Ajay had always considered himself oddly temperamental. For months, however, he had been noticing a strange phenomenon – he would experience bouts of boundless euphoria, as if everything within and beyond his reach was conquerable, followed by deep, acrid sorrow. Trapped in this vicious cycle, he talked to his mother – and was told, rather hysterically, that he was ‘not insane’, and that ‘no girl would want a mad husband’. Ajay didn’t get help, and reached a stage where he didn’t need it anymore. He committed suicide.
People and cases like Ajay’s abound frequently – almost ubiquitously, as the psychologists would have us believe. As ubiquitously as the stigma that comes pre-packaged with mental illness. In his seminal work, Madness and Civilisation: History of Insanity in the Age of Reason, Michel Foucault argues, amongst other things, that madness as culturally conceived, is a construct. It is the culture, Foucault argues, that determines what is normal (and inversely, what is not), what is adaptive, what is sanity, and thence, what is ‘madness’. It is culture, also, that ascribes to ‘maladaptive’ behaviour the baggage of ‘madness’.
Without picking on a specific geographical slice, madness isn’t just cultural – madness is taboo. As a form of taboo, madness develops with other modicums of cultural conformity – that is to say, basically, that the construct of madness, as well as its suffused stigma, are but underpinnings to generate normative conformity to the society. Madness, then, is almost pestilential – its mention egregious, its exhibition worthy of social punishment. This becomes problematic when an individual is afflicted with mental illness – ranging from an anxiety disorder to something as socially outrageous as schizophrenia. The individual realises that something is wrong, and wants help – stuck, however, in his milieu, ‘help’ is a distant idea.
What shapes the individual’s concern, problematically, is the gamut of schemas associated with ‘madness’ – mental illness is associated with ‘madness’ and ‘insanity’, attempts are made to repress all anxiety-provoking cognitive mention, and help is avoided like a leper – for how would, as Ajay’s mother articulated, the society see a ‘mad person’? Who would, especially in the context of a marriage-focused, collectivistic society such as ours, marry a ‘mad’ person? Not to exclude, also, is the systematic trivialisation of mental illness – that begins as harmless mockery such as calling someone ‘retarded’, and punctuates to generally sorrowful people calling themselves ‘depressed’. These are, as most do not realise, terms of immense medical and etymological seriousness. In a cultural milieu of their often trivial overuse, much is culled from the veracity of the disorder.
Why is this worrisome? We are, without underplaying it, in a great time for the psychological sciences. It is believed, in fact, that the twenty first century belongs to these ‘young’ sciences – particularly psychology. Massive, magnificent strides have been made into the field, and a variety of therapy models are being developed for individuals of different sensibilities. The science, however, seems to be feeding into deaf ears – as cultural stigma keeps the afflicted away from what is now available, and more importantly, accessible.
As we look around, we also look forward. Organisations geared towards this regard seem to be mushrooming, and for the better. Steeped in the awareness that ‘madness’ and ‘insanity’ are terms too culturally problematic to be retained, these call, as is the need of the hour, for treating mental illness with the ease rendered to physical illness. For the time being, one can only hope.
What does it truly mean to be mad? Not in the colloquial way we ask – ‘are you mad!?’ Or throw around ‘paagal ladki!‘, but be truly stark raving crazy?
Well, there are levels to that question. Before I even begin to look at them, I’d like you to try out something. I want you to hear this word in your head as you read it: MAD! What are the ideas, images, words that come up when you hear that word in your head? MAD. Mentally ill. Mental illness. I’m not even starting off on separate diagnoses. Just these words, then – Mad. Mental. Paagal. Crazy. Insane.
I’m sure there are very graphic images floating around in your head right now. I’d like you to just make a note of them. These symptoms, if you will, of madness.
We’ll come back to this in a bit though.
Again I ask, what does it mean, to be mad?
By law, it means that you cannot do many things – sign a document, own property, get married, for instance. Socially as well, it means that you need to hide it, you are not understood, it means you need to be kept away ‘for your own good’, that your opinions regarding your own treatment aren’t considered as options, you’ve got no say in where or how you live, I could go on. But why? Why is there so much fear surrounding the idea of madness? The need to segregate? Where does it come from?
Let us go back to the list we made earlier. In my experience, most people picture torn clothes, incoherent ramblings, poor personal hygiene, unkempt hair, screaming, angry, violent people, in the lists. This is what we know from TV, and stories and other such sources.
But the thing is, mental illness isn’t usually accompanied by physical signs/warnings, so many people just cannot comprehend what’s going on, and usually feel that since there’s nothing physically wrong with the person, there’s probably nothing wrong. They’re throwing tantrums, being difficult, being stubborn.
Today, we at The Red Door, in collaboration with Youth Ki Awaaz would like to challenge your notions on mental illness. We will be bombarding you with different stories across two weeks that we hope will challenge the existing images you associate with mental illness. I challenge you to keep your list, the one you just made. I’d like to invite you to follow our posts for the next 14 days. I invite you to make a new list in two weeks.
And I hope, by the end of two weeks when you hear those words, the ‘bad MAD’ words, the list will contain more positive and inclusive words for you.
How many of us know that 16th October is ‘World Food Day’? World Food Day is celebrated around the world that day, because it coincides with the establishment of the Food and Agricultural Organization (FAO). It is a day when people get together to declare their commitment to hunger in our lifetime. Hunger not only makes one suffer, it also affects health severely. The statistics of hunger are staggering and shocking. One in nine people on earth is currently under-nourished. Here are ten facts about hunger that you should be aware of:
1. There are currently 795 million people hungry people on earth. India itself is home to the largest under-nourished and hungry population, with 195 million people going hungry every day.
2. Close to 165 million children are stunted as a result of under-nutrition and infection, leaving them physically and intellectually weak. According to the United Nations Children’s Fund, 24 countries with the highest levels of stunted children are concentrated in Sub-Saharan Africa and South Asia alone.
3. Nearly half of all deaths in children under age 5 are attributable to under-nutrition. This translates into an unnecessary loss of about 3 million young lives a year. In India itself, 3,000 children die every day due to malnutrition. Malnutrition also increases a child’s risk of dying from many diseases – most prominently measles, pneumonia and diarrhoea.
4. Around half of all pregnant women in developing countries are anemic, because they lack access to iron-rich foods. Anemia is responsible for causing 110 deaths during childbirth every year.
5. Though women make up a little over half of the world’s population, they account for 60% of the world’s hungry. In India, the nutrition of children is particularly worse because of the state of their mothers. 36 percent of Indian women are chronically under-nourished, from their childhood itself. This can be attributed to the fact that girl children are less wanted in a patriarchal society, where men receive food before women. Data from Bihar and Madhya Pradesh shows that girls represent up to 68 per cent of the children admitted to programmes for the severely malnourished.
6. To prevent hunger, a child needs to be taken care of the most during the first 1,000 days of its life, from pregnancy to age two. According to the World Food Programme, a proper diet during this period can protect children from mental and physical stunting that can result from malnutrition.
7. It costs just $0.25 (INR 16) per day to provide a child all the vitamins and nutrients he/she requires to grow healthy.
8. According to the International Food Policy Research Institute (IFPRI), climate change and erratic weather patterns will push another 24 million children into hunger in the future.
9. There is enough food to feed everyone in the world. If total world food supplies are divided equally – all food grown divided into equal portions – there will be plenty for everyone, with some to spare; in fact, today the world produces 10 percent more food than is needed to feed everyone. But 30% to 50% of 1.2-2 billion tonnes of food produced around the world never makes it to a plate, and gets wasted.
10. Two types of acute malnutrition are wasting (also called marasmus) or nutritional oedema (also known as kwashiorkor). Wasting is characterised by rapid weight loss and can also lead to death.
Eradicating hunger is one of the key Sustainable Development Goals for 2015, and the target is to end hunger by 2030 and ensure food access to all parts of the population. Organizations like UNICEF are helping countries by supplying them with essential micronutrients like iron and Vitamin A which is essential for a healthy immune system. Organizations like Feeding India too are channeling excess food from individuals, corporates, weddings and restaurants to the ones in need. What we call food wastage can be converted into food security for others. Awareness about malnutrition is necessary to tackle this problem and help the world reach its target of reducing world hunger by fifty percent.
“Vaccines cause autism.” “Immunization makes you infertile.” “Vaccination is a part of America’s conspiracy to reduce Muslim population“. “Immunization was made mandatory so that multinational companies can make more profit.”
Diphtheria is a vaccine-preventable disease that was brought under control in India by introducing DPT vaccine in the immunisation program in 1985. However, Kerala has been experiencing a relapse of for a few years now. In 2008 alone, more than 12 cases were reported from Malappuram (1). Recently, two children died of Diphtheria, and more than five have been infected; all of them residents of the same hostel. According to reports, a considerable number of people are at risk.
Even individuals who have received vaccination bear the risk of harbouring bacteria in their body without showing any symptoms (carrier state). Thus, there is a high risk that a major epidemic may break out in this area. Moreover, medicine for Diphtheria is hard to procure as most of the pharmaceutical companies no longer produce this. One doesn’t have to look far for the reasons behind this sorry state of affairs. Any health worker in Malappuram and Calicut would say that the problem is not lack of availability of vaccines or doctors but that a large number of people here reject immunisation.
