MEDICAL SERVICE VOL. 42 No. 4 APRIL-1985

Item

Title
MEDICAL SERVICE VOL. 42 No. 4 APRIL-1985
extracted text
a clinical approach to headache in general practice • leprosy eradication­
myth or reality? • role of natural family planning programme and voluntary
health programme • healthy youth—our best .resource • chai annual meet—
1984—a comment on the exhibition • malnutritions' insidious partner

official house journal
of the catholic
hospital association of India

medical
service
"the love of Christ
urges us" 2 cor 5 :14

vol 42

editorial board

no 4

april 1985

contents

dr c m francis
dr ravi narayan
dr prem chandran John
dr daleep mukarji
mr augustin veliyath
fr george lobo sj
prof george joseph

1

editorial

2

2

a clinical approach to headache in general practice
belinda viegas

3

leprosy eradication—myth or reality ?
t k parthasarathy

9

role of natural family planning programme and
voluntary health programme services
sr dr Catherine bernard

13

healthy youth—our best resource
fr thomas joseph chd, chai

17

towards a low-cost rational therapeutics
navin machado

21

cover design

7 chai annual meet-1984—a comment on the
exhibition

27

p m isaac bangalore

8

malnutritions insidious partner
david w t cromption and m c mesheim

29

news from the diocese
sr beatrice

33

10 surveillance of essential drugs

35

dr paul neelamkavil
fr edwin m j

3
4

editor

5

fr john vattamattom svd

6

9

published by the catholic
hospital association of india
c b c i centre, goldakkhana
new delhi-110001

printed at kalpana printing
house new delhi-110016

,,Articles and statements published In this journal
do not necessarily reflect the policies and views of
the catholic hospital association of india"

EDITORIAL
Healthy Youth: A Hope for Tomorrow
Young people getting together and indulging in arson, looking, burning
of buses, blocking roads and traffic etc. are daily occurences in our country.
Our news papers have to devote a considerable portion of their space
everyday in reporting of such incidents. If we take any riots (like what
unfortunately happened following the brutal assasination of Mrs Indira
Gandhi), disturbances, strikes in schools and colleges etc. We see it is the
youth that are being used for the purpose. This is one side of the picture.
On the other hand we also see how actively our youth are involved in works
of relief and rehabilitation after a calamity whether natural or man made. Or
how they are engaged in work camps, in sports and games, and many adven­
tures which bring honour and name to the country and achieve positive
results. This shows that there, is a sign of hope for the future provided
the elders direct our youth and above all give examples.

If we critically analyse and if we are honest enough to admit we will
be able to find very easily that the society is very often responsible for the
destructive tendencies and activities of youth. Making use of the youth,
particularly of school and college students by political parties to achieve
their own interests is a common practice in our country with painful
consequences of the society paying a heavy price and the education system
getting deteriorated day by day. This will tell upon the future of the
developing countries, particularly our country. It is estimated that by the
close of this century, developing countries including ours will have more
than 80 per cent of those between the age group of 15 and 25 years. This
calls for a more serious consideration towards this all powerful reservoir of
human potential by all concerned. These power resources should be used
to the maximum to build up a healthy human society where there will be
more sense of true freedom—freedom of the children of God, justice, care and
concern and respect for one another.
"The young have a large role to play in health care": says Dr. Mahlet,
the Director General of'WHO, "they themselves are most aware of their own
health problems; they maintain an open mind and represent the group best
able to appreciate the basic tenets of primary health care, beginning with
the responsibility of caring for themselves. Studies have shown that a
majority of youngsters want to help others and want to assume responsi­
bility. A good place to start may be with national community programmes
that demonstrate how to keep fit and achieve a healthy.lifestyle".
As we are almost in the middle of the International Year of the Youth, let
us all realise the tremendous potential in our youth and direct them, with all
honest efforts, to build up health communitiesand a healthy nation at large
for, a healthy youth of today is our hope for a better tomorrow.

A Clinical Approach to Headache in General Practice
—Belinda Viegas

(Text of the Departmental Seminar compil­
ed by Thomas M.J., Dept, of Psychiatry, St.
John’s Medical College, Bangalore).
The initial problem in the management of
headache is to decide whether any special
investigation is warranted. In the majority
of patients a carefully elicited history will
establish the pattern so clearly that any special
tests are superfluous. When there is diag­
nostic difficulty or when the history suggests
a serious disorder, investigations become
necessary and good judgement is required to
determine the sequence of tests which is
safest for the patient and most likely to pro­
duce a definite answer.

The initial approach will depend on the
duration of headache, i.e.
1.

The acute severe headache.

2.

Acute recurrent episodes of headache.

3.

The headache of subacute onset.

4.

The chronic headache.

When a headache suddenly develops in a
patient for the first time, the presence or ab­
sence of fever and neck rigidity are of great
importance. Patients with acute headache,
photophobia, elevation of body temperature
and neck stiffness obviously have an intracra­
nial disturbance and the question of lumbar
puncture arises. The C.S.F. commonly shows
a lymphocytic pleocytosis if headache is
present at the height of a viral invasion. When
a confident diagnosis of a specific infection
cannot be made after examination of a patient,
L.P. may be necessary to distinguish between
April 1985

meningitis, encephalitis, and subarachnoid
hemmorhage. The normal C.S.F. should not
contain more than 5 lymphocytes/cm and
should never contain polymorphonuclear cells.
A high polymorph count is almost always
caused by bacterial meningitis and a purely
lymphocytic-reaction indicates a viral meningo­
encephalitis, but mixed cellular reaction may
be found in both viral and bacterial infections,
particularly. in tuberculous meningitis. The
glucose content of C.S.F. assume a particular
significance in these doubtful cases. The
C.S.F. level of glucose depends upon the blood
level. But, providing that the patient is not
hypoglycemic and that the fluid has not been
allowed to stand for some hours before exa­
mination, a C.S.F. glucose of 30mg/100 mi
or less suggests a bacterial or cryptococcal
meningitis or the rare carcinomatosa menin­
gitis
Apart from the diagnosis of infectious dis­
ease’ L.P. may be required to confirm suba­
rachnoid hemorrhage. If this diagnosis is self
evident and the patient conscious, it is often
better to proceed immediately to a ECT scan
and cerebral angiography in a centre suitably
equipped for it, since L.P. gives no additional
information and may precipitate further bleed­
ing.
After head injury there may be difficulty in
distinguishing post-concussional headache
from that of an expanding intracranial hae­
matoma. A persistent headache and insidious
drowsiness are always signals- to be on the
alert. Dilatation of one pupil or a minimal
hemiparesis are late signs which should prompt
immediate CT scanning or carotid angiography
and neurological intervention. Neck stiffness
3

arising in this context is a particular source
of concern as it suggests midbrain compres­
sion from "coning** of one of the temporal
lobes through the tentorial opening. When
radiography of the skull demonstrates a frac­
ture of the lateral aspect the possibility of an
extradural haematoma from a torn middle
meningial artery should be borne in mind, and
justifies close observation of the patient. A
CT scan is particularly helpful in following the
course of patients with a post-traumatic hea­
dache of doubtful origin. Unilateral or bilateral
subdural haematomas can be missed by CT
scanning in their iso-dence phase so that there
is still a place for cerebral angiography in
doubtful cases.
Acute headaches without neck stiffness may
also be of intracranial origin. Blood pressure
may suddenly increase in acute nephritis,
toxaemia of pregnancy, malignant hyperten­
sion and the crisis caused by phaeochromocytoma or in a patient on monoamine oxidase
inhibitors taking sympathomimetic drugs or
tyramine containing foods. The finding of
hypertension on examination does not of
course exclude an intracranial lesion as the
source of headache. The blood pressure is
usually secondarily elevated in patients with
subarachnoid and intracerebral haemorrhage.
Acute headaches of extracranial origion
such as sinusitis, retro-bulbar neuritis, acute
angle glaucoma and abcesses around the
roots of the upper teeth can usually be diag­
nosed clinically.

Some of the entities mentioned above such
as sinusitis or pressor reaction of phaeochromocytoma may recur periodically. Repeat­
ed episodes of meningitis suggest either de­
fective immunological mechanisms or more
commonly, that the nasopharynx communi­
cates with the sub-arachnoid space through a
fracture in the floor of the anterior fossa.
This leads to CSF rhinorrhoea with clear fluid
dripping from the nostril when the head is

4

best forwards. Unlike nasal secretions CSF
contains glucose so that it can easily be con­
firmed if the fluid is of intracranial origin.
Repitition of a subarachnoid haemorrhage
from an intracranial aneurysm carries a morta­
lity in the vicinity of 50% like that of the origi­
nal episode.
Cerebral, cerelellar or spinal
angiomas on the other hand may bleed, little
often with little or no residual deficit.

