Health Spectrum, June 2016

Health Spectrum
Healing The
Sufferings of People
Healthcare In
Rural India
Adult
Vaccination
Adult
Vaccination
June 2016 Volume I Number I Price `50
www.healthspectrum.org
Dr. Sushma P Sinha
Dr. Raju Vaishya
Dr. Rahul Gupta
Dr. Dharminder Nagar
Dr. H S Chhabra
Dr. Vivek Nangia
Dr. Rohan Khandelwal
Dr. Ira Chopra
Dr. Pallavi Vaishya
Dr. Mukesh Batra
Dr. R K Tuli
Dr. Yuvraj Kumar
Dr. Shobhana Mittal

2 Health SpectrumJune 2016
HEALTH STUDY/RESEARCH

4 June 2016
Doctors should provide
simple, easy and accurate
health information to
patients
I think one of the main problems in
Indian medicine is the tremendous
gap in knowledge that exists
between patients and doctors.
This leads to doctors developing
a paternalistic attitude and they
investigate, prescribe and advise
courses of treatment which are
accepted by patients unconditionally
but may not always be in their
best interests. There is a great
need for vehicles to provide health
information to patients which
is simple, easily understood,
authoritative and, most important,
accurate. I have had experience
of trying to narrow this gap in
knowledge through television
programmes such as the World
this Week many years ago, via
the internet - Doctor NDTV and
now www.Raxadoctor.com and
am delighted that a monthly health
magazine ‘Health
Spectrum’ is being
launched. I am sure
it will become very
popular. It deserves
to be.
Dr. Samiran Nundy
Dean, The Ganga Ram Institute for
Postgraduate Medical Education
and Research, Sir Ganga Ram
Hospital, New Delhi
Health Spectrum : a
platform to discuss health
Problems and solutions
This is a good initiative by Medi
Media to lauch monthly health
magazine ‘Health Spectrum’.
With increasing number of
people seeking the Dr Google for
medical problems, it is important
that we have a credible group of
professionals who can give unbiased
and scientific information to the
public. Also a lot of information
on the internet is for the western
population and does not suit
the Indian public. For example,
Avocado fruit for breakfast to loose
weight. Non communicable and life
style diseases are rapidly competing
with infections and cancer and will
eventually become the number one
cause of medical problems in India.
A forum like “Health
Spectrum’ would give
opportunity to discuss
the prevention and
management of these
health problems and its
solutions
Dr Arun Prasad
Senior Consultant Surgeon -
Minimal Access Surgery (Gastro
intestinal, Robotic, Bariatric &
Thoracoscopy), Apollo Hospital,
New Delhi.
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Share your opinion at
healthspectrumindia@gmail.com.
Letters
It gives me immense pleasure to know that Mr Vinod Kumar
(Editor) is launching a monthly health magazine “Health
Spectrum” with the objective to create health awareness in our
society and will cover all aspects of Health and Medicine. I
would like to congratulate Mr. Vinod & his entire team for the
inaugural issue of the magazine.
Dr. Sunita Godara
Asian Marathon Champion 1992
Director-Health Fitness Trust
President-Health Fitness Society
June 2016, Volume 1, Number 1
Editor : Vinod Kumar
Managing Editor : Sushila Kumari
Editorial Advisors :
Dr. Jitendra Kumar
Dr. Manoranjan Sahay
Dr. Pallavi Vaishya
Content Team :
Himanshu Patra, Jyoti Choudhary,
Prem Babu Sharma, Ajit Kumar, Deba
Sahoo (Delhi), Sama Irani (Mumbai),
Aloka (Ranchi), Arun Kr. Mayank
(Patna) & Deepa Tomar (Singapore)
Art Director : Kripa Shankar
Design & Graphics : K A Choudhary
Admin & Business : Satnam Singh
M : +91 8826335577
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Head Office :
909-910, B-Wing, Naurang House,
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Published & Printed by Vinod Kumar
at Angkor Publishers (P) Ltd,
B-66, Sector 6, Noida-20130
Published from 21, UNI Apartments,
Sector-11, Vasundhara, Ghaziabad –
201012
Editor : Vinod Kumar
Email : info@healthspectrum.org
Website : www. healthspectrum.org
Note : Views expressed in articles are the
views of the individual author. They do
not represent the views or interests of
Health Spectrum.
facebook/spectrumhealthindia
Title Code : UPENG04171

5Health Spectrum June 2016
Editor Speak
The need for constant
health awareness
O
ur health, which is an invaluable asset of our life, is determined and affected by an
array of diverse factors — from the genes that we inherit from our parents to the
climate we live in and the work we do. But there is a growing body of scientific
evidence that shows our lifestyles play a huge part in how healthy we are. From what we eat
and drink, to how much exercise we do, and whether we smoke or take drugs, every single
factor is impacting our health, not only in terms of life expectancy but also in terms of our
ability to live without experiencing chronic diseases
In India, the situation is absolutely different because Indians are discarding their centu-
ries-old lifestyle and traditional food and recklessly adopting a western life and junk food.
Due to this fast-changing scenario, India is witnessing an alarming spurt in several life-
style diseases. The disturbing fact that starkly stares in our face is that the country accounts
for the highest number of diabetes cases and some other health problems like cancer and
cardiovascular diseases. It is hardly surprising that India has become the world capital of
several life-threatening ailments.
There are a number of factors contributing to the dismal health scenario in our coun-
try. Indians are genetically predisposed to a numbers of diseases, particularly cardiovas-
cular problems, but vast disparities in the healthcare delivery and lack of awareness about
medical facilities among the general public have largely contributed to it. It is imperative to
generate mass awareness about the symptoms, repercussions, complications and treatment
of a disease. Most of the time, ignorance about a disease proves fatal.
India may be witnessing an Information Revolution boom with the emergence of hun-
dreds of TV Channels, newspapers and websites, but it is ironical that majority of people
still have no access to quality and authentic health information. Even in the 21st century,
people depend on hearsay or primitive health techniques.
It is precisely because of this reason that we, a small but dedicated team of health
communicators, have decided to bring out “Health Spectrum”, with the avowed objective
of disseminating scientifically proven health information among the general public. It is
one baby step in that direction but our ultimate objective is to position the magazine as
a bridge between Health Experts/Doctors/Researchers/ Health providers and the general
public. We hope that it will become a medium of communication between them.
In this inaugural issue, we are honoured to share with our readers the profound and
thought-provoking articles from some committed people. The first issue of ‘Health Spec-
trum’ is now in your hands. We appreciate your support and are delighted to have you as a
reader of the magazine. We earnestly hope that you will constantly provide guidance and
support to this initiative through a sustained readership.
We will look forward to your suggestions and feedbacks for improving the magazine.
After all, it is your magazine. We will surely publish the worthwhile comments from our
readers.
With warmest thanks,
Vinod Kumar
Editor
Health Spectrum
Email : editor.healthspectrum@gmail.com
Greetings and a warm welcome to our very first issue of Health Spectrum!
India may be witness-
ing an Information
Revolution boom with
the emergence of hun-
dreds of TV Channels,
newspapers and web-
sites, but it is ironical
that majority of people
still have no access to
quality and authentic
health information.
Even in the 21st cen-
tury, people depend on
hearsay or primitive
health techniques.

June 2016Contents
In The News
l President bestows Florence
Nightingale Awards on 35 Nurses 7
l International Convention on
World Homoeopathy Day 8
l Foundation Stone laid for three
new Medical Colleges at Rajouri,
Anantnag and Baramulla 9
Regular Columns
Face to Face 24
Case Study 26
Q A 48
Fitness Mantra 38
New Study/Research
l Every fourth woman in urban
India either overweight or obese 10
l Electronic Waste: Health
Hazards For 5 Lakh Child Labourers 11
l Dietary Habits Processed
Foods Spurring Cancer Incidence
in India 12
Articles
l Is Left-handedness a Handicap
for Training in Surgery?
- Dr. Rohan Khandelwal 27
l Blue Light Hazard: Eyes Face
Threat from Blue Violet Light
-Dr. Ira Chopra 28
l Cholesterol Woes 52
Parenting
l Understanding Psychology of Your
Children - Dr. Shobhana Mittal
7
9
28
30
20
14
l Huge manpower
gaps bedevil healthcare
in rural India: How
Private Sector Can Help
- Dr Dharminder Nagar
l Redefining Wheel-
chair: Empower People
with Disabilities with
Technology
-Dr. H. S. Chhabra
l India Needs
Universal Neonatal
Hearing Screening
Beauty Care 32
When Beauty is more than Skin Deep
– Dr. P. K. Talwar
Healthy Motherhood 33
Know what to expect from high-risk
pregnancies
Food Nutrition 34
Important to take Balanced,
Nutritious Diets during
Pregnancy
– Dr. Pallavi Vaishya
Fitness36
Benefits of Swimming
Alternative Medicine
l Homeopathy: Treatment of
the ‘Cause’ and ‘Effect’
-Dr. Mukesh Batra 40
Holistic Medicine
l Era of Holistic Medicare
-Dr. R. K. Tuli 44
Adult Vaccination
- Dr. Vivek Nangia
Cover Story
Current Issue
12

In The News
The President Shri Mukherjee with Florence Nightingale Awardees. Shri J.P. Nadda and the Health and Family Welfare Secretary,
Shri B.P. Sharma are also seen.
President bestows Florence
Nightingale Awards on 35 Nurses
T
he President of India, Shri Pranab Mukherjee
presented the National Florence Nightingale
Awards to nursing personnel on May 12, 2016) on
the occasion of International Nurses Day at Rashtrapati
Bhavan.
Speaking on the occasion, the President said nursing
professionals are the backbone of the healthcare system.
Nurses play a vital role in all aspects of healthcare, be it
national health campaigns like polio eradication, mid-
wife services and community education. Their level of
commitment and care are much valued in both urban and
rural areas, including remote areas of the country. Their
contribution is critical in the achievement of the nation’s
healthcare goals. Their inputs into health sector policies
are equally important for they help in creating the neces-
sary supportive work environment for their practice.
The President said emerging global threats such as
microbial resistance, new pandemics, infections, and
natural disasters have added to the pressure and demands
on healthcare services. The services of nurses are crucial
for a response system that a government creates to meet
these challenges. Nursing personnel in our country are
increasingly better educated and well-trained. They are
now more adept at communicating with patients, and connect-
ing with citizens, communities and policy makers. In the next
fifteen years or so, the nature of their services will undergo
significant change. Training and capacity building in this field
will require new levels of innovation and leadership. Yet, one
thing will endure. And that is, the premium all communities in
the world place on the sensitivity, empathy and humanity of
Indian nurses.
Minister for Health and Family Welfare, Shri J P Nadda
congratulated the award winners and appreciated their exem-
plary services. Shri Nadda also informed that the Ministry has
undertaken number of initiatives for strengthening of nurs-
ing cadre. The Florence Nightingale awards are given to the
outstanding nursing personnel employed in Central, State/
UTs. Nurses working in Government, Voluntary Organiza-
tions, Mission institutions and the private institutions can apply
with the due recommendation of concerned State Government.
The Florence Nightingale Awards carries Rs.50, 000/- cash, a
certificate, a citation certificate and a Medal.
Also present at the award ceremony were Sh B P Sharma,
Secretary (Health and Family Welfare) and senior officers
from the Ministry of Health and Family Welfare along with
invitees. n
The President presenting Award to Nursing Sister, Medical Speciality
Hospital, Chandigarh, Ms. Jaswinder Bakshi.

