'Nayana' - a unique mobile Eye Care initiative for people with diabetes

'Nayana' - a unique mobile Eye Care initiative for people with diabetes

[To listen to the audio podcast of this article, or to download the MP3 audio file, click here]



Nayana (which means 'eye') - a diabetes retinopathy prevention and treatment van - is a venture funded by the World Diabetes Foundation (WDF) in Karnataka state and is indeed a great boon for the rural people living with diabetes retinopathy. Three year ago when the van was first introduced in this area retinopathy treatment was only been available at certain urban hospitals. This means traveling 200-300 Km to access such care, resulting in huge barrier for people who live in rural areas and semi-urban areas. However, now Karnataka has achieved impressive results after introducing a unique to bring the treatment out the patients.

Every month the van visits 23 locations across 13 districts catering to the needs of 18.31 million people. These locations consist Of 8 Eye Hospitals/Eye Departments Of larger hospitals, 3 Government hospitals and 11 other clinics.

"We have completed 375 field days. We see an average of 33-34 patients per location. This is the only van in India which is providing these kinds of facilities for the prevention and treatment of diabetes retinopathy,' said Dr. Shivaram, a senior ophthalmologist and coordinator of this mobile eye care van, based in Yalundar, Karnataka. He further said, 'After the introduction of this van, 80 per cent of the people living with diabetes in rural areas have started getting treatment of retinopathy.'

People living with diabetes in this area have made a Diabetes Forum. This forum organizes periodical meetings to address the problem of diabetes. Mr. Mahadev Appa, a patient of diabetes retinopathy and retired government employee, said, 'I had been suffering from diabetes for the last 20 years. However, I had no idea about diabetes retinopathy till 2 years back when this van came to my village, B.R. Hills. Then I got myself checked and was diagnosed with diabetes retinopathy. I immediately started taking treatment and today my retinopathy problem is gone." His 24 years old daughter Gayatri feels that her father has got a new lease of life.

The increasing number of diabetes mellitus cases pose major health care challenges in India. According to the WDF, diabetes is the leading cause of blindness worldwide. In India it is estimated that one in five people who have had diabetes for more than 10 years will develop diabetic retinopathy.

The main stages of diabetic retinopathy are:

(i) non-proliferative - background diabetic retinopathy, characterized by the development of occasional small blisters (microaneurysms) caused by enlarged capillaries and small haemorrhages on the surface of the retina. Moderately severe to very severe non-proliferative diabetic retinopathy is also known as pre-proliferative diabetic retinopathy.

(ii) proliferative - symptoms of which include: blurred or double vision; reduced vision; and dark or floating spots.

In the non-proliferative stages, abnormal blood vessel permeability results in the leakage of water, blood cells, proteins and fats into the surrounding retinal tissue. At this stage, diabetic retinopathy usually shows no symptoms unless accompanied by diabetic macular edema.

People progress from pre-proliferative to proliferative diabetic retinopathy when new blood vessels grow from, and across the retina in response to lack of oxygen delivered by the original vessels. This is called neovascularisation. However, these new vessels are very weak and are even more likely to break and bleed into the clear gel (the vitreous) that fills the back cavity of the eye, blocking vision. Scar tissues may also form near the retina, detaching it from the back of the eye and resulting in blindness.


Diabetic macular edema

This is a common complication associated with diabetic retinopathy. It corresponds to a swelling in the macula, one of the areas of the retina. When some of the small blood vessels in the retina are blocked, the surrounding ones dilate to compensate for this. The dilated vessels are generally leaky and fluid builds up in the macula, which in turn causes the macula to swell and cease to function. It is the most common cause of visual impairment in patients with non-proliferative retinopathy. Loss of vision can occur suddenly and treatment is not very successful.

Treatment

'There is no pharmaceutical therapy available at present that stops the progression of diabetic retinopathy. However, lasers are widely used in treating diabetic retinopathy.. Laser is an intense and highly energetic beam of light that emerges from a light source and is focused on the retina' said Dr. Shivaram.

Nayana is thus actually rekindling the light in many eyes, which would otherwise have become sightless.

Amit Dwivedi

(The author is a Special Correspondent, Citizen News Service (CNS). Email: amit@citizen-news.org, website: www.citizen-news.org)

Published in
Central Chronicle, Madhya Pradesh/ Chhattisgarh
Pakistan News, Islamabad, Pakistan
My News, Delhi
Ghana News, Accra, Ghana
Assam Times, Guwahati, Assam
News Track India, Delhi
Media for Freedom, Kathmandu, Nepal
Madhumeh (diabetes)
Citizen News Service (CNS) - India/ Thailand/ South Africa
Bihar Times, Patna, Bihar
Howrah News Service (HNS), West Bengal
Op-Ed News (OEN), UK
The Seoul Times, Seoul, South Korea
Truth Feeds
Kerala News, Thiruvananthapuram, Kerala
Mangalorean Times, Mangalore, Karnataka
Medical News, Australia
News Blaze, USA
Medical News India
Zimbio News/ Google News
Twitter news aggregator
Diabetes Care eGroup

'Nayana' - a unique mobile Eye Care initiative for people with diabetes

'Nayana' - a unique mobile Eye Care initiative for people with diabetes

[To listen to the audio podcast of this article, or to download the MP3 audio file, click here]



Nayana (which means 'eye') - a diabetes retinopathy prevention and treatment van - is a venture funded by the World Diabetes Foundation (WDF) in Karnataka state and is indeed a great boon for the rural people living with diabetes retinopathy. Three year ago when the van was first introduced in this area retinopathy treatment was only been available at certain urban hospitals. This means traveling 200-300 Km to access such care, resulting in huge barrier for people who live in rural areas and semi-urban areas. However, now Karnataka has achieved impressive results after introducing a unique to bring the treatment out the patients.

Every month the van visits 23 locations across 13 districts catering to the needs of 18.31 million people. These locations consist Of 8 Eye Hospitals/Eye Departments Of larger hospitals, 3 Government hospitals and 11 other clinics.