By the latest official count, out of 3,55,279 children below the age of five, 4,729 had not taken any kind of vaccination. If children between five and ten years of age are counted, the statistics get even scarier. One out of three children growing up here is vulnerable to a large number of diseases ranging from tuberculosis, whooping cough, polio to measles. It may seem like an irony that this is happening in a state where there is a large number of health centres, doctors and, a high literacy rate. The children, here, are being kept away from immunisation by their parents and guardians based on false beliefs.
The Danger Of False Knowledge
The belief that immunisation causes health problems has become the major reason for the rejection of immunisation. The growing number of quacks and self-proclaimed doctors in the state has not helped matters either. Most of the people in Mallapuram have no access to accurate information about vaccination. A large number of people believe in the tall claims made by pseudo-doctors. Posts claiming that vaccines against already eradicated diseases are a part of the Government’s policy to help multinational companies, and that immunisation causes sterility have been making rounds on social media for a few years now. Some eminent newspapers even published news about vaccinations crippling children even though doctors and scientific journals emphasize that the risks of immunization are negligible, and that the problems are being exaggerated. Since, most people lack scientific knowledge about these topics, they often fall prey to sugar coated lies. The number of times these messages have been circulated on social media stand testimony to this.
Moreover, a few locally powerful religious groups have been urging its followers to forego immunisation. Similar opposition was also meted out against the rubella vaccination initiative, which aimed at protecting all teenage girls from rubella. Almost all health initiatives including iron and folic acid supplementation and vaccination against elephantiasis were looked upon with suspicion.
Why Are People Believing These Falsities?
The cause of the problem seems to be that people are losing faith in the health initiatives of the Government. Moreover, many are falling prey to the selfish motives behind propaganda. Lack of widespread awareness programs in the state has made the problem worse. Many private hospitals promote ‘glamour vaccines’ that are costly and not needed in Indian health scenario. These include vaccines for rare diseases that children have little chance of contracting. Another contributory problem has been the lack of vaccines in many hospitals. Due to the closure of Pasteur Institute in Koonor and Central Research Institute in Kasauli, vaccine scarcity can turn into a disaster.
How To Battle This Problem?
Even though the Government sprung into action after the Diphtheria deaths, health workers are finding it difficult to battle the stubborn mindsets of people. Recommendations have been put forth to make immunization mandatory for school admissions, insurance schemes, etc. and to incorporate Diphtheria vaccine along with tetanus vaccine. Task forces have been set up to vaccinate all the children at risk.
However, none of this is possible unless the orthodox mindset of people is given up. The problem here is not the lack of facilities, but the lack of awareness and the spread of false knowledge. Hence, the first step should be the creation of a health force that will be able to operate at the grass root level with full cooperation from the people. Other steps like availability of all vaccines should also be taken.
Though the adage, prevention is better than cure, is one of the first things medical students learn, this is not upheld in real life. It seems that we have to wait until the problem becomes complicated and serious to start looking for a solution. Proper vaccination coverage is the first step towards the dream of ‘health for all’ which is the third Sustainable Development Goal. Vaccines prevent diseases, cut health care costs and ensure the well-being of the entire nation. As William Foege said, they are the tugboats of preventive health. We should never let false knowledge and ignorance sink them.
(1): T, Dr. Jayakirshna. Diphtheria Thirichuvarunnu. Mathrubhumi Arogya Masika- September 2008 edition.
At SocialCops, our mission is to solve the world’s most pressing problems using data. On the World Mental Health Day, we are taking one more tiny step towards our mission.
Today, we’re announcing a partnership with The Live Love Laugh Foundation, the non-profit founded by Deepika Padukone to focus on mental health to open data about mental healthcare professionals and institutions in India – so people who need help can find it, at the click of a button.
A simple searchable interface and map, a mental health seeker just needs to type in their location and the map around them will get populated with therapists around them. At SocialCops, this is a small step towards leveraging our open data platform to help solve problems that matter.
Awareness about mental illness in India is limited and the country is going through a silent crisis that needs immediate attention. Even today, people go to temples and dargas to get rid of the ‘evil’ that has ‘possessed’ an individual because of which they behave in a strange way, believe many. Last year, a journalist friend, narrated to me a story that he witnessed, where his cousin, suffering from a mental illness, was taken to a Sadhu. He was instantly cured when the Sadhu thumped him on the back. This incident took place in the middle of the night, when nobody was there to witness the spectacle.
The conversation around mental health in India gets buried into dark corners in the hope that it will go unnoticed and cure itself.
In an effort to change this some hospitals and mental health organisations have started helplines to provide an open medium for individuals who would otherwise feel ashamed or scared to talk about their disease.
1. National Institute of Behavioural Institutions, West Bengal: 09836401234
Obsessive Compulsive Disorder, commonly known as OCD, is a potentially disabling illness that traps people in endless cycles of repetitive thoughts and behaviours. In the United States, 1 in 100 children has OCD or OCD-like symptoms. There are many myths surrounding the disorder. Some people believe that excessive stress leads to it, and even family dynamics may be a cause of it.
Parents often dismiss it as a ‘habit problem‘, when the symptoms are first visible in children. Two common symptoms are obsessions and compulsions. According to the International OCD Foundation (IOCDF), obsessions are thoughts, images or impulses that occur again and again and feel outside the person’s control. Individuals with these thoughts find them disturbing. It is accompanied by intense and uncomfortable feelings such as fear, disgust, doubt or a feeling that things have to be done in a way that is ‘just right’.
This disorder can affect any person at any stage of their life. It is necessary to take the symptoms into account and provide medical care to the person afflicted with it. It is curable, it is not a sign of mental instability. Disorders like these go unnoticed many times because awareness levels are low, but it is necessary to abort the stigma and help the person.
Note: Anxiety is caused by an overreactive my with repeating thoughts that are fearful. Betsy, who suffered from anxiety disorder at first tried to avoid facing the true causes of her problem and chose to suppress her feelings with medication and alcohol which only made matters worse. It took her a while to realise that she was harming herself, but once she did, she took the following steps to heal herself.
Once I decided to work with it and not run away from it, I worked diligently on healing my anxiety using alternative therapies, which took six months to heal completely.
Key Things I Did To Heal My Anxiety
1. I stopped taking any mind-altering substances, including medical pills and recreational drugs and alcohol. All these substances dulled my awareness level and suppressed thoughts and emotions, which did not allow me to find the underlying cause. To heal the cause I had to allow my reactions to surface, so I could see them and question them.
2. I became open to grace and reception of help from a higher power for guidance and strength. I prayed every day, asked for help, and kept my eyes open looking for any clue, sign, helper, or book that could give me information to help me heal. I acted on things that came my way, trusting I was being guided and helped.
3. I meditated two or more times each day, not missing any days. Over time, I gained skills in self-observation being able to detect my thoughts and emotions and became skilled at monitoring them as they appeared. I felt this was the most important thing I did. Because I understood that to go beyond a programmed response, I must be able to see it. With meditation, my awareness gradually increased and then I could see what situations triggered strong reactions and what thoughts I had that preceded it. Then I understood that I could drop the repetitive thought-train by taking my focus out of thinking and this by itself would then stop the anxiety reaction from every manifesting.
4. Instead of running away from myself, I did an about-face and started to look within to find out Who I was. It was about getting brutally honest with myself and having the courage to see myself clearly and find out the truth about myself. In general, this is called “self-inquiry” and I did it as much as possible. I kept asking questions about reactions I saw inside myself and about how other people reacted to my self-expression. With this, I was looking for the cause of my behaviors and was gaining self-knowledge. Self-inquiry is about using our left and right brain. Both brains are needed and the more we use them as a pair the better. This is not a reactive use of the mind but rather a decision to wield it. With our left-brain we use logical analysis to review memories, experiences and things we have observed — we go through our history and memory banks. This process makes it visible and we can move these symbols around and look at things from different angles.
From this process, I gained self-knowledge that was essential to heal my programmed reactions. For example, self-inquiry started when I observed I had anxiety and asked the question: “Why am I anxious?” Then I investigated that question step-by-step with further observation and inquiry to get more answers. A finer question arose observing when I ate in a restaurant I could barely eat feeling I might choke but when I was at home with nobody around I had no anxious reaction at all. This was a dichotomy raising an essential question: “Why did I react in public but not at home?” Those kinds of questions eventually led to gaining knowledge about how this reaction was triggered and how it happened. After I had a reaction, I would review my thoughts leading up to it and get insight about how the anxiety reaction itself happened. I kept doing this, until eventually I saw how the entire thing manifested and it became clear that I was creating the anxiety. It had nothing to do with the outside world or other people or situations ‘causing it’ as I first thought, the reality was I was the cause. Once I could see that, then I had the ability to choose my next reaction.
5. I learned to feel tension and emotions in my body by doing body scans often. Instead of escaping from unpleasant emotions, I learned to feel them and took responsibility for them realizing that I created them and other people did not cause me to react in fearful, angry or anxious ways. I often scanned my body during the day for muscle tension and consciously would relax these muscles. I would keep especially close tabs when I felt a strong emotion was triggered. When emotional charge builds in the body it causes strong tension. We habitually clench and tighten certain muscles when we feel stressed. When I found those areas, I would consciously relax them. By doing this action, we take focus out of our thoughts, which is the cause of the building tension, and we can diffuse the entire reaction. Besides conscious relaxation of muscles, I would also use massage, exercise or baths to help release body tension. By doing this often, I prevented my personality from getting highly charged and reactive. I found once my personality was highly charged and I had a panic attack, then it could take many days to relax that state. A more advanced technique is to recognize anytime one is triggered with a strong emotion of any kind and then just be one with that emotion by feeling it in the body wherever it is without judging it or analyzing it in any way.
