Gangtok: Sikkim is the second-smallest state in India in terms of area after Goa. It is also the least populated in the country with just 600,000 people. Yet, in some matters, this Himalayan state towers over others, leading the way where the rest of India falters.
Among the most innovative schemes undertaken in this state is the Comprehensive Annual and Total Check-up for Healthy (CATCH) Sikkim. This programme is aimed at tracking the health status of people in the state, so prevention, rather than cure, can become the order of the day when it comes to public health.
Launched in August 2010, CATCH covered 50 per cent of the state’s population by the end of 2012.
CATCH is aimed at prevention rather than cure, a cheaper and more effective way to address the healthcare needs of a population than providing for expensive treatment once disease sets in.
The aim of CATCH is to ensure a comprehensive check-up on an annual and periodical basis to all people in the state. A database of the health status of individuals would be maintained. Check-ups and healthcare under this programme are provided free of charge.
Chief Minister Pawan Kumar Chamling, launching the programme two years ago, said: “Our aim is to provide community-based comprehensive annual check-ups and care, free of charge. We will bring healthcare to the doorsteps of the people and make Sikkim the healthiest state.”
The Political and Economic Journal of Sikkim reports that the primary focus is to get an annual health check-up done for all citizens. After that, comprehensive care based on the history of the patient would be provided.
Ramesh Dahal, a resident from Yangang, told the Journal: “This is a good initiative for those who are poor and cannot afford treatment. In a recently concluded CATCH health check-up camp, the doctors checked my sugar and blood pressure. I was advised what to eat and how to lead a healthy lifestyle. It was extremely informative for the villagers.”
He added: “We hardly get any time to think of our health since we are so occupied with our farms. But with this system, at least we will be able to get regular check-ups.”
Scattered health-based programmes are now being converged by building partnerships in the health sector.
Currently, one state referral hospital, four district hospitals, 25 primary healthcare (PHC) centres, 147 sub-PHC centres and one medical college function in the state. All of these establishments are working together to implement CATCH.
A detailed medical history of each citizen would be created under CATCH, which can be updated on each annual check-up. A physical check-up, during which a screening of major health problems is done, would be part of the programme. In case a disease is detected, the patient is sent for free consultation.
After the physical check-up, a laboratory investigation is done, and citizens are counselled by an expert on how to maintain a healthy lifestyle.
“We live near Nimtar in Sumic-Mangthang village. The main road is far away from here. So it was helpful when doctors came to us and conducted check-ups,” said a grateful Mansingh Subba, resident of Mangthang. [Source: IANS]
International Pediatric Cancer Day 15th Feb.
Childhood Cancers and We
How serious is Indian Society of Medical and Pediatric Oncology with regards to child hood cancer awareness?
How Serious and aware are our Indian Childhood Specialist Community about the appalling numbers of childhood cancers that are reporting to us in late stages??
How Serious are State Health Departments with Regards to Annual Health School Health Check up.
How Serious are State Education Departments with regards to School Health and Cancer Education and also selection of those teachers who themselves are not addicted to tobacco and related carcinogens.
Children’s Day is Observed since time immemorial but did anyone care to think about Indian Children’s Health and rising incidence of cancers in them on this day?
Should Children’s Day date in India Bring a Reminder for the Health of Indian Children Also!
Even though we have this international day the 15th Feb.
Is it not time to revive at least Yearly Routine School Health Checkups in all the schools of all the levels.
( Remember Father of School Health Checkup program, Prof.Kailash Nath Agarwal of Varanasi )
The Americans say, think and do things for the sake of their own children and the future of their children’s children. The Padmabhushan and Mag Say Say Awardee Indian Oncologist and the Founder of First Pediatric Cancer Unit way back in 1956 messages with regards to children affected by Pediatric Cancers, “They also have a tomorrow” .
Indeed what do we have to say for our Indian progeny is an unanswered question?
The mega issue has still not been dealt, that has been a target of constant neglect, ignorance and criminal indifference if we may call it, by all the sections of educated society Urban or Rural, today both the categories of children are at a very serious risk as they were never before. The results are evident in our OPDs..
With regards to the cancers found in Indian children it is not the small percentage of the all the malignancies which they represent but it is the appalling and intriguing ,sheer number and varieties with which they reach our hospitals.
The State Health Authority: It is about time that the cancer is declared as a “Notifiable disease” helping us to know the exact quantum of cancer, especially so,the new outgrowths in varieties of Indian Child Hood Cancers.
It is also about time that the Annual School Health Check up Program is revived and launched if we have to save our children from multitudes of disease, cancer being one of the most challenging one. Phimosis, Undescended Testese, abnormal breast development, Nodes and swellings, Hepatospleenomegali , Amaurotic Catseye Reflex, unexplained fever and weight loss, skin rashes .Like much publicized Self Breast Examination, Self Nodal Examination and like promotion of Breast awareness , Also promotion of…Nodal Awareness!! Yes it is possible!
Has ISMPO given any thought of significance of Observing International Childhood Cancer Day in Vehemence ?
Still you have 10 + days !!!!
The Society :The pollution, the adulteration, , the unknown and known external effects that bring about changes in genes or in emryo to culminate into cancers once the baby is out of womb!! Increasing concern of Electromagnetic Radiations from Mobile Phones to gonads( Hungarian human sperm count fall) and from Mobilephone Towers or High tension wire pillars to human inhabitations. Radars, Microwave Owen, cordless phones the list is endless.
The falling of moral values and ethics in children and adolescent.
Example prolonged scientific sessions in International Gynec Cancer Society Conference ( Prague 2010) to discuss pros and cons of HPV Vaccination in Preadolescent and Adolescent.