"We have completed 375 field days. We see an average of 33-34 patients per location. This is the only van in India which is providing these kinds of facilities for the prevention and treatment of diabetes retinopathy,' said Dr. Shivaram, a senior ophthalmologist and coordinator of this mobile eye care van, based in Yalundar, Karnataka. He further said, 'After the introduction of this van, 80 per cent of the people living with diabetes in rural areas have started getting treatment of retinopathy.'

People living with diabetes in this area have made a Diabetes Forum. This forum organizes periodical meetings to address the problem of diabetes. Mr. Mahadev Appa, a patient of diabetes retinopathy and retired government employee, said, 'I had been suffering from diabetes for the last 20 years. However, I had no idea about diabetes retinopathy till 2 years back when this van came to my village, B.R. Hills. Then I got myself checked and was diagnosed with diabetes retinopathy. I immediately started taking treatment and today my retinopathy problem is gone." His 24 years old daughter Gayatri feels that her father has got a new lease of life.

The increasing number of diabetes mellitus cases pose major health care challenges in India. According to the WDF, diabetes is the leading cause of blindness worldwide. In India it is estimated that one in five people who have had diabetes for more than 10 years will develop diabetic retinopathy.

The main stages of diabetic retinopathy are:

(i) non-proliferative - background diabetic retinopathy, characterized by the development of occasional small blisters (microaneurysms) caused by enlarged capillaries and small haemorrhages on the surface of the retina. Moderately severe to very severe non-proliferative diabetic retinopathy is also known as pre-proliferative diabetic retinopathy.

(ii) proliferative - symptoms of which include: blurred or double vision; reduced vision; and dark or floating spots.

In the non-proliferative stages, abnormal blood vessel permeability results in the leakage of water, blood cells, proteins and fats into the surrounding retinal tissue. At this stage, diabetic retinopathy usually shows no symptoms unless accompanied by diabetic macular edema.

People progress from pre-proliferative to proliferative diabetic retinopathy when new blood vessels grow from, and across the retina in response to lack of oxygen delivered by the original vessels. This is called neovascularisation. However, these new vessels are very weak and are even more likely to break and bleed into the clear gel (the vitreous) that fills the back cavity of the eye, blocking vision. Scar tissues may also form near the retina, detaching it from the back of the eye and resulting in blindness.


Diabetic macular edema

This is a common complication associated with diabetic retinopathy. It corresponds to a swelling in the macula, one of the areas of the retina. When some of the small blood vessels in the retina are blocked, the surrounding ones dilate to compensate for this. The dilated vessels are generally leaky and fluid builds up in the macula, which in turn causes the macula to swell and cease to function. It is the most common cause of visual impairment in patients with non-proliferative retinopathy. Loss of vision can occur suddenly and treatment is not very successful.

Treatment

'There is no pharmaceutical therapy available at present that stops the progression of diabetic retinopathy. However, lasers are widely used in treating diabetic retinopathy.. Laser is an intense and highly energetic beam of light that emerges from a light source and is focused on the retina' said Dr. Shivaram.

Nayana is thus actually rekindling the light in many eyes, which would otherwise have become sightless.

Amit Dwivedi

(The author is a Special Correspondent, Citizen News Service (CNS). Email: amit@citizen-news.org, website: www.citizen-news.org)

Published in
Central Chronicle, Madhya Pradesh/ Chhattisgarh
Pakistan News, Islamabad, Pakistan
My News, Delhi
Ghana News, Accra, Ghana
Assam Times, Guwahati, Assam
News Track India, Delhi
Media for Freedom, Kathmandu, Nepal
Madhumeh (diabetes)
Citizen News Service (CNS) - India/ Thailand/ South Africa
Bihar Times, Patna, Bihar
Howrah News Service (HNS), West Bengal
Op-Ed News (OEN), UK
The Seoul Times, Seoul, South Korea
Truth Feeds
Kerala News, Thiruvananthapuram, Kerala
Mangalorean Times, Mangalore, Karnataka
Medical News, Australia
News Blaze, USA
Medical News India
Zimbio News/ Google News
Twitter news aggregator
Diabetes Care eGroup

'Diabetes doctor is at your doorstep' in Chunampet villages

'Diabetes doctor is at your doorstep' in Chunampet villages



The phrase 'the doctor at your doorstep' sounds incredible! But it is true. This is what the ‘MDRF-WDF Chunampet Rural Diabetes Prevention Project’ is about.



Recent studies have proved that diabetes has reached a pandemic stage, not only in urban India , but its prevalence rate in rural areas is also increasing rapidly. As of now, an estimated number of more than 20 million people with diabetes live in rural areas. According to Dr Viswanathan Mohan, a renowned diabetologist, ‘the incidence of diabetes in rural Kerala is more than in its urban areas. This could be due to eating of more rice (which is a staple food of south India), changing life styles leading to a more sedentary existence, and the genetic Indian disposition towards diabetes.’



Yet, virtually all diabetes efforts in India are currently focused in the cities.



With this in view, the above project was launched in March 2006 by the Madras Diabetes Research Foundation (MDRF), with the support of World Diabetes Foundation (WDF), Denmark. The project, which is of 4 years duration, led by Dr S.Ravikumar and his team, is being conducted in cluster villages at Chunampet, which is about 100km from Chennai.



In the words of Dr Mohan, one of the principal investigators of the project and President of MDRF, "This project aims to implement the four A test i.e. make diabetes health care available, accessible, affordable and acceptable in rural areas. It aims at addressing prevention of diabetes at all the three levels - primary, secondary and tertiary."





The highlight of the project is the use of a fully equipped Tele-medicine Van as a novel tool to make diabetes health care, including treatment of its complications, accessible to the rural population. With its help, 23449 people (above 20 years of age) from 42 villages have been screened for diabetes and its related complications, especially eye and foot complications. Thus 87.7% of the total population of these villages has been screened within a period of one and a half years. Just for the sake of figures, 970 people had known diabetes and 1114 persons were diagnosed for the first time. 1061 retinal examinations have been done in the telemedicine van. Those identified to have sight threatening diabetic retinopathy are treated free of cost at the main centre. Medicines are not provided free, except in very special cases of type 1 diabetes. But tests and specialized treatments are free. Thus effective strategies in community based diabetic screening programmes in a rural setting have been evolved by involving ophthalmologists of urban areas via telemedicine.