6. I quit running away from things I feared, once I became aware of one then I would face it and move through it. I found I had to confront things that triggered strong fear. Avoiding my fears only reinforced my anxiety and I ended up becoming afraid of more things. This is known as exposure therapy, learning to face what you are afraid of and learning how to go through it, stay calm inside and not react. Once I faced a big fear and got through it without having a panic attack, this empowered me and I realized I could do it and did not need to run anymore.
7. One of my key revelations was that I valued other peoples’ opinion of myself more than my own and I was hypersensitive on how others viewed me. When I walked into a room, I always felt like everyone in the room was looking at me and judging me. One of my most valued properties of my self-image was my intelligence and the thing I feared the most was people thinking I was crazy or that I was wrong. So that is why the panic attack was so threatening to me, if I were to have one in public then people would see that there was something wrong with me and think that I was crazy. I also had an extreme fear of failure and avoided taking risks.
You cannot see the daily changes so much but you will be able to see them on a weekly or monthly basis. The best part is this way will cure the problem, because you will discover the cause and realize you do have the power to go beyond your old program and drop it.
Editor’s note: This article is the third of a three-part series on Betsy’s journey of dealing with anxiety disorder. Part I talks of coming to terms with her problem, Part II discusses her insights on the problem and how one can stop a panic attack.
Anxiety is caused by an overactive mind with repeating thoughts that are fearful. Whatever thoughts we think, generate feelings as an energetic charge in the body muscles. With anxiety, we are fearful or worry about the future or what will happen and then our body muscles charge with adrenaline to prepare us for ‘flight’. But there is no real threatening situation in reality, so we do not run which would discharge the adrenaline. With repeated thoughts like this over time, we stay in a highly charged anxious state. The strong fear vibration in our body is physical and this feeling in turn generates more thoughts that are fearful. With anxiety, we are caught in a circle of fearful thoughts, which keeps the body highly charged with adrenaline, and it is hard to stop it or turn it off once we are in the circular trap.
Anxiety is a learned pattern of thinking and emotionally reacting, and comes from the survival strategy we adopted when we were young as a means to protect ourselves from harm in our environment. All mental health disorders with different labels are survival strategies of the same nature, being a combined cognitive and emotional response programming. In reality, everyone who has not healed their survival strategy has a suppressed mental health disorder, which is the pattern itself. This pattern is learned in our earliest years and exists in our subconscious mind as a programmed response that plays automatically when we feel threatened in life situations. This pattern is valuable for us until the point comes when we need to let it go so we can take another step in our evolution.
When we become aware of ‘our old pattern of thinking and emoting’ as being problematic for functioning in our daily life, this is a positive thing! We are being shown a hidden program from our subconscious mind and now that we are aware of it and can see it, the next is we can now do something to remove this old programming, as we no longer need it. With successful erasure of this program, we will be more spontaneous and our awareness will jump to a higher level. So the truth is everyone whom is not awakened is crazy because of this hidden response happening, but it is within societal accepted standards until it blows up with higher energy and one gets the diagnosis of having a mental health problem. But once you see directly that this programmed response is indeed ‘craziness’, that is your first moment of true sanity!
How To Stop A Panic Attack Or Any Strong Unwanted Reaction
The way to diffuse a reaction once it is activated is to diffuse it in reverse order of how it built up. First you release the body tension, because once it builds up it ‘triggers’ more of the same kind of thoughts, keeping you stuck in the vicious circle, feeling you cannot stop it. Once you relax the body, then the mind will subsequently calm down. Repeated fearful thoughts cause an adrenaline and anxiety charge to build in the body. If you think fearful thoughts, you will indeed feel afraid. This emotional energy in the body is much stronger than the thoughts themselves. So the way to stop the reaction is to first diffuse the large energy charge in the body that is triggering more thoughts.
First, relax the body muscles and after that tension is gone then your awareness will increase and you can be aware of your thoughts. Once you can observe your thoughts, then you redirect your focus away from thinking by putting your focus (gazing) upon something that does not need thinking, such as a tree or an object in the room or just by observing your breathing. This takes much practice before you can succeed to stop the reaction fully and you must be willing to let go of thinking. This is a key point, because we are not initially willing to drop this reaction as we have had it for a long time and we chose it to protect ourselves from perceived harm. It is our way of escaping reality. Therefore, it is not easy to drop it, because we get a value out of it, by reacting that way. One has to make a clear decision that the value one gets from reacting this way is no longer worth the price one has to pay to keep it.
When you have reached that point, then it is easy to be willing to drop the old thinking pattern and no longer reinforce it. The less you reinforce the old thinking pattern, the more you give the signal to your brain and body that you no longer need this programming and it will be removed from the subconscious memory – it will be erased. The more you practice, the better you get at it and each time you will have less anxiety and stay calmer. Then the day will come where you will have full control over the reaction and your anxiety will be gone.
This way to cure a mental health pattern is slow and it will not give the instant relief a pill will. But if you stick with it, you will get improvement on a daily basis. You cannot see the daily changes so much but you will be able to see them on a weekly or monthly basis. The best part is this way will cure the problem, because you will discover the cause and realize you do have the power to go beyond your old program and drop it.
Editor’s note: This article is the second of a three-part series on Betsy’s journey of dealing with anxiety disorder. Part I talks of coming to terms with her problem, Part II discusses her insights on the problem and how one can stop a panic attack. Part III will highlight key steps Betsy followed to overcome her anxiety.
We all are aware that Coke harms our body but have you ever wondered what are the various steps in which it gradually breaks down your body? Coca-Cola and Pepsi, the two biggest soft drink companies in the world, have admitted that their products are bad for your health. Much of this surrounds the excessive amount of sugar their product contains.
Consuming too much sugar leads to increased belly fat, heart failure, diabetes and even cancer. It is recommended that the average adult consumes no more than 9.5 teaspoons of sugar a day. But a can of Coke contains 10 teaspoons. So, what is the future of our body system with this high amount of sugar?
The Renegade Pharmacist, in this infographic, breaks down in detail what coke does to our body in the first 60 minutes. Read on and don’t be shocked!
Many articles about working smarter, not harder have been doing the rounds of the internet. Any such articles would tell you about various methods that one can adopt to be more efficient with the least effort. However, we often ignore that the body and the brain need nourishment to perform smartly.
Did you know that 60% of the solid matter that makes up our brain is fat? And feeding ourselves essential and saturated fats keeps the grey cells active.
From staying hydrated to eating foods that have the same effect as the ‘smart’ drug Adderall, here’s a visual that’s going to help you fight mental lethargy.
Last year, in eastern Bihar’s Phulvari Sharif, 24-year-old Masahun Khatun was five months pregnant when she fell in the front yard of her house. For the next three weeks, Masahun and her husband shuttled between government hospitals and private practitioners, spending over Rs 40,000 on healthcare, as they tried to get an abortion. Masahun did not survive and her husband, a daily-wage labourer, is struggling to raise their four kids. This is their story:
Almost a decade after the government launched the Janani Suraksha Yojana (JSY; Mothers’ Protection Programme) to reduce maternal and infant mortality by promoting institutional delivery, too many Indian mothers die of causes related to childbirth.
The positive news is that the MMR has declined from 212 in 2007-09. Some states, such as Kerala (66), Tamil Nadu (90) and Maharashtra (87) have MMRs that match richer countries such as Brazil (69), Philippines (89) and Cuba (80).
Assam (328), Uttar Pradesh (292), Uttarakhand (292), Rajasthan (255), Odisha (235), Madhya Pradesh (230), Chhattisgarh (230), Bihar (219) and Jharkhand (219) have the eight worst maternal mortality rates in India. These numbers match some of the world’s poorest countries, such as Mauritania (320), Equatorial Guinea (290), Guyana (250), Djibouti (230) and Laos (220).
How the public healthcare system fails the poorest Indians
Three video stories by Video Volunteers (a global initiative that provides disadvantaged communities with story and data-gathering skills) reveal how difficult childbirth is for the poor who have to depend on public-health services, and end up spending money that, in most cases, they do not have:
Below is the story of a pregnant woman in Bihar who was charged Rs 500 for cutting an umbilical cord. She also had to pay for painkillers needed before her delivery. Women in the village report that when they refused to pay, the ANMs refuse to attend to them. This is despite the government scheme (JSY) that hopes to reduce out-of-pocket expenditure for women below the poverty line by providing free ante-natal checkups, IFA (iron tablets) tablets, medicines, nutrition in health institutions, provision for blood transfusion, and transport to and from health centres.
This report below from Deogarh in western Jharkhand reveals corruption among auxiliary nurse mid-wives (ANMs) of a hospital who force pregnant women to pay for their services post-delivery.
As this report below details, pregnant women are forced to spend out of their pocket or are referred to other faraway health facilities because there aren’t enough medicines at a state-run health facility. Arti Devi was asked to deposit Rs 500 at a state-run health facility. It was a sum she could not afford, so was asked to go to another government hospital.