In The News
T
he Minister, Shri Shripad
Yesso Naik also released a
commorative stamp and a
souvenir on this occasion.
Shri Naik, in his inaugural address, ex-
pressed regret over the fact that the po-
tential of Homoeopathy remains largely
unexplored and, therefore, underuti-
lized in public health. This, despite the
fact that Homoeopathy is practised in
more than 80 countries of the world
and is known to be effective in various
communicable and non-communicable
diseases, chronic diseases and diseases
of children and mothers, he added.
He said that, during pregnancy, when
expecting mothers are usually advised
not to take much medication, Homoe-
opathy is a safe alternative. The scope of
prevention of various epidemic diseases
through Homoeopathy is also huge, but
not yet tapped, he added.
The Secretary, Ministry of AYUSH
Shri Ajit M. Sharan informed the gath-
ering that the Government of India is
putting in all efforts to develop centers
of excellence in Homoeopathy. North
Eastern Institute of Ayurveda and Ho-
moeopathy is being given impetus and
work on All India Institute of Homoe-
opathy has been initiated, he added.
He also said that the centers of excel-
lence so formed would be models for
education, research and patient care in
specific fields. Shri Sharan highlighted
the importance of research for scientific
advancement of Homoeopathy.
The International Convention on
World Homoeopathy Day was organ-
ised by CCRH, an autonomous research
organization of Ministry of AYUSH,
Government of India and an interna-
tional organisation Liga Medicorum
Homeopathica Internationalis (LMHI).
Scientists and homoeopathy doctors
from 23 countries including Brazil,
Russia, South Africa, Italy, Netherlands,
U.K., Austria, Armenia, Canada, Israel,
Australia, Bangladesh, Japan, France,
UAE, Cuba, Nepal, Turkey, Argentina,
Slovenia, Pakistan, Ghana and Kenya
participated in this convention.
The event was organized to com-
memorate the 261st birth anniversary
of the founder of Homoeopathy Dr.
Christian Friedrich Samuel Hahne-
mann, a German physician, who was
a great scholar, linguist and acclaimed
scientist. The theme of the conven-
tion is ‘Integrating Homoeopathy in
Healthcare’.
During the convention, speakers de-
liberated upon various significant issues
in Homoeopathy. It includes special
sessions on ‘Homoeopathy on Cancer’,
‘Homoeopathy on Mental Health’, ‘Ho-
moeopathy on Epidemics’, ‘Homoeopa-
thy on Public Health, Clinical Research
studies, Drug Validation and Drug
Development’ among others.
Among the invited guests were
Mohd. Nasim, Minister of Health
Family Welfare, Govt. of Bangladesh,
Mr. Mushtaq Alam, Minister of State
for Health, Govt. of Nepal, Mrs. Fozia
Manzoor, Counsellor of High Commis-
sion, Pakistan and Mr. Anura Jayawick-
rama, Health Secretary, Sri Lanka. n
International Convention on
World Homoeopathy Day
Prevention of various epidemic diseases through homoeopathy is huge, says Shri Shripad Yesso Naik
Shri Shripad Yesso Naik lighting the lamp to inaugurate the “International Convention on World Homoeopathy Day”, in New Delhi on April 09, 2016.

U
nion Health and Family
Welfare Minister Shri J P
Nadda laid the foun-
dation stone for three
new medical Colleges at Rajouri,
Anantnag and Baramulla districts
in Jammu and Kashmir, today. “The
new Medical Colleges will strengthen
the medical infrastructure and give
a big boost to tertiary healthcare and
medical education in the region”, Shri
Nadda stated. He said that with total
outlay of ₹ 189 crore each, the three
new Medical Colleges will add 300
MBBS seats per year in the States with
100 seats per College. In addition, the
medical infrastructure in the districts
will be strengthened with addition
of a 300 bed facility attached to each
college.
Ms. Mehbooba Mufti, Chief Min-
ister of Jammu and Kashmir; Dr. Ji-
tendra Singh, Union Minister of State
(I/C); Shri Bali Bhagat, State Minister
for Health Medical Education; and
Ms. Asiea Naqash, Minister of State
for Health Medical Education,
Government of Jammu Kashmir
were also present at the ceremonies.
The Union Health Minister stated
that in addition to these new initia-
tives, the Government Medical Col-
lege, Jammu and Government Medi-
cal College, Srinagar in the State of
JK have been taken up for upgrada-
tion under PMSSY with an outlay of
₹ 120 Crore (i.e. Central contribution
of ₹115 Crore and State share of ₹ 5
Crore) for each medical college. He added that ₹ 2194.8 crore
since inception and ₹ 688.8 crore during last two financial years
has also been released to Jammu Kashmir state for implemen-
tation of programmes approved under National Health Mis-
sion (NHM). Shri Nadda said that the State is receiving higher
allocation per capita like the North East (NE) States. State also
has a provision of Hard Area Allowance, where maximum of ₹
20,000 is provided to Medical Officer.
Shri Nadda stated that the Hon’ble Prime Minister had an-
nounced development package for Jammu Kashmir on 7th
November, 2015 which includes creation of two AIIMS-like in-
stitutions. Moreover, one time grant of up to ₹120 crore each for
2 State Cancer Institute at Jammu and Srinagar and up to ₹45
crore each for 3 Tertiary Care Cancer Centre (TCCC) at District
Hospital in Kupwara, Kishtwar Udahmpur districts has also
been approved. Shri Nadda said that these new initiatives shall
significantly improve the healthcare facilities in the State. n
Foundation Stone Laid For
Three New Medical Colleges At
Rajouri, Anantnag And Baramulla
Shri J.P. Nadda and Ms. Mehbooba Mufti laying the foundation stone for the new Medical
College, at Baramulla, in Jammu and Kashmir
Shri J.P. Nadda and Ms. Mehbooba Mufti laid the foundation stone for the new Medical Col-
lege, at Rajouri, in Jammu and Kashmir
A big boost to tertiary healthcare and medical education in the region: J P Nadda
In The News

New Study/Research
Every Fourth Woman In Urban India
Either Overweight Or Obese
R
ecent surveys by various agencies
have claimed that India has world’s
third highest number of obese
persons behind the USA and China and even as
experts claimed that the problem is more acute
among women than men.
On the basis of data of the third round of
the National Family Health Survey (NFHS) and
Indian version of Demographic Health Survey
(DHS) which is conducted in more than 80
countries all-over the world, experts claimed
in urban India, about 25 percent of w omen are
either overweight or obese, which is higher than
the prevalence among men (20%) .
A sensational 44% of diabetes burden and
an estimated 10% to 40% of certain cancer bur-
dens are attributable to overweight or obesity.
Obesity reduces the life span of an individual
by an increased risk of diabetes, cancer, heart
attacks, stroke, kidney and liver failure.
This problem has added to the already
existing woes of our country that has been
struggling to come to grips with undernutrition
and infectious diseases. With a substantial 40%
of the country being under nourished and an
estimated 20% ‘over nourished’, overall India
has 60% malnourished people and “this is mat-
ter of concern.
As India is struggling to eradicate the
problem of undernutrition and anaemia mean-
while, our country already witnessed the over-
weight and obesity problem which has more
than 30 million obese people, and the number
is increasing alarmingly. These findings only
throw up the challenge of two different nutri-
tion-related health problems in the country.
India has to therefore grapple with the problem
of undernutrition and anaemia in one hand and
overweight or obesity on the other hand. (by
Shama Irani) n
Obesity has added to
the already existing
woes of our country
that has been strug-
gling to come to
grips with undernu-
trition and infectious
diseases. With a sub-
stantial 40% of the
country being under
nourished and an
estimated 20% ‘over
nourished’, overall
India has 60% mal-
nourished people
and “this is matter
of concern.

I
ndia’s 5 lakh child labourers face health
risk due to dismantling and recycling the
electronic waste produced in the country,
according to a report by the Associated
Chambers of Commerce and Industry (AS-
SOCHAM) – Frost and Sullivan, India’s 5 lakh
child labourers face a serious health risks due
to the electronic waste (e-waste) generated in
the country, according to a study by the Associ-
ated Chambers of Commerce and Industry of
India (ASSOCHAM)-Frost and Sullivan.
According to the report, child labourers in
the age group of 10-14 years who are found en-
gaged in various e-waste dismantling activities,
without adequate protection and training in
handling and recycling the waste, are at greater
health risk.
India is expected to produce 30 lakh metric
tonnes (MT) of electronic waste (e-waste) per
year by 2018 from the present 18.5 lakh MT.
More than 95 percent of e-waste generated
in the country is managed by the unorganised
sector and scrap dealers, the study revealed.
E-waste includes discarded computer
monitors, motherboards, cathode ray tubes,
printed circuit board, mobile phones and
chargers, compact discs, headphones, white
goods such as liquid crystal display/plasma
televisions, air conditioners and refrigerators.
These products contain toxic substances, in-
cluding lead, cadmium, mercury, hexavalent
chromium, plastic, polyvinyl chloride and
other heavy metals.
“This deadly mix can cause severe health
problems in those handling the waste. Printed
circuit boards, for instance, contain heavy
metals like antimony, gold, silver, chromium,
zinc, lead, tin and copper. The method of ex-
tracting these materials from circuit boards is
highly hazardous and involves heating the metals in the open,”
B K Rao, chairman of ASSOCHAM Health committee that re-
leased the ASSOCHAM paper, said.
The study showed the people who are engaged in recycling
e-waste without any proper training, including children, use
primitive and hazardous methods like acid stripping and open
air incineration for processing e-waste. These methods are
highly unsafe and cause pollution by releasing toxins from the
e-waste into the environment.
“Exposure can cause headache, irrita-
bility, nausea, vomiting and eyes pain. Re-
cyclers may suffer liver, kidney and neuro-
logical disorders”, Rao added.
The ASSOCHAM report has advocat-
ed bringing about a new legislation in the
country which prevents the entry of chil-
dren into the labour market, particularly
the e-waste dismantling activities. It said
children should not be allowed to collect,
segregate or distribute e-waste.
The study further said that Mumbai
tops the list of cities generating high e-
waste, with 120,000 MT produced there
every year. Delhi-NCR (98,000MT) and
Bangalore (92,000MT) follow Delhi in
terms of e-waste generation. Chennai, Kolkata, Ahmadabad,
Hyderabad and Pune are the other cities in India that generate
high quantities of e-waste, the study revealed.
It added that only 2.5 percent of India’s total e-waste gets
recycled because of poor infrastructure and inadequate legis-
lative framework which has led to wastage of natural resourc-
es, and irreparable damage to environment and health of the
people working in industry. n
Electronic Waste: Health Hazards
For 5 Lakh Child Labourers
India is expected to produce 30 lakh metric tonnes (MT) of electronic waste (e-waste) per
year by 2018 from the present 18.5 lakh MT. More than 95 percent of e-waste generated in
the country is managed by the unorganised sector and scrap dealers, the study revealed.
The study further
said that Mumbai
tops the list of cities
generating high
e-waste, with 120,000
MT produced there
every year. Delhi-NCR
(98,000MT) and Ban-
galore (92,000MT) fol-
low Delhi in terms of
e-waste generation.
New Study/Research