Attacks of cerebrovascular insufficiency are
clearly demarcated by symptoms and signs
of the territory which is rendered ischaemic.
The classic story of internal carotid insuffi­
ciency usually seen only in part is that of blurr­
ing of vision is one eye resulting from retinal
ischaemia, accompanied by fleeting paraesthesia or paresis of the opposite side. If the
dominant hemisphere (the left in right handed
subjects) is involved, dysphasia is an addi­
tional symptom. Transient ischaemic attacks
may be accompanied by headache on the side
supplied by the defective carotid artery.
Insufficiency of the vertebra-basilar artery is
characterized by momentary vertigo, dysar­
thria and ataxia, or by a combination of brains­
tem symptoms and signs including diplopia,
tinnitis, deafness, paraesthesia over the face
and body and hemiparesis or quadriparesis.
Because of the posterior cerebral arteries which
supply the occipital cortex arise from the
basilar artery, the patient may experience a
temporary homonymous hemianopia, visual
hallucinations like those of migraine or a
complete bilateral
suppression of vision.
Since the medical part of the temporal lobe,
the entry portal of the brain for memory, is
also within the distribution of the posterior
cerebral artery, amnesia may be a feature of
vertebrobasilar attacks. The occipital hea­
dache which may be present for the duration
of the attak is insignificant compared with the
dramatic nature of the focal neurological
symptoms. Paroxysmal cardiac dysrhythmias
may produce the attacks through hypotension.
Medical Service

sudden neck movements may obliterate the
lumen of the vertebral artery in the neck of
spondylitic patients, and arm movements may
induce a shunting of blood from the vertebral
artery into the subclavian artery if its intralu­
minal pressure is lowered. Inequality of the
radial pulses and a bruit over the clavicles or
in the neck may indicate the site of stenosis.
Embolism from subacute bacterial endocraditis
must be considered if a cardiac murmur is
detected.
Intermittent hydrocephalous is a rare cause
of recurrent headache, but should be consi­
dered if the history is relatively short, if the
headaches are severe, if they are precipitat­
ed by a quick forward movement of the head
or are associated with obscuration of vision,
impairment of consciousness, myoclonic jerks
or weakness of the legs. The final diagnosis
will depend on CT scanning and other neuro­
logical investigations.
The pattern of pain and headache in tic
douloureux, cluster headache and migraine
are usually sufficiently distinctive for a diag­
nosis to be easily made. Where doubt exists
other conditions may be excluded by investi­
gations. But a positive diagnosis depends upon
the clinical history. The frequency and dura­
tion of headache establish the temporal pattern
which is so important in the diagnosis.

Migraine may recur irregularly at intervals
of months and years but commonly a pattern
has become established by the time a patient
seeks medical advice. The headache may be
linked to the menstrual cycle or may appear one
to ten times each month without any obvious
cause, disappearing only during pregnancy,
holidays, admission to hospital or other periods
of prolonged rest. It may last from a few hours
to several days, but is usually followed by a
period of freedom from headache before the
next attack starts.

Cluster headache on the other hand has an
intriguing periodicity. It usually recures in
April 1985

bouts lasting from 2 weeks to 3 months and
then vanishes completely for 3 months to as
long a 4 years. During a bout, the headache
returns once, twice, or more in 24 hours and
lasts from 10 minutes to 2 hours on each
occasion. The fact that the pain persists for
this length of time clearly distinguishes it from
trigeminal neuralgia, which recurs as trasient
jabs of pain, each lasting a fraction of a second,
although the jabs may be repetitive. The two
disorders are mentioned together because
they are commonly confused in general prac­
tice. One point that the conditions have in
common is the tendency to remit spontane­
ously for months or years. The distinction bet­
ween the two is most important because the
mechanism and treatment of each are entirely
different.

Tension headache is set apart from those
just considered by the absence of any paroxys­
mal quality or periodicity about it's course.
While acute forms of tension headache may
appear at the end of a stressful day in a busy
office or a house of screaming children the
usual story of the sufferer is that there is al­
ways a headache lurking in the background.
Such patients have some sort of headache all
day and every day. They are never really free
except for an hour or two after ingestion of
their favourite caffeine containing analgesic.
There is a form of headache intermedicate
between this undulating pattern and the parosysms of migraine. This is termed tension—
vascular headache, because surges of more
severe throbbing ' headache become superim­
posed every few days or weeks on an other­
wise monotonous background of constant
discomfort.

Headache is commonly bilateral except in
migraine attacks (of which about 2/3rds
are one sided). Cluster headache and tic
douloureux are almost always strictly unilate­
ral. Tension headache is usually bilateral but
sometimes may be one sided owing to asym­
5

metrical muscle contraction, found particularly
if there is associated imbalance of bite.

The most important distinction here is
between pulsating or throbbing headache in­
dicating a vascular origin and a constant ache.
Migraine commonly starts as a dull headache,
but may develop a throbbing quality and later
become a constant severe pain. Tension
headache is usually dull constant, tight, pres­
sing or band like.

The only form of headache with a recogni­
sable prodromal phase is migraine. Before the
headache starts there may be visual hallucina­
tions or a complex succession of neurological
symptoms which adhere to much the same
sequence on each occasion. Visual hallucina­
tions may take the form of simple flashes of
light or a coloured display of zig-zag scintilla­
tions moving slowly across the field leaving a
scotoma behind. There may be patch or gene­
ralized blurring of vision at the height of the
disturbance or a clearly defined homonymous
heminopia.
There are a wide variety of symptoms linked
with migraine headache including photo­
phobia, gastro-intestinal disturbance, fluid
retention and focal neurological changes.
The reddened forehead,' injected conjunc­
tiva, lacrimating eye and occasional Horner's
syndrome of cluster headache are distinctive
vascular phenomena. The nostril on the affect­
ed side may block or run with fluid.

The explosive pains of tic doulourex may
be detonated by stimulation of any area served
by the trigeminal nerve. Talking, chewing,
swallowing, shaving or even a puff of wind
blowing on the face are trigger factors com­
monly mentioned^
Alcohol usually triggers cluster headache
during a bout but not at other times. It may
also bring on migraine when the patient is in
a susceptible phase and not in the refractory
period after an attack has recently ended.
6

Certain foods are said to induce migraine
but doubt has been cast on whether in the
traditional migraine, precipitants act specifi­
cally or by a psychological conditioning pro­
cess. Vascular reactivity appears to be altered
by hormonal changes, thus accounting for the
association between migraine and menstrua­
tion and its relief in some women during preg­
nancy.
The migrainous patient usually prefers to .
lie in a darkened room whereas the sufferer
from cluster headache prefers to sit up or pace
the floor, holding his hand over the affected
eye. Rebreathing into a paper bag or the in­
halation of air with 10% CO2 is said to shorten
the vasoconstrictive phase of migraine and the
inhalation of CO2 relieves most patients with
cluster headache.

Voluntary relaxation of forehead and jaw
muscles will reduce the severeity of tension
. headache.

Headache of subacute onset is of interest
to the doctor and of potential danger to the
patient. Someone who has never experienced
more than "ordinary headaches" which most
of us get at times, starts to complain of a
different sort of headache which may affect
one or both sides and becomes progressively
more severe. If the patient has been complain­
ing of ear-ache or of nasal obstruction with
pain over the forehead or maxillae before the
onset of headache, thoughts turn to the compli­
cations of otitis media and sinusitis.

If the patient has signs of raised intracranial
pressure, a CT scan is the investigation of
choice and will pick out most cases of cerebral
abscess, tumor, infarction or haemorrhage. If
the ventricles are not enlarged or displaced,
"Benign intracranial hypertension" is suspect­
ed but it must be borne in mind that bilaterally
symmetrical subdural haematomas may es­
cape detection by CT scan.
Medical Service

The rare cases of Addison's disease or
hypocalcemia presenting with increased in­
tracranial pressure must be remembered and
excluded. In patients over the age of 55 years,
the blood picture and ESR should always be
examined to pick up the odd patients with
temporal arteritis.
In the patient who has suffered from
headaches for a year or more, the prospect of
a tumor or other serious intracranial disorder
being the cause is more remote. If the patient's
headaches have been consistent in character
for 5 years or more one may feel fairly con­

fident that they are not caused by an intrac­
ranial tumor, although the occasional patient
may be found to have a tumor which is quite
unrelated to the headache with which he
presented.
As a general rule any headache which has
been present for more than 5 years is a tension
headache or migraine and diagnosis depends
on the history. The greater the time spent in
taking the history of a patient with headache,
the more likely are the correct diagnosis and
solution to emerge, and the more interesting
will the patients's problem be to the doctor.

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7

Leprosy Eradication
Myth or Reality ?
The anti-leprosy work offers many challenges—and if we can respond to these
adequately, eradication of leprosy will become a reality. The myth that the disease is
divine dispensation and cannot be eradicated can be broken. How fast this can be
achieved depends on how seriously we take up the challenge.
—T.K. Parthasarathy

The war on leprosy has been mounted
again, now in a big way. The goal is eradica­
tion of this scourge by 2000 A.D. Appropria­
tely, the National Leprosy Control Programme
has been redesignated as the National Leprosy
Eradication of Leprosy under the chairmanship
of Dr. M.S. Swaminathan, then member. Plann­
ing Commission.
The emphasis will be on the traditional
method of disease control the twin front of
case detection and treatment but on a more
vigorous and sustained scale. The treatment
strategy will shift from the single drug regimen
to multi-drug therapy.
Health education will be the sheetanchor of
the programme; make the people realise that
leprosy is like as any other communicable
disease, encourage those with symptoms of
the disease to seek medical advice promptly
and persuade patients to take regular and
complete treatment.,

A policy guidance and surveillance body
called the National Leprosy Eradication Com­
mission, headed by the Union Minister for
Health and Family Welfare has been set up
at the National level. A National Leprosy
Eradication Board—another body suggested
by the Swaminathan Committee—has been
set up under the chairmanship of the Secre­
tary, Ministry of Health and Family Welfare,
as the executive body of the Leprosy Eradica­
April 1985

tion Commission. The States with a high
incidence of the disease will similarly set up
such policy guidance and implementing agen­
cies under the chairmanship of the Health
Minister and Health Secretary respectively.
The Programme has also been included in the
new 20-point programme.

Preliminary estimates based on the 1981
census indicate that the total number of cases
in India will be about 3.95 million. Out of this
20 per cent cases will be of infectious type
and 25 per cent have one or other form of
disability. Twenty per cent of cases are children
under 14 years of age. Nearly 400 million of the
680 million population (1981 census) live in
areas endemic to the disease—areas where
the disease prevalence rate is 5 and more per
1000 population. According to the Working
Group, 12 States and Union Territories are
highly endemic. Tamil Nadu, Andhra Pradesh,
Pondicherry and Andaman and Nicobar is­
lands have a prevalence rate of 13 and above
per 1000 population; Orissa, West Bengal and
Nagaland have a rate between 9 and 12/1000.
There are seven States with a prevalence rate
between 5 and 8/1000. Besides, there are
considerable variations in the prevalence with­
in the same State. In Tamil Nadu the rate
ranges between 15/1000 in
Coimbatore
District to 28/1000 in Salem District while
in West Bengal the prevalence is between
4/1000 in Darjeeling and 25/1000 in Purulia.