The JSY gives pregnant women–who deliver babies at home and live below the poverty line–Rs 500 as cash assistance, irrespective of the mother’s age and number of children, to give birth in a government or accredited private health facility.
The scheme focuses on poor, pregnant women, with a special focus on states with low institutional delivery rates: Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Odisha, and Jammu and Kashmir.
The scheme also provides performance-based incentives to women health volunteers known as ASHA (Accredited Social Health Activist) to promote institutional deliveries.
Cash Entitlement For Mothers
Mother’s package (Rs)
ASHA’s package* (Rs)
Mother’s package (Rs)
ASHA’s package** (Rs)
The Promise Of Direct Transfers
A direct transfer of JSY benefits to the bank accounts of pregnant women started in 2013 and is now underway in 121 of 640 Indian districts.
JSY beneficiaries have increased from 0.7 million in 2005-06 to 10.4 million in 2014-15, an indicator that many pregnant women know of the scheme.
About 900,000 ASHAs get performance-based incentives to motivate pregnant women to give birth in health facilities. Of 10.4 million JSY beneficiaries in 2014-15, a large majority (nearly 87%) live in rural India.
State Subsidies Available, Yet Women End Up Paying
As many as 60% of women in Uttar Pradesh acknowledged paying money from their own pockets for certain services, according to an assessment of JSY conducted by United Nations Population Fund in Bihar, MP, Odisha, Rajasthan and Uttar Pradesh in 2012.
Paying For Medical Expenses
Percentage of women interviewed who said they made some payment to the institution (%)
Average amount paid as hospital charges (in Rs)
Average amount paid as medicine charges (in Rs)
Average amount paid as other charges (in Rs)
Total average amount paid (in Rs)
Women in Madhya Pradesh reported the lowest out-of-pocket expenditure, Rs 299, followed by Bihar with Rs 719.
Households spent an average of Rs 5,544 per childbirth in rural areas, according to a recent survey by the statistics ministry.
Video Volunteers is a global initiative that providesdisadvantaged communities with story and data-gathering skills, and IndiaSpend. Salve is a policy analyst withIndiaSpend.
This article was originally published on IndiaSpend.com, a data-driven and public-interest journalism non-profit.
You could be surrounded by honking cars on a road cramped with vehicles, standing in a metro or bus full of loud humans, or you could be having a hard day and want an instant pick-me-up. Music comes to our rescue wherever, whenever.
Studies reveal that listening to music releases the happy hormone-dopamine. It has the power to alter our moods, it can also make us better human beings, because music makes us more empathetic and sensitive.
In all honesty, nobody really needs a reason to listen to music.
Fast food giant McDonald’s has been under a cloud in recent years as its US customers turn to alternatives. In this “Fast food reinvented” series we explore what the sector is doing to keep customers hooked and sales rising.
While excess weight and obesity is a growing global concern, there has been more and more advertising and promotional effort encouraging the consumption of unhealthy food.
In many cases this marketing is targeted at children, and takes place online. In our recent study we investigated the impact of online marketing communications on children and their intention to consume unhealthy food. We found fast food ads on social networking sites can manipulate young audiences – their purchasing likelihood, their views of fast food and their eating habits.
The qualitative study included a sample of 40 Australian children who use social networking sites. Half (21) of the children were male and the average age was 14 (the youngest being 12 and the oldest 16). Their parents were also present during the interview, however they agreed not to intervene during the conversation.
A growing problem
The prevalence of excess weight and obesity among Australians has been growing for the past 30 years. Between 2011 and 2012, around 60% of Australian adults were classified as overweight, and more than 25% of these fell into the obese category. In 2013, more than 12 million, or three in five Australian adults, were overweight or obese. On top of that, one in four Australian children were overweight or obese. Excess weight and obesity is only beaten by smoking and high blood pressure as a contributor to a burden of diseases.
Despite this, the food industry is succeeding in using marketing communications to change attitudes, perceptions and perceived norms associated with unhealthy food.
Consumers are lured by surprisingly cheap deals, which are especially attractive to teenagers and young adults with low income. But sales promotions such as discounts and coupons often offer only short-term benefits to consumers and are usually not effective among middle-age adults.
However, if a promotion is offered for a long period of time (i.e. more than three months), it can actually influence customer habits, encouraging repeat purchases – for example, the $1 frozen Coke.
Similarly, sales promotions can make other brands be perceived as less attractive by customers after a period of time. For instance, the $1 frozen Coke campaigns by McDonald’s and Hungry Jack’s affect the perception of frozen Coke in terms of monetary value. Many consumers become less willing to buy a frozen Coke that is more expensive than $1. The same can be said of $2 burgers or $5 pizzas.
“The ads make me feel like this is where we belong to. This is our lifestyle…where we hang out and can be ourselves.”
“This is about our culture, young, active and free. We are kids but also not kids. We are different.”
Peer pressure is heavily related to eating habits, especially during puberty when there is usually a shift from home influence to group motivation. Teenagers and young adults in particular tend to choose a particular type of food under peer pressure.
More than 70% of teenagers will choose a food according to the preference of their friends. This means marketing communications promoting fast food consumption can create a snowball effect within this group of customers. For example, Jack, Sara and Park go out together. If Jack and Sara order Big Burgers with extra cheese, the likelihood that Park will order another Big Burger with extra cheese is approximately 75%. In contrast, only 2.7% of people aged over 40 choose fast food because of their peers.
It’s clear marketing efforts by fast food chains can promote unhealthy eating habits. Also, peer influence plays an important part in forming eating habits. This means the intervention of government and health organisations should concentrate on increasing customers’ attention to health issues, self-efficacy and perceived norms, and at the same time, lessening the influence of marketing efforts aimed at motivating unhealthy eating habits.
Earlier, as a student, and now a practitioner, of public health, I always wonder why opinions about abortions are so polarized. Why is it that most people prefer not to talk about abortion? After all, it is one of the most widely conducted surgical procedure in the medical field. From Chinese literature of Emperor Shen Nung’s time to the Ebers Papyrus of Egypt and later, the 10th-century Persian physician Al-Rasi, all talk about abortion and contraception. Some historical figures like the Roman satirist Juvenal have gone as far as explicitly writing about “our skilled abortionists”. Over the years, these voices have been silenced by conservatism in religion, politics and by hegemonic gender roles. As a young working woman, I find the silence hypocritical and stifling. Conservatism, in development and public health, specifically in abortions, is a huge challenge.
International Conventions On Abortion
Several international laws explicitly state that young girls and women have the right to demand and access credible and relevant sexual and reproductive health information. These documents strongly support health as a human right, to be enjoyed by all, irrespective of differences and social classifications. Article 12.2 (a) of the International Covenant on Economic, Social and Cultural Rights, The Convention on the Elimination of All Forms of Discrimination against Women, Article 24 of the Convention on the Rights of the Child, the 1995 Beijing Platform for Action and the Millenium Development Goals, in addition to the most commonly quoted Programme of Action of the 1994 International Conference on Population and Development- all comprehensively and explicitly state that the right to sexual and reproductive health for every young person, girl and woman is all encompassing. The rights elicited in these Declarations not only state those aspects of health that need to be prioritised but also note the obstacles that hinder the furtherance of the right to health from a gendered perspective.
Encouraging agency for girls and women (Covenant on Economic, Social and Cultural Rights); the dynamic of relationships that women must navigate in families, marriage and associated vulnerabilities (discrimination), and a woman’s right to determine her fertility are some of the perspectives considered in these Declarations. The comprehensiveness of some of these is evident as they urge nations against criminalising aspects of sexual and reproductive health, as stated in the Beijing Platform for Action. These documents embolden young girls and women to experience sexuality and reproductive health, not only as ‘fertility’ but as being sex positive. They advocate for an understanding of relationships and pleasure through the implementation of valid sexuality and reproduction related education programmes.
While researching for this article, I was appalled at my ignorance of the scope of these texts, and at the same time pleasantly surprised to know that there are voices speaking in support of the agency of women. And the questions, why are we still scared to talk about it? Why do my friends and family still believe that to get an abortion would be a scene from their worst nightmare? Why am I told never to tell anyone? loom larger than ever.
Religion And Abortion
Besides religious arm wringing, lack of awareness, criminalisation and stigma have furthered the pro-life cause. When abortion or aspects of it are a crime, it not only forces women to resort to unsafe methods and service providers, but it perpetuates stigma as well. Interestingly, the perceived stigma of legal abortion dissuades professionals from choosing to train in the procedure. In countries like India, physicians are not always aware of the country’s liberal abortion laws. And medical professionals, who are unaware contribute to the already existing prejudice. Thus the vicious circle continues. Unsafe abortions, though, whether a high or low concern, remain a public health issue. Beyond religion and politics, medical and international development fraternities also have a role to play in normalizing abortion in communities and clinics.
The experiences of girls and women cannot be explained in terms of religion, and that a ‘man’ always knows best. ‘Viability’ is not a universal term, it is a personal philosophy. The choice to end a pregnancy is as noble and as brave as the choice to care for a physically challenged baby. But this is a choice and a personal one at that. If you are to practice choice and faith with relation to safe abortions, choose to support the girls and women in your life. Talk to them about contraception- the right way to use them, where you can find one, how you can ask for one and the like. Have faith that, armed with the correct information, she will be capable of choosing what she believes is best for her. And should you have to deal with a spiritual dilemma- non-violent dialogue/protest is your safest bet to heaven.