New Study/Research
Not just the numbers have increased, the age of incidence of cancer is also markedly low
today, ringing a sense of alarm among doctors and experts
R
apid changes in dietary habits, increased consump-
tion of packaged foods, high levels of industrial and
environmental pollution and the inadvertent entry
of chemicals in the human food chain are factors
that are spurring an alarming rise in cancer incidence in India.
Dr Tanmoy Mukhopadhyay, Senior Consultant Clinical
Oncologist, Apollo Gleneagles Cancer
Hospital, Kolkata says not only has the
numbers of several cancers increased in
recent years, but in an alarming trend
the average age of incidence has also
reduced drastically in recent years. On
an average, nearly 12 lakh new cancer
cases get added annually to the 25 lakh
existing patients across the country.
“The downward shift in the average
age of cancer incidence is also a very dis-
turbing trend. Earlier, the risk of cancer
was believed to increase with age. What
was earlier considered a disease primar-
ily of the old in now increasing afflicting
young men and women, even in their
30s and 40s. The common factors that
are responsible for the rise in increase
of cancer incidences are lifestyle, food habits, chemical usage
such of pesticides, insecticides, fertilizers, preservatives and
likewise,” says Dr Mukhopadhyay.
“Change in dietary habits from traditional to western,
increasing intake of processed/ preserved/packaged foods and
decreasing consumption of raw vegetables and fruits are fac-
tors that are being recognized as probable
risk factors. Another hazardous factor is
dangerous industrial and environmental
toxicants that are rampant in our air and
water bodies and find their way into our
fruits and vegetables. Excessive use of
pesticides also pollutes fruits and vegeta-
bles, as does the use of chemicals that is
used for artificial ripening of the fruits
and vegetables,” adds Dr Mukhopadhyay,
explaining the probable causes for rising
incidence of cancers.
Consumption of packaged foods has
been a regular practice of lifestyles in
the west where incidence of colorectal
cancers has traditionally been high. In-
creasing urbanization and convenience is
prompting more and more Indians today
Dietary
Habits
Processed
Foods
Spurring
Cancer
Incidence
in India
At the same time, a turn
towards sedentary life-
styles, increased obesity,
smoking and drinking
are all factors that con-
tribute to increasing risk
of breast cancer among
women,” says Dr Mukho-
padhyay. It is estimated
that by 2030 the number
of new cases of breast can-
cer in India will reach just
under 2,00,000 per year.

to adopt western lifestyles. Eating lots of red or processed meat
increases the risk of bowel cancer, stomach and pancreatic
cancers. Another reason for the rise in cancer incidence is the
high consumption of alcohol, smoking and tobacco.
“Lack of awareness is one of the leading challenges faced by
India in fighting cancer. A majority of diagnoses in India hap-
pen in advanced stages (stages 3 or 4) unlike the West where
regular screenings have ensured that most cases are diagnosed
in early stages and treated. Delay in diagnosis often means
that a treatable disease becomes untreatable. Many people,
especially in rural areas, tend to see local medical practitioners
who might lack sufficient knowledge of the disease,” says Dr.
Mukhopadhyay.
According to the World Cancer Report 2014, commis-
sioned by the International Agency for Research on Cancer
(IARC), WHO’s research body, cancers figure among the
leading causes of mortality worldwide, with approximately
14 million new cases and 8.2 million cancer related deaths in
2012. While the 5 most common cancers among men in 2012
were lung, prostate, colorectum, stomach, and liver cancer;
among women the 5 most common sites diagnosed were
breast, colorectum, lung, cervix, and stomach cancer. A study
has revealed that in 2007 Kolkata had topped the metros in
new lung cancer cases.
“Indian cities and urban centres have witnessed major
lifestyle and behavioral shifts including greater independence
of women and their increased participation in professional
fields. This has helped delay marriages, pregnancies, reduced
the number of pregnancies as well as duration of breast feed-
ing while increasing consumption of oral contraceptives. At
the same time, a turn towards sedentary lifestyles, increased
obesity, smoking and drinking are all factors that contribute to
increasing risk of breast cancer among women,” says Dr Muk-
hopadhyay. It is estimated that by 2030 the number of new
cases of breast cancer in India will reach just under 2,00,000
per year.
What is scary is the estimate that cases are expected to rise
by about 70% over the next 2 decades, something that calls
for urgent attention on prevention and lifestyle modification.
It is predicted that by the end of 2020, over 10 million people
would die globally each year because of cancers with 70%
deaths from the developing countries only. WHO believes
that around one third of cancer deaths are due to the 5 leading
behavioral and dietary risks which are High body mass index;
Low fruit and vegetable intake; Lack of physical activity; To-
bacco consumption; Alcohol intake.
A sedentary lifestyle that includes lack of exercise, eating
junk foods, inadvertent use of chemicals in foods can increase
the risk of cancer. Keeping a healthy body weight can help
reduce the risk of bowel, breast (postmenopausal), kidney,
womb, esophageal, pancreatic and gall bladder cancers. There-
fore, adopting such as regular exercise, eating food on time,
intake of nutritious food, quitting habits like smoking and
alcohol can help in preventing cancer. (by Sagarika Dutta)n

Current Issues
F
or all the animated talk about India’s rapidly-growing, medical-tourism
attracting healthcare sector and projections of it becoming a USD 280 bil-
lion industry by 2020, the fact remains that our health sector is bedevilled
by major disparities when it comes to accessibility between urban and
rural areas.
According to estimates almost 70% of the doctors in India are concentrated
in urban centres, serving around 30% of the total Indian population. Urban India
enjoys access to almost 65% of the country’s hospital beds despite having less than
30% of the total population.
At a time when technology and infrastructure make distances shorter, we still
have a long way to go in building the bridges to cover the gaps in rural healthcare.
Home to more than 60% of the national population, India can no longer simply
dismiss its rural sector as the ‘sick child’, and needs to take essential steps in order
to steer its healthy recovery.
Huge Manpower Gaps Bedevil
Healthcare In Rural India
How Private
Sector Can Help
Dr Dharminder Nagar
MD CEO, Paras Healthcare, says
that quality tertiary healthcare is
not available even to a bulk of urban
population living outside a few
glittering metropolitan cities.

One of the raging issues in the uplift-
ment of health and sanitation in remote
areas has been the sheer lack of trained
medical professionals to cater to the eve-
ryday needs of the habitants, who are
thereby deprived of the basic medical fa-
cilities necessary for survival.
Forget the rural hinterland, remote
villages and tribal areas, quality tertiary
healthcare is not available even to a bulk
of urban population living outside a few
glittering metropolitan cities. For exam-
ple, in north India while Delhi NCR re-
mains a hub of the best multi-specialty
hospitals, even a 100 km move outside
the region will leave you without a decent
tertiary care hospital. This is evident from
the fact that the Delhi NCR hospitals are
crowded with people coming from Uttar
Pradesh, Bihar, Haryana and even West
Bengal.
A lot of people have to travel long dis-
tances to avail of life-saving treatments
like dialysis. In the absence of quality car-
diac care in smaller towns and villages,
many people fail to survive a heart attack
as they are required to travel long distanc-
es to nearby cities with decent healthcare
facilities.
While primary healthcare facilities
continue to suffer from shortage of staff
and absenteeism, private sector finds little
incentive in investing heavily in rural ar-
eas. However, through some low cost but
effective initiatives, the private sector can
play a positive role in helping address the
deficit of manpower in rural healthcare to
some extent:
TELEMEDICINE CENTRES
Telemedicine,asweknow,referstothe
use of information technology to provide
medical consultation in far flung areas.
It is intended to overcome geographical
barriers, connecting users who are not in
the same physical location with an aim to
improve health outcomes. Remote popu-
lations, which often lack minimal physi-
cian presence can benefit to a large degree
by telemedicine centres through which
physicians can offer basic minimum con-
sultation and medical advice. Notably,
communicable diseases are among the
leading afflictions affecting rural popula-
tions and basic consultation and hygiene
advice can also go a long way in treatment
and reducing their incidence.
PRIVATE-PUBLIC
PARTNERSHIPS
We need more public private partner-
ships to involve the private sector in rural
areas. These partnerships can offer incen-
tives to doctors to offer services in rural
areas for a small number of days of a year.
With severe shortage of specialized cardi-
ologists, nephrologists, neurologists and
gynaecologists, rural populations often
have to make with less skilled doctors or
worse quacks. PPPs that can take skilled
doctors of reputed hospitals to offer ser-
vices in rural health centres and recom-
mend patient transfer if needed, can play
a role in bridging this gap.
TURNING TO
SMALLER CENTRES
It is understandable that for a pri-
vate entity it doesn’t make much business
sense to open tertiary care hospitals in
villages. However, the needs for profit and
social benefit can be balanced by open-
ing hospitals in smaller towns and cities
which cater to large surrounding popula-
tions.
TRAINING LOCAL
MANPOWER
Notably, the deficit in manpower in
rural areas is not just about doctors, it is
about healthcare providers in toto. Even
nurses, radiologists, pathologists and
paramedics are hard to find. Launching
training programs for nurses and para-
medics in smaller centres is another im-
portant initiative that can help address
manpower shortage to an extent. n
We need more public
private partnerships
to involve the private
sector in rural areas.
These partnerships
can offer incentives to
doctors to offer ser-
vices in rural areas for
a small number of days
of a year. With severe
shortage of specialized
cardiologists, neph-
rologists, neurologists
and gynaecologists,
rural populations often
have to make with less
skilled doctors or worse
quacks.

