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59th Annual Conference
EDITORIAL ….
Hand full of health professionals in an over performing health system,
manhandled every now and then by beurocrats and politicians at all
levels have disillusioned the confidence of common people of our
state. Lack of budgetary provisions, increase demand of service,
awareness of common people ineffective management of manpower, non
technical persons in health management and administration, illogical
priority fixation make health providing system Orissa a square peg in
a round hole.
Noble lauriate & Economicst Amartya Sen has rightly
concluded that a phenomenal growth in economy can be achieved in third
world by giving prime importance to primary education and primary
health care in all respect. We are already late, now it is time to
restructure the health decision making body and thereby fixation of
priority in all sector with more administrative power to health
professionals.
Health is a highly sensitive area directly dealing with
the people and society as a whole, hence highly educated and skilled
manpower needs to be inducted in to the service with salary structure
at par with UGC or judiciary scale or central scale or else this will
remain as an identified area of all left overs who do not find a
suitable job elsewhere. Skilled and committed health professionals
further declined to come to the service inspite of all restricting
measures like deregistrations, registrations after two years of
government job, post graduation of after one year of peripheral
service, forcible five years of service, suspension order, pay cuts,
irregular service and transfer terrorrisation, ceassasion of annual
increment by government may prove counter-productive.
Therefore govt. should introspect the problem with
positive gesture dealing with duty hours of a doctor, to avail or not
to avail public holidays, more deployment of health professionals and
paramedicals to take additional load of patient treatment, adequate
lady attendants for legal harassment of male doctors, national
programmes, and medico-legal cases, job satisfaction of a doctor to be
assured, self respect of a doctors, national programmes, and
medico-legal cases, job satisfaction of a doctor to be assured, self
respect of a doctor should not be outraged by bueracrats and
politicians at all levels, inaccessible terrains should be made
accessable, modernizations of health infrastructures and health
professionals matching to the need of common aspirations, logistics
and unrestricted freedom to medical offices at par with BDOs in
dealing with people in the event of any unnatural deaths, emotional
issues and financial problem arising while dealing with poor, needy
and destitutes as well as in emergencies and natural calamities in
rebuilding the society at block level. Reforms in post-mortems and
development in science and technology should be acknowledged to all
the medical officers from time to time should be a responsibility of
the Government. Civil administrations who enjoy huge power in all
terms should work together to bring health system a people friendly
one.
The increasing population and the resultant poverty is
another problem face by the medical profession. In any OPD an average
doctor is made to see not less than 50 patients in one hour. There is
not way he can justify treating a patient by giving him two minutes
which includes the time for history taking examination councelling,
writing prescription an explaining about the deasese and drug
prescribed.
There is not much reference in the earning structure of
the medical person in the Govt. sector that most of the govt. doctors
end up doing illegal practice after their hospital hours. This spreads
a wrong message in the community. I am of the firm opinion the law
makers, the politicians and beauracrats should ensure that the doctor
should be so well paid that they do not even think of indulgent in
corrupt practices.
Preservation of Finger Identity & Conduction of Night Post Mortems (an
error or a negligence)
By Dr.
S. Acharya
MBBS, M.D., F.M.T. MIAFM
It is
not unwise to say that almost all medical officers are in various
types of preoccupation in their minds regarding these two frequently
met aspects of medicolegal post mortems. Hence it is felt to be high
lighted and clarified keeping in mind that preservation of law should
be lawful and this is the most needed in the medicolegal field, may be
what so ever.
Unknown and unidentified are to different meanings. Unknown means one
whose name & address not known. Here the body is availbale in clean &
complete external appearance and could be very well recognised from
photograph. In such use of finger prints becomes optional and a still
difficult technique hence need not be requisitioned to the autopsy
surgeon which is seen to be a frequent practice by the police.
Unidentified means a body whose external appearance is so distorted to
ascertain its individual recognition and such situations are :-Gross
disfigurement of the head & face by -
- advanced decomposition - mutilating injuries
- pouring corrosives - burning
- attack by wild animals & acquatic creatures.