Demystifying Medical Abortion
The central message is that a safe abortion can not only save a life in the most straight-forward reality of decreased maternal mortality and morbidity but, if performed legally and safely, it allows the young woman to fulfill her aspirations. These will include one of these or a combination of the following: going back to school/college/university, earning a livelihood and improve her social mobility. Programmes like the NIKE Girl Hub and Gapminder’s Hans Rosling have all provided credible evidence that education leads to better reproductive health in young girls. By disallowing her fundamental right to choose, you simply stop her from ever moving out of the ‘vicious’ cycle of poverty, illiteracy and gender-based violence you often ‘quote’ as the evils of this millennium.
Reporting on abortion needs to be brought into the mainstream as it is fundamental to maternal health, by involving the medical as well as the international development fraternity. The Human Rights discourse has provided a good foundation for advocacy efforts by the two groups. The biggest hurdle in the implementation will be that of criminalisation. However, initiatives have shown that even in settings where abortion is criminal, both clinicians and advocates have initiated programmes to ensure that women have access to information on medically safe and successful procedures.
At the medical level, doctors must be encouraged to train for providing a safe procedure, irrespective of its social implications in a legal or restricted setting. Licensing procedures in restricted settings should be made easier to generate demand for the service. Abortion-related complications should be reported, and governments should ensure that providers and clients are protected from non-state aggression. The medical abortion method is very beneficial as, in severely restricted settings it allows for harm reduction strategies, which protect both the clinician and the client, without hampering access to evidence-based information. This has been the experience of initiatives such as Women on Waves and the Uruguay model, both of which have successfully helped women undergo a medical abortion.
The development sector needs to de-medicalise and demystify abortion to align with equality, equity and health as human rights, enshrined in the laws mentioned above. In legalized and restricted settings abortion counseling can be implemented by intermediate service providers such as pharmacists and paramedics. Medical abortions are often mistaken to be a surgical procedure when in reality it is medically induced through pills. Providers of herbal abortifacients can also be trained to provide the medicines. International non-governmental and advocacy organisations need to work towards decriminalizing and destigmatising abortions, especially in very religious communities and also within their institutional structures (commonly known as ‘Value Clarifications’). They must encourage greater acceptance of modern contraceptives to reduce the demand for clandestine procedures.
Stories have an impact. Whether it is your own or that of a friend, acquaintance; or mere hearsay – even a myth says something about the individual, community, or a school of thought. Abortion too is a part of many stories. Some are of brave and angry women demanding a greater place in our world for women’s choices; some are that of priests and clergyman for recognition and redemption rather than termination. Some are of advocates at parliaments, international organisations and community movements. But most stories are that of your friends, maybe even yourself. And they often go unheard. Maybe you don’t think that it’s important to talk about it, or you are afraid to talk about it, for fear of being judged or incarcerated. For many, it is now just a memory. The voices of others are silent if your voice is not heard, if it is not articulated. They are silent until promises are kept and memories turn empowering not embarrassing.
In January this year, the government asked for public opinion on tougher new laws to curb smoking: To raise the minimum smoking age to 21 from 18, and to ban the sale of single cigarettes, which account for 70% of nationwide cigarette sales.
People responded enthusiastically; 45,000 emails and 100,000 letters poured in to the health ministry, as Reuters reported earlier this month. What they said, however, is not known because the government hasn’t yet read the messages, according to a health ministry representative quoted in the story.
Curbing smoking is very important to India for two reasons:
About one million Indians die from smoking-related causes every year, which are among the top three ways to die
Smoking also saps Indians of money; more money, it emerges, than it earns for the government.
Indians aged 35 to 69 spent Rs 104,500 crore ($15.9 billion) in 2011 on diseases associated with tobacco–including cancer, respiratory diseases, tuberculosis and cardiovascular diseases. This figure is almost six times as much as central-excise tax collections from all tobacco products that year, according to the Government of India, WHO and the Public Health Foundation of India.
To put the health cost of tobacco in further perspective, it exceeded the combined annual state and central government expenditure on health care by 12% in 2011.
Taxes on cigarettes rise–not enough–but they do. Bidis are the problem
“Raising taxes is a win-win situation,” said Arun Thapa, Acting WHO Representative to India. It’s good for human health and for the country’s fiscal health.”
Over the last 19 years, taxes on cigarettes in India have risen 1606%. As the next part of this series will tell you, that isn’t quite enough, and the six-tier tax structure is so complex–based on stick lengths and filters–that companies manipulate it with relative ease to keep demand intact.
The biggest problem in curbing tobacco use lies with the influence wielded by those who make the humbler–but more damaging–cousin of cigarettes, the bidi.
Taxes on a pack of bidis are 7% of the retail price, less than a tenth of the WHO’s suggested level of 75%. A 20-stick pack of best-selling cigarettes is taxed around 60% of retail price.
Bidi smokers face a higher risk of developing potentially-fatal chronic obstructive pulmonary disease (COPD), among other illnesses, because tobacco is packed more loosely in bidis, requiring smokers to inhale more strongly.
But the bidi industry has consistently squeezed concessions from the government.
Million of jobs and livelihoods at stake, so taxes must stay low, argue bidi barons
Here are some concessions the government gives the bidi industry:
Handmade bidi units (98% of bidis are handmade ) producing less than two million sticks in a year are exempt from excise duty.
Bigger bidi makers pay a duty of 1.6 paise per handmade stick and 2.8 paise per machine-made bidi. The duty on cigarettes varies between Rs 1.28 and Rs 3.37 per stick.
Some eight million people work as bidi rollers nationwide, said a representative of the All India Bidi Industry Federation.
No socio-economic case for low bidi taxes, contend experts
In 2013, the bidi industry contributed less than 3% to the government’s central excise collection from tobacco products, not surprising, given the low excise duty it pays.
A Public Health Foundation of India study says there is indeed scope for taxes on bidis to be increased.
“Doubling bidi excise would help cut consumption by 40% and increase tax revenue by 22%,” said Monika Arora, director, Health Promotion and Tobacco Control Initiatives, Public Health Foundation of India.
Essentially, the argument goes, higher tax rates would offset any loss of excise from fall in consumption. In the bargain, spending on “useful” goods and services will grow.
“Money not spent on bidis or cigarettes will not disappear from the economy,” said Prabhat Jha, founding director of the Centre for Global Health Research, University of Toronto. “It will be spent on other products which generate employment.”
Additional revenue could help the government meet the cost of transitioning bidi workers to other means of employment. The government has previously considered a cess on cigarettes to encourage farmers to switch from tobacco to other crops.
So, why not tax all segments of the tobacco-products industry, experts suggest, to fund a gradual transition? Bidi workers, among some of India’s most disadvantaged people, can only benefit.
Bidi workers: Among India’s worst paid workers and plagued by ill health
“The effect (of high taxes and low consumption) on bidi employment will take years,” said the University of Toronto’s Jha. “It does not mean current bidi rollers will lose their jobs. It means fewer people will take low paying bidi rolling jobs in the future.”
West Bengal, Maharashtra, Andhra Pradesh and Karnataka are among India’s top bidi-producing states. In West Bengal’s district Murshidabad, bidi rolling is pretty much the only livelihood.
Bidi workers in Murshidabad earn Rs. 100/- per 1,000 bidis. Those in Uttar Pradesh earn Rs. 90/- per 1,000 bidis. Bidi workers are among the lowest-paid ‘manufacturing’ employees in India, according to this 2014 study. They constitute 1% of all employment in India but collectively earn 0.1% of all wages.
“They earn minimum wages or ‘negotiated’ wages,” said Sable. ‘Negotiated’ means a lower wage than the minimum government-prescribed wage, for which Sable said the consent of the local government authority is always taken.
“Lower wages are negotiated because the cost of the bidi has to be kept low for the consumer and also ensure parity with wages in neighbouring states,” said Sable.
Collusion between local government authorities and the bidi industry–as Sable admits to–keeps bidi workers in penury, while tying their daily wage to punishing targets of about 1,000 bidis a day causes ill health, write Sunanda Sen and Byasdeb Dasgupta in their book “Unfreedom and Waged Work: Labour in India’s Manufacturing Industry.”
Most workers are given tobacco to roll at home. Protective measures such as masks and gloves are unheard of, and soon enough, they suffer the ill effects of exposure to tobacco flakes and dust.
“Ear, throat and lower respiratory tract infections are common among bidi workers,” said Arora. “So are cancer and tuberculosis.”
Many women workers suffer gynaecological problems and pregnancy complications. This should be a concern, as 90% of the workforce is female.
Transitioning bidi workers to other manufacturing jobs would be good for them. Raising taxes on bidis would be good for the country as a whole. The only people who might not benefit are the bidi company barons.
(Bahri is a freelance writer and editor based in Mount Abu, Rajasthan.)
This article was originally published on IndiaSpend.com, a data-driven and public-interest journalism non-profit.