W
hen our eyes first come
across a person sitting in a
wheelchair, we often feel a
pang of overwhelming sym-
pathy and try our best to accommodate the
occupant with the best of intentions. The lack
of wheelchair friendly facilities and infra-
structure in our nation, required to make the
lives of these specially-abled people easier, can
leave one quite red-faced and helpless at such
a point.
In today’s time, there are millions of wheel-
chair occupants in India who suffer from the
twofold consequences of unavailable spaces
dedicated to wheelchairs in pavements, pub-
lic places and buildings, and the absence of a
low cost motorized wheelchair in the market.
This is especially true for the rural and semi
urban population which faces the financial
constraints that prevents ownership of such
a technological advancement, and also deals
with uneven terrain making such an entity es-
sential for survival.
However, a wheelchair doesn’t and
shouldn’t symbolize dependence, agony and
disability. With some technical and social
support, a wheelchair occupant in our society
can become much more independent and lead
a dignified life. Afterall, they are free think-
ing intelligent individuals who like everyone
else want to lead a life with purpose. The ge-
nius physicist, cosmologist Stephen Hawk-
ings whose body has been severely affected by
motor neuron disorder continues to enamour
the world by his mental prowess, and theories
about black holes and the expanding universe.
A highly advanced technologically equipped
wheelchair has been crucial in helping him
lead a highly productive life despite the physi-
cal disability.
Technology-backed wheelchair modification is the new route towards making
wheelchairs self-sustaining and dignified. writes Dr H S Chhabra.
Empower People With
Disabilities With Technology
Redefining Wheelchair
Dr H S Chhabra
Medical
Director Chief of Spine
Service at Indian Spinal
Injuries Centre, New Delhi
Health Solution

A number of small to major inter-
ventions can go a long way in helping
individuals with disability lead inde-
pendent and productive lives using
technologically equipped wheelchairs
that can not only be used as a transport
mechanism but also be flexible enough
to maneuver all areas of a house or a
workplace, offer a greater adaptive driv-
ing experience and even personal mobil-
ity seating and positioning systems that
make the experience more comfortable.
For example, manual and electric wheel-
chairs and foam, gel and air cushions for
proper seating.
Specialized computer software and
equipment like adaptive keyboards,
monitors and voice recognition pro-
grams are only few of the exciting tech-
nologies which can be explored. Ergo-
nomic workstations and modifications
for home and workplace with different
environment control units for home,
work and school can completely change
the lifestyle of the individuals with dis-
abilities. India can move towards finally
becoming a disabled friendly nation
through such initiatives.
This is not only an achievement that
will reaffirm the scientific and techno-
logical prowess and advancement of the
nation, but will also boost the human
resource development by enhancing
the standard of living and capabilities of
these individuals.
Researchers internally are working
on incorporating path-breaking tech-
nologies into the wheelchair. Designers
have even conceptualized and put into
development models of wheelchairs that
can climb stairs, move at faster speeds to
allow the users faster transport, be ad-
justable into public transport systems
and enable the users travel easily to and
fro from work.
Approximately 65 million wheel-
chairs are needed worldwide, and those
in less-resourced environments, such as
India, are faced with the difficult chal-
lenge of accessing devices that can pro-
vide functional mobility for an afford-
able price. Unfortunately, efforts have
not addressed the needs of people who
would benefit from appropriate wheel-
chairs, and low-cost western style de-
vices are beginning to crowd the market
despite the fact they perform poorly,
fail prematurely, and in some cases have
been discontinued in the western mar-
kets.
Though some such services are avail-
able in India as well, cost remains an ob-
stacle that prevents many from availing
them. In this context, the Department
of Assistive Technology of Indian Spi-
nal Injuries Centre is working with the
University of Pittsburgh, USA closely for
transferring the latest technology in the
field to the Indian settings.
A recent example of this collabora-
tion is the low cost motorised wheel-
chair, ISIC-LOCOMO . ISIC has part-
nered with the Ministry for the People
with Disabilities in order to bring the ve-
hicle to India, and remodel it according
to Indian needs terrain. At a relatively
low and affordable cost of Rs. 45000 as
compared to the imported motorised
wheelchairs (which cost a whooping
1.5 lakh), ISIC-LOCOMO boasts of a
unique suspension system to accom-
modate Indian environment conditions.
It also features a 360 degree joystick
controller and rechargeable battery to
ensure ease of operation and has a light
weight and easy-to-fold and assembling
consistency to enable portability.
This will result in the fulfillment of
the dream of both the organizations in
helping people with disabilities to lead
self-reliant lives, with the help of tech-
nology and modifications.
It is high time that we stop feeling
sorry for these victims of unfortunate
circumstances, and instead empower
the people with disabilities by enabling
them to live a life of independence and
self-sustenance. After all, this effort is a
very small price to pay to restore the dig-
nity of the disabled, and can only bear
the sweetest of fruits for the nation in
the future. n

Health Report
H
earing impairment is one of the most
prevalent congenital disabilities in
India, with an estimated 8 per 1000
infants born with moderate to pro-
found hearing impairment. However, more than
half of the children born with hearing defects fail
to get timely medical intervention resulting in
substantial language and speech development de-
lay and a consequent loss of growth and cognitive
development.
As we celebrate World Hearing Day (March
3), experts in the field are pointing out the need to
establish better hearing screening mechanisms for
newborn babies to ensure that all children born
with hearing impairment are detected early on in
life. The theme for this year’s World Hearing Day
is ‘Childhood hearing loss: act now, here is how!’
It aims to draw attention to preventable causes of
hearing loss, right health measures needed to pre-
vent the same and importance of early identifica-
tion and suitable, timely interventions in children
afflicted with hearing impairment.
Unlike developed countries which have imple-
mented near universal newborn hearing screen-
Majority of Hearing Impaired Infants Fail to Receive Crucial Early Medical Attention
that becomes a major obstacle in their normal growth cognitive development
Neonatal Hearing Screening
India Needs Universal

ing programs under which newborns
are tested at birth, India lacks such a sys-
tem. Consequently, hearing disability is
discovered much later in a large number
of children. Hearing impairment in chil-
dren leads to substantial language and
speech delay that causes cognitive and
developmental challenges. This further
leads to academic challenges and delays
in learning. In the absence of a screening
at birth mechanism, suspicion of hear-
ing disorder by family members is still
the main mode of detection of child-
hood hearing impairment, and this di-
agnosis often doesn’t occur as late as two
years of age.
“Children learn 90% of their lan-
guage in early childhood (0-3 yrs) inci-
dentally. This is possible only when they
are hearing well. A child absorbs a lot of
information and cognitive ability in the
first 2-3 years of life, this includes ability
to speak, pick up languages and identify
objects. Without ability to hear, much
of this crucial time is lost on children
and they may suffer significant cogni-
tive losses. In most cases, children are
brought to us much later, at 2, 3 or 4
years of age, sometimes even later. Most
parents in India determine that their
child may be suffering from hearing dis-
ability much after birth when they ex-
perience lack of response to sounds in
a child or inability to speak. To improve
this, we need a system where all children
are tested at birth in hospitals. A cohe-
sive universal system will prevent delay
in intervention,” says Neevita Naraya-
na, leading Audiologist and founder of
Sphear Speech Hearing Clinic.
Early detection of hearing impair-
ment can prevent related disability of
speech, language, cognition and overall
development of the child. But, absence
of neonatal hearing screening in the
country delays identification, correc-
tive measures and rehabilitation of such
children. It is recognized that children
identified with hearing loss prior to 6
months of age have better chance of de-
veloping skills equivalent to their peers
by the time they enter kindergarten. The
American Academy of Pediatrics rec-
ommends that hearing loss in infants
should be identified and when possible
treated before 6 months of age. Children
identified much later may suffer from ir-
reversible and permanent impairments
in speech, language, and cognitive abili-
ties.
“Permanent hearing loss is one of
the commonest congenital disorders
with the incidence being much more
than the conditions newborns are rou-
tinely screened for. Despite existence of
mechanisms to test auditory function of
newborn babies, this screening is rarely
done in the absence of an established
universal screening program. Besides,
due to major lack of awareness about
new age solutions, many people believe
a congenital hearing disability cannot
be treated. However, today there are not
only advanced diagnostic tools but also
highly advanced solutions such as hear-
ing aids, cochlear implants and auditory
brain stem implants that can allow sig-
nificant improvement in hearing abil-
ity of even completely deaf persons. We
need to create greater awareness about
the availability of such mechanisms.
Today auditory brain stem implants can
enable even completely deaf children to
hear,” says Dr Ameet Kishore, Senior
Consultant Surgeon, ENT Cochlear
Implants at Indraprastha Apollo Hospi-
tal, New Delhi Sphear Speeh Hear-
ing Clinic.
Lacks of a universal program to
screen babies remains a major obstacle
in early identification of disability and
quick corrective intervention in the
form of hearing implants. Reducing the
age of diagnosis is a major challenge for
Indian healthcare. Universal screening
at birth has found to have lowered the
age at which infants receive hearing aids,
from 13-16 months to 5-7 months in de-
veloped countries. This prevents a huge
burden of secondary disability.
Children with a hearing disability
are at risk of delayed speech and lan-
guage development and poor academic
performance as a result. In India, such
children also sometimes face ridicule
and may experience loss of confidence.
When implanted on time, the new age
devices can allow complete assimilation
of a child into the mainstream – includ-
ing schools and social activity.
How is the screening done?
The screening is done in two sim-
ple tests namely Otoacoustic Emis-
sions (OAE) and Auditory Brain Stem
Response (ABR). While the former in-
volves placing a sponge earphone in the
ear canal to measure whether the ear
can respond properly to sound, in later,
earphones are placed on ear, while elec-
trodes are placed on the head and ears
to measure the respond of the brain to
emitted sound.
Notably, the hearing loss could be
indentified in the first test itself, as dur-
ing the test a measurable echo should
be produced when sound is emitted
through the earphone in case of a nor-
mal hearing. However, no echo could
signify the feared impaired hearing. n