This seems to be a unique example of private public partnership, with the doctors ‘reaching out to the unreached’, and following a structured care recall programme by going back to the people frequently for follow up action.



Of course, the WDF did fund and initiate the project at the behest of MDRF. But then Mr. C. Ramakrishna donated his land, the National Agro Foundation lent its support, the Indian Space Research Institute provided the satellite communication for the telemedicine van, and Dr S. Ravikumar, project director, along with his dedicated team are managing the work with exemplary zeal. Apart from taking state of art medical care virtually to the people’s doorsteps, they regularly organize public awareness camps and nutrition workshops. I saw one such workshop where a cookery session of simple and healthy recipes was in progress and another one where the importance of diabetes care was being spread through a puppet show.



All these efforts have resulted in a perceptible reduction of glycated haemoglobin (HbA1c) by nearly 2%, which can lead to a risk reduction of 76% in retinopathy and 34% in albuminuria in persons living with diabetes. This would obviously lead to tremendous economic savings.



Apart from this, the project has empowered the local people, especially women and youth to become educators and catalytic spokespersons, spreading the message of better eating habits and healthier living. Surely it can be replicated in other parts of the country.



Shobha Shukla



The author teaches Physics at India's Loreto Convent and has been writing extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).



Published in

Ghana News, Accra, Ghana

Asian Tribune, Thailand/ Sri Lanka

News Blaze, USA

My News, Delhi

Madhumeh (diabetes)

Citizen News Service (CNS) - India/ Thailand/ South Africa

Chennai - click india.com, Tamil Nadu

Google News, India

Health-e News, India

Media for Freedom, Kathmandu, Nepal

News Track India, Delhi

Bihar Times, Patna, Bihar

Mangalorean Times, Mangalore, Karnataka

The Seoul Times, Seoul, South Korea

Op-Ed News (OEN), UK

Truth Feeds

Howrah News Service (HNS), West Bengal

Pakistan Post, Karachi, Pakistan

'Diabetes doctor is at your doorstep' in Chunampet villages

'Diabetes doctor is at your doorstep' in Chunampet villages



The phrase 'the doctor at your doorstep' sounds incredible! But it is true. This is what the ‘MDRF-WDF Chunampet Rural Diabetes Prevention Project’ is about.



Recent studies have proved that diabetes has reached a pandemic stage, not only in urban India , but its prevalence rate in rural areas is also increasing rapidly. As of now, an estimated number of more than 20 million people with diabetes live in rural areas. According to Dr Viswanathan Mohan, a renowned diabetologist, ‘the incidence of diabetes in rural Kerala is more than in its urban areas. This could be due to eating of more rice (which is a staple food of south India), changing life styles leading to a more sedentary existence, and the genetic Indian disposition towards diabetes.’



Yet, virtually all diabetes efforts in India are currently focused in the cities.



With this in view, the above project was launched in March 2006 by the Madras Diabetes Research Foundation (MDRF), with the support of World Diabetes Foundation (WDF), Denmark. The project, which is of 4 years duration, led by Dr S.Ravikumar and his team, is being conducted in cluster villages at Chunampet, which is about 100km from Chennai.



In the words of Dr Mohan, one of the principal investigators of the project and President of MDRF, "This project aims to implement the four A test i.e. make diabetes health care available, accessible, affordable and acceptable in rural areas. It aims at addressing prevention of diabetes at all the three levels - primary, secondary and tertiary."





The highlight of the project is the use of a fully equipped Tele-medicine Van as a novel tool to make diabetes health care, including treatment of its complications, accessible to the rural population. With its help, 23449 people (above 20 years of age) from 42 villages have been screened for diabetes and its related complications, especially eye and foot complications. Thus 87.7% of the total population of these villages has been screened within a period of one and a half years. Just for the sake of figures, 970 people had known diabetes and 1114 persons were diagnosed for the first time. 1061 retinal examinations have been done in the telemedicine van. Those identified to have sight threatening diabetic retinopathy are treated free of cost at the main centre. Medicines are not provided free, except in very special cases of type 1 diabetes. But tests and specialized treatments are free. Thus effective strategies in community based diabetic screening programmes in a rural setting have been evolved by involving ophthalmologists of urban areas via telemedicine.



This seems to be a unique example of private public partnership, with the doctors ‘reaching out to the unreached’, and following a structured care recall programme by going back to the people frequently for follow up action.



Of course, the WDF did fund and initiate the project at the behest of MDRF. But then Mr. C. Ramakrishna donated his land, the National Agro Foundation lent its support, the Indian Space Research Institute provided the satellite communication for the telemedicine van, and Dr S. Ravikumar, project director, along with his dedicated team are managing the work with exemplary zeal. Apart from taking state of art medical care virtually to the people’s doorsteps, they regularly organize public awareness camps and nutrition workshops. I saw one such workshop where a cookery session of simple and healthy recipes was in progress and another one where the importance of diabetes care was being spread through a puppet show.



All these efforts have resulted in a perceptible reduction of glycated haemoglobin (HbA1c) by nearly 2%, which can lead to a risk reduction of 76% in retinopathy and 34% in albuminuria in persons living with diabetes. This would obviously lead to tremendous economic savings.



Apart from this, the project has empowered the local people, especially women and youth to become educators and catalytic spokespersons, spreading the message of better eating habits and healthier living. Surely it can be replicated in other parts of the country.



Shobha Shukla



The author teaches Physics at India's Loreto Convent and has been writing extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).



Published in

Ghana News, Accra, Ghana

Asian Tribune, Thailand/ Sri Lanka

News Blaze, USA

My News, Delhi

Madhumeh (diabetes)

Citizen News Service (CNS) - India/ Thailand/ South Africa

Chennai - click india.com, Tamil Nadu

Google News, India

Health-e News, India

Media for Freedom, Kathmandu, Nepal

News Track India, Delhi

Bihar Times, Patna, Bihar

Mangalorean Times, Mangalore, Karnataka

The Seoul Times, Seoul, South Korea

Op-Ed News (OEN), UK

Truth Feeds

Howrah News Service (HNS), West Bengal

Pakistan Post, Karachi, Pakistan

WDF transforming health policy through DIPAP

WDF transforming health policy through DIPAP

Diabetes in Pregnancy—Awareness and Prevention (DIPAP) - a success story of World Diabetes Foundation (WDF)


Prevalence of diabetes is increasing globally and this includes pregnant women with gestational diabetes mellitus (GDM).