India’s medical education system is one of the largest in the world. The 381 medical colleges in the country produce about 45000 doctors annually. Ever since the first medical college was established in 1835 in Kolkata, the scope of health education in India has widened. From just 19 colleges and 1000 students in 1947, the sector has grown to house the largest number of medical colleges in the world. Many more are coming up in both the private and public sectors. However, little have these statistics done to better the state of public health in India. It is indeed a paradox that the country that has produced some of the best doctors and research papers in the world is home to more than 89 lakh unvaccinated children. Studies have shown that every seven minutes, a mother succumbs to death during childbirth in India. Basic health care in many villages is still a dream. Monsoon season has become synonymous to epidemics. Even preventable diseases have become nightmares in the Indian scenario. According to Indian Medical Journal’s 2013 report, our country needs about 600,000 more doctors to carry out healthcare related tasks. It was in this context that the government decided to increase the number of medical colleges in India. It may seem logical that more doctors would bring relief to an ailing health system. However, experts are of the opinion that matters are not that simple and require more serious thoughts and actions.
The government has been going on with programs to increase the number of medical colleges for a few years now. Health ministry has already planned 14 new medical colleges and has taken decisions to enhance the number of seats in six existing colleges around India. Many new private colleges have also been allowed. The government also plans to set up 200 more medical colleges over the next ten years thus increasing the number of MBBS seats by 10000. Though it has been proposed that this plan will pave the way for a better healthcare system, the concerns and questions raised by these reforms are many.
Lack Of Faculty
The lack of faculty in medical colleges is a problem that has been haunting the system for years. The disproportionate increase in the number of medical colleges has only aggravated the problem. With a large number of UG seats and very few PG seats, the issue is fast getting out of hands. Many medical colleges don’t have enough number of teachers to meet the MCI regulations. It is well known that many private colleges import doctors from various hospitals on the days of MCI inspection to pose as faculty. In government institutions, there is a large-scale transfer of doctors from one college to another. These make-do arrangements do harm to old and new medical colleges alike. Even though MCI has adopted physical measures like head counting to tackle this problem, little has these done to stop malpractices. While attempts have been made to make norms less stringent, it should be remembered that steps like these will only add on to the reduction in the quality of medical education and increased the workload of already overburdened doctors.
Makeshift Medical Colleges
Another important problem is that most of the new colleges lack an adequate infrastructure to educate students. Setting up a medical education institution is far different from establishing an arts or science college. Many new colleges just don’t have enough patients or investigation facilities, let alone a proper lecture hall and record books. Even the new AIIMS-like institutes set up in Patna and Bhubaneswar have been reported to lack even basic infrastructure. Many colleges haven’t even completed construction or land acquisition but have started classes for students. Red tape delay and corruption have made matters worse.
Skewed Distribution Of Colleges
Though India has more than 300 medical colleges, the fact that these are distributed in a skewed fashion has resulted in misdistribution of services. More than sixty percent of these institutions are located in South India, especially Kerala, Karnataka, Tamil Nadu, Andhra Pradesh and Maharashtra. Same applies to most of the new institutions coming up too. They are mostly concentrated in profitably potent areas. This is in spite of MCI’s regulation that for a medical college to be established there should be sufficient clinical load in that area. The clustering of colleges has led to a lack of availability of clinical material and faculty in many colleges. Moreover, most of the medical colleges serve urban areas rather than rural areas, leading to further deterioration of already ailing rural health system. It is high time we opened eyes to these problems.
Problems Of Privatisation
Encouraging privatisation of medical education can have many unforeseen consequences. Increased participation of private giants will result in the commercialisation of education, increased gap between rich and poor and the formation of a cadre of money minded, robotic physicians. It is a well-known fact that many private colleges adopt illegal measures to get MCI recognition, including the import of people to pose as patients during MCI inspections. In the long run, the entire health system of the country is affected, and it is the common man who suffers. Ensuring the quality of private medical colleges and making accreditation restrictions more stringent has become the need of the hour.
Creating socially committed doctors should be the aim of medical education. It is high time India focused on quality rather than quantity. While opening new medical colleges may make headlines, it is important to realize that makeshift medical colleges will only worsen the condition of our already sick health sector. Many short term solutions like increasing the retirement age of medical college teachers, providing better incentives and channeling more funds have been proposed. However, it is important to seek a long-term solution. It is true that the healthcare industry needs more manpower. However, the fact that most of the young doctors who pass out prefer to work in foreign countries and cities should not be overlooked. Hence, better implementation of the present medical education programs so as to fill the gap in the rural health sector is necessary. According to Dr. P.K. Sasidharan, a leading physician and public health expert, increasing the number of medical colleges is useless unless and until a sea change occurs in our health policy. More attention should be given to decreasing the disease burden and increasing health awareness. Instead of focusing on creating more super specialists, strengthening of basic healthcare should be given more priority. The dream of basic healthcare can only be achieved through more innovative and well-planned strategies.
In the years since the world started going digital, one of the big changes has been that we don’t need to remember very much. Why risk forgetting a partner’s birthday or a dinner date with a close friend when you can commit the details to your computer, laptop, smartphone or tablet and get a reminder at the appropriate time?
Paul McCartney gave a useful insight into this in an interview over the summer. He claimed that back in the 1960s The Beatles may have written dozens of songs that were never released because he and John Lennon would forget the songs the following morning. “We would write a song and just have to remember it. And there was always the risk that we’d just forget it. If the next morning you couldn’t remember it – it was gone.”
How different to the way he records now then, when he can “form the thing, have it all finished, remember it all, go in pretty quickly and record it”.
In one study, for example, 1000 consumers aged 16 and over were asked about their use of technology. It found that 91% of them depended on the internet and digital devices as a tool for remembering. In another survey of 6000 people, the same study found that 71% of people could not remember their children’s phone numbers and 57% could not remember their work phone number. This suggests that relying on digital devices to remember information is impairing our own memory systems.
But before we mourn this apparent loss of memory, more recent studies suggest that we may be adapting. One such study from 2011 conducted a series of experiments looking at how our memories rely on computers. In one of them, participants were asked to type a series of statements, such as ‘an ostrich’s eye is bigger than its brain’.
Half of them were told that their documents would be saved, and half were told that they would not. Everyone was then tested to see if they could remember what they had typed. Those who had been told their work would be saved were significantly poorer at remembering the information.
In another experiment, participants were asked to type a series of statements that would be saved in specific folders. They were then asked to recall the statements and the folders in which the files were located. Overall, they were better at recalling the file locations than the statements. The conclusion from the two experiments? Technology has changed the way we organise information so that we only remember details which are no longer available, and prioritise the location of information over the content itself.
This idea that individuals prioritise where information is located has led some researchers to propose that digital devices and the internet have become a form of transactive memory. This idea, which dates back to the 1980s, refers to a group memory that is superior to that of any individual.
More recent research has extended this line of work and found that saving information on a computer not only changes how our brains interact with it, but also makes it easier to learn new information. In a study published last year, the participants were presented with two files that each contained a list of words. They were asked to memorise both lists. Half of the participants were asked to save the first file before moving on to the next list, while the others had to close it without saving.
The experiment revealed that the participants recalled significantly more information from the second file if they had saved the previous file. This suggests that by saving or ‘offloading’ information on to a computer, we are freeing up cognitive resources that enable us to memorise and recall new information instead.
In sum, anyone worrying that technology is wrecking one of our most important abilities should take some reassurance from these findings. It doesn’t necessarily mean that there is no cause for concern: for instance McCartney said in the same interview that the songs in the 1960s that did make it to the recording studio were the most memorable ones. So it is possible that the lack of technology made The Beatles better songwriters.
But it may be that just as oral storytelling was usurped by the written word, having digital devices to outsource our memories means that it is no longer necessary for us to try to remember everything. And if we can now remember more with a little help from our technology friends, that is arguably a great step forward. Rather than worrying about what we have lost, perhaps we need to focus on what we have gained.
Avinash will not grow older. Neither will the nine other people who have died of dengue already. What is most tragic about Avinash’s story is that his parents committed suicide after he passed away. “Babita’s left hand and Laxmichandra’s right hand were tied together with a dupatta. Babita was wearing her nightdress, just as she was when we last saw her about an hour before,” said Kavita Sejwal, their landlord.
2015’s dengue outbreak has been termed as the largest in the last five years. 1800 cases have already been registered. The season that should have been a welcome respite has turned into a source of dread and disease all over India.
The Delhi Govt. has ordered 1000 extra beds in state run facilities and cancelled holidays of health personnel, but there’s a limit to what they can do. Is it not better to make efforts from our end and prevent, instead of cure?
1. The dengue causing female Aedes aegypti mosquito breeds in dark places, closets and corners in domestic spaces. Cleaning out the junk and spraying with mosquito repellents regularly, helps in keeping the indoors mosquito-free.
2. Temephos (brand name Abate) is a pesticide that can be sprayed on stagnating water, that can’t be cleaned out, like water in coolers. Things that one can do, without waiting for someone from the municipal corporation to turn up, is to spray the water with Temephos or petrol to prevent larvae formation.
3. It can’t be emphasised enough that stagnating water in public spaces like puddles, garbage dumps, requires to be drained and sprayed with pesticides. While regular insecticide sprays are done by municipal corporations, we, as residents of the area, can take up the charge of making the community spaces healthier. It is, after all, our children who play in parks and grounds.
4. The dengue mosquito is active throughout the day, especially two hours, after sunrise and before sunset, and there is no vaccine for prevention of dengue. What one can personally do is wear clothes that covers as much skin as possible like full sleeved clothes and full pants, or any other clothing that covers most of our skin.
5. There are many products in the market like Odomos, which have DEET or Picaridin in them. These cream based products can be applied on the exposed portions of the body, as it confounds the mosquito’s senses and makes a person invisible to them. However, the creams should not be applied on the hands of young children and infants.