“Prevention is better than Cure” is something
that we have always known of. But did we know
that the most effective way to prevent an infec-
tious disease or its severe outcome, is vaccina-
tion?
Vaccination annually prevents ~6000000
vaccine preventable diseases worldwide. Vac-
cines contain the same germs or sometimes
only a part of the germ that cause disease, but
they have either been killed or inactivated to
the point that they do not cause a disease but
stimulate the immune system to produce an-
tibodies, thus providing immunity from the
disease.
Diseases that used to be common around
the world, including polio, measles, diphtheria,
pertussis (whooping cough), rubella (German
measles), mumps, tetanus, rotavirus and Hae-
mophilus influenzae type b (Hib) can now be
prevented by vaccination.
However, when we think of vaccines, we
envision teary-eyed children at the doctor’s
clinic.Vaccines and immunization in India, so
far, have been primarily directed towards in-
fants and children, although, vaccination is as
important for adults as it is for children.
The adolescents and adults suffer a much a
greater burden of illness and death due to vac-
cine preventable infectious diseases than do
children. The success of our national childhood
Adult
Vaccination
Dr. Vivek Nangia
Director of Pulmonol-
ogy, Medical ICU and
Sleep Medicine at Fortis
Hospital, Vasant Kunj,
New Delhi
Cover Story

immunization program has resulted in
the dramatic reduction in the incidence
of vaccine-preventable infectious diseas-
es in the younger population but for it to
benefit the population at large it needs
to be complemented by vaccination in
adults. The vaccine recommendations
for the adults depend on factors like age,
lifestyle, high-risk medical conditions,
travel plans, and what vaccines one has
received in the past.
Not everyone was, or is, fully vac-
cinated as a child. If one missed get-
ting vaccines for diseases like Measles,
Mumps, And Rubella or Chickenpox (or
varicella) as a child — or any of those
diseases themselves – then one must get
the vaccination as an adult.
For diseases like Diphtheria, Teta-
nus, Pertussis(whooping cough) im-
munity is not lifelong. One may have
received the DPT vaccine in childhood
but a booster shot of Tdap and then Td
vaccine is recommended every 10 years.
An estimated 43 million episodes of
ARI (acute respiratory infections) are
documented, of which 4–12% of res-
piratory illnesses, are due to influenza
Influenza(common Flu) spreads very
easily and can be a serious illness. Be-
sides being very debilitating, it can also
be life threatening, especially, in those
with a weak immune system. Influenza
virus undergoes mutations and changes
in its genetic constitution very often,
thus creating new strains and rendering
the previous immunity useless. Hence,
each year a new vaccine is developedto
protect against the three or four strains
of influenza anticipated to be most com-
monly circulating in the upcoming flu
season. All children, adolescents and
adults must receive a Flu vaccine every
year at the onset of autumn, if they do
not have a medical reason not to receive
the vaccine.
Herpes Zoster or Shingles is a dis-
ease primarily of the adults. It is caused
by the same virus that causes chicken
pox and can occur more than once. It
manifests as a rash anywhere in the body
including face and eyes with excruciat-
ing pain. This pain could interfere with
day to day activities like eating, speak-
ing, sleeping and could last for months.
All adults more than 50 years must re-
ceive the shingles vaccine, even if they
You may think that vaccines are only for children and may not realize that even adults
get sick from vaccines preventable diseases. You need vaccines throughout your adult
life, more so in the later decades when your immune system starts getting weak and you
are prone for more diseases. Vaccines are important to your health and here are some
reasons why.
v You may be at risk for serious vaccine preventable diseases that are still
common
v Chronic diseases like Diabetes, Heart disease, Kidney disease
or Lung disease increases the risk of some vaccine preventable
diseases:
v Diabetics, in particular, are highly vulnerable to many infections.
v You can’t afford to risk getting sick:
v You can protect your health and the health of those around you by
getting the recommended vaccines:
v Immunization provides the safe and best protection against vaccine
preventable diseases:
Importance of adult vaccination
For diseases like
Diphtheria, Tetanus,
Pertussis(whooping
cough) immunity is not
lifelong. One may have
received the DPT vac-
cine in childhood but a
booster shot of Tdap and
then Td vaccine is recom-
mended every 10 years.

Cover Story
have suffered from the disease.
Hepatitis B is a severe liver disease.
It is 50-100 times easier to be infected
by hepatitis B than by HIV. It can be ac-
quired by coming in contact with an in-
fected person’s blood or other body flu-
ids. This could happen during a sexual
intercourse or just by sharing personal
items like toothbrush and razors. Most
infected people are symptom free in the
initial stages, thus they appear normal
and yet are capable of transmitting the
disease to others. One’s partner may
not appear ill, but could be carrying the
disease. A 3 doses course of Hepatitis B
vaccination is all it takes to acquire pro-
tection from this deadly disease. It also
reduces the risk of liver cancer to some
extent.
Human Papilloma Virus (HPV) is
another common sexually transmit-
ted viruses which is the most common
cause of cervical cancer in women and
oral and genital cancers in men and
women as also of genital warts in both
the genders. At least half of sexually ac-
tive individuals get infected with HPV
sometime or the other in their lives. The
vaccine to prevent HPV is most effec-
tive when administered at the onset of
puberty (12-13 years of age) but can be
given to girls until the age of 26 years
and boys up to the age of 21 years.
Pneumococcal disease is caused by
a bacteria, and can lead to serious life
threatening infection in the lungs, brain
and bloodstream. It can also cause de-
bilitating disease in the joints, heart, ears
and sinuses. It is transmitted through
droplets released by an infected person
while talking, laughing, coughing or
sneezing. Anyone can get pneumococcal
disease. The risks are higher in elders (
65 years of age), cigarette smokers and
in those suffering from asthma, HIV,
chronic diseases of heart, lungs, liver or
kidneys and diabetes. Those suffering
from cancers, leukemias, lymphomas,
those on chemotherapy or immunosup-
pressive therapy are also vulnerable to
acquiring this disease.India alone con-
stitutes to around 43 million childhood
pneumonia cases(23% of the world’s
total) and the estimated incidence of
0.37 episodes per child-year for clinical
pneumonia is predicted.
There are two types of pneumococcal
vaccines (PCV 13 and PPSV 23) that are
now available and both must be given to
all the elders. In the younger age group
PPSV 23 or both may be given depend-
ing upon the medical condition.
Typhoid and Hepatitis A are diseases
which are transmitted through contami-
nated food and water and can be easily
and effectively prevented by appropri-
ate vaccination. For those traveling to
Sub Saharan Africa and Tropical South
America,it is mandatory to take the Yel-
low Fever vaccination.A single dose is
sufficient to protect against the disease
for as long as 10 years.
Research has shown that cost in-
volved in vaccination is significantly
outweighed, by the long term benefits
that it provides. In today’s busy and high
pressure lives, missing work because of
a preventable illness can result in major
financial losses. With ever increasing
costs of healthcare, the cost of the vac-
cine is only a fraction of what one would
have to incur towards its treatment,
leave alone the irreparable organ dam-
age that the infection may leave behind,
if one survives it.Vaccines work with the
body’s natural defenses to reduce the
chances of acquiring certain infections
and suffering from their complications.
Unlike most medicines, which treat or
cure diseases, vaccines prevent them.
Vaccines are regarded as one of the top
ten effective public health interventions.
Gift yourself a vaccination program this
festive season and lead a more confident,
protected life. Remember, you are never
too old to get vaccinated. n
Human Papilloma Virus
(HPV) is another com-
mon sexually transmit-
ted viruses which is the
most common cause of
cervical cancer in women
and oral and genital can-
cers in men and women
as also of genital warts in
both the genders.

- Himanshu Patra
Dr. (Prof.) Raju Vaishya , a surgeon of interna-
tional repute, is best known for his swift surgical
skills in the field of Orthopedic Joint Replace-
ment. He has been working at Indraprastha
Apollo Hospitals, New Delhi as a Professor and
Senior consultant for the last 20 years having total
working experience of over 35 years. He is the
founder president of Arthritis Care Foundation.
Dr. Raju has an outstanding academic career
throught. He did his basic medical education
MBBS and MS in Gwalior ,India, and subsequent
higher super specialty training and education (M
Ch and FRCS) in the United Kingdom.
Apart from his distinguished clinical work
in the field of arthroscopic and joint replace-
ment surgery, he is well known for his academic
contributions. He has more than 150 published
articles in various International and national peer-
reviewed medical journals and has been regularly
invited to give lectures, chairing sessions,etc. in
Orthopaedic conferences around the world. He
has been awarded for the best paper publication
on numerous occasions by Delhi Or-
thopedic Association and
Apollo Hospitals. His
work was recognized
in the Limca book of
records in 2012, 2013
2015 for doing bilateral
Total Knee Replacement
in 93 years old gentle-
man, bilateral Total Knee
Replacement in the oldest
couple in a single sitting,
ACL reconstruction on
oldest man. Dr. Raju
talks to Health Spectrum
about his success story of
professional practices.
***
‘Healing the
sufferings of
people’
Corporatization should be
taken as a blessing and boon
for the Indians. A lot of new
technologies have been transferred
here, as a result highly professionals
retained and returned back in our coun-
try. Instead of brain drain it has become
a brain gain (a reverse trend), Dr.
Raju Vaishya
Face to Face

Q. As a successful doctor, what is the secret of your success?
Ans. Passion, dedication and honesty towards the profession.
Q. How do you take your career as a doctor?
Ans. It is a very noble profession and gives us the opportunity
to heal the sufferings of people.
Q. What are the challenges as a healthcare provider?
Ans.Need to understand the patient’s problem, expectations
and provide an amicable solution, holistically.
Q. According to you, What is the most important aspect of the
healthcare to be focused?
Ans.Lot of emphasis needs to given for preventive medicine
than the curative therapy, as ‘prevention is always better than
cure’.
Q. What are the steps Government should initiate to provide
quality healthcare to the masses?
Ans.National programs to improve the sanitation, to provide
clean and safer water, basic education to children about the
health, safer roads and working environment for workers and
laborers. Government should also provide the healthcare
facilities within easy reach to all the population across India.
Q. What are the reasons that the patients are not willing to
visit private healthcare centres?
Ans. The patients have problems of searching doctors of their
choice. They are equally not interested to visit the government
hospitals. In government hospitals patients mostly do not get
adequate and prompt care as per their expectations. Therefore,
they look for private hospitals. In India, private sector has con-
tributed almost 50% to healthcare. Public, private partnership
is the need of the hour in the healthcare sector.
Q. What are the changes you see in the field of Health Care?
Ans. There is a sea change as far as patients’ awareness is con-
cerned. They have various options like google search machine
etc. of searching doctors and gaining some knowledge before
coming to doctors. Things are changing very fast.
Q. Usually, doctors have more or less hectic schedule of clini-
cal activities, how do you balance between your work and
family?
Ans. It is often very difficult to keep a strict balance between
the professional work and the family commitments, as a doc-
tor. But an efficient time management can help in coming over
this challenge.
Q. What are your hobbies? How do you find times for those?
Ans. I like sports like playing Lawn tennis, Table
tennis, Swimming and watching Cricket. Medical
research and publication are other passions and
hobbies for me.
Q. Had you not been doctor, what would you
have been?
Ans. Scientist.
Q. What makes you happy or satisfied?
Ans. Relieving peoples’ sufferings to the best of
my abilities and a happy supportive family.
Q. How do you see yourself after 10 years from
now?
Ans. Would love to retire from an active clinical
practice, but would provide guidance, teaching
and social work for the younger doctors and
general public.
Q. Any event in your life, professional or per-
sonal which has influenced you most?
Ans. Meeting, Dr Prathap C Reddy, Chairman,
Apollo group of hospitals in London (in 1989),
when I was working in UK. He showed a glimpse
of hope and light of better healthcare opportunity
in India. This helped me in returning back home
to serve the needy people of India. And there has
been no looking back since then.
Q. What is your opinion so far corporatization is concerned?
Ans. Corporatization should be taken as a blessing and boon
for the Indians. A lot of new technologies have been trans-
ferred here, as a result highly professionals retained and
returned back in our country. Instead of brain drain it has
become a brain gain (a reverse trend).
Q. What’s about medical tourism?
Ans. It is a good concept and a successful one. Patients from
other countries visit India and also take treatment which has
been cheaper in comparison to other developing countries. It
has a lot of potential to boost the healthcare business. India is
on move, many things will be happening in years to come in
the health care sector. n

