downforce around roundabouts!!
Delhi traffic is a race in itself,with no quarter given and numerous obstacles to test your reflexes,the car's braking power and torque. Everyone waits for the lights to go and the race begins - people walking across the Ring Road tests your machine's braking power with cars slowing down in 3 seconds from 100kph to 30kph, evasive maneuvering to avoid the auto on one side and the truck on the other while making sure the car trying to overtake you does not get through and finally of course that much vaunted acceleration into a corner as you just make the crossing with the signal on amber!
So, I wonder where we are going to have a F1 race. I suspect this might also be good news for Narain as it might be difficult to muster a crowd without a local driver to attract some jingoistic spectators and add some excitement to the proceedings. Either way, I probably wont get to see it, so why am I complaining.
Good luck to those who deal with Delhi Transport Authority!!
Monday, May 28
Surely, this is not in Noida!?
Check this link out and please tell me where in Noida I can be captivated by this scene.
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