6. Covering overhead tanks, water storage facilities, putting meshes on air/water pipes are some infrastructural changes that retards the breeding process of the mosquitoes. The dengue mosquito can fly within 200 meters of its breeding site so it becomes imperative to cover up all open water storage facilities.
7. In domestic spaces, using mosquito coils, electric vapour mats can kill the mosquitoes and keep us safe. And these products are needed more in the day time than night, unlike popular belief.
8. In India, mosquito nets are not an uncommon site. It is also possible to spray limited amounts of Permethrin, an insecticide, on mosquito nets that are hung over the beds to keep the insects away.
9. While dengue doesn’t spread from person to person, an infected person should be kept away from spaces where they can be bit again because the infected mosquito can spread the disease further by biting a healthy person.
10. Finally, if you feel a fever coming on, get yourself tested. Early detection is the key to quick recovery. While dengue fever is not fatal, sometimes the patient develops Dengue Haemorrhagic Fever or Dengue Shock Syndrome, which can become a serious health risk.
Preventing dengue can’t be the Government’s responsibility alone. Following instructions issued by the Government about maintaining clean surroundings is the role of the community and the individual too. Don’t let anymore Amans and Avinashs die of a disease that is easily preventable.
Recently published research suggested alcohol and drug-related absenteeism costs the Australian economy around AU$3 billion a year. One of the report’s authors was quoted in the media as saying that “alcohol puts a bit of a tax on your immune system“. She said people may not realise drinking or drug-taking was: “causing their stomach upset, headache or worsening cold by Monday…”
Complex and tightly controlled, the immune system is made up of different cells and tissues, that together protect us from viruses and bacteria.
Chronic alcohol abuse can definitely alter the way our body responds to pathogens – reducing the numbers of killer T cells, for instance. These are white blood cells that act like the immune system’s soldiers, working to eliminate infected cells.
A reduction in killer T cells leaves people more prone to infections. But it’s possible other factors sometimes present in people who chronically abuse alcohol, such as poor diet, can also have that effect.
Drinking can influence the inflammatory response too. Inflammation is an important part of the immune mechanism that helps immune cells travel to the infection site (although if uncontrolled, inflammation can cause chronic disease and pain).
One recent study found that in the 20 minutes after a binge drinking session, participants had developed higher than normal levels of inflammation in their body. But two hours later, inflammation had dropped below the original levels.
As their blood alcohol level fell, the number of monocytes (types of white blood cells known as “phagocytes” because they’re able to recognise and ingest microbes) also fell. Participants’ blood showed decreased numbers of natural killer cells as well. These play a similar role as the killer T cells.
Similar results were found in a 2014 study on binge-drinking mice; their phagocytic cells decreased along with other changes to the immune system. These findings suggest even a single session of binge drinking may increase the risk of viral infections, such as colds. But moderate drinking (one drink per day for women and two for men) shows a different picture.
A 1993 study looked at the association between smoking, drinking and the risk of developing the common cold – with volunteers given saline drops containing cold-causing viruses. It found drinking one or more glasses of alcohol a day decreased the risk. But this was only true for non-smokers; smokers were more prone to colds regardless of how much they drank.
A larger 2002 study examined the effects of wine, beer and spirits on the risk of developing the common cold. Participants were asked about their drinking and other lifestyle habits, as well as any colds they had over the course of a year.
People who drank wine – red wine in particular – had fewer colds than those who didn’t drink at all. And people who drank more than 14 glasses of wine per week had been the least ill that year. Beer and spirits didn’t appear to be protective against infection. But nor did they increase the risk of developing colds.
But these studies looked at the association between alcohol and colds. What about alcohol’s effect on the immune system itself?
It also found monkeys who were moderate drinkers had slightly increased levels of certain cytokines. These are small proteins that help coordinate the immune response to infections and cell damage, either enhancing or dampening the response.
In these monkeys, the number of immune response-enhancing cytokines had increased, and that might be the mechanism that helped their improved response to the vaccine. It’s possible moderate drinking in humans may also enhance the immune response to vaccines and viral infections.
Different types of alcohol, as well as different intake levels, seem to play a strong role in our susceptibility to colds. And a weekend of binge drinking may indeed increase your susceptibility to viral infections, such as colds.
Given drinking is a social activity, going out for a drink increases exposure to infections as well. Still, like many other things in life, exercising moderation when drinking could help boost your immune response to the common cold and other viral illnesses.
Two years after her wedding in Jaisalmer, Rajasthan, Bhanu (left), then 17, swallowed sleeping pills and tried to kill herself. Kriti Bharti (right), a psychologist, helped Bhanu (her name has been changed for this story) annul her marriage to a 55-year-old barber, who allegedly paid her grandfather a marriage fee of two lakh rupees. Image source: indiaspend.com
On a cold December day in Jodhpur, 2014, Bhanu, 17, suddenly collapsed. Her parents rushed her to the hospital where doctors said their daughter—a married woman—had attempted suicide by swallowing sleeping pills.
After the recent release of suicide data by the National Crime Records Bureau (NCRB), the discourse has primarily focused on farmer suicides, a politically-sensitive issue. But Bhanu’s case is a reminder that little or no attention is focused on home-makers, a demographic more prone to suicide than farmers.
About 18% (20,412) of all suicides in 2014 were by housewives, against 4.3% (5,650) by farmers, according to the NCRB. There appears to be a decline, overall, in home-maker suicides, but the data reveal two things: one, a quiet, festering problem in Indian marriages and two, a problem with the numbers.
P Sainath, journalist and Magaysasay award winner who pioneered reporting on farm suicides, believes many women categorised as “housewives” are farmers.
“Women farmers’ suicides are routinely undercounted because conventional societies mostly do not acknowledge women as farmers,” Sainath wrote this week. “And only a few have their names on title deeds or pattas. One result of this is that the ‘housewives’ category explodes in those years where states claim nil women farmers’ suicides. In some states, ‘housewives’ (including many who are farmers but not acknowledged as such) make up 70 per cent of all women suicides in some years.”
Even if that is wholly true, there is little question that thousands of home-makers are indeed killing themselves, as IndiaSpend‘s inquiries with psychiatrists and NGOs across the country confirmed.
Suicides By Home-makers (left) & As % Of Total Suicides (right), 2010-14
How Bhanu went from 6th-standard dropout to teen bride
Bhanu, then 15, was married—against her wishes—to Ramchandra, 55, a barber and farmer. Since Bhanu’s father was a poor barber in Ajmer, he and his wife (Bhanu’s mother) handed over their daughter, and the responsibility for her eventual marriage, to her grandfather in Jaisalmer.
Bhanu’s grandfather pressured Bhanu to drop out of school, abandon studies and focus on learning housework, obviously in preparation for marriage. Bhanu, then in class six, became a bride in waiting. Her grandfather struck a wedding deal for Rs 2 lakh, without informing her parents.
Bhanu was forcibly married, following an ancient tradition called aamne samne ki shadi (literally, a wedding facing each other), where families cement ties through marriage.
While Bhanu married Ramchandra, his niece, age 8, married Bhanu’s 35-year-old uncle. Since Bhanu’s parents and she were more than 480 km apart, they did not hear about her marriage, until it was too late.
When Bhanu’s parents came to the eight-year-old’s wedding, they were shocked, they said, to find wedding rituals underway for their daughter as well. They protested and tried to file a police complaint. The police refused, although the marriage was illegal (18 is the legal age).
“It was unimaginable for us that someone like her grandfather, whom we trusted so much, had married her off in a deal,” said her father, who requested that his name not be used. “It was quite shocking for us, but somehow we controlled ourselves and approached Kriti for help.”
Determined to annul the marriage, Bhanu’s parents contacted Kriti Bharti, a rehabilitation psychologist and founder of the Saarthi Trust, an NGO in Jodhpur. Bharti helped them file a court case and gain custody of their daughter. As the case was being tried, Bhanu’s husband repeatedly tried to take her away by force, claiming she was now his.
Do the data explain why home-makers commit suicide? Not quite
NCRB data on suicides and the attributed causes are not trustworthy and detailed enough, said experts. The data do not reflect the fact that suicide is not an event, but a complex interplay of factors.
Deaths in rural India are certified by village headmen (“panchyatdars”), although cases are investigated by the police and the process of registering a death is particularly inefficient in rural areas, according to this study published in the Indian Journal of Psychiatry
“When it comes to data regarding suicides and the reasons for it, NCRB figures cannot be trusted at all,” said Vikram Patel, a psychiatrist with extensive experience on suicide. “Given the complexity of suicides, just listing single reasons for suicide is too simplistic. Further, the police aren’t trained to handle suicide cases and investigations and reporting is done randomly.”
Dr Rajesh Rastogi, Chief Psychiatrist at Delhi’s Safdarjung Hospital, agreed. “Just saying that dowry torture or domestic violence caused depression for a woman to commit suicide is naïve,” he said.
“When the police investigate a matter, the reason that is the most publicly visible is attributed as a cause for suicide,” said Kamna Chibber, a clinical psychologist at Delhi’s Fortis Hospital. But that is not usually the real cause.
IndiaSpend had reported previously on how the data on farmer suicides are unreliable. That applies to home-maker suicides as well. Families often do not report suicide.