9

The Government of India in Leprosy Cont­
rol Programme as early as 1954 with the main
objective of detecting cases and treating them
with modern anti-leprotic drugs free of cost
so as to effectively control the spread of the
disease in the community. Upto March 1983,
3.16 million cases have been registered.
During this period, 0.26 million cases have
been discharged from the control as diseasearrested or deleted otherwise thus leaving a
balance of active cases registered till the end
of March 1983 at 2.90 million. In this process,
the National Programme has so far established
6960 Survey, Education and Treatment (SET)
Centres, 389 Leprosy Control Units and 607
Urban Leprosy Centres. During the current
plan (VI Plan) the Programme is completely
aided by the Central Government. Under this
the entire maintenance and operational cost
of the units set up by the States since 1978
will be borne by the Central Government.
The Programme expects to cover the entire
population in the endemic areas by the next
Plan Period.

Encouraging results have been reported
from selected areas. The Indian Council of
Medical Research had assessed the working
of a few centres in Maharashtra and Tamil
Nadu which had been functioning for over
15 years. According to published reports,
the problem in the units evaluated "have shown
definite decline in new cases detection, in­
fectivity rate and deformity rate. "An assess­
ment of the total work in Tamil Nadu indicated
that the prevalence rate has come down from
20.4/1000 population in 1970 to aboutl 5/1000
in 1980." It is stated that the results could have
been much better, if along with case detection,
multi-drug regimen had been introduced.

The anti-leprosy armamentarium today has
powerful curative and prophylactic drugs. The
disease is completely curable, without any
deformity, if detected early and treatment ins­
tituted promptly. The treatment has to be
taken regularly for a long period as prescribed
10

by the doctor. The only lacuna is the absence
of a vaccine against the disease to achieve
primary prevention. So far not much success
has been achieved in developing an immuniz­
ing vaccine to protect healthy persons. A
large number of research workers around the
world are vigorously engaged in developing a
vaccine.
Systematic case detection

The working Group, besides recommending
systematic case detection and treatment in
highly endemic districts, has urged that the
existing single drug therapy by dapsone
(DDS) should be supplemented by one or more
bactericidal drugs like rifampicin and clofazimin at least in the treatment of smear positive
or infectious type of disease. The Working
Group had recommended that the multi-drug
therapy should be launched in the form of a
campaign ultimately leading to the eradica­
tion of the disease.
The Government had accepted the recom­
mendations of the Working Group and decided
to introduce multi-drug regimen project
(MDRP) in all the 92 highly endemic districts
in the country in a phased manner. The ulti­
mate objective is to convert all infectious cases
into non-infectious within a short period and
thus reduce the quantum of infection with a
view to interrupting the chain, of transmission
in the community.
The multidrug regimen campaign was
introduced initially on a trial basis in 1981
in Wardha district of Maharashtra. It was de­
cided later to introduce the MDRP in eleven
endemic districts namely Wardha and Amaravati (Maharashtra), Purulia (West Bengal),
Santhal Parganas (Bihar), Ganjam (Orissa),
North Arcot (Tamil Nadu), Srikakulam and
Vizianagarm (Andhra Pradesh) and Vado­
dara (Gujarat). The other districts will be
covered during 1983-84 and 1984-85. The
project has already been introduced in Purulia

Medical Service

in February 1982, and in Ganjam, North Arcot,
Srikakulam and Vizianagarm in February and
March 1983.
Health Education
The availability of powerful drugs alone
cannot lead to the eradication of the disease.
Cases have to be detected in a sustained man­
ner and drugs provided to the patients regu­
larly. It should also be ensured that the patients
take the drugs regularly and for the period
advised. The greatest barrier to the successful
case detection are ignorance, prejudice and
wrong notions. Even today leprosy is feared
and it is very widely believed that the disease
is the direct result of sin committed in the past
life, and it is a divine punishment and hence
cannot be cured. The moment one is told that
he/she is a victim of leprosy, despondency
sets in. The ugly deformities in the hands and
feet and face leads to social boycott of the
patient and the family. Because of the attitude,
some patients leave their homes and take to
begging and live far away from the home to
avoid identity.
In fact leprosy is a less infectious and less
contagious disease than tuberculosis. Only 20
percent of the estimated cases are lepromatous
(infectious)—those disseminate leprosy becillus through nasal secretions. Although many
are infected, only a very small number develop
the disease. Even among the people who live
in close contact as spouses of lepromatous
patients only 3 to 5 per cent get the infection,
according to experts.
In spite of such findings, leprosy patients
are despised and looked down upon. Such an
attitude makes the victimsand those with signs­
and symptoms avoid diagnosis. In the light
of* such social implications, the Working
Group has recommended, rightly too, "that a
nationwide mass education campaign needs to
be launched and pursued vigorously and re­
April 1985

move superstitions and wrong beliefs and so­
cial stigma attached with leprosy".

Most of the leprosy patients belong to the
poorer sections of the community and these
usually crowd in the slums where the parents
and children huddle together in the small
shanty dwellings. This gives rise to the prob­
lem of leprosy in children. As stated earlier,
20 per cent of the leprosy cases in the country
are children. Dr. R. Ganapathy, Director of the
Bombay Leprosy Project, in an article in
Swasth Hind (January 1983) has said that
"while surveys of 10 per cent of child popu­
lation attending randomly selected munici­
pal schools revealed a general prevalence rate
of 3 per 1000, there existed pockets of endemicity of the order of 10.8 per 1000 in some
schools in the northern suburbs of the city".

Dr. F.M. Noussitou, WHO consultant, has
said that in countries or areas where the pre­
valence rate of leprosy is 5/1000 or more
convenience of the' examination of school
children has to be considered. "This method
of case detection is recommended when the
estimated prevalence among the students is
in the range of 4-5 per 1000 or more". (Lep­
rosy in Children, WHO, 1976). The Working
Group has also recommended that "screen­
ing of pre-school children and youth for pos­
sible infection through skin camps should
become a regular activity".

Public Participation
A programme of this magnitude with the
complexity of social and economic problems
cannot go on full steam under the govern­
ments efforts alone. Official activities should
be supported and supplemented by people's
participation. The public should feel that they
ate partners in the programme. What are the
ways in which the public could provide the
needed support? .

Health education of the people on the cor­
rect information about the disease and edu­

11

cation of the patients that the disease is cur­
able and that the patients should continue to
take the long treatment regularly could be
one such public education activity. The Work­
ing Group has said the objectives of a health
education campaign could be "to create an
awareness and interest among the people
about the programme and develop positive
attitudes and pratices towards effective action
to control of leprosy depends on health edu­
cation, early diagnosis using active methods
of case finding and early treatment of all forms
of the disease.
Another aim could be to motivate voluntary
agencies to sustain and promote the objectives
of the National Eradication Programme by
undertaking specific responsibilities such as
community self surveys, in the endemic areas,
holding of skin camps, initiate activities for
case detection, case holding, drug distribution
and rehabilitation. There are 56 voluntary
organizations today engaged in leprosy cont­
rol activities. The Working Group has also
suggested that "voluntary communicators"
should be placed at the grassroot level. Such
a communicator "will be one of the community
selected for his positive attitude towards lep­
rosy and his ability to work with the people".
He will not be paid any salary "but his work
will be recognised either by small awards or
by public recognition".

12

All channels of mass communications, both
governmental and private could take up the
challenge the programme presents and put
out suitable message in a sustained manner.
If such an education programme could be plann­
ed and implemented in which the newspapers
and magazines, radio, television, film and
other media units could participate in a plann­
ed way, the Eradication Programme would be
able to remove the fears in the people's mind
and make case detection work easy. The health
worker on his part should pick up the message
put out on the mass media channels and build
an educational programme in the community,
in the clinics and during home visits. They
can involve the teachers, and educational
authorities in the health education work.

The anti-leprosy work offers many chal­
lenges—and if we can respond to these ade­
quately, eradication of leprosy will become a
reality. The myth that the disease is divine
dispensation and cannot be eradicated can be
broken. How fast this can be achieved de­
pends on how seriously we take up the chal­
lenge. We include the government and the
public.

Courtesy : SOCIAL WELFARE

Medical Service

1

Role of Natural Family Planning Programme and
Voluntary Health Programme Services
—Sr. (Dr.) Catherine Bernard

Contextualizing Primary
Family Planning :

Health

and

Health and Family Planning in our present
time is. very much a service distributed by a
group of health professionals to a group or
community whose role is often expected to be
passive recepients. It can be said that very
much of the existing health and Family Plann­
ing facilities in.India cover only a small part
of the population, while the vast majority of
the people cannot afford the cost of insti­
tutional health care and hence have very
little or no access to basic health care or ferti­
lity awareness facilities.

It can be said therefore that Primary Health
Care and F.P. is planning, promoting and main­
taining health. It is understanding that health
is a component of the overall socio-economic
development with emphasis on 'starting from
people rather than programme'. This under­
standing therefore requires an approach en­
tirely different as contrasted to curative health
services.

sequently it is liikely to have a profound in­
fluence on fertility regulation measures as
well.

Health Services and Family Planning in
India—a brief overview
Health and F.P. are closely finked even
though F.P. is not essentially a health com­
ponent. Health Care services and facilities in
India are very much oriented to conditions of
technology and industrialization with empha­
sis on highly sophisticated curative practices.