GDM is defined as a transient abnormality of carbohydrate/ glucose intolerance of variable intensity - a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy. Women with this condition are at an increased risk of diabetes in future, as are their children and the following subsequent generations.

Thus an important public health priority in the prevention of diabetes is to address maternal health during ante and post partum period. Primary prevention will most likely reverse or halt the trend of increasing diabetes cases. Keeping this in mind, the World Diabetes Foundation (WDF) has been funding the project Diabetes in Pregnancy - Awareness and Prevention (DIPAP), run by diabetologists at Dr V Seshiah’s Diabetes Care and Research Institute at Chennai, working with the Tamil Nadu government in India.

There is no current national data regarding GDM. But on the basis of a community based study carried out in the Government Maternity Hospital , Chennai, it was found that the prevalence of GDM in urban, semi urban and rural areas was 17.8%, 13.8% and 9.9% respectively. Greater incidence in urban areas could be attributed to a more mechanized and sedentary life style coupled with increased maternal age.

The morning of 27th November 2008 was bleak indeed, what with the terrorists indulging in inhuman and senseless killings in Mumbai and cyclone Nisha playing havoc with normal life in Chennai. But somehow we managed to reach the government hospital of Chennai Municipal Corporation at Saidapet. This is one of the several hospitals where the DIPAP project has been running successfully since 2004.


It really lifted my low spirits to see about 20 women who had braved the inclement weather to be there for screening/ follow up action for GDM. The two lab technicians, Vimala and Radhi, appointed by the project managers, were busy taking the blood samples for glucose monitoring.

Uma Bhaskar, a 29 year old mother of two kids was all praises for the project team. She was a high risk patient due to her obesity and was diagnosed with GDM during her first pregnancy, 4 years ago in a private clinic. But did not follow it up, till she came to this hospital two years ago during her 2nd pregnancy. She had to be administered insulin during pregnancy and is still on oral medication, along with diet control. She comes for regular checkups and feels that likes of her have benefited immensely from this programme.

21 year old Gayatri, mother of a one year old daughter, travels 21 km. to reach this hospital. She was referred to this hospital for an ultra sound scan and diagnosed with GDM during routine screening. However, she was able to control her condition through diet control and regular walking, and did not require medication. She remarked with a grin that now she was eating less sweets and felt better equipped to manage her condition, thanks to DIPAP.

Dr Madhuri Balaji, who is closely associated with this project, spoke of the main problems faced during implementation of the project:

(i) lack of awareness in pregnant women about GDM;

(ii) failure of the women to follow up with subsequent check ups (the first checkup should be done around 12 weeks of gestation, with follow up screenings during 24th and 30th weeks). This may happen due to relocation of the woman to her mother’s house for delivering her first child, as is customary. Or, if it is her second pregnancy, then she cannot afford the long wait at the hospital with a small child in tow;

(iii) diet and other controls may not be followed once the pregnancy period is over. The woman has other things to care about now and her well being comes last in the family.

The medical officer in charge of this hospital Dr Shanthi Viveka, was all praises was this laudable effort of WDF, as were the other nursing staff. They felt that the project has benefited everyone. But they were a little wary as to what would happen once WDF disassociated itself with the project. She cited shortage of hospital staff as well as poor infrastructure, as possible impediments in continuing with the mandatory screening of pregnant women all over the state.

WDF has thus successfully implemented a system which screens and controls gestational diabetes. It has been able to initiate a change in health policies in the region to the extent that it has now become mandatory to screen all pregnant women for GDM in Tamilnadu. But it remains to be seen how well the government will implement it through its own resources all over the state. Also,this example is worth emulating in other parts of the country too.

Shobha Shukla

The author teaches Physics at India's Loreto Convent and has been writing extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).

Published in
Scoop Independent News, New Zealand
Asian Tribune, Sri Lanka/ Thailand
News Blaze, USA
Medication Wire
News Track India, Delhi
Media for Freedom, Kathmandu, Nepal
Citizen News Service (CNS), UP, India/ Thailand/ South Africa
Feed Xirincs
Twitter
Bihar Times, Patna, Bihar
Madhumeh (Diabetes)
Medical News, Australia
Howrah News Service (HNS), West Bengal
Northern News Lines, Chandigarh
My News, Delhi
Pregnancy and Childbirth, NBC Chicago

WDF transforming health policy through DIPAP

WDF transforming health policy through DIPAP

Diabetes in Pregnancy—Awareness and Prevention (DIPAP) - a success story of World Diabetes Foundation (WDF)


Prevalence of diabetes is increasing globally and this includes pregnant women with gestational diabetes mellitus (GDM).

GDM is defined as a transient abnormality of carbohydrate/ glucose intolerance of variable intensity - a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy. Women with this condition are at an increased risk of diabetes in future, as are their children and the following subsequent generations.

Thus an important public health priority in the prevention of diabetes is to address maternal health during ante and post partum period. Primary prevention will most likely reverse or halt the trend of increasing diabetes cases. Keeping this in mind, the World Diabetes Foundation (WDF) has been funding the project Diabetes in Pregnancy - Awareness and Prevention (DIPAP), run by diabetologists at Dr V Seshiah’s Diabetes Care and Research Institute at Chennai, working with the Tamil Nadu government in India.

There is no current national data regarding GDM. But on the basis of a community based study carried out in the Government Maternity Hospital , Chennai, it was found that the prevalence of GDM in urban, semi urban and rural areas was 17.8%, 13.8% and 9.9% respectively. Greater incidence in urban areas could be attributed to a more mechanized and sedentary life style coupled with increased maternal age.

The morning of 27th November 2008 was bleak indeed, what with the terrorists indulging in inhuman and senseless killings in Mumbai and cyclone Nisha playing havoc with normal life in Chennai. But somehow we managed to reach the government hospital of Chennai Municipal Corporation at Saidapet. This is one of the several hospitals where the DIPAP project has been running successfully since 2004.


It really lifted my low spirits to see about 20 women who had braved the inclement weather to be there for screening/ follow up action for GDM. The two lab technicians, Vimala and Radhi, appointed by the project managers, were busy taking the blood samples for glucose monitoring.

Uma Bhaskar, a 29 year old mother of two kids was all praises for the project team. She was a high risk patient due to her obesity and was diagnosed with GDM during her first pregnancy, 4 years ago in a private clinic. But did not follow it up, till she came to this hospital two years ago during her 2nd pregnancy. She had to be administered insulin during pregnancy and is still on oral medication, along with diet control. She comes for regular checkups and feels that likes of her have benefited immensely from this programme.

21 year old Gayatri, mother of a one year old daughter, travels 21 km. to reach this hospital. She was referred to this hospital for an ultra sound scan and diagnosed with GDM during routine screening. However, she was able to control her condition through diet control and regular walking, and did not require medication. She remarked with a grin that now she was eating less sweets and felt better equipped to manage her condition, thanks to DIPAP.

Dr Madhuri Balaji, who is closely associated with this project, spoke of the main problems faced during implementation of the project:

(i) lack of awareness in pregnant women about GDM;

(ii) failure of the women to follow up with subsequent check ups (the first checkup should be done around 12 weeks of gestation, with follow up screenings during 24th and 30th weeks). This may happen due to relocation of the woman to her mother’s house for delivering her first child, as is customary. Or, if it is her second pregnancy, then she cannot afford the long wait at the hospital with a small child in tow;

(iii) diet and other controls may not be followed once the pregnancy period is over. The woman has other things to care about now and her well being comes last in the family.

The medical officer in charge of this hospital Dr Shanthi Viveka, was all praises was this laudable effort of WDF, as were the other nursing staff. They felt that the project has benefited everyone. But they were a little wary as to what would happen once WDF disassociated itself with the project. She cited shortage of hospital staff as well as poor infrastructure, as possible impediments in continuing with the mandatory screening of pregnant women all over the state.

WDF has thus successfully implemented a system which screens and controls gestational diabetes. It has been able to initiate a change in health policies in the region to the extent that it has now become mandatory to screen all pregnant women for GDM in Tamilnadu. But it remains to be seen how well the government will implement it through its own resources all over the state. Also,this example is worth emulating in other parts of the country too.

Shobha Shukla

The author teaches Physics at India's Loreto Convent and has been writing extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).

Published in
Scoop Independent News, New Zealand
Asian Tribune, Sri Lanka/ Thailand
News Blaze, USA
Medication Wire
News Track India, Delhi
Media for Freedom, Kathmandu, Nepal
Citizen News Service (CNS), UP, India/ Thailand/ South Africa
Feed Xirincs
Twitter
Bihar Times, Patna, Bihar
Madhumeh (Diabetes)
Medical News, Australia
Howrah News Service (HNS), West Bengal
Northern News Lines, Chandigarh
My News, Delhi
Pregnancy and Childbirth, NBC Chicago

Activists decry India's deferment of pictorial health warnings on tobacco products

Activists decry India's deferment of pictorial health warnings on tobacco products

Civil society in India has strongly condemned the recent decision of the Group of Ministers (GOM) in India to defer the implementation of pictorial health warnings on tobacco product packages which was to come in to effect from November 30, 2008. The pictorial warnings have been deferred, again, till at least end of May 2009.

This decision of GOM is very unfortunate and has appalled the public health community across the country, said members of Advocacy Forum for Tobacco Control (AFTC). By repeatedly postponing the implementation of pack warnings on tobacco packages, the government is failing from performing its important duty to provide essential information to make Indian consumers aware of the effects of tobacco, particularly to the vulnerable poor and the illiterate, further said AFTC members.

“The decision to defer and unduly delay the mandatory placement of pictorial health warnings on tobacco products is a cynical abdication of governmental responsibility to protect people’s health by providing them much required information on the deadly effects of tobacco consumption” said Dr K Srinath Reddy, President, Public Health Foundation of India.

“The government should set up strong and transparent mechanisms at the highest levels to prevent industry interference in the implementation of tobacco control measures and policy making processes. Since the tobacco industry sells a product that kills one million people in India annually, therefore, industry’s interests will always be in conflict with the nation’s public health and economic aspirations” remarked Bhavna B Mukhopadhyay, Senior Director, Voluntary Health Association of India (VHAI).

Article 11 of the Framework Convention on Tobacco Control (FCTC) imposes a time bound obligation on each of its signatory parties, of which India is also a part, to implement pictorial health warnings on tobacco product packages within 3 years of its coming into force. The deadline for India to implement pictorial health warning was 27 February 2008. It’s a national shame that India, once considered a global leader in tobacco control has repeatedly failed to enforce this provision of pictorial health warnings. Countries across the world (who are party to FCTC) have unanimously adopted international standards for implementing the international tobacco control treaty that mandates health warning labels that cover 50 percent or more, and no less than 30 percent, of tobacco packaging and feature effective pictures of health conditions caused by tobacco.

“The news of postponement of implementation of pictorial warnings was most unfortunate. Especially because it came within a day of unanimous adaptation of guidelines for article 11 of FCTC dealing with the packaging and labeling of tobacco products by the Conference of Parties of 160 governments meeting in Durban, South Africa on November 22, 2008. The Government of India was present in that meeting and the decision was applauded by the entire global community” noted Luther Terry Awardee Dr PC Gupta, Director, Healis Sekhsaria Institute for Public Health.

The decision to defer the implementation of already diluted, delayed and long overdue pictorial health warnings on tobacco packages is nothing but retraction of India’s commitment to FCTC. By deferring the implementation of graphic warnings, the international position of India will be pushed much below from the 34th position that was accorded to India in the recent international status report adopted by Canadian Cancer Society to a much lower ranking.

"It is high time that national tobacco control policies in India are congruent to what India is obligated to do by ratifying the international global tobacco treaty - Framework Convention on Tobacco Control. Last week in the global meeting, India adopted the strong guidelines for Article 5.3, to protect health policies from tobacco industry interference” remarked Bobby Ramakant, from the Indian Society Against Smoking, Asha Parivar, who also represents Network for Accountability of Tobacco Transnationals (NATT).