Case Study
PATIENT CONDITION
A 55 year old housewife found uncon-
scious at home by neighbors. She was
taken to nearest Hospital in Buland-
shahar and CT scan was done at after 2
hours which showed brain hemorrhage.
She was referred to Fortis Hospital, Noi-
da for brain angiography, Patient was
admitted in Fortis Hospital in uncon-
scious condition. She had difficulty in
breathing.
INVESTIGATION
She required ICU care and ventilator for
breathing. Her heart was not working
properly. She was resuscitated in ICU
and brain angiography was done after
2 day. There was an aneurysm which
has caused brain haemorrhage and she
needed surgery to prevent rebleeding.
But she was not fit for any anaesthesia.
After one day, her condition was further
deteriorated and blood pressure falled to
minimum level. Her pupils dilated and
doctors thought she will not able to sur-
vive for more than two or three hours.
SURGERY
With efforts by critical care and neuro-
surgery team her condition improved.
She was then operated upon after 36
hours. surgery was successfully per-
formed at Fortis Hospital, Noida. Sug-
eons has to perfomed craniotomy and
clipping on the patient. surgeons had to
open the skull because there was a large
blood clot also which was to be evacu-
ated.
AFTER SURGERY
After surgery she had severe pneumonia
and she stayed in ICU and she kept on
ventilator for 10 days. Then she became
conscious and shifted to ward.Now af-
ter oen month she has regained all her
brain function. There is some left side
weakness, but her condition is improv-
ing fastly.
ABOUT COILING/CLIPPING
Coiling or Clipping of aneurysm are
methods to prevent re-rupture of an an-
eurysm. Coiling is done in Neurocath-
lab, where without opening the skull,
the aneurysm is packed with coils. It is
a relatively new method with excellent
results. In clipping, the skull is opened,
aneurysm is exposed and a clip is placed
across its neck. This is a time tested
method and provides permanent cure.
Spontaneous brain haemorrhage is very
common and almost 50% patients ex-
pire before they can be shifted to a ter-
tiary care hospital. Patients who are un-
conscious before surgical treatment take
months to recover. Unfortunately, there
are few centres for rehabilitation in India
and patient has to be shifted home after
definitive treatment. Hence, role of pre-
vention and timely intervention cannot
be overemphasised.
Brain haemorrhage is bleeding into the
brain tissue or its surface due to rup-
ture of blood vessel. It can be spontane-
ous or due to head injury. Spontaneous
Brain haemorrhage is usually associated
with high blood pressure (BP). Different
types of brain haemorrhage may have
different reasons.
SURGEONS ADVICE
For preventing brain haemorrhage fre-
quent monitoring and control of blood
pressure with medication and lifestyle
modification are most important. Brain
haemorrhages are more frequent in ear-
ly morning especially in winters. Drink-
ing lot of water and timely consump-
tion of medicines is essential. Minor
headaches should not be neglected and
a Neurosurgeon/Neurologist should be
consulted. (by Vinod Kumar) n
Medical Emergency
Sudden Brain Hemorrhage patient recovered after brain surgery.
Chief Surgeon
Dr. Rahul Gupta,
Senior Consultant Neurosurgeon,
Fortis hospital, Noida.
Team Members :
Dr Anil Dhar
Dr A P Singh
Dr Manish Marda

Articles
D
espite the progress
made by our society,
left handedness is
still not widely ac-
cepted. Parents like to see their
children write with their right
hand initially and start correcting
them if they use their left hand.
Despite coming from a family,
where my mother is left handed,
I have faced the music many
times in my life for using my
left hand. My teachers at school
used to scold me for my awkward
way of writing despite having a
reasonable hand writing (which
is uncommon for doctors?? ). In
spite of the scoldings, I persisted
with my own way of writing and
one advantage of my style was
that nobody could copy my work
during the exams.
Uncommon way of writing in
India but common in the west.
I always wanted to become
a surgeon from the second year
of medical school and while
observing my seniors (who were
mostly right handers) operate,
the thought of a left handedness
being a handicap crossed my
mind many times. My teachers,
most of whom were right handed,
did not have much to say when I
approached them with this query
as a medical student but none of
them discouraged from taking
surgery as a career.
The thought of working as a left
handed surgeon started haunting me
again when I started my residency.
Initially, I did find things a bit diffi-
cult because all the instruments were
designed for right handed surgeons
and left handed instruments (like left
handed golf clubs) were not widely
available. Most of my seniors, initially
found it difficult to teach me the basics
and used to get a bit annoyed when I
used to start operating by standing on
the left side of the table (for those who
are not aware, most of the procedures
are done by standing on the right side
of the table). My mother, who is a suc-
cessful left handed gynaecologist, was
a constant source of inspiration during
this tough period.
After the initial hiccough’s, my
seniors became accustomed to my left
handedness and taught me the skills
more patiently. In no time, I mastered
the techniques with my left hand and
then started to hone my skills with the
right hand as well. In fact, I tie right
handed knots better than left
handed knots (probably because
I was taught by a right handed
surgeon).
Now when I look back, being
right handed or left handed really
does not matter in the long run
(in terms of a surgical career) and
I would urge an aspiring surgeon
not to give up the dream of pur-
suing a career in surgery because
of being left handed. There have
been many studies conducted on
this topic and they have found no
difference in surgical outcomes
between right and left handed
surgeons.
Some helpful points for a left
handed surgical trainee:
v Don’t switch away from your
dominant hand. Get good at do-
ing the basics with your left hand
(cutting straight with a scalpel,
basic dissection, basic suturing),
then learn how to do everything
right-handed. If you start too
early trying to do everything
with both hands, you’ll probably
flounder around and not improve
as quickly as you should.
v Learn to tie knots right handed
first, since you’re going to learn to
tie with both anyway.
v Use scissors with your right
hand initially. Learning to cut
left handed with right-handed
scissors is tricky, especially with
heavy Prolene or other sutures.
v Once you’re good with your
dominant hand, by all means work on
ambidexterity. Being able to operate
with both hands has been advanta-
geous to me as I’ve progressed through
residency.
v Don’t let being a lefty deter you
in any way from pursuing a surgical
career.
In the end I can just say one thing :
I may be left handed, but I am always
right! n
Is Left-Handedness a Handicap for
Training in Surgery?
Dr. Rohan Khandelwal
Consultant - Oncosurgeon (Breast Services)
W Pratiksha Hospital, Gurgaon
Head - Medical Affairs at Curofy
Email Contact : rohankhandelwal@gmail.com
+91-9810072878

T
he effects of harmful Ultra Vi-
olet Radiation on the health
of skin and eyes have been
well documented and much
talked about in recent years. However,
researchers today have identified that
ultra violet light is not the only harm-
ful component of light when it comes to
visual health. The Blue Violet spectrum
of visible light is another component
that has the potential to cause damage to
retinal cells of the eyes. In fact, research-
ers have coined a new term to describe
the danger this light spectrum presents
to critical structures within the eye. They
call it “blue light hazard”.
Interestingly, blue violet light (wave-
lengths between 380 and 500 nm) is not
just emitted by the sun but also by artifi-
cial sources of light such as LEDs, CFLs,
and digital devices such as computers
and smartphones. Given the increased
usage of new age lighting devices and
an increasingly ubiquitous existence of
smartphones and computers, what we
are witnessing today is a much higher
exposure to blue violet light than say five
years back.
This development has prompted a
new wave of research and studies in the
field of ophthalmology as well as oph-
thalmologic optics. But before moving
on to that let’s understand with greater
precision the effects of blue violet light
on the structures within the eyes.
What is Blue Light?
The small spectrum of the electro-
magnetic radiation which our human
eyes are capable of perceiving is termed
‘visible light’. A human eye typically re-
sponds to wavelengths between 390 to
700 nm (nano metre). This entire visible
spectrum can further be divided into
different bands which includes blue,
green and red lights. Blue light has a
Dr. Ira Chopra
Consultant Eye Surgeon,
Paras Hospitals,
Sushant Lok, Gurgaon
Not Just UV Radiation, Eyes Face
Threat from Blue Violet Light as Well
Blue
Light
Hazard
Articles

wavelength of between 380 nm and 500 nm, making it one of
the shortest, highest-energy wavelengths. While this range of
visible light spectrum plays a generally beneficial role on health,
in particular by regulating the internal biological clock, a small
but specific section of this band has been found to cause dam-
age to retinal cells.
Because they have shorter wavelengths and higher frequen-
cy and higher energy, blue light waves create flickering and glar-
ing effect on the eyes. This is perhaps why prolonged exposure
to computers, television and smartphones causes strain to the
eyes, headaches or fatigue. Researchers believe that prolonged
exposure to blue light may cause retinal damage and contribute
to age-related macular degeneration, which can further lead to
loss of vision. In most cases, this photochemical damage accu-
mulates over a lifetime.
Where is Blue Light?
Well, it is everywhere! While sun is the main source of blue
light emission, it is certainly not the only source. Today, we are
literally surrounded by sources of blue light and therefore con-
tinuously exposed to it.
While solar radiation is considered to have 25% to 30% blue
light, the modern, energy efficient light sources such as CFLs
and LEDs emit significantly higher amount of harmful blue
light (roughly 26% of the light from CFLs is blue while an es-
timated 35% of light emitted by LEDs lies in the blue portion).
On the contrary, the conventional, incandescent lamps which
were widely used till a few years back, were noticed to emit very
little blue light.
Besides, our eyes hardly stops working in front of digital
screens today. The digital screen technology has evolved radi-
cally over the years, and many of today's electronic devices use
LED back-light technology. Computers, cell phones, flat-screen
televisions and tabs are just among a few of the devices that use
this technology. With their wide-spread use, not only has our
cumulative exposure to blue light increased, but the duration of
exposure is also radically higher today.
What are the Solutions Preventive Mechanisms?
The natural filters of the human eye do not provide suffi-
cient protection against blue light. Therefore, any preventive
mechanism has to start with greater awareness and attempts to
reduce exposure of harmful blue light. Researchers have also
been off late working on mechanisms to help selectively filter
the harmful wavelengths of blue light while transmitting the
beneficial ones.
In this context, researchers at Essilor and the Paris Vision
Institute have succeeded in identifying the very narrow band
of blue light that is associated with photo toxic damage of the
retinal cells. The culmination of this research has led to the de-
velopment of lenses that has the ability to selectively filter the
narrow but harmful wavelengths of blue light that are damaging
to the eyes while allowing the healthy band of blue light to play
its normal roles. The technology has been incorporated in the
latest spectacle lenses manufactured by Essilor such as Crizal
Prevencia and Eyezen.
Protecting Your Vision
Limiting the amount of screen time is very important for
the generation that lives by digital devices. While one cannot
do away with the requirements of work, we can certainly reduce
the leisure time spent on digital devices. Reducing time spent
on chatting and surfing the Internet can be helpful in reducing
eye strain, headaches and digital mental fatigue.
Using screens and digital devices in a correct posture is also
important. Make sure the screen causes minimal glare, reduce
brightness and surrounding lights and make sure the screen is
always right ahead of your face to ensure least strain on the eyes.
Take regular breaks from screen time. Stand up from your
desk every two hours and just walk around the workplace for
five minutes. Blink more often.
Wearing protective eye wears in front of digital screens has
emerged as the most viable preventive option in the face of in-
creasing prevalence and exposure to blue light radiation. Stud-
ies have also showed that wearing protective lenses with blue
light filters helps reduce symptoms of eye strain and fatigue. n