This approach is very much present even
in the medical education in our country. Un­
fortunately a similar system pervades many
of the medical institutions started by Reli­
gious Congregations and Missionaries. Even
though established for and in rural areas they
are caught up in the political attitude of the
existing medical system and carry health ser­
vices in total submission to the dictates of the
drug industry.

One can -take this system into the Sphere
of Family Planning. India opened its first
F.P. clinic in 1925 and 5 years later the Govern­
ment
of Mysore opened the first state sponsor­
1. That it is shaped around the lifestyle
ed
birth
control clinic. This was the first state
.of the people itself.
sponsored clinic in the world. In 1935 Mar­
2. Local people should be active in plann­ garet Sanger—founder of Planned
Paren­
ing, so that their needs and priorities are thood came to India and the F.P. Association
met.
of India was founded in Bombay. In 1959
3. Health Care offered should make maxi­ India became the first country to adopt F.P.
as a national policy. Since then in each of the
mum use of Community resources.
5 year plans millions of Rupees have been
Therefore, Primary Health approach starts
allocated for F.P./population control prog­
from people rather than programme and con­
rammes.
The WHO Executive Council in its 1975
meeting at Geneva stated that Primary Health
Care must ensure :—

April 1985

13

It is interesting to note that inspite of efforts
being made both in public and private sectors,
we still remain caught up in the attitude that
F.P. is a medical problem and fertility is a
pathology to be treated or arrested and preg­
nancy a problem to be dealt with. On close
look at this system, it is not surprising to note
that the medical profession continues to bene­
fit the drug industry rather than the people.
We therefore need to take a took at F.P. and
its impact on the Family
(contemporary
F.P. approach).
For F;P. to be acceptable to the Indian
people, it must be recognised that F.P. does
not belong to the realm of medicine and medi­
cal care. Fertility and/or pregnancy is not a
disease to be arrested or eradicated, but rather
an integral component/process of the in­
dividual to be integrated, and respected. It
must also be recognised that fertility and ferti­
lity regulation must remain within the power
and capability of the couple to use and choose
within the frame work of responsibility and
human dignity.
It is when fertility and F.P. services pro­
liferate, remaining confined and controlled by
specialists and health workers, such services
and programmes will not have the desired
effect and impact on the given population.

This leads us to the topic of NFP and NFP
programmes, wherein approach and emphasis
is on:.
1. People/Persons and not on problem,
■ 2. Respect,
3. Responsibility.

NATURAL
FAMILY PLANNING—THE
BILLINGS OVULATION METHOD
What is Natural Family Planning

Natural. Family Planning is planning for
achieving or avoiding a pregnancy by plann­
14

ing the time for intercourse. By becoming
aware (observing and recording) certain na­
turally occuring symptoms and bodily change
that occur in a woman's menstrual cycle and
using the knowledge as a guide, a couple
can learn to identify times of fertility and in­
fertility in each menstrual cycle. If the decision
is to achieve pregnancy, they will know when
pregnancy can occur, if they wish to avoid
pregnancy then they should abstain from in­
tercourse on those days when conception
can take place.

Methodology of Natural Family Planning
The Calendar Rhythm— is an isolated me­
thod not advocated by contemporary natural
family planners. The Calendar method leads
to many unplanned pregnancies because of
variations that can occur in the women's
menstrual cycle. Because of these variations
the calculations that seem to apply to regular
menstrual cycles will not hold good and there-.
fore accounts for 'failures' of the method.

Basal Body Temperature and Sympto
Thermal Methods
Ovulation is indicated by the thermal shift
that occurs in the thermometer as a result of
hormonal changes that occur in the woman's
body.

Other symptoms like breast tenderness,
abdominal pain, backache, cervical mucus are
other symptoms of ovulation, and may assist
in interpreting the thermal shjft which occurs
as a result of Ovulation.

Ovulation Method—Billings
Drs. Billings of Australia pioneered the use
of the cervical mucus as a single parameter
for the prediction of ovulation and its appli­
cation to Natural Family Planning. Women
are taught to observe their mucus patterns
at the vulva, relying primarily on the sensa-

Medical Service

tion of wetness "and lubrication. The mucus
can usually be felt and/or seen when the wo­
man washes or after going to the toilet.

cognised by most clients. The use of marking
a chart has facilitated deserving fertility patterns
and overcomes the barrier of illiteracy.

According to the world's famous scientist—
Brown, Berger and Odeblad, whenever total
oestregen exceed the threshold of 15 mg per
100 ml per 24 hours the cervical mucus is
sufficiently liquefied to leave the cervix and
appear at the vulua. If a cycle is ovulatory,
the mucus will become increasingly lubrica­
tive, elastic and clear until it reaches its peak.
The changing behaviour of the mucus is call­
ed the build up 'Peak' is therefore defined as
the last day of lubricative mucus, not neces­
sarily the day of maximum stretch (elasticity).

Special Circumstances :

The Billing method persumes that once
the fertile type mucus has begun, sperms can
be maintained in a viable state in the cervical
cryts and other uterine sites until ovulation.
Experiences have shown that couples must
abstain from the onset of fertile—type mucus
until of 72 hours beyond 'peak'. Women are
taught to distinguish between mucus related
to ovulation and other vaginal discharges,
also the fertile type mucus by its elasticity and
lubricative quality.

When couples wish to avoid pregnancy
they must abstain from the onset of mucus
until the fourth day after peak. In case of short
menstrual cycles they are asked to abstain
during monstration, which may mask the on­
set of mucus in a woman with a short menst rual cycle.
After the learning stage many women can
distinguish menses from mucus and also their
baseline discharge as distinct from cervical
mucus.
After the Ovulation, progesterone abruptly
suppresses the peak mucus, the pattern con­
tinues with sticky mucus for a day or two and
then returns to dryness. After a few cycles
the physiological changes are so easily re­

April 1985

The Ovulation Method Billings can be
used in times of breast feeding, pre menopause,
irregular menstrual cycles. Using the method
can also help detect pathological situations
like vaginitis or cervicities etc. and the neces­
sary medical assistance is given.

Effectiveness of Natural Family Planning
Unlike contraception, NFP can be used to
achieve or avoid pregnancy. The underlying
assumption in contraception is that the couple
use a device, technique or medication in order
to prevent conception resulting from coitus.
Natural Family Planning on the other hand is
based on the timing of coitus and calls for
abstinence during the fertile phase if preg­
nancy is not desired.
Some of the major use effectiveness con-:
tinuation rate studies carried out show the re­
sults achieved in different countries—USA—
92% Continuation rate—of 329 users for 12
months (Dolack) USA (Klaus). 95% conti­
nuation rate for 1090 Users—with 24 months.

NFP and Health Care Systems
If one refers to the understanding of Pri­
mary Health Care and the role of NFP—one
must recognise and admit that NFP is not
only a form it is Primary Health Care—for
NFP is planning—to achieve or avoid preg­
nancy and in doing so maintains health. It
is by integrating fertility that health is main­
tained. Furthermore it is shaped around the
lifestyle of the people to be served for it integ­
rates culture, physical integrity and procrea­
tive choice. In this process the person/couple
become actively involved, become aware of
their needs and strive to meet their priorities.
{Contd. on Page 28)
15

Healthy Youth—Our Best Resource
Fr. Thomas Joseph, CHD, CHAI

(Address Presented for the symposium
on 'Healthy Youth—Our Best Resource' orga­
nized by the Indian Federation of the United
Nations Association, at New Delhi on 9th
April, '85, the world health day).
Healthy Youth, as the best resource for the
development of the nation, is a theme worth
reflected upon in the International Year of the
Youth. My reflections are based on the ex­
perience I gained from four years of my in­
volvement among the rural youth of one of the
backward and tribal districts of Kerala, and
from my present experience in the promotion
of community based health programmes laun­
ched by CHAI.

effort to differenciate them existentially, based
on the difference in the socio-political en­
vironment to which they belong. Because,
when we think about the well being of the
youth we have to be very clear about which
youth we are talking about. Is it the rural ones
who constitute the majority of the youth po­
pulation of India? or is it the urban or the
slum youth? I feel it is crucial, because their
health problems vary from region to region
and from place to place, depending on the
different socio-political milieu.

Youth is a unique period in the human life
span, wherein a person experiences a 'belong­
ing' and not so belonging' state in his/her
existence as an individual. The drastic bio­
logical and psychological changes experienced
The World Health Organization has defined
within
himself/herself,
the sociological
health as, 'a state of complete physical, men­
experience of the transition from childhood
tal, and social well being, and not merely the
dependency to the adult autonomy, the in­
absence of disease or infirmity'. This defini­
tolerance, misunderstanding and the neglect
tion has widened the horizon of health to a
experienced from parents, teachers and the
much broader concept than what we all con­
'grown ups' in general, the disturbing conflict
ceived ten years ago. In the past we con­
and tension arising out of the idealistic en­
centrated our effort on the promotion of physi­
thusiasm and the uncompromising impatience
cal health with an aim of alleviating the suffer­
with hypocricy, the frustrating disillusion­
ing of the humanity from physical ailments.
ment on the affairs of the society around-all
But today, ever since the new definition of
these and many other personal experience
WHO, our perspectives have broadened and
make the people of this age groups, phenoaccordingly we aim our efforts towards the
-'well being' of the total person in his existen­
menaly different and substantially unique
tial milieu, through an integrated and com­
from any other groups. The above charac­
prehensive approach. The new thrust on the
teristics of the youth clearly prove the fact
mental and social dimensions assumes para­
that their health understood as total well be­
mount importance, when we think of health
ing involves many factors, not so thought
in relation to the youth of today.
about till recently as normally related to health.

However, an overall understanding of the
youth in general may not, I am afraid, fall in
the correct perspective unless we make an

April 1985

Contrary to the experiences of social scien­
tists, the medical profession contents that
youth is a healthy group. It may be partly

17

because of their limited understanding of the
concept of health in the broader sense, and
partly because of the inadequate training they
received during the course of study, to under­
stand the teenage problems deeply.

coholicaddiction, involvement and participa­
tion in the anti-social activities etc.. They
are all but symptoms of certain deep rooted
illness of the society, to which the youth are
'condemned' to cope with.

A sizable bulk of the population in India
today is constituted of the youth, between
the age group of 15-25. According to reliable
sources, it amounts to 135 million, out of the
700 million population of our country. At
the global level, the total number of 15-24
age group was 850 million in 1980, far exceed­
ing the entire population of India.

In the communal violences and the riots
that our country witnessed in the recent past,
the urban and slum youth, played a very signi­
ficant role. The incidence of teenage preg­
nancies, 'accidents' as the youth nickname it,
the mushrooming of illegal centres of abor­
tion in our cities, eve teasing, bride burning
and other assaults on women, child marriage
and early parenthood—all these according to
me are real symptoms and reflections of an
unhealthy society, rather than unhealthy
youth. It is important that a proper social
diagnosis is done and an overhauling of the
society is initiated, so that we may have a
healthy generation of youth in mind, body,
and spirit—growing towards adulthood, in
whose hands the future of the nation will be
safe and secure.

The youth of a particular period of history
is the authentic reflection of the society of
that time. If our youth is not in a state of
total well being, it is because the society is
not well. Only a healthy society can give birth
and sustain a generation of healthy youth.
The health of the society ultimately depends
on healthy economic, social political, reli­
gious and cultural aspects of that society.
These factors are important, because they are
the determining forces of the total well being
of individuals families and communities.

If we dare to take a quick look at the
Indian society 'as a whole, can we objectively
say that the overall environment is condusive
to the emergence of a generation of healthy
youth? The prevailing object poverty of the
majority of our people, concentration of wealth
in the hands of a few, widespread unemploy­
ment, the existing low wages especially in the
rural areas, rampant corruption and dishonesty
prevailing in all spheres of life, sharp decline
of the human and sublime moral values in
personal and social life, the growth of the
capitalistic values and the cut-throat compe­
titions, unrealistic and mythifying role of the
media, etc., etc., are some of the glaring mala­
dies of the society we are living in. These
are reflected in the life of the youth in general
in the forms of frustration, drug and al­
18

Youth is our resource, that too, healthy
youth; none of us will dispute over it. As
we have seen above, the health of the youth
is conditioned by the health of the society.
A radical transformation of the society is in­
evitable, for our nation to become healthy.
Now the question I want to raise here is: can
we positively try to harness the enormous
potentialities of the youth in India to transform
the very society they belong to, which in turn
can ensure a healthy generation of youth in
the long run? I am highly optimistic about
this possibility, provided we win their con­
fidence, through sincere involvement and hum­
ble search, walking along with them side by
side.
It is hightime that we thought of ways
and means for positively channelising the
energy of the youth for creative purposes.
The unorganized sections of youth should be

Medical Service

organized at local and regional levels,and a
value based a warn ess building process should
be initiated among them through nonformal
education, functional literacy and continuing
education for the school dropouts. There
are hundreds of thousands of nominally
existing youth organizations especially in the
rural areas of our country, which should be
reactivated, through well thought out plans
for nation building. I am confident that if thiey
are properly motivated and adequately trained
they can make immense contribution towards
the national goals of 'Health for all by 2000
A.D.' 'eradication of illiteracy; and integrat­
ed rural development etc. Different opportu­
nities should be generously provided to them
for effective utilization of their youthful and
powerful resources, and thus inclucating in
them the feeling that they are important of
all, that we are hopeful of them.
To ensure their participation and collabo­
ration, our very outlook of the youth and their
problems need to be changed. We must start
looking at them as individuals with unique
personalities of their own and not merely as
'little adults' or 'overgrown children'. Any
amount of sympathy will only put them
down,but real empathy can build them up.
Efforts should be made along with them to
develop their own inherent resources to cope
with emerging needs of this particular age and
to develop their own potential to become crafts­
men of their own lives and life of the entire
nation. Special attention has to be directed

April 1985

towards vulnerable sections of youth, such as
those belonging to broken homes, victims of
physical, emotional and sexual assaults, mem­
bers of SC and ST groups, homeless, un­
employed, extremly poor etc., care should
also be taken for the chronically ill and physi­
cally disabled youth, so that they may not be
pushed out of the main stream of social life.

At this juncture, I would like to quote an
incident from the Life of Jesus Christ, as nar­
rated in the Holy Bible (Lk. 7 :11 -15) A young
man,* the only son of a widow died, and at
the time of the funeral procession, Jesus
Christ happened , to pass that way, learning
from the people assembled that this young
man was the only son of the widow, Jesus
Christ was moved with compassion, and rea­
ching out his hands to the coffin, he touched
the young man; and giving him new life,
enabled him to stand up, and then gave him
back to the widow, for whom this young man—
her son was the only resource in life.
The youth of today needs a life giving touch
from all those for whom the youth and the
entire human society is still a matter of con­
cern.

Yes the healthy youth is our best resource.
We can make our youth healthy, if we can
make our society healthy. And the youth is
our best resource to build a healthy, humane
and Just Society.

19

Towards A Low-Cost Rational Therapeutics
Reflections of an intern in a rural health centre
—Navin Machado

In this paper I attempt to elaborate on the
following 3 areas in the light of my experience
as an intern in a small rural health centre.
Firstly rational therapeutics in a rural setting.
Secondly, the genesis and propogation of
the tonic culture. Thirdly, the mystique of
injections.

Of the remaining one third the following
was the break up in decreasing order or impor­
tance—amebiasis, arthralgias and arthritis,
helminthiasis, other diarrhoeas, anemia, eye
and ear infections, malnutrition, gynaecologi­
cal disorders, vitamin deficiencies, dental dis­
orders, acid-peptic disease, malaria, leprosy
and other.

Background
My study encompassed 750 clinical cases,
over a period of two months. It was done in
Huskur, which is a village 22 kms from Banga­
lore, 6 km off the Bangalore — Hosur Road.
Huskur has a population of 1500, there are 15
villages in a radius of 5 kms. The centre
thus caters to a population of about 7500.

Rational therapeutics for Primary Health
Care

The drugs used in treatment were 27 in all,
yes 27 in all, against 60,000 drugs and chemi­
cals in our national formulary. These includ­
ed those used for symptomatic treatment:
aspirin, paracetamol, CPM, and antacid, an
antispasmodic, diazepham, cough mixture
There are two general practitioners in the
and turpentine linament. Antihelmintics, pipe­
village. One comes daily, the other bi-weekly.
razine citrate and Bephenium hydroxynaph­
There is a government PHC 5-6 kms away and
thoate vitamins and minerals. Vitamin A and B
a clinic run by religious sisters 6 kms away
complex, ferrous sulfate, chemotherapeutic
from the main road.
agents and antibiotics, (sulfaphenazole, peni­
and nitrofurazone
The people are predominently Telugu speak­ cillin, chloramphenical
ointments, chloroquine and metronidazole).
ing immigrant population. Most are small
Tropical preparations: iteol, gentian violet,
scale and marginal farmers.
benzyl benzoate. Others such as aminophyl­
line, local anaesthetic and oral rehydration
In my study, all diagnosis were clinical*
mixture.
Skin diseases constituted about 35% of cases
(of these, half come under the category of
The question that now arises is, how effec­
wounds and wound infection and about a
tive was the treatment—effective in medical
third had either impetigo or furuncles). The
remaining had ABCD deficiencies, scabies, terms. Only 5% of our patients were referred
fungal, and other skin diseases. About 30% to a hospital which means 95% of diseases
had respiratory diseases (of which URTI
were managed with less than one-two­
constituted half, asthma, about a quarter and
thousandth of the drugs and chemicals in our
the rest had lower respiratory tract infection
national formulary. Follow up was possible
and a few pulmonary TB).
in only about 1/3rd of cases, almost all of

April 1985

21

COMMUNITY HEAL TH C l_L
47/1, (First Floor) St. Marks Road,

Bangalore - 560 001.-

which showed a satisfactory response to
treatment. The incidence of side-effects were
few, minimal and far between, effec­
tive in economic terms. On an average it
cost the patient one rupee. I must mention
here that this included treatment for upto 5
days in many cases. Cost effectiveness was
maintained on the following basis.
(a)

Preventive aspects were stressed,

(b)

drugs were used along the following
principles, firstly, symptomatic treat­
ment alone was used, unless defini­
tive treatment was indicated by the
nature of the disease, after all "about
4 out of 5 illnesses are self-limiting"
(Helping health workers learn, David
Werner and Bill Bower) Secondly
definitive treatment was used as far
as possible as single drugs, in as few
doses as pharmacologically justified
and only when a definite diagnosis
was made.

Low cost, rational management
I shall illustrate, with a few examples. Air­
borne contact dermatitis :—a skin allergy to
Parthenium was treated as follows: avoidance
of the addergen, minimising the exposed area
of the body, application of any available oil
to the exposed area, keeping finger nails short
daily evening bath and change of clothes.
Only in more severe cases were antipruritics
or salicyclic acid, ointment give. Topical
steroids were reserved for more resistant cases
and a short course of systemic steriods only
for the most severe cases. The reluctance to
use drugs unnecessarily is obvious.

Upper respiratory tract infections : simi­
larly symptomatic treatment and simple mea­
sures such as steam inhalation and saltwater
gargles were advocated for all those -of viral
aetiology. A differentiation between those
22

of viral and bacterial aetiology is emminently
possible on clinical grounds. Sulfonamides
were used for those of a bacterial nature. And
compare the costs Rs. 3/- for a course, against
Rs. 30/- for a course of erythromycion, the
so called drug of choice. (The treatment equal­
ly effective, the cost 1 /1 Oth, the consequences
for reaching). Drugs relegated to history in
Western text books are used effectively in an
Indian setting. More expensive and often life­
saving antibiotics are used only when abso­
lutely indicated, such that the ever worrying
problem of drug resistance is kept in abeyance.