Civil society organizations strongly urges to the Indian government to implement the graphic warnings without further delay. The government must act now to protect Indian citizens, especially the vulnerable children and illiterates from serious health hazards caused due to tobacco consumption.

Shobha Shukla

The author teaches Physics at India's Loreto Convent and has been writing extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).

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Activists decry India's deferment of pictorial health warnings on tobacco products

Activists decry India's deferment of pictorial health warnings on tobacco products

Civil society in India has strongly condemned the recent decision of the Group of Ministers (GOM) in India to defer the implementation of pictorial health warnings on tobacco product packages which was to come in to effect from November 30, 2008. The pictorial warnings have been deferred, again, till at least end of May 2009.

This decision of GOM is very unfortunate and has appalled the public health community across the country, said members of Advocacy Forum for Tobacco Control (AFTC). By repeatedly postponing the implementation of pack warnings on tobacco packages, the government is failing from performing its important duty to provide essential information to make Indian consumers aware of the effects of tobacco, particularly to the vulnerable poor and the illiterate, further said AFTC members.

“The decision to defer and unduly delay the mandatory placement of pictorial health warnings on tobacco products is a cynical abdication of governmental responsibility to protect people’s health by providing them much required information on the deadly effects of tobacco consumption” said Dr K Srinath Reddy, President, Public Health Foundation of India.

“The government should set up strong and transparent mechanisms at the highest levels to prevent industry interference in the implementation of tobacco control measures and policy making processes. Since the tobacco industry sells a product that kills one million people in India annually, therefore, industry’s interests will always be in conflict with the nation’s public health and economic aspirations” remarked Bhavna B Mukhopadhyay, Senior Director, Voluntary Health Association of India (VHAI).

Article 11 of the Framework Convention on Tobacco Control (FCTC) imposes a time bound obligation on each of its signatory parties, of which India is also a part, to implement pictorial health warnings on tobacco product packages within 3 years of its coming into force. The deadline for India to implement pictorial health warning was 27 February 2008. It’s a national shame that India, once considered a global leader in tobacco control has repeatedly failed to enforce this provision of pictorial health warnings. Countries across the world (who are party to FCTC) have unanimously adopted international standards for implementing the international tobacco control treaty that mandates health warning labels that cover 50 percent or more, and no less than 30 percent, of tobacco packaging and feature effective pictures of health conditions caused by tobacco.

“The news of postponement of implementation of pictorial warnings was most unfortunate. Especially because it came within a day of unanimous adaptation of guidelines for article 11 of FCTC dealing with the packaging and labeling of tobacco products by the Conference of Parties of 160 governments meeting in Durban, South Africa on November 22, 2008. The Government of India was present in that meeting and the decision was applauded by the entire global community” noted Luther Terry Awardee Dr PC Gupta, Director, Healis Sekhsaria Institute for Public Health.

The decision to defer the implementation of already diluted, delayed and long overdue pictorial health warnings on tobacco packages is nothing but retraction of India’s commitment to FCTC. By deferring the implementation of graphic warnings, the international position of India will be pushed much below from the 34th position that was accorded to India in the recent international status report adopted by Canadian Cancer Society to a much lower ranking.

"It is high time that national tobacco control policies in India are congruent to what India is obligated to do by ratifying the international global tobacco treaty - Framework Convention on Tobacco Control. Last week in the global meeting, India adopted the strong guidelines for Article 5.3, to protect health policies from tobacco industry interference” remarked Bobby Ramakant, from the Indian Society Against Smoking, Asha Parivar, who also represents Network for Accountability of Tobacco Transnationals (NATT).

Civil society organizations strongly urges to the Indian government to implement the graphic warnings without further delay. The government must act now to protect Indian citizens, especially the vulnerable children and illiterates from serious health hazards caused due to tobacco consumption.

Shobha Shukla

The author teaches Physics at India's Loreto Convent and has been writing extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).

Published in
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Ghana News, Accra, Ghana
Asian Tribune, Sri Lanka/ Thailand
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Citizen News Service (CNS), UP, India/ Thailand/ South Africa
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Another blow to enforcement of tobacco control policies in India

Another blow to enforcement of tobacco control policies in India

Pictorial warnings on tobacco products postponed 7th time

Right after the strong and effective guidelines to stop tobacco industry interference in health policies were adopted by the government representatives of 160 countries including India, the pictorial warnings on all tobacco products that were supposed to become mandatory from 30 November 2008 in India, were, again delayed – reportedly due to hectic lobbying by the industry allies and other entities like the beedi growers’ association.

Pictorial warnings on tobacco products have been delayed, at least, seven times. Before going to the 3rd Conference of Parties (COP3) to the global tobacco treaty (Framework Convention on Tobacco Control), the Indian Ministry of Health and Family Welfare had revealed before the Central Information Commission that tobacco industry is putting "pressure" to relax the tobacco control policies (source: The Hindu, 14 November 2008).

The Article 5.3 of the global tobacco treaty, if defined broadly, recognizes “the tobacco industry's fundamental and irreconcilable conflict with public health.”

The tobacco industry interference has times and again weakened and delayed the enforcement of the public health policies - for example, more than 70 court cases were filed against tobacco control policies in Indian courts in September 2008, and due to aggressive lobbying, the consultative Group of Ministers (GoM) formed to review the pictorial warnings on tobacco products, had diluted the pictorial warnings provision and postponed the implementation of pictorial warnings on tobacco products at least six-times earlier. This is the seventh time the pictorial warnings on tobacco products have been again postponed, as reliable sources revealed, to the end of May 2009.

The industry interference in public health policies certainly needs urgent attention to save lives otherwise it will continue to threaten to reverse the great advancements made in forging public health policies and implementing them. Meantime tobacco continues to kill more than a million people in India, and 5.4 million globally, every year.