A
s an adult, we may be of
whatever chronological age.
But as a parent, we are only
as old as our child is. Parent-
ing is an on-going process, which is both
challenging as well as rewarding. As a
parent, understanding and responding to
your child begins from the moment the
baby is born. Be it teething aches, nappy
change, growing pains, bruised knees
or teenage troubles, being a parent is a
never-ending role where one evolves and
learns on-the-job. Each child is unique,
with their own set of strengths, weak-
nesses and personality traits. Under-
standing your child can go a long way in
strengthening your bond with your child
and nurturing their growth and develop-
ment in a wholesome way.
KNOW YOUR CHILD:
Spend time Communicate : The
key to having a trusting relationship with
your child is to know your child as an
individual. Not all children are similar
in traits and each child differs in their
personality, interests, temperament and
adaptability to change. As children grow,
their likes and dislikes also transform.
Whether you have your hands full with
a tight work schedule or deadlines at the
work place, set aside time for your child
to stay in tune with them and let them
know that you are there for them.
It is important for parents to grow
along as their child grows. If a parent
wishes that their teenager opens up to
them honestly and shares their problems
with them, the foundation of healthy
communication lies in early childhood
itself. It is important to spend quality
time with your child right from a young
age. Parents must pay attention to the ap-
parently small thingstheir young one has
to say- how their day was, what sports
they played, what they learnt in class,
who their friends are. It is important to
understand your child’s fears, apprehen-
sions as well as strengths and abilities.
Sharing these seemingly small things
Understanding
Psychology Of Your Children
Dr. Shobhana Mittal
Attending psychiatrist,
Cosmos Institute of Mental
Health and Behavioural
Sciences, New Delhi.
Parenting

goes a long way in forming a channel of
communication between a parent and a
child, and facilitates an environment of
trust and belongingness. It also helps the
parent know and understand their child
better.
BUILD YOUR CHILD’S SELF
ESTEEM
The growing years can be tough on
a child, with challenges likechanges in
their body that occur with adolescence,
increasingly critical evaluation at the ac-
ademic front and adopting mature social
roles. These can take a toll on a child’s
self-esteem.
As a parent, you are the main source
of confidence and encouragement for
your child. Children often look to their
parents for validation and support. Con-
stant criticism from a parent with little
encouragement can hamper a child’s
self-esteem.It is important to instil con-
fidence in your child by acknowledging
their strengths, lending them gentle en-
couragement and allowing them to de-
velop their individual talents in activi-
ties like sports, music or dance.
STIMULATE ALL ROUND
DEVELOPMENT OF YOUR
CHILD
Just like it is important to take care of
your child’s academics, it is also essential
to stimulate an over-all development of
your child.““The growing years are cru-
cial not just for the psychical growth, but
also for the intellectual, social and emo-
tional development of your child.Right
from a young age, children learn to form
social bonds, share with others, learn
to deal with their emotions and satisfy
their curiosity. It
is important that parents provide their
child with opportunities to develop in
a balanced manner, keeping over-all
growth and development in mind.
TEACH YOUR CHILD TO BE
RESPONSIBLE
As a parent, it comes naturally to tell
your child about “dos and donts”. But the
key to efficient parenting lies in teaching
your child to be responsible and enable
them to make well thought of decisions.
It is important to make your child real-
ize their responsibility at an early age.
Often, parents focus on punishing
their child when the child commits a
mistake. But for learning positive be-
haviour, encouragement of good behav-
iour is also important. When your child
finishes their homework on time orputs
their toys back in the box after playing, a
word of praise can go a long way in en-
couraging their responsible behaviour.
Let your child learn from their mis-
takes, rather than preventing your child
to make small mistakes.Also, ask your
child’s opinion in some family decisions,
be it which colour to paint the house
or which destination to choose for the
next family outing. Try and understand
the logic behind your child’s outlook
rather than the shortcomings of their
opinion. Involving children in decision
making helps them develop confidence
and improves their judgement, which
helps them make responsible decisions
as growing up,
NEVER LOSE TOUCH OF
YOUR INNER CHILD!
It is important to stay flexible and
look at things from a child’s perspec-
tive. You need to be your child’s friend
at times, in order to allow them to open
up to you. At the same time, limits have
to be set to provide boundaries for chil-
dren. Juggling your role as a parent and
as a friend can be a tough balancing act.
As parents, it is easy to forget what
it was like to be a
child. Sometimes,
it is important
to step into
your child’s
shoes and look
at things from
their point of
view. For this to
happen, it is im-
portant to stay in
touch with your in-
ner child! n
As a parent, it comes
naturally to tell your
child about “dos and
donts”. But the key
to efficient parenting
lies in teaching your
child to be responsi-
ble and enable them
to make well thought
of decisions.It is im-
portant to make your
child realize their
responsibility at an
early age.

When
Beauty Is
More Than
Skin Deep
Having a greater control over their looks has empowered a lot of
women, and leading the charge to ‘empower through beauty’ are
dynamic women aesthetic physicians in India
A
yesha, 28 was always
troubled by the deep acne
scars on her face that had
been there since teenage.
No matter how well she used concelaers
and other make up tools, there was no
hiding them. With people often enquir-
ing about the cause of these scars, not
just this affected her appearance but
also her self esteem tremendously.
Established in her profession and
earning well, Ayesha decided to take
greater control over her body and met
an aesthetic physician. A few session
with skin lasers, and her scars are now
only marginally visible. Ayesha hasn’t
been happier and has never felt more
confident.
For the new age bold and confident
girls like Ayesha, life is to be lived on
their own terms and cosmetic proce-
dures are just one resource that offer
this sense of empowerment.
Whether we like to believe it or not,
beauty is a desirable thing. Who doesn’t
want to look beautiful? Yet, there has
always been this lingering belief that
there is something wrong in taking a
cosmetologist’s help in improving our
appearance.
“For a lot of women, a greater
control over their bodies and appear-
ance is a boon. For a woman
who hosts guest travelers all the time
as an air hostess, it is of utmost impor-
tance to have a good appearance. Not
only to enter the profession, but also to
remain in it. Same is true for women
in showbiz or women who have roles
in front of the camera such as actors
and news anchors. For all such women,
cosmetic procedures are really helpful.
Even women outside such professions
today are actively seeking options to
improve their appearance, and there
should be absolutely nothing wrong
with it,” says Dr P. K. Talwar, leading
cosmetic plastic surgeon and director
of Cosmetic Laser Surgery Centre of
India, New Delhi.
For women in such careers and
fields, cosmetic procedures are a way to
keep themselves fighting fit, much like
fitness training is for athletes. Today, an
increasing number of women are taking
recourse to cosmetic treatments, both
surgical ad non invasive, to achieve
some of their dreams. In this sense,
having a greater control over their ap-
pearance makes them empowered.
“More popular though are non-
invasive treatments like Botox, fillers,
lasers, medi-facials, oxygen and vitamin
infusion therapies etc that are quick
and do not
carry the need of going under the knife.
Facial contouring to redefine features is
another popular aspect of facial aesthet-
ics today and a number of women like
to get their lips augmented, their cheeks
highlighted and their chins redefined.
Procedures to do away with scars,
pigmentation an acne marks are among
the most popular,” adds Dr Talwar.
If we talk about the field of der-
mato cosmetology, the leading names
that prop up in our minds in India are
invariably all women. Studying medi-
cine, but decisively choosing aesthetic
medicine as their careers, women have
literally overrun this field.
Of course, there has to be a differ-
ence between undergoing cosmetic pro-
cedures and becoming obsessed with
them. The latter is not recommended
and doctors always advice clients to
be realistic in their expectations and
not become dependent on cosmetic
procedures.
With increase in purchasing power
and greater exposure to the entertain-
ment industry, the awareness and
demand has grown in the cosmetic
industry. (by Sushila Kumari) n
Beauty Care

R
emember Kia from ‘Ki and Ka’ and her reac-
tion on realizing that she was pregnant. For
her the world shattered as she presumed
her career to come to an end. Kia rightly
represented the ambitious careerist working women
of today, for whom pregnancy and child birth is no
more a priority, till at least they achieve certain level
of success in their career. And by then they are most-
ly in their 30s, may be late 30s or early 40s also.
Pregnancy for these women may not be smooth.
With age, other comorbid complications like thyroid,
gestational diabetes, high blood pressure, pile in dur-
ing pregnancy making the journey tougher. However,
thanks to medical development, today such high-risk
pregnancies can be managed at ease with care.
According to Dr. Leena C D, Consultant Obstetrics
and Gynecology, Columbia Asia Hospital, Hebbal there
has been an increase in the number of high-risk preg-
nancy cases.
“Mothers with a history of recurrent miscarriages, hy-
pertension, diabetes, ART pregnancy, too many surgeries,
abnormality of the uterus, etc. comes under the high risk
pregnancy. Also, lately a lot of women have started opting
for pregnancy at a later stage in life. Women older than 35
years of age often fall under the high risk category,” said
Dr. Leena
The first 12 weeks of the pregnancy are most crucial
especially for women with a past history of recurrent loss.
One can identify complications by hypertension after 20
weeks and by diabetes after 24 weeks. It’s extremely crucial
that these issues are identified as early as possible in the
pregnancy to avoid complications and miscarriages.
“One has to be extremely careful during a high-risk
pregnancy. In case there is a history of more than three
losses, the chances of miscarriage can increase from 5% -
25%,” added the doctor.
Here are a few suggestions by Dr. Leena for to-be-
mothers with high-risk pregnancies:
v It is important to go for frequent check-ups with your
doctor.
v Ask your doctor for anti-platelet drugs requirements.
v Get the heartbeat checked ever 2 weeks for any com-
plications.
v Get all the necessary tests done for early detection of
complications like hypertension, diabetes and thyroid.
v Restricted activity is one of the most important factors
during this period. (by Jytoti Chaudhary) n
Know what to expect from
high-risk pregnancies
Healthy Motherhood

P
regnancy is a wonderful
milestone in the life of a
woman. It is an experience
that a woman would like
to nurture in her heart for a lifetime.
It is a time when a woman will be
overwhelmed with a variety of emo-
tions ranging from the happiness
of being pregnant to the anxiety
about the proper health, growth and
development of young baby to be.
Child bearing imposes both
physical and mental strain on
the body and mind. To be able to
counter this, it is important that the
mother has a healthy diet during
pregnancy. A nutritious and rightly
balanced diet during pregnancy ,is
important not only to maintain the
Pre pregnancy
nutrition is as im-
portant as nutri-
tion during preg-
nancy, as both help
to determine fetal
growth and there-
fore size and health
of an infant at birth.
Food Nutrition

maternal nutritional needs and the develop-
ment of a healthy fetus but also to provide
continuous adjustments in maternal body
composition and metabolism.
While it is important to have proper
nutrition and right diet during pregnancy,
pre-pregnancy nutrition is equally impor-
tant, as it helps determine fetal growth and
therefore size and health of an infant at birth.
Well balanced, nutritious diet also plays a
great role post pregnancy as well by ensuring
a good health to the mother and child during
lactation.
Conceiving is not an easy pro-
cess and requires both health and
mind to be prepared to take the
leap. A major part of the nutrition
given to the body during pregnan-
cy is partaken by the fetus.
Therefore, it becomes im-
portant for a woman to store her
nutrition much in advance be-
fore she decides to get pregnant.
Hence, it is important to ensure
intake of nutritious and well bal-
anced diet pre pregnancy. And, since
nutritious diet provides strength during
lactation, post pregnancy nutrition becomes
equally important.
The drain of pregnancy and child feeding
is such that it often leads women excessively
deprived of nutrients. In women who do not
take conscious care of their nutritional status,
this can be dangerous for both short-term and
long-term health. Calcium is one of the most
crucial mineral needed for the growth of a
fetus and this deprives pregnant women of a
lot of their own body reserves.
During pregnancy, the nutrient to the fetus
is provided by the food taken by the mother.
While nutrients such as mineral, vitamins
and others are required for the mother to stay
healthy to be able to deliver the child, nutri-
tious diet is also important to ensure proper
supply of nutrients to the developing fetus. In
many cases women recover their bone calcium
after they have delivered the baby and have
breastfed her, many are left with depleted
bones for life. This can be prevented if you
take care of your calcium intake and bone
health from early years and ensuring a healthy
from the time you decide to get pregnant.
Following are the nutritional requirements
during pregnancy:
Energy carbohydrates: Additional en-
ergy is required during pregnancy to support
the metabolic demands of pregnancy and fetal
growth.
Protein: During pregnancy there is a need
for additional protein. It is to support the
synthesis of maternal and fetal tissues. The
efficiency of conversion of dietary protein to
milk protein is 70%. So the need for protein
is greatest when lactation has reached its
maximum.
Minerals: In pregnancy the
needs for calcium, iodine, iron and
zinc and in lactation calcium and
iron increases.
Vitamins: During pregnancy
Vitamin D, Vitamin E, Vitamin K,
Vitamin C, Thiamine, Riboflavin,
Folic Acid and Vitamin B6and dur-
ing lactation Vitamin C and Vitamin B are
highly essential.
Fluid intake: You need to drink plenty
of water. At least 4-6 glasses in addition
to what is contained in the form of milk
and other beverages. This should be
taken throughout pregnancy and in
lactation, an increased fluid is neces-
sary for adequate milk production.
Supplements: These should be
taken as per doctor’s prescription.
Self-medication is not recommended.
Besides a healthy and varied diet,
it is also important to bring changes
in the lifestyle such as practic-
ing light exercises regularly and
avoiding stress and tension.
You should try not to
overload your sys-
tem and keep it
fresh with
Dr. Pallavi Vaishya
Senior Nutrition Consulant,
Kailash Hospital, Noida

Health Benefits of
I
t may seem ironic, given that human beings are land
dwellers, that one of the most comprehensive and
effective forms of exercise we know involves dunk-
ing ourselves into an alien environment. Humans
are not naturally designed to swim very efficiently, unlike
penguins, sharks, seals and Michael Phelps. This, however,
is exactly what makes it such a powerful fitness tool. Exer-
cise—effective exercise, at any rate—must necessarily take
your body out of its comfort zone, and swimming achieves
this quite literally.
It is also inherently safer, despite what Jaws and Bay-
watch would have you believe, than almost any form of
land exercise, says Gokul Kamath, coach of the national
swimming team in 2006-07. Kamath, currently head
coach at the Navi Mumbai Sports Association, says: “Un-
like running and other types of impact exercise, swim-
ming is impact-free and can be practised by people of all
ages. It also works out your entire body.”
Also, according to Santosh Jacob, a doctor of sports
medicine and founder of the Indian Academy of Sports
Research, Chennai, swimming is one of the few exercises
“that incorporates respiratory and cardiovascular effort
(breathing and blood circulation) without stressing the
joints”. So with a scorching summer around the corner,
you have good reason to ditch the sweaty gym for a cool
pool.
Resistance training
Swimming’s standout quality is that it is at once both
kinder to, and more demanding of, your body than any
land exercise. Water’s higher density relative to air means
that your muscles are forced to work harder in a pool
than they would on land. The effect is similar to resistance
training, used to increase muscle strength, says Ashok
Seth, chairman and chief cardiologist, Escorts Heart Insti-
tute and Research Centre, New Delhi, and himself a scuba
diver certified by the Professional Association of Diving
Fitness

Instructors. “Also, unlike other forms of
aerobic activity (such as running, tennis
or aerobics classes), swimming requires
you to use almost all your muscles at the
same time, both upper and lower body,”
he adds. All swimming techniques, ex-
cept the backstroke, harness the deltoids
(upper back/shoulder), abdomen, glutes
(buttocks), hamstrings (back of thighs),
quadriceps (front of thighs) and plantar
(foot) muscles to varying degrees.
The higher density of water also
counteracts gravity, reducing stress on
joints and muscles. “All forms of activ-
ity or exercise put stress on our joints,”
says Dr Jacob. “A joint with pre-existing
arthritis will definitely be aggravated by
running, as it is an impact exercise. But
when swimming, you exercise at 30% of
your body weight and, hence, cut out the
risk of musculoskeletal stress, which may
lead to the degeneration of joints and ag-
gravation of muscle tears.”
Indeed, Dr Seth says, not only does
water ensure there is no direct impact
on joints, it also prevents the jerks that
are part of even gentler aerobic exer-
cises such as walking. “All movements in
swimming are controlled, slowed down
by the resistance of water, which means
there is hardly any risk of injuring your-
self,” he says.
This is significant for everyone, from
pregnant women to someone recovering
from injury—indeed, pretty much any-
one with a reduced capacity for tolerating
jarring, repetitive workouts.
Good for the heart
Swimming is particularly beneficial
for pregnant women as it strengthens the
abdominal muscles, of particular impor-
tance to carrying a baby. It also strength-
ens the back muscles, making it easier
for mothers-to-be to support the extra
weight during pregnancy. Other com-
mon issues associated with pregnancy—
high blood pressure and joint stiffness—
can be eased by swimming.
Swimming reduces blood pressure
and lowers the resting heart rate, re-
ducing risk of cardiovascular diseases.
“Though there are no evidence-based
studies on the effect of swimming on is-
chaemic heart disease (characterized by
reduced blood supply to the heart mus-
cle), a controlled workout involving 30
minutes of freestyle or breaststroke can
definitely reduce the risk of a heart at-
tack,” says Dr Jacob.
But what about people with existing
heart conditions? For them, Dr Seth ad-
vises caution, “Patients with heart disease
can drown if there is a problem while in
the pool, so before swimming they need
clearance from the doctor.”
For the rest of us, though, Dr Seth
says, “It is perhaps the only form of ex-
ercise that provides aerobic benefits
from raising your heart rate and increas-
ing your lung capacity (because it needs
breath control), as well as exercising
muscles throughout your body.” Ruchira
Tendolkar, technical director, BFY Sports
and Fitness, Mumbai, notes that the ben-
efits of a daily swim include stronger
heart and lungs, better blood circulation,
increased strength and endurance, and
enhanced neuromuscular coordination.
“These translate into a reduction in risk
factors for lifestyle diseases (coronary
artery disease, diabetes and so on), such
as improvements in lipid profile, better
control of blood glucose, reduction in
blood pressure and a reduction in weight
as well,” she adds.
Swimming also offers special benefits
for seniors. “It increases a person’s capac-
ity to use oxygen, which deteriorates with
age,” says Dr Jacob. Dr Tendolkar adds
that it helps maintain flexibility, which
also tends to decline with advancing age.
Different strokes
While running—and to a lesser extent
weight training—restrict your joints and
muscles to a limited range of movements,
swimming is more flexible. Depending
on your level of fitness, you can adopt the
demanding butterfly stroke, the milder
freestyle or the fluid breaststroke.
Dr Jacob says: “The butterfly stroke
is the most demanding of all and burns
the most calories, while the backstroke
and the breaststroke are less demanding.
A combination of freestyle and butterfly
is ideal for the experienced swimmer; a
mix of freestyle and breaststroke is best
for beginners.”
Post Comments
The breaststroke, Dr Jacob adds, is
perfect for warm-ups, and has the lowest
potential to pull or strain your muscles.
Freestyle is somewhat more vigorous and
requires more effort, while the butterfly
stroke makes the highest demands on
your muscles—especially your back and
shoulders—and lungs. The backstroke is
slightly different from the rest as it relies
less on muscle power, activating mainly
the muscles of the abdomen, groin and
neck.
Weighty matters
Experts are not unanimous in en-
dorsing swimming as simply a good
weight-loss tool. An hour at moderate in-
tensity (raising your heart rate to 60-70%
of its maximum capacity) in a 60kg man
burns 540-650 calories.
“For significant weight loss, it would
have to be sustained for a much longer
time,” says Dr Seth. Or you would need to
work harder, making it an intense work-
out (90% of maximum heart rate), which
depends on your effort and fitness level
rather than speed, Dr Jacob points out.
That’s the difference between, say, a brisk
walk in the park versus one that leaves
you sweaty and breathless.
Recreational swimmers don’t usu-
ally make that effort, Kamath notes. To
shed serious inches, therefore, they may
be better off adding other cardiovascular
(such as running, cycling or aerobics)
and anaerobic exercises targeting specific
muscle groups.
Dr Seth also notes two drawbacks
to swimming. The first is that access to
a pool, and a hygienic one at that, is not
universal. Not only must it be well chlo-
rinated, it must enforce rules of shower-
ing well to clean up before a dip. “Un-
fortunately, we Indians tend to regard
swimming itself as a bath,” says Dr Seth.
The other caveat is weather. Unless
it is a heated, enclosed pool, you have to
wait for summer. Which, fortuitously, is
right now. (by Priyanka Sharma) n

FITNESS FUNDA
OF A DOCTOR
FITNESS FUNDA
OF A DOCTOR
Dr. Yuvraj Kumar running in
Mumbai Marathon on January 17, 2016
Dr Yuvraj Kumar is Head of Department of Orthopedics and Joint Replace-
ment at Asian Institute of Medical Sciences (AIMS), Faridabad. Dr. Yuvraj
Kumar is an orthopedic surgeon who has done fabulous work in Spine Sur-
gery Joint Replacement . Dr. Yuvraj is a fitness freak. He took part in a
number of marathons.

Health Spectrum, June 2016

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