Is it corporate sector driven propaganda or it is the growing concern for the increasing incidence of adolescent coitarche! Added new feature of frequency of rapes , and or convinced ,influenced or pressurized consensual sex that is no less than a rape sans violence!!!
The western food culture of poisonous insecticide enriched soft drinks, and unhealthy junk food, the affluence.( Watch the bust-line of adolescent females in metropolitan towns….schools and coaching centres ….. and the prediction that is being evidenced as rising incidence of breast cancers in metropolitan towns.)
The concept of man to women relations sans Brahmacharya the :celibacy while unmarried , even approval to Gay Culture. Not much publicized child prostitute vis-à-vis pedophilia .
The tension of the studies, worry for career, heavy school bags!!!
The industrial expansions and resultant pollution in the residential neighborhood with pregnant mothers and their toddlers. The uncaring Paa who makes them smoke even as they are in mother’s womb. A modern or rural MOM who smokes even at the verge of her becoming mother, unawares some time !
The rural pregnant to be mother with Khainee quid in her mouth or Biri smoke in her lungs .
The rag picker boy, the child labor in the chemical toxic industry, large population of uneducated undernourished children of the slum dwellers, to be named a very few.
Parental front: things are worse-once again both for rural and urban parents, illiterate or functional illiteracy no….no ….no even the educated and affluent!
The right and wrong of food, the proper upbringing with moral values, in the name of the “liberation in the society”, permission to premature unethical sex with its full justification. Homo, hetero, and masturbated sex as an accepted norms in their children’s entertainment list .
The increasing incidence of animal sex in adolescent creates new worries for newer venereal infections. If HIV virus can come from monkeys of central African jungles then some virus or bacteria not come from sheep, goats, buffalows of bitches, the tools for “Alternative” for sexual entertainment ? Yes Yes it is happening let us not be shy of talking it , lest it it is too late!!!
International Gynec Cancer Society Conference ( Vancouver 2012) :The panelists on HPV infection and Vaccine were answerless with due admittance of the fact , when confronted with similar facts.
Alcohol as symbol of social status that starts with beer and ends at Vodka. Money power to purchase Scented Sweet Supari laced with Addictives , gutka, alcohol and junk food – lack of knowledge of micronutrients for their children .
Last but not the least the total ignorance of the first recognizable symptoms of childhood cancers and the knowledge of familial transmission and predisposition of many of them( retinoblastoma, Wilms` tumour and even breast cancer) and hence the prevention of such child’s birth in first place.
Newer Methods of Addiction: Inhalation of the white correction fluid and its dilutant thinner!!! . Or for that matter the nail polish !
The medical profession , policymakers , implementing agencies and their indifference during several Mega Programs : total lack of proactive attitude towards comprehensive health care . For them the setting of the targets such as pulse polio is the end of their responsibility, forgotten were the facts related to other vaccinations , including the cancer preventive ones such as hepatitis B and C, even the mention of HPV polyvalent as in Indian Pediatric Association Vaccination Schedule. They missed the bus on the Health Awareness( including cancer awareness) of the parents who brought the children for polio vaccination and for which the educative literature could be delivered with the same infrastructure and mechanism with lowest possible cost. Imagine the scenario 10 years of quadrennial hepatitis vaccination and distribution of cancer education material to the parents. The Disease burden on our hospital would have been much less!!
Evidence :The Delhi Kanchanpuri Slum Trial Distribution of Cancer Awareness Material and its shocking outcome!!!!!
Is there a need to establish Pediatric Cancer Registry in every Pediatric Medicine Department and networking of the same with ICMR National Cancer Registry Project?
Is not there an urgent need to establish a separate Pediatric Oncology Unit in every teaching Medical Institution in the Pediatrics Medicine Departments?(RCC Thiruananthpuram, TMH Mumbai have done it !!!)
Under the shadow of the latest concept “Detect Cancer even when it is asymptomatic-not alone with the knowledge of 11 danger signals of cancer but with the help of biological tumor markers. What could have been scenario today on early detection of all the cancers and pediatric cancers in particular? Can anything be done to detect child hood brain tumours that have started reporting to us in large numbers with their devastating stages?
The Forestry programme, the greenery programme lacked vision the greenery cum food programmes or coined as Anticancer Agro Forestry can give food from tree plantation: Plant only that tree which provides the edible fruit: a future fruitery with every possible cancer preventive micronutrients if not granary for the exploding undernourished underfed populations of this country- Greenery, atmospheric purification global cooling and fruits all in one go!!!! No body thought of it. Why? Metropolitan Agroforestry Concept and Grey water harvesting to support it!
The Literacy and Educational front: both medical and non medical (Schooling and collegian-teach them young or catch them young whatever you may want to call) The present and future generation of medical personnel: Oncology is not the part of internship training in most of the medical college nor is there any chapter of preventive oncology in the Bible of undergraduate preventive medicine teaching that is Park text book of preventive medicine (age 40 years of publications)….. With subject such as oncology not there in the undergraduate level what shall be the attitude towards early detection of cancer of the new generation of doctors that are coming out of our medical colleges ? MBBS UG trainees recommending surgery for every tumour mass!
Primary to Higher Secondary Teaching:What shall be the scenario of the children with regards to malignancies. No serious teaching of cancer prevention in the primary and secondary school level teaching curriculum although the teaching syllabus standards are high and every class level can have some topics related to preventive oncology which can be taught to them : the experiment has succeeded with the book kanser ki kahani jo hai Bacchon ko Sunani ( the story of cancer which ought to have been told to children).The education of not so literate parents through their school going children with the help of such a book could have proven a boon to the society.
The Childhood competitive life: The heavy School education curriculum and the worst kind of competition created for the meritorