Dr. Usha Nandini, Post Graduate in MD Psychiatry Tirunelveli Medical College, Tamil Nadu
As medicos, we have been in and around hospitals and healthcare setups for a while now. We are considered to be part of one of the glorious professions in the world. We deal with life and death situations literally almost daily. Even with so much privilege to make changes in other people’s life, we find ourselves helpless in certain circumstances. There does not go a day where we feel like we are handcuffed in a situation which is actually solvable or preventable. The feeling that you could do something, but actually can’t is inevitable. No, I am not talking about scenarios where we do our best and still lose the patient. I am talking about scenarios where the patient is not affordable to the best care that he/she could get. I am talking about when a demented patient is abandoned in your ward by his/her own children. I am talking about when a child is brought with so much emotional issues because he/she lacks adequate parental care. I am talking about when a wife attempts suicide because she couldn’t deal with the alcoholic husband or when the whole family attempts suicide because they couldn’t pay the loan or when a child is deprived of quality education because the family doesn’t understand the value of education. I am talking about how substance abusers aren’t born but are victims of the society that they live in or how taking the proper medications can prevent the spread of TB but people aren’t that interested in stopping the spread. How some don’t even care to vaccinate their children as per schedule. The socioeconomic and cultural issues are more often, than not involved in the overall etiopathogenesis of illnesses.
Our country had faced far more extreme issues in the past. Thanks to the progress made by various policies and development in Preventive and Social Medicine aspects that we are far better than we were 50 years ago. But is our progress enough? With high visions for our country in 2020, shouldn’t we be at a far better position with respect to these issues?
The financial situation of a country is directly responsible for developing the social conditions like social justice, reduction in inequality, gender equity and inclusion of all sections of the society in the process of development. This in turn is involved in the prevention and treatment of various illnesses in an effective way. For example, if a family doesn’t have to struggle so much financially, they wouldn’t think twice before providing their dependents (children and elderly) with the adequate care needed.
The societal pressures as in how one should live and settle down at a particular age, about how their sexual orientation is, the insecurities of the changing generations etc. build up so much of frustration in adults of these days. This ends up in alcoholism, substance abuse, depression, hypertension, CAD and various other disorders. The stigmas associated with infectious diseases, mental illnesses etc. deprive the patients of the basic care they need to come out of their illness and lead a good quality of life. For example, a 16 year old girl develops an episode of acute psychosis. It is almost completely manageable if brought to the doctor at the right time. But no, the stigma associated does not allow her to get this basic care. She is instead taken for religious rituals or even worse locked up in a room until her illness washes away who she was and makes it nearly impossible to bring her back to lead an average life. The stigma associated with taking medicines for a long time has resulted in expensive complications with respect to diabetes and hypertension where people pay for it with one of their organs or limbs or sometimes life.
We have brought down the incidence of infanticides, feticides, maternal mortality, infant mortality, improved the various ways to make sure patients take drugs regularly like DOTS etc. We have eradicated Polio from our country and are almost at the verge of eradicating a few more diseases. This is not an easy task and we have come a long way since independence. But for a country with the second largest population, we have a long way to go with respect to the social aspects of medicine.
India of my dreams in 2020 is one where we would not need a “Dr. Kalam” to inspire us instead each of us take our roles seriously and work towards making the world a better place.