Also when these pictorial warnings were finally approved by a GoM, why did the GoM met again in an emergency meeting a week before the pictorial warnings provision was about to become mandatory? GoM including the Union External Affairs Minister - Pranab Mukherjee, the Union Information and Broadcasting Minister - PR Dasmunsi, the Minister of State for Labour and Employment - Oscar Fernandes the Union Minister for Commerce and Industry -Kamal Nath, Union Minister for Culture and Urban Development -Jaipal Reddy and Union Health and Family Welfare Minister Anbumani Ramadoss,

The GOM in an earlier meeting this year headed by India's External Affairs Minister Mr Pranab Mukherjee had agreed for two mild images of a scorpion signal depicting cancer or an x-ray plate of a man suffering from lung cancer as pictorial warning to deter people from smoking.

These pictorial warnings provide smokers with helpful information on the health effects. Most smokers want this information, and certainly want their children to have this information too. The tobacco industry is continuing its decades-long strategy of trying to minimize the effectiveness of package warnings. The tobacco industry is no friend of smokers - and ironically it's true that 'the tobacco industry kills its best customers'.

Pictorial warnings on all tobacco products are a good public health strategy because the cost of package warnings is paid for by tobacco companies, not government. Also this should not be looked upon as an isolated initiative rather has to be supported by comprehensive healthcare, legislative and education programmes to attain long-run public health gains. Pictorial warnings may also be appropriate, particularly in countries with low literacy rates or where research shows that smokers are ignoring standard warning labels.

Several nations have implemented strong health warning label requirements. Examples include:
- Canada, whose health minister recently proposed enlarging the labels from 30% of the package face to 60%;
- Thailand, which has added the message "SMOKING CAUSES IMPOTENCE" to its list of required warnings; and
- Australia, which was the first nation to require that "how to quit" information be printed on every pack.
- South Africa, Singapore and Poland also require strong warning labels.

Over past years there were consistent efforts to water down the implementation of the tobacco control policies in India. India's Union Minister of Labour and Employment, Mr Oscar Fernandes, who is also a member of GoM, had earlier said while replying to a written querry in the Lok Sabha (parliament) on 21 April 2008: "Public health measures such as pictorial health warnings on tobacco products don't have any immediate economic impact on the industry due to the item's addictive nature and the time taken for demand reduction, according to various studies." Mr Fernandes also told the Parliament that 'his ministry was receiving representation from various organisations/central trade unions such as CITU, the Tobacco Institute of India, Federation of Farmers Association and others particularly relating to apprehension of loss of employment, arrangement of alternative jobs to the affected 'beedi' workers and adverse effect on health among others (Source: PTI, 21 April 2008).

On 15 December 2006, GK Sanghi had raised the question in Rajya Sabha about Government's response to the 'beedi' workers agitating against the proposed printing of skull and bones on 'beedi' packs. In May 2007, Gutkha (chewing tobacco) manufacturers in India were attempting to get a court injunction to delay the directive requiring all tobacco products to carry health warnings. Another interesting attempt was made in the same month (May 2007) when External Affairs Minister Pranab Mukherjee suggested in his letter that the sign will likely offend the Muslim community, who are employed in the beedi industry of Murshidabad, as they unlike Hindus bury their dead, and do not burn them. Another major move to water down the Indian Cigarette and other tobacco products Act also happened in May 2007 when Tamil Nadu Chief Minister M Karunanidhi called on the central government to defer implementation of the legislation, saying that "the move has threatened the livelihood of 1.5 million beedi workers in the State." Karunanidhi said beedi manufacturers in the State have stopped production with some tobacco industry players threatening to go on an indefinite strike from 1 June 2007 if the Act is enforced. Also in May 2007, The Karnataka Beedi Association in India said that the directive to print skull and bones on beedi packs would result in a steep decline in beedi sales adversely affecting the welfare of beedi workers. The All India Beedi Industry Federation had also written to Prime Minister Manmohan Singh that the 2 October 2008 smoking ban has made things tough for the beedi industry. Meanwhile, "we have told the Prime Minister ... that a forced printing of the pictoral (cancer) warning … will lead to a further decline in sales by 30%," had said Rajnikant Patel, president of the All India Beedi Industry Federation to the media.

As per the World Health Organization (WHO)’s MPOWER Report (2008), despite conclusive evidence, relatively few tobacco users understand the full extent of their health risk. Graphic warnings on tobacco packaging deter tobacco use, yet only 15 countries, representing 6% of the world’s population, mandate pictorial warnings (covering at least 30% of the principal surface area) and just five countries with a little over 4% of the world’s people, meet the highest standards for pack warnings.

“The bidi workers, majority of whom are bidi smokers, are in favour of pictorial health warnings on bidi packets. About 73 percent of the workers agreed that bidis are harmful to health and 79 percent felt that picture based warnings are important on bidi packets, at least to protect the younger generation,' according to the study conducted by the Voluntary Health Association of India (Source: IANS, 3 November 2008).

The fight to enforce public health policies, and put a check on industry interference, is clearly a long uphill battle indeed.

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Another blow to enforcement of tobacco control policies in India

Another blow to enforcement of tobacco control policies in India

Pictorial warnings on tobacco products postponed 7th time

Right after the strong and effective guidelines to stop tobacco industry interference in health policies were adopted by the government representatives of 160 countries including India, the pictorial warnings on all tobacco products that were supposed to become mandatory from 30 November 2008 in India, were, again delayed – reportedly due to hectic lobbying by the industry allies and other entities like the beedi growers’ association.

Pictorial warnings on tobacco products have been delayed, at least, seven times. Before going to the 3rd Conference of Parties (COP3) to the global tobacco treaty (Framework Convention on Tobacco Control), the Indian Ministry of Health and Family Welfare had revealed before the Central Information Commission that tobacco industry is putting "pressure" to relax the tobacco control policies (source: The Hindu, 14 November 2008).

The Article 5.3 of the global tobacco treaty, if defined broadly, recognizes “the tobacco industry's fundamental and irreconcilable conflict with public health.”

The tobacco industry interference has times and again weakened and delayed the enforcement of the public health policies - for example, more than 70 court cases were filed against tobacco control policies in Indian courts in September 2008, and due to aggressive lobbying, the consultative Group of Ministers (GoM) formed to review the pictorial warnings on tobacco products, had diluted the pictorial warnings provision and postponed the implementation of pictorial warnings on tobacco products at least six-times earlier. This is the seventh time the pictorial warnings on tobacco products have been again postponed, as reliable sources revealed, to the end of May 2009.