“The stigma leads to under-reporting,” said Lakshmi Vijaykumar, a psychiatrist and member of the World Health Organisation’s International Network for Suicide Prevention & Research. “Many families want to avoid harassment by the police and avoid social ostracism, therefore, they never approach the police.”
What is driving housewives to suicide? Men play a big role
NCRB doesn’t give disaggregated causes data on housewives, only the data for overall suicides.
Based on various psychiatrists’ and psychologists’ experiences, three points stand out:
1. Family background, past psychiatric history, genetic conditions and the immediate environment are significant factors.
2. Issues such as marital dissatisfaction, torture for dowry, domestic violence and economic difficulties are only the triggers or, in medical terminology, “stressors”. While the occurrence of more stressors increases risk, their mere presence cannot cause suicide.
3. India’s patriarchal society and stigma around women discussing depression and mental health issues play a significant role in increasing suicidal tendencies.
The cumulative and repetitive interaction of several factors in a complex manner results in suicides, according to a psychological autopsy study done in Bangalore, the only one on “completed (successful) suicides” and domestic violence.
“Personal, biological and external environmental factors and the ability to handle stress and depression play a huge role,” said Patel.
Many studies note that almost 80% of those who commit suicide have depressive symptoms.
Rastogi explained it in simpler terms: Two friends are sitting in a room and a snake enters. Person A is terrified to see the snake, but person B has often stayed in rural areas and has killed many snakes. He barely flinches and advances to shoo away the snake.
What he means is that people handle stress differently. While one spouse may fight back against domestic violence and torture, another may keep quiet and accept it as her fate.
“A woman commits suicide only when she is fully convinced that there is no other way to reduce her drudgery. She feels that she is not able to do anything to improve her situation,” said Chhibber.
Bhanu certainly felt that way. She told IndiaSpend that she was always battling her 55-year-old husband Ramachandra.
“He constantly threatened me that he would take me with him forcibly, but I didn’t want to go with him,” said Bhanu. “Even during court sessions, he would intimidate me, which really scared me. I lost hope that things would ever get fine. Hence, I decided to end my life.”
Patel said these were widespread fears. “Domestic violence (emotional and physical), and economic difficulties are the major precipitating factors for suicides by married women,” he said.
Women may have support from friends and family but may not have the financial independence to end a marriage.
Why do so many wives aged 15-29 kill themselves?
Over the past four years, 43% of suicides by home-makers have been in the 15-29 age group.
Suicides By Home-makers In The 15-29 Age Group (left) & As % Of All Home-maker Suicides, 2010-13
IndiaSpend has reported previously how India has 36 million child brides, despite laws prohibiting child marriages.
“This is the age group when the experiences associated with gender disadvantage are the most common,” said Patel, a view echoed by Chhibber.
Bhanu was 15 years old when she was married against her wishes, pushing her into deep mental conflict. Eventually, despite the support of her parents, the teenager could not cope.
“Youth is the time when one is still trying to find one’s footing in life… often due to an unsupportive environment or one’s own personality traits, one is unable to achieve these milestones well and soon enough in life. In such circumstances when trouble strikes, it just becomes easier for one to collapse,” explained Sanjay Chugh, a Delhi psychiatrist. “As we grow older, we become more mature… in times of trouble, do have back up plans.”
Young brides get no allowances for the sudden burden of household responsibilities. A time of discovery and aspiration, for many, remains unfulfilled.
“It pressurises her immensely,” said Bharti, “leading to mental imbalance and suicidal tendencies.”
Why aren’t housewives’ suicides discussed?
Farm suicides are widely discussed in India, but no one really talks of housewives killing themselves.
“In our country, there is a stigma and fear surrounding mental health and a stifling silence around any conversation pertaining to mental illness,” said Kundu. “Even talking about it is taboo.”
“If we have a body part which is burnt, we like to hide it from others because we believe that it can never heal,” said Bharti. “Similarly, our society has already believed that the issue of women getting equal rights and respect cannot be solved; therefore, these discussions never happen. Until, we believe that we truly can solve this situation, we can’t do anything.”
To Vijaykumar, the key point is political irrelevance. “It’s simple,” she said. “Housewives’ suicides aren’t politically important, that’s why politicians and experts don’t discuss it (the issue) much.”
Why decriminalising attempted suicide can help
India accounts for 21% of the global disease burden and is struggling with high malnutrition and high infant- and maternal-mortality rates. So, suicide has never been a significant public-health issue.
It does not help that India is short of mental-health professionals by 87%, according to data tabled in Parliament in 2013.
Last year, the Centre announced a plan to decriminalise attempted suicide and scrap section 309 of the Indian Penal Code, which provides for a year in prison and a fine for anyone attempting suicide.
The Law Commission of India’s 210th report also suggested removing section 309, but there the matter rests.
Vijaykumar listed three benefits of this move:
1. It will allow anyone who has attempted suicide to be treated immediately without the medico-legal process. This will also remove the stigma.
2. It will be affordable for the family–private hospitals often overcharge to treat such patients, citing the legal process involved.
3. It will help collect data on those who attempt suicide and plan services for them. These cases are often under-reported or reported as accidents.
“Rather than pressing charges against the victim, the focus should be on prosecuting the person who compelled the victim to commit suicide. The victim has already faced hardships and therefore, putting further pressure on her is unfair.” said Bharti.
Back in Jodhpur, the police did not charge Bhanu with Section 309 because Bharti pressurised them not to, leaning on them, successfully, to file a case of abetment to suicide (Section 306) against Ramchandra. Much legal action depends on arbitrariness.
Bhanu, with Bharti’s help, is now preparing to appear for her class ten examinations through the open-school system as a private candidate, which means she does not have to complete previous classes. She lives with her parents in Jodhpur, as her case meanders through the city’s courts.
Bhanu’s experience has shaped her ambitions. “Kriti didi (Bharti) is my idol, and I want to become a social worker like her,” said Bhanu. Her ambition: To eventually urge and help girls forced into early wedding to annul their marriages.
Bhanu is a pseudonym. We have not revealed her real name at her request.
(Saha is a freelance journalist based in New Delhi.)
Although India is a leading producer and exporter of vaccines, the country is home to one-third of the world’s unimmunised children. However, this is apparently no cause for worry, as believed by some parents in the U.S., since “God gave everyone the ability to heal from within and he gave us all the tools to heal naturally.” Contrasting the state of infant vaccinations in the U.S. with that of India seems almost ridiculous, yet with the growing number of anti-vaccination activists in America, the outcome remains surprisingly similar- gradual increase in the number of unimmunised children, causing widespread diseases, disabilities, and even death. While most American parents are wary of getting their children vaccinated due to an unfounded fear of vaccines causing autism, parents in India are unable to do so simply because they do not have the resources or the knowledge to comprehend why vaccination is needed. Hence, both the cases are based on uncertainty and fear of the unknown, and little is being done to dispel them of preconceived notions.
The Anti Vaccination Movement (AVM) in America is two pronged- one prong denies any direct correlation between vaccines and the diseases that they are taken as protection against diseases, while the other goes one step further and into the territory of vaccines being harmful for health. Supporters of the latter belief claim that the MMR (mumps-measles-rubella) vaccine causes autism, despite there being no evidence for the same. The American Academy of Pediatrics has released a list of more than 40 studies showing no link whatsoever between vaccines and autism, yet parents continue to protest against vaccines. The movement has further been popularised by celebrities such as Jenny McCarthy, who claimed to discover that her son ‘became’ autistic as a result of his shots- even though autism is a congenital disease.
When California sought to tighten its immunisation laws after a measles outbreak- a disease thought to be eradicated fifteen years ago- it faced angry protests from vocal activists, who went so far as to claim that the new law that made vaccination mandatory was akin to the Holocaust. This was based on the pro-choice argument of individuals being able to decide what ‘goes into their body’. Little did these activists keep in mind that unvaccinated kids would be endangering those who were too young, or others who were unable to get vaccinated due to medical conditions. Although the idea of stopping vaccination in its entirety seems far-fetched, these activists have been successful enough to force three states to pull back a ‘personal belief’ exemption for vaccination.
In India, vaccines are similarly available yet unable to be accessed by those who need them the most. However, this is not a matter of choice. Fewer than 44 percent of India’s young children receive the full schedule of immunisations. This is mainly due to ignorance and hence decreased demand, as well as the much popularised polio shots having stolen the spotlight- consequently side lining other vaccines available. For example, pneumonia is the leading killer of children in India, accounting for the death of a majority of children under five years of age. Vaccines for pneumonia, although available elsewhere, and not sold in India- attributing it to the low demand for these. In India’s slums, surveillance as well as keeping tabs on diseases is an arduous task. In many instances, people are unable to discuss or even identify the symptoms- thereby proving time and again the dangers of obliviousness.
Pneumonia accounted for 371,605 deaths in children under age five in 2008, India. According to recent estimates, the 81,275 annual deaths from measles in India account for three-quarters of the global deaths from this disease. It is estimated that two-thirds of the children who die of measles and the other preventable childhood diseases would have survived if they had been immunised. In America, non-vaccination brought an almost eradicated disease back. The limbs of a boy were amputated in order to save him for meningitis – which could’ve been prevented if he had been vaccinated. In such a case, the course of action open to us is simple: in order for this to stop, more of us must speak up until there’s no doubt remaining that vaccines are safe, necessary, and they work.
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