In such cases use of finger prints comes to some valuable help in
identification if at all facility for superimposition photography &
D.N.A. Testing are not available.
Where ever necessary deciter of the finger prints are to be made by
the I/o taking the help of the scientific offier and requisition to
the medical officer is not legal. The medical officer is not
technically trained for the purpose and decifer of finger prints
requires special nonglud paper in proper format and printers ink which
are neither supplied by police nor available to the mortuary.
The medical officer doing post mortem is only entitled to preserve the
skin of the pulp of the fingers only when oso requisitioned by the
police. Only in cases of highly decomposed bodies where preservation
of the pulp skin causes destruction of the quality of the Print
decifering the autopsy surgeon for the sake of helping investingation
can preserve the finger tips only separated from their end phalanxes -
The finger tips & their pulp skin will always be preserved with
preservative in ten separate labelled & sealed containers using one
for each finger. In bodies submersed sufficiently under water causing
the skin of the fingers to come out like gloves becomes an easy &
useful object for preservation for the purpose and should be presered
in the same way as the pulp skin. One should see that removal of pulp
skin requires again its special technique and instruments to be made
available to the mortouaries and so also their preservatives and
coutainers. Lest the precedure should be abandoned and Left to the
police for decifering of finger prints by the scientific officer.
However it may be concluded that the autopsy surgeon should see to
adopt such procedures of conduction of post mortem not to disfigure
the body and preservation of finger tips of their pulp skins should
not be undertaken it facilities does not prevail to them and the
matters be intimated in writing to the police I/o so that arrangements
for taking finger prints by scientific officer be made.
Night Post Mortems -A
Duty or a compliance
By Dr.
S. Acharya
MBBS, M.D., F.M.T. MIAFM
It is a
well known fact to all that medicolegal postmortems & the battles are
to be stopped at sunset since the age of kings. However both have been
obsolete now a days. So also it is an erroneous believe that post
mortems can be conducted at night by the order of collector & district
magistrate.
Now let us discuss why the mediolegal post mortems are prohibited
after sunset under artificial light some of the reasons are as follows
:-
1) These will be visual errors in correct interpretation regarding the
injuries
2) Artefacts are produced and cause misinterpretation as antemortem
wounds.
3) There will be probabilities of missing smaller & minor findings of
immense medicolegal value.
4) Recognition and preservation of trace elements could be missed.
5) The matter becomes a dispute to the court and will require proper
explanation.
6) The evidential value of the findings ceases in the eyes of law and
may not be beyond reasonable doubt to the perview of the court and
remains open to cross examinations.
7. It is not feasible to arrange light as it is ideally required.
The Collector & District Magistrates are neigher empowered nor legal
in passing out orders for conduction of P.M. exams at night as they
will not be legally responsible for the above aspects. Except only
under sittuations of break down of law & order about which the
magistrate is himself confirmed can submit a written request for night
conduction of post mortem and in such he or his representative would
accompany to keep the discipline & confirm adequate light arrangement
at the place of exam.
Production of extraneous compulsion & threat to a medical officer at
autopsy by any body is so illegal that it is open to the court.
Thoughts are there in the mind of every body then, what is the proper
& adequate light facility it at all post mortems are to be made under
artificial light.
It is a light having the following adjectives "Clear, colourless,
shadowless non reflective, briht & broad, overhead light" the
arrangement of which is not available at the morgues of our state.
Again what ever may be the artificial light the medical officers
should borne in mind that visual errors can not be avoided in
depicting correct findings & small findings because in practice no
light can replace a broad day light, Hence practice of night post
mortems should be avoided as much as possible.
The post mortem findings are only the eye estimations mind will not
know what eyes can not see. Lastly it may be concluded with the saying
of Indian Evidence Act that "a doubtful evidence is no evidence" and
ignorance of law is not an excuse."