The industry interference in public health policies certainly needs urgent attention to save lives otherwise it will continue to threaten to reverse the great advancements made in forging public health policies and implementing them. Meantime tobacco continues to kill more than a million people in India, and 5.4 million globally, every year.

Also when these pictorial warnings were finally approved by a GoM, why did the GoM met again in an emergency meeting a week before the pictorial warnings provision was about to become mandatory? GoM including the Union External Affairs Minister - Pranab Mukherjee, the Union Information and Broadcasting Minister - PR Dasmunsi, the Minister of State for Labour and Employment - Oscar Fernandes the Union Minister for Commerce and Industry -Kamal Nath, Union Minister for Culture and Urban Development -Jaipal Reddy and Union Health and Family Welfare Minister Anbumani Ramadoss,

The GOM in an earlier meeting this year headed by India's External Affairs Minister Mr Pranab Mukherjee had agreed for two mild images of a scorpion signal depicting cancer or an x-ray plate of a man suffering from lung cancer as pictorial warning to deter people from smoking.

These pictorial warnings provide smokers with helpful information on the health effects. Most smokers want this information, and certainly want their children to have this information too. The tobacco industry is continuing its decades-long strategy of trying to minimize the effectiveness of package warnings. The tobacco industry is no friend of smokers - and ironically it's true that 'the tobacco industry kills its best customers'.

Pictorial warnings on all tobacco products are a good public health strategy because the cost of package warnings is paid for by tobacco companies, not government. Also this should not be looked upon as an isolated initiative rather has to be supported by comprehensive healthcare, legislative and education programmes to attain long-run public health gains. Pictorial warnings may also be appropriate, particularly in countries with low literacy rates or where research shows that smokers are ignoring standard warning labels.

Several nations have implemented strong health warning label requirements. Examples include:
- Canada, whose health minister recently proposed enlarging the labels from 30% of the package face to 60%;
- Thailand, which has added the message "SMOKING CAUSES IMPOTENCE" to its list of required warnings; and
- Australia, which was the first nation to require that "how to quit" information be printed on every pack.
- South Africa, Singapore and Poland also require strong warning labels.

Over past years there were consistent efforts to water down the implementation of the tobacco control policies in India. India's Union Minister of Labour and Employment, Mr Oscar Fernandes, who is also a member of GoM, had earlier said while replying to a written querry in the Lok Sabha (parliament) on 21 April 2008: "Public health measures such as pictorial health warnings on tobacco products don't have any immediate economic impact on the industry due to the item's addictive nature and the time taken for demand reduction, according to various studies." Mr Fernandes also told the Parliament that 'his ministry was receiving representation from various organisations/central trade unions such as CITU, the Tobacco Institute of India, Federation of Farmers Association and others particularly relating to apprehension of loss of employment, arrangement of alternative jobs to the affected 'beedi' workers and adverse effect on health among others (Source: PTI, 21 April 2008).

On 15 December 2006, GK Sanghi had raised the question in Rajya Sabha about Government's response to the 'beedi' workers agitating against the proposed printing of skull and bones on 'beedi' packs. In May 2007, Gutkha (chewing tobacco) manufacturers in India were attempting to get a court injunction to delay the directive requiring all tobacco products to carry health warnings. Another interesting attempt was made in the same month (May 2007) when External Affairs Minister Pranab Mukherjee suggested in his letter that the sign will likely offend the Muslim community, who are employed in the beedi industry of Murshidabad, as they unlike Hindus bury their dead, and do not burn them. Another major move to water down the Indian Cigarette and other tobacco products Act also happened in May 2007 when Tamil Nadu Chief Minister M Karunanidhi called on the central government to defer implementation of the legislation, saying that "the move has threatened the livelihood of 1.5 million beedi workers in the State." Karunanidhi said beedi manufacturers in the State have stopped production with some tobacco industry players threatening to go on an indefinite strike from 1 June 2007 if the Act is enforced. Also in May 2007, The Karnataka Beedi Association in India said that the directive to print skull and bones on beedi packs would result in a steep decline in beedi sales adversely affecting the welfare of beedi workers. The All India Beedi Industry Federation had also written to Prime Minister Manmohan Singh that the 2 October 2008 smoking ban has made things tough for the beedi industry. Meanwhile, "we have told the Prime Minister ... that a forced printing of the pictoral (cancer) warning … will lead to a further decline in sales by 30%," had said Rajnikant Patel, president of the All India Beedi Industry Federation to the media.

As per the World Health Organization (WHO)’s MPOWER Report (2008), despite conclusive evidence, relatively few tobacco users understand the full extent of their health risk. Graphic warnings on tobacco packaging deter tobacco use, yet only 15 countries, representing 6% of the world’s population, mandate pictorial warnings (covering at least 30% of the principal surface area) and just five countries with a little over 4% of the world’s people, meet the highest standards for pack warnings.

“The bidi workers, majority of whom are bidi smokers, are in favour of pictorial health warnings on bidi packets. About 73 percent of the workers agreed that bidis are harmful to health and 79 percent felt that picture based warnings are important on bidi packets, at least to protect the younger generation,' according to the study conducted by the Voluntary Health Association of India (Source: IANS, 3 November 2008).

The fight to enforce public health policies, and put a check on industry interference, is clearly a long uphill battle indeed.

Published in
Northern News Lines, Chandigarh
News Track India, Delhi
India Line
Counter Currents
Ghana News, Accra, Ghana
News Blaze, USA
Citizen News Service (CNS)
Bihar Times, Patna, Bihar
Op-Ed News (OEN), UK
Tobacco-Kills
Tambakoo-Kills
Snus News and Other Tobacco Products
In-com news
Media for Freedom, Kathmandu, Nepal
Bangladesh News, Dhaka, Bangladesh
American Chronicle, USA
California Chronicle, California, USA
WilliamBowles
Twitter
Bangladesh News Service, Dhaka, Bangladesh
Los Angeles Chronicle, Los Angeles, USA
The Seoul Times, Seoul, South Korea
Medical News, Australia