Lower respiratory tract infections : were
treated with injectable pencillin for 7 days,
when there were problems regarding comp­
liance, treatment was switched to oral pencil­
lin, 20 out of 21 cases were managed on
these lines. And compare the costs, for a
child of 4 years Rs. 15/- against Rs. 50/for a course of oral Ampicillin or Rs. 300/for a course of intervenous Ampicillin and,
gentamycin, admission to a hospital, a chest
X-ray and an intravenous line. And in a country
such as ours cost must be an important con­
sideration. The question that then arises, is,
would any more drugs be desired ? The
answer to which is, if we are to maintain the
same cost effectiveness, no more drugs are
called for, unless ofcourse, more drugs are
made available to the common man's pocket.
The implications of this study are obvious
and / am sure my discerning reader has per­
ceived the depth of the problem. It is only
when every mother accompanying a child,
that is brought to a sub centre, is given dietary
and immunisation advice irrespective of
nature of the illness; when diarrhoea is treat­
ed with dietary and ora! rehydration advice
alone, unless definitely indicated, when
anemia is treated with dietary advice and
ferrous sulphate tablets costing 1.4 paise/
day; when helminthiasis is diagnosed with
certainity on clinical grounds and treated
effectively within Rs. 2/-, then and only then

Medical Service

can the hope for 'Health for all by 2000 AD'
be realised.

Tonic Culture
’ This was a study of the people who came
to the subcentre asking for tonics. The victims
of this tonic culture, fell into 4 groups, (a)
firstly children under 3 years of age often of
mothers who had inadequate breast milk,
or stopped breast feeding early due to various
socio-economic considerations. The children
were then put on artificial feeds, which were
hopelessly inadequate, resulting inthe vicious
cycle of malnutrition and infection.
These mothers believed that tonics were
appetizers, when the loss of appetite was
invariably related to chronic under-nutrition
and infections; that tonics were meant to put
on weight (Mothers who didn't have money
to buy pulses, vegetables, eggs and milk had
money to buy tonics); that tonics were buil­
ders of immunity as the child had frequent
colds and diarrhoeas.

Secondly young girls in the latter half of
the second decade. Girls who had not attain­
ed menarch’e, probably as a normal variant,
girls who had white discharge often physio­
logical ; girls who had scanty periods, which
are the rule, rather than the exception in the
early years of womanhood.
Here mothers
believed that their daughters hady 'less blood*
and scanty periods and hence required a
tonic.

Thirdly newly—married men,
who had
problems coping' with the stresses of providing
for a family or disappointments in their sexual
lives.

Fourthly the elderly, especially women,
many of whom had degenerative diseases for
which the treatment is not always effective
and often time—consuming. The patient was
April 1985

told she had 'weakness', which was taken as
an indication for a tonic. The diagnosis ex­
cluded them from household work they were
no longer capable of and the bottle of 'tonic'
in the corner served as a passport to a more
sedentary life.

We all know that the only indication for
vitamins and minerals are specific deficiency
states. Tonics are not appetizers, body buil­
ders, builders of immunity, menstrua! regula­
tors, aphrodisiacs or cures for weakness.
If the myth of tonics has lived, we who
are involved in health, must be responsible
for both acts of commision by not discourag­
ing such beliefs and acts of commission by
prescribing it for all types of problems.

Mystique of Injections

The third area is the mystique of injections.
most people were nebulous about the diffe­
rence between the same drug been given
orally and parenterally but they considered
injections superior to oral preparations be­
cause of the following factors :—
A. factors for which doctors were res­
ponsible
(1)

Firstly when an illness was of a more
serious nature, irrespective of the
necessity, the need for an injection
was specified to make some quick
money.

(2)

Secondly even if the injection didn't
cost much, a much higher charge
was levied eg. in our sub-centre the
list of charges reads, any injections
Rs. 3/- though aminophylline costs
Rs. 1/- and Benzathine Pencillin
12 lakh units costs Rs. 4.50.
{Contd. on Page 32)

23

If the patient can not come to the Dispensary
the Dispensary should go to him
By community health we mean not only
the health needs of a community but also
other aspects which go to make up the general
well being of the community. The concept
of community health is based on the principle
that the health of person does not always
depend upon the condition of his physique
alone but also, to some extent, on his mental
and moral states which are again influenced by
his social and economic conditions. Therefore
our health programme are not exclusively
limited to looking after purely health needs
of the community but also to economic, cul­
tural and social needs of the community.
Socio Educational Centre has been working
on two sectors:
1. Youth Activities,
2. Mother and Child Health Programme.
Under the youth activities we have

—

Social Leadership Training Programme

— Vocational Training
—

Centre,

Poor Children's Educational Assistance.

Under Mother and Child Health Prog­
ramme we have

24

—

Health and Adult Education Programme

—

Clinic

—

Mobile clinic

—

Individual health care

—

Small savings scheme

—

Pre-matrimonial

—

Balawady for pre-school children

—

Functional literacy.

course

Our Purely health programme in the com­
munity are concerned with curative as well as
preventive health services to the community.
We have a dispensary in the Centre at Gundala. The people around have been making
use of its services ever since it was opened in
1975. The doctor and the nurses working in
the dispensary after attending to the medical
needs of the patients, take the opportunity to
give them health education on the prevention
of diseases. This dispensary is also in charge
of the Mother and Child Health Programmes.
It runs a mobile clinic also. Twice in a week
our doctor and nurses, visit one of the eight
villages adopted by the Centre for the present,
to attend to the health needs of the people.
They attend to the curative as well as preven­
tive health needs of the people. All the small
and the simple health needs of the people are
attended to while big and serious cases are
referred to the hospitals, both government
and private, with which the Socio Educational
Centre is in contact with. While and after
attending to the health needs of the people
the doctor and the nurses educate the people
on how to prevent all kinds of diseases for
"prevention is better than cure".
Under individual health care the Socio
Educational Centre takes care of lepers, T.B.
patients, people disabled by accidents and
chronic diseases and the aged. Besides sup­
plying and buying medicines for these people
we also supply food to all the deserving cases.
The community health rendered by Socio
Educational Centre are not only curative health
services confined to dispensary alone, but they
also form part of the other service activities
pursued by it. But in this case the Health
services are of preventive nature. This is
based on the service motto "that if the patient

Medical Service

can-not come to the dispensary the dispensary
should go to him" In the case of the rest of
activities under this section the preventive
side of health care is dealt with. The Social
worker-incharge of the Small Savings Scheme
on her routine visits to the beneficiaries imp­
resses upon them, as well as theirfriendsand
neighbours, how their small savings can help
them to meet their sudden health needs caus­
ed by any contingency or accident with out
going to the money lenders to borrow money.
They also take the opportunity to give them
health education on personal hygeine and
sanitation of their home and surroundings
to prevent the incidence of diseases so that
they could save the money which they will
have to spend when any member of the
family falls ill.

For the pre-marita! education to the youth
we have a mobile team visiting various vil­
lages in the diocese according to need. The
youth are taught the duties and the responsi­
bilities of the wife and husband towards each
other, the responsibility of parents towards
their children, family planning and the neces­
sity to keep home clean and tidy and free from
disease and want.
In the Balawady the children are taught
the need of putting on clean clothes and keep­
ing themselves clean. The teachers impress

April 1985

upon the parents the necessity of keeping their
children neat, clean and healthy, so that they
may be protected from all kinds of infantile
ailments.

Functional literacy is used in Adult Edu­
cation. As we work among women personal
hygeine and health sanitation of home and
surroundings, food and nutrition are the im­
portant subjects through which they are taught
the three Rs. In all the activities under the
first sector, the subject of community health
is given its due importance.
In the curriculam of both the leadership
training and the vocational training we con­
duct every year, the educators or the catalysts
are taught to teach the people the importance
of health and sanitation both personal and
public and how to apply and practise prin­
ciples of health and sanitation in their daily
life. The trainees in the vocational training
are taught the principles of personal hygiene,
health sanitation to be practised in their life
at home and elsewhere. In the activity of
poor children’s educational assistance, the
Socio Educational Centre, in addition to the
financial assistance also provides the children
with a free medical check up and free medi­
cines.
—Sr.

Damiana

Elamthuruthil

25

C.H.A.I. Annual Meet-1984
A Comment on the Exhibition

Now that’ CHAI conference 1984 is quite
far away, and all the noise has died down. I'd
like to make a critical comment or two on one
specific part of it, the exhibition. I lay great
faith in education, and hence I believe that the
exhibition was very important. I spent much
of my free time at the exhibition—discussing
and also observing.
The exhibition was a mixed Success.
There was a section on herbal medicine which
evoked a lot of interest and enthusiasm, even
among doctors. This must have given a boost
to the participants' opinion of the value of
Herbal medicines. Hopefully, the plan to pub­
lish the information on Herbal Medicine will
go through in English and in Malayalam if
possible.
Another section tried to analyse the SocioEconomic—Political factors underlying the
whole problem. This section was ignored, by
and large, because none really understood
what it was trying to say. One occasion
where a single picture is NOT worth a thou­
sand words!

The first section on Rational Drug Therapy,
was the most energetic. It created so much
of excitement! Much more than anyone
would have dreamed of. But also, there was
more heat than light—confusion prevailed.