Pressure
determines Patience
By
Dr. Prithwiraj Panda, M.D
It was a stretched summer afternoon. Heat was not away.
Dr. Benudhar Mohanta, M.O. PHC, Bhaludega, reached from his subcentre
visit. He asked his driver to keep all the record book from the jeep
to the PHC office. Suddenly he could here a cry I the PHC barandha.
Then a crowd gathered, simpathysing the mother who was crying
helplessly for her one year old baby who was having convulsion. Then
and there Dr. Mohanta ran frantically and found the baby having high
fever and having feats. His whole hearted effort brought smile in the
face of the mother after 40 minutes of consolation diagnosis and
treatment.
While taking a glass of water from his son Vineet who
asked his father that you are late for your lunch, come and have it.
Dr. Mohanta handed the tumbler and wiped his face in a hanky, saw in a
fatigued eye, a group of 40-50 people looking at him with eyes filled
with agony, helplessness and questions. Then Dr. Mohanta said Vineet
“I am going in a minute. Then he went into his outdoor and started
seeing one by one with a smile and touch of love. Mrs. Mohanta knows
her husband cannot enjoy food until and unless he has not finished the
patients gathered in the OPD.
Silence came to prevail after the old clock hanged on the
wall rang 8pm. Dr. Mohanta thought I have to attend the Hon’ble
Keonjhar District Court as an expert witness. Then the statistical
assistant came with a bunch of files and report returns. Dr. Mohanta
went through these and asked why our achievements are not remarkable
inspite of all our measures.
- Malarial deaths have increased
- Infant mortality have been similar in past few years.
- Outbreak of diarrhoeal disease
- Vaccinations dropouts have increased
- Low acceptance of family welfare programmes.
Suddenly the discussion came into a abrupt halt when block chairman
entered with a big crowed of followers.
Dr. Mohanta greeted him with a smile and offered him a chair. Block
Chairman, Laxman Munda introduced a young man Bharat Naik, Sarapanch
of Bandhamal G.P. and told to Dr. Mohanta, “he requires your help.”
Dr. Mohanta asked him to sit and in a querried eye looked at him. Then
he said not me, my wife is to deliver her baby. She is in severe
labourpain and unable to deliver. So please come with me Laxman Munda
and his 20 member team looked at Dr. Mohanta for a positive answer.
Dr. Mohanta said there is a subcenter in nearby Bihumara village. So
please take her there the ANM Shantilata Jena is a fine lady. Her
delivery record is very good, go an avail the service of her there in
her sub centre or you can bring her here in an ambulance. This did not
satisfied them. Sarpanch wanted it is a matter of prestige that his
wife is going to sub centre for delivery. Dr. Mohanta could realize to
tell this team a blunt no on the ground that what is right and what is
wrong, will only muster dissatisfaction among this so-called peoples
representatives. Again Dr. Mohanta knew few years back Dr. Satapathy
was treated by these who masterminded an unlawful incident for a
natural death of an old lady brought to the hospital in her last
moment to breath her last at PHC. He also knows he can’t satisfy
everybody who ever comes for asking helps to visit his ailing
relatives in their village. After a huge strom in his mind in agreed
to this with a fear in mind that the lady may die because of her
husband’s arrogance is standing between the proper assessment and
facilities available. He also knows that if she die a big enquiry will
follow until and unless some miracle will happen his own senior member
of his fraternity in the district level will find it quite comfortable
to recommend his name for suspension on the basis of negligence of
duty. Again a night mare will follow. Poor Dr. Mohanta had to become
ready to sit in the back seat of motorcycle of that Bandhamal Sarpanch
and vanish in to the darkness of the night. Mrs. Mohanta could only be
a passive onlooker with sound of motorcycle slowing down to the
silence.
Mrs. Mohanta is a post graduate lady in Economy and had her M.Phil
done. She belongs to a city. After marring Dr. Mohanta she chose to be
with her husband in the village PHC quarter. Son Vineet reads in class
ten and daughter Preet reads in class three. She found her time best
consumed in going through children’s lessons everyday. This incident
is not very unusual one to her. But she is really pained when Dr.
Mohanta skips his food like this.
Bharat Naik took Dr. Mohanta through the silence of village night.
They went through the country road ups and downs with sound of cricket
all around the roadside bushes. Dr. Mohanta asked to push the
motorcycle while passing through the diversion in a small dilapidated
bridge and reached the village after one and half hour of travel. The
village has slept. Sarpanch took him to his house and offered him a
glass of water but Dr. Mohanta rush straight to the lady who was in a
labourpain and found that OS is not dilated and gave a saline drip and
few injections. He ascertained the condition of the baby and the
mother and found that satisfactory and waited for another half an hour
to deliver a baby boy. The happiness spread all around. It was 1.30 am
in the night. Dr. Mohanta knows God only can tell when a day ends for
a doctor. Suddenly an old lady appeared and said her knees and back
are very much paining. For that reason she is unable to work. Dr.
Mohanta smiled at her and tell her to follow certain exercises and
asked to come the PHC for investigation. She smiled away and asked
instead for some medicine. Dr. Mohanta looked for his bag and gave few
medicine to relief pain. Then another old man showed his skin for some
problems. Dr. Mohanta has already started felling the pressure of his
job. He can’t dissatisfy anybody asking for his professional help. He
prescribed few ointments and creams. Suddenly he discovered a small
crowd of old and young people with a number of problems with a
dealing, sleeplessness and vision & hearing impairment. Dr. Mohanta
gently asked them to come to the dispensary for actual assessment.
It
was almost 2.30a.m. Both of them proceeded to his quarter and reached
in the early hours. Mrs. Mohanta was restless. She was awake. Any
motorcycle sound passing nearby gives her an impression of her husband
returning home. But it was 3.30 in the morning her husband reached
home. Her eager children slept without having the dinner with his
papa. Mrs. Mohanta heaved a sigh of relief when she saw her husband
getting down through the broken window pan of her bedroom. Dr. Mohanta
was about to come home when another person appeared before him to
inform him that a person seriously wounded by a beer in the jungle
lying in the shade of the dispensary. He went then started stitching
all bleeding wounds and give few injections for pain and wound
healing. And it is the beginning of another day which never ends for a
doctor. A lot more to be done in court, report returns, monthly
meeting, supervision of national programmes, at CDMO office in the
family, children’s education and to end with expecting a terrifying
transfer order in every summer before he sleeps.
An appeal - A Duty or compliance
Dr.
Bijay Kumar Swain
Treasurer, OMSA
Dear Friends,
My heartfelt greetings to you all, being a proud member of a
Legendrary, Preindependent association of service doctors of Orissa.
Not only a dignified association by age, but the largest association
amongst all officials of heighest fraternity of noble profession. I
must congratulate you all, being a member of a proud family.
Like the members of a joing family of the present era, some of the
members do not pay respect to the noble cause of association most of
them are self centered & beleive in their own to fight for themselves,
being opertunistic. They feel, what OMSA had done for them ?
But I will be happy if they can tell boldly what they have done for
OMSA, physically, mentally & economically ?
Are you really proud to be a member of this association, without a
Hous of it's own in the capital city of Bhubaneswar ?
Are you really proud, when your President, & General Secretary moving
with the valuable records in their bag & the Treasurer keeping the
properties of OMSA without a office.
Certainly not. Will you not happy to hold OMSA conference in your own
premises of OMSA Bhawan like the Engineers & OAS association in next
year ?
Moreover to strengthen the organisation the movement of office bearers
and for many other official work your support is a must, to feel proud
that you are one of the architect to participate in the process to
build the future Konark.
This should be a call from every bodys heart, mind & soul.
Lastly I request you to please go through the expenditure statement of
your money & give your valuable suggestions for future rectification.
There are 3 different passbooks opened in State Bank of India, OUAT
Branch operated jointly by General Secretary & Treasurer & Editor OMSA
Voice & Treasure for smooth & proper management of properties of OMSA.
The accounts are savings Book Account, OMSA Bhawan Account & Term
deposits for Life membership & OMSA Voice Account. All the
expenditures are presented before the CWC & CEC & passed time to time.
Hence all members are requested to become a party to OMSA property by
generously subscribing the Life Membership or donations for OMSA
Bhawan & OMSA voice.
Long
Live OMSA.
NATIONAL LEPROSY
ERADICATION PROGRAMME IN ORISSA
Dr.P.K. PatnaikASLO, Orissa
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The National Leprosy Elimination Programme (NLEP) is under
implementation in the State since 1982-83. The programme is being
supported by WHO, W.B. (through Govt. of India) and international
agencies like Lepra India, GLRA etc.
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The objective of the programme is to eliminate leprosy by detecting
all the cases of leprosy from the community and bring them under
Multi Drug Therpay (MDT).
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Elimination of leprosy means bringing down the prevalence rate of
leprosy one or below one case per 10,000 population, so as it will
no more be public health problem.
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The State’s prevalence rate of leprosy was 121.4 per 10,000
population in the year 1982-83 and at the national level it was 55
per 10,000 population.
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Due to successful implementation of the programme in the State the
prevalence rate of leprosy at the State level has come down to only
1.06 per 10,000 population by March 2006 and at national level H haa
coma down to 1.00 per 10000 population.
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Phulbani, Malkangiri, Kendrapara, Jagatsighpur, Jajpur, Keonjhar,
Balasore. Gajapati, Pun, Rayagada, Cuttack, Koraput, Bhadrak, Ganjam,
Khurda, Nayagrah, Kalahandi, Mayubhanj & Nawarangpur (19) Districts
have achieved elimination goal. In 7 districts the PR is below 2 per
10,000 population those districts are Nuapada, Deogarh, Sundargarh,
Dhenkanal, Sambalpur, Jharsuguda & Angul only in 4 district the PR
is more than 2 those districts are Bolangir, Boudh, Sonepur &
Baragarh. In 190 blocks out of 314 blocks of the State, leprosy
elimination target has been achieved.
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Since beginning of the programme 825944 cases have been cured with
MDT and now only 4177 cases of leprosy are on record in the State
and all are undergoing Multi Drug Therapy.
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Now the leprosy elimination services have been extended to ad health
facilities including Sub-centeres of the State after 5 rounds of
training to alt general health care staffs in leprosy.
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For acceleration of leprosy elimination in the State 5 rounds of
Modified Leprosy Elimination Campaigns and 158 SAPEL, 166 LECs & 2
Block Leprosy Awareness Campaigns were implemented in the State
since 1998 and altogether 121875 Nos. of new leprosy cases were
detected and treated with MDT.
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In the 1” MLBC 62,844 cases, in the 2” MLEC 27,197 cases, in the 3”*
MLEC 14,122, in the 4” MLEC 10,130, in the MLEC-V 5947, in the BLAC-I
933 & in the BLAC-II 702 new cases of leprosy were detected within
the short spells of the campaigns.
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For prevention of disabilities 323 nos. of block level Prevention of
Disabilities camps were organized in the State.
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Structural Integration has successfully been implemented in the
State during June 2004.
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Entire leprosy elimination work is being carried out by General
Health Care System.
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100% cases are undergoing MDT from General Health Care System.
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More then 90% cases are voluntarily reporting themselves for
detection.
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99.6% of cases are regular in treatment.
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Disability rate amongst new cases has reduced to only 3.19% from 13%
in 1983.
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The integration of leprosy elimination services with general health
care system. ICDS & Panchayati Raj system will further be
strengthened during 2006-2007.
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State has planned to achieve goal of elimination of leprosy at State
level by 30”* April 2006.
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State has planned to achieve goal of elimination of leprosy in all
30 districts by 31” March 2007.
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