The most intriguing poster was entitled
"Banned and Bannable Drugs". Everyone
wanted to know—what does "bannable"
mean ? Are these drugs banned ? If so, how
are they available in the market? Why are
they banned? What do we use in inflamma­
tion, if Analgin and Phenylbutazone are ban­
ned ?..-.. Too many questions, few or no
answers. They all went away with* guilty

April 1985

feelings, discussing this poster. They con­
tinued to discuss it a month after the confe­
rence—in a hospital in Andhra Pradesh, in
many hospitals in Kerala, wherever I went, I
was asked about the poster. But their phar­
macies already contained a few thousand
rupees worth of such drugs and their doctors
continued to use such drugs, so they said
that those Bangalore doctors were talking
nonsense. Guilt has to be rationalized!
Another poster sarcastically said "Ayur­
vedic Drugs" and showed Garlic Pearls and
what not. Many of the visitors decided that
garlic pearls etc were good. Humour is use­
ful, but not if it distracts understanding.

The language used was generally of an
unnecessarily high scale. Most of the parti­
cipants are Malayalis and Tamilians working
in Kerala or North India, and hardly speak
English. .(The exceptions were the minority
Bangaloreans and. Mangaloreans) Most ex­
hibitions fail due to complex vocabulary or
complex grammatical constructions.
The posters criticised; they did not offer
solutions. This created a "negative" at­
mosphere—I can't describe it better.

There was no one around to guide, discuss
or stimulate the visitors; hence the con­
fusion and anxiety created by the Drug Po­
licy section; hence the apathy towards the
S-E-P section. I tried to play this role,
whenever I had free time-but that was only
for short periods of time.
The solution is obvious from the problems.
The exhibition must be planned beforehand,
so that it will be systematic—presentation of
problems,discussion of etiology, suggested
solutions (or whatever). It must be aimed

27

their role in immuno-suppression, pregnancy
outcome, reduced productivity and even
school performance. These potentially impor­
tant issues should not be overlooked and
deserve further investigation.
The public
health significance of any relationship bet­
ween humans and their intestinal parasites
will not be assessed satisfactorily until thorough
longitudinal studies are carried out. Human
parasitology has left the zoological arena and
has become an interdisciplinary subject now
requiring contributions from anthropologists
clinicians, epidemiologists,
immunologists
and sociologists, among others. The same
may be said of nutritional science as it attempts
to unravel the complex causes of human
malnutrition. In our opinion the case for
longitudinal studies, conducted by interdiscip­
linary teams of scientists in communities where
malnutrition and intestinal parasitism prevail,
needs to be made to those agencies with the

financial capacity to support such research.
It is only when the results of such studies are
available that the actual rather than suspect­
ed impact of intestinal parasites will be identi­
fied and appreciated.

In the past, health planners, no doubt
through lack of information because of the
insidious nature of the parasitic disease, per­
haps tended to discount the public health
significance of parasites lie giardia, ascaris
and hookworms. However, on the basis of
current knowledge we would urge public
health planners wherever possible to review
priorities for public health measures that could
begin to relieve the burden of human intesti­
nal parasitic infection. Depending upon local
conditions, this approach may also bring some
relief from the ravages of malnutrition.
Courtesy: Herald of Health

(Contd. from Page 23)
B. factors which influenced a patient in
such a judgement :(1)

32

Firstly dramatic relief of symptoms
e.g. breathlessness in an acute
attack of asthma, of inflammation in
infection, of fever, of intractable vo­
miting. This has lead to the myth of
one—injection cures, even in con­
ditions such as bronchopnumonia.

(2)

Secondly cost, isn't it natural for
some one to assume that anything
that costs more should be better.

(3)

Thirdly the air of mystery for a pa­
tient related to the administration of

'

an injection. Here it must be point­
ed out that, for the patient, allopathy
differs from other traditional systems
of medicine only in this respect.

My plea is 3 fold, that injections are not
given unnecessarily to raise finances, that all
injections are not included under a higher
charge and that when there is a choice bet­
ween the route of administration of a drug
and the difference is only in the time taken
for the onset of action, this should be ex­
plained to the patients with the relative costs
and he/she be given the choice of the route
of administration of the drug.

Medical Service

News from the Diocese
Beginning with this issue we are starting
a new column in Medical Service "News from
the Diocese. This would give details of the
development in the Dioceses with regard to
the work initiated to promote the involvement
of CHAI. The relevance of this could be
viewed against the background of the attempts
being made to reorganize and revitalize CHAI
in each Diocese. The "Diocesan Co-ordina­
tors of CHAI", wherever appointed are re­
quested and welcomed to prepare a report of
the attempts made in this regard in their res­
pective Dioceses and send it to the office for
publication—Editor.

Diocese of Mysore
A meeting of the key personnel related with
health and development was convened on 7th
February, 1985. There were 22 participants.
Sr. Beatrice, Diocesan Co-ordinator of CHAI,
welcomed everybody. Tne meeting was all
about seeking collectively ways and means
[ to make the health care system of the Diocese
relevant and responsive to the needs of the
poor. The meeting got started with the
opening prayer and the inaugural address was
given by Rt. Rev. Dr. M. Fernandez, the Bishop
of Mysore. Quoting relevant passages from
the 'Cor unum' document he stressed the need
for Christian solidarity with the poor and the
need for health services of the church reaching
the real needs of the poor, and urged us to
strive for the development of the people in
all respects.
J- Following this, the Diocesan Social Ser­
vice Director Fr. Becket D'Souza spoke about
the importance of wholistic approach in our
healing ministry. He based his talk on the
gospel message of the paralytic man at the
pond of Bethsaida (John 6 : 1-9). Jesus

April 1985

took note of this uncared and helpless person,
reached out to him and healed him.

Some analysis on the existing health care
delivery system of the Diocese was also at­
tempted. Dr. Pius started with sharing some
of the draw backs in the health activities of
the Diocese and stressed the need for preven­
tive aspects. The participants reflected upon
the drawbacks in the system at three levels—
at the private practice level, at the institutional
level and at the level of government health
centres and hospitals.
Further they raised
these questions for their discussion—What
all diseases one comes across, what percen­
tage requires a doctor and medicines and what
percentage does not require, how much health
education is given, how much the people are
involved in health care and what could be
done in future.
To initiate action for the future, a three
member committee was set up for the CHAI
unit. The following resolutions were taken:

Improve the cooperation and coordination
among the institutions. CHAI members
should meet thrice a year, tentatively Feb­
ruary, June and November.
We will not use banned and expired drugs
and will not collect money for free ser­
vices.
We will not isolate patient from the family,
family from the community and community
from the society.
We will try to stick to wholistic approach.
With all these deliberations and resolutions,
the meeting came to a close by the evening
with a colourful dance which presented the
idea of leadership development to reform the
Indian Society.
—Sr. Beatrice.
33

SOLfil MOBILE RESOURCE CELL
(SMRC)
—a regional Training team —
The SMRC is one of the units of SOLA! (Trust). It is a mobile style
training team consists of our full time trainers and ten part time honorary
resource persons. It is available to support the training needs of the Rural
Development and community based Health programmes in the voluntary
sector.

Areas of Training
• SOCIAL LIFE ANIMATION
• COMMUNITY BASED HEALTH ACTION
* Building groups for collective action
* Health Education — Political prospective
* Organising Women for liberation
* Youth power planning and action
* Consumer education and action
* Environmental education and action
* Herbal medicine
♦ Development education (General course)
* Media for Development

I

‘

Priority groups for training (For sensitizing and skill development pro­
grammes.)
* People's organisations (youth groups. Women groups/village leaders)
♦ Action groups/small organisations
* Teacher Training Colleges/lnstitutes
* Seminarians (Preferably Deacons)
* Diocesan programmes for rural areas
* Traditional drama groups
* Writers
Areas of operation
Tamilnadu, Pondichery, Chittoor Dist. of Andhra Pradesh & KGF
(Karnataka)
Languages : Tamil/English'Telugu/Kannada.
Cost : A reasonable contribution to SOLAI (Trust) will be fixed on the
basis of the financial position of the inviting organisations and the
duration, nature and the number of participants of each course.

For further details please write:
The Chief Resource person
Solai Mobile Resource Cell
So lai (Trust) Christianpet
Katpadi-632 007. N.A.

i

“Surveillance of Essential Drugs”
Surveillance is a word that has been used
in the past to mean 'watching carefully over a
person having an infectious disease, to see
both predictable and unpredictable behaviour
of both, patient, and disease (and sometimes
the environment also). In recent times however.
Surveillance has been used to mean—" the
exercise of continuous scrutiny of, and watch fullness over the distribution arid spread of
infections and factors related thereto, for effec­
tive control". (Ref. I). It is not just passive
reporting of disease, but prompt investigat­
ing, confirming in the lab., detecting the source
of infection, route of transmission, identifying
both primary (index) and, secondary cases,
systematic collection of morbidity and mor­
tality data, consolidation and evaluation of
data, special field investigations and rapid
dissemination of information for control and
prevention. (Ref. 2, 3). Surveillance could
be an important component of Health Infor­
mation Systems and thus provide health agen­
cies with overall intelligence and disease
accounting capability. Thus, early warning
of unexpected occurrence of diseases and
changes in prevalence, and its potential effect
on the community could be suggested. (Ref.
I). Surveillance can be seen as an essential
aspect of rational design and evaluation of any
control programme. (Ref. I). It is now being
used in many other areas viz. Nutritional Sur­
veillance, Epidemiological Surv., Environ­
mental and Demographic Surv, etc.
Applying this concept of Surveillance to
Essential Drugs, we can see that it is very
basic to any rational drug policy we could
think of. By substituting the word "essen­
tial drug(s)" in place of "infectious disease",
the cohcept of disease surveillance becomes
"essential drugs surveillance."

April 1985

Components of an essential drug surveil­
lance system would include an essential drugs
committee, a quality control laboratory, field
officers, data collection and analysis wing,
an epidemiological wing, educational wing
and an evaluation and follow-up wing.
Essential drugs Committee should include
a physician, a Maternal and Child Health
specialist, a Pharmacologist, a Pharmacist,
Health Ministry representative, representatives
from Directorate General of Health Services
(DGHS), State Health Directorate and Dis­
trict Level (DHO, DMO, etc.), a few represen­
tatives of both Consumers and noted Drug
companies (i.e. manufacturers of essential
drugs), Field Officers (to be discussed below)
and a Legal adviser. The membership of this
Committee should be temporary and, exclud­
ing the representatives from the Govt, side,
all others could be on a three or five yearly
basis (or whichever interval is found to be
convenient, operationally). This Committee
should meet at suitable intervals and decide on
the list of essential drugs to be accepted,
and also what are the policies based on the
experiences of both the consumers and pro­
viders of drugs, especially in relation to side
effects, cost, availability, acceptability, sta­
bility during storage, etc.
Field Officers would be members of the
Committee who, in allotted areas, could ins­
pect hospitals, health centres and dispensa­
ries at stipulated intervals and report back to
the Committee. They could even conduct
surprise checks on prescription, dispensing,
drugs storage practices, etc.

Quality control laboratories could be set
up as regional essential drugs control contres.
These could be the present day drug control
35

Training Officers
QUALIFICATION
Post graduate in Rural Development and Diploma in Health Education or
Dip. in Sanitation.
or
Graduate in Nursing or statistics and Post graduate in Sociology or
Anthropology.
or
Post graduate in Economics or Social work and Diploma in Marxian
Thought.
or
Post graduate in Nutrition and Diploma in communication.

EXPERIENCE
* atleast 3 years grass root level experience in Rural Development/Community Health programmes.
♦ experience in conducting participatory training programmes at different
levels.
* Good knowledge in Tamil is essential/Knowledge in Telugu or Kannada
is preferable.
* ability and interest in conducting short training programmes on Social
Life ANIMATION in rural areas of Tamilnadu, Pondichery and in certain
pockets of Andhra and Karnataka.
Programme Asst. (Technical)
QUALIFICATION : Dip. in Arts/drama/communication.
EXPERIENCE
* Conducting training programmes for Animators.'Community organisers.
* Producing simple educational aids and experience in Popular theatre/
Journalism is preferable.

Office Secretary
QUALIFICATION : Type writing Higher in English and Tamil
♦ Experience in office administration
* Short hand in Tamil is preferable.

Pay commensurate with qualification and experience.
Apply with Bio-data on or before 30-4-85
Managing Trustee
So lai (Trust)
Christianpet, Katpadi-632007.

N.A.

labs, adequately integrated with both con­
sumers and private hospital representatives.
These labs, could be linked with international
labs, to achieve national and internatjonal
standards.
An epidemiological wing would be neces­
sary in any drug surveillance system to re­
cognise drug problems (overuse, misuse
and. emergence of toxicity among essential
drugs, etc.), to verify the problems (based on
past data), to confirm and study the ecology
of the problems, to collect, analyse and tabu­
late data in addition to conducting field trials
and of course to give recommendations to
the essential drugs committee.

The educational wing should inform the
consumers, pharmacists, medical practitio­
ners and institutions about the drug policies,
toxicities, banned drugs etc., and conduct
seminars, audiovisual presentations, quizzes,
competitions, and even bring out publications
such as bulletins or .journals.
Finally, the evaluation and followup wings
would conduct continuous and terminal eva­
luation of the drug surveillance system. This
could be in the form of questionnairs (KAP)
Knowledge Attitude Practices, or in terms
of specified time or population-bound ob­
jectives. Terminal evaluation could be at the
end of a specified period of time, when some
specific, objectives are achieved. Follow up
would consist of action taken, based on re­
commendations, (set by the epidemiological
wing in consultation with the essential drugs
committee), and findings of evaluation.
This essential drug surveillance system
discussed above could be implemented at any

April 1985

level right from national to voluntary (mission
hospital or health centre) level with suitable
modification. If time and money permits, help
from management sector could be utilized,
to scientifically implement this system at all
levels viz. through the use of Operations Re­
search etc.
In conclusion, all that has been written may
sound highly theoretical and complicated,
but in a matter as important as essential drugs,
no stone should be left unturned if we are to
deliver an efficient system to the people. Any
pitfalls of a system are likely to increase and
proliferate like a cancer, and spoil whatever
good that has been done, especially in count­
ries like India. So it is the duty of all of us to
see that everything that is earthly possible
(within the resources available) is done to
tackle this problem of drugs used in the health
sector.

References : (I) WHO 1968, Report of the
Technical Discussions at the 21st. World
Health Assembly On National and Global
Surveillance of Communicable Diseases;
(Unpublished document e A21/Tech. Discussion/5, WHO Geneva. (2) Benenson, A.S.
ed (1980). Control of Communicable Diseases
in man, 13th, edition, American Public Health
Association, New York. (3) Kerr L. White et a/
(1976) Epidemiology as a fundamental
science, Oxford University Press, New York.
An article by

Dr. PRATAP NAIDU, M.D. (P.S.M.)
C/o. Linn Health Centre,
Yellary, Tq. Yadgiri,
Di st. Gulbarga,
Karnataka - 585 321

37

CHAI

NOTES

NEWS
15 Months Training in Community Health and
Development Concluded

On completion of the 15 months training
in Community Health and Development orga­
nized by CHAI (CHD), 14 sisters of 'Mission
Sisters of Ajmer' were awarded with certi­
ficates at a function hosted in this connect­
ion on 20th of April, 1985. Bishop Ignatius
of Ajmer Diocese distributed the certificates
at the function presided over by Fr. John
Vattamattom SVD, the Executive Director
CHAI, and attended by the training team of
Community Health Department. Sister Yvone,
the mother general of the congregation, go­
verning body members and a good number
of the sisters were present at the function;
Appreciating the training programme,
Bishop expressed the hope that the trained
sisters would fulfill the charism of the congre­
gation better. This would be a magnificent
work for the Diocese and the country. Earlier,
while giving the welcome speech Mother

Yvone said that the trained sisters are taking
the congregation back to the original purpose
for which it was founded. In his presidential
address, Fr. John mentioned that through vil­
lage work they are giving the love of Christ
and thus themselves to the people. This
demands rededication and recommitment
Two of the trainees shared their experiences.
The training and village work instilled in them
newer insights and reinforced their commit­
ment to their own religious life. Fr. Thomas
Joseph, programme director of CHD of CHAI
expressed the team's appreciation over the
performance of the sisters both at the theoreti­
cal and practical levels. He appreciated the
congregation for the process of rediscovering
its real purpose through organizing the train­
ing programme and motivating sisters for vil­
lage work. Sr. Nicolette, one of the trainees
proposed the vote of thanks.

Employment

Mr. J.R. Livingston Rose
T.C. 14/1309
Observatory Lane
Palayam, Trivandrum 33
Kerala, is a General and Psychiatric Nurse.
institutions interest may contact directly.

38

Seeks suitable employment. Those

Medical Service

April 1985

Indian Hospital Association
C-11/72, Shahjahan Road, New Delhi -110011

SI. Name of the Institute
No.

Type of the Course

Duration

Remarks

1 All India Institute of Medical
Sciences, New Delhi - 110029

Masters in Hospital Admi­
nistration (M.H.A.)

2 years for medical
graduate and 3 years
for non medical gra­
duates.

Admission twice a year.

2 Y.M.C.A. Institute of Manage­ Diploma in Hospital Ad­ 1 Academic year
ment Studies New Delhi-110001 ministration (D.H.A.)
/
3 Faculty of Business Manage­ Master of Business Admi­ 3 years
ment Delhi University, Delhi - nistration (M.B.A.) in Health
Care Administration (H.C.A.)
110007

w
co

Open to medical graduates.

Open to medical graduates
only

4 Armed Forces Medical College
Pune, Pune University.

Diploma in Hospital Ad­
ministration (D.H.A.) and
Degree in Hospital Admi­
nistration (M.H.A.)

1 year for Diploma,
2 years, for Degree.

Open to medical graduates
of the Armed Forces.

5 Post Graduate Institute of Medi­
cal Education and Research,
Chandigarh.

Diploma in Hospital Admi­
nistration

1 year.

Open to medical and non­
medical graduates.

6 National Institute of Health and
Family Welfare, New Delhi,
Delhi University.

M.D. (Health Administration) 2 years

Open to medical graduates.

7 National Institute of Health and
Family Welfare, New Delhi

Short Course in
Administration.

2 weeks

Open to medical and non­
medical graduates

Hospital

A
o

8 Indian Hospital
Association,
C-ll/72, Shahjahan Road, New
Delhi - 110011

Short Course in Hospital
Administration.

2 weeks

Open to medical nursing
and non medical graduates

9 Institute of Medical Science, Sri
Nagar, Jammu and Kashmir.

Degree in Hospital/Health
Administration.

2 years

Open to medical graduates
(Likely to start)

10 C.M.C. Hospital, Velloore Tamil
Nadu.

Certificate Course in Hos­
pital Administration.

1 year

Open to non-medical gra­
duates only

11 National Institute of Health and
Family Welfare, New Delhi

Diploma Course in Hospi­
tal Administration.

1 year

Open to medical graduates
(likely to start)

12 Tata Institute of Social Sciences,
Sion-Trombay Road, Deonar,
Bombay - 400088 (Extra Mural
Studies)

Certificate Course in Hos­
pital Administration

1 year

Open to medical and non­
medical graduates

I year

Open to medical and non­
medical graduates

1 year

Open to non-medical gra­
duates.

13 Hospital Services Committee Diploma Course in Hospital
Bombay Management Associa­ Administration.
tion, Bombay.

14 Pune University Pune at Sancheti Hospital and Ruby Hall
Clinic-Pune.

Certificate Course in Hospi­
tal Administration.

Medical Service

Note : For details write to the respective Institutions.

Compiled by: Dr. P.N. Ghei
Secretary General
Indian Hospital Association
Media
MEDICAL SERVICE VOL. 42 No. 4 APRIL-1985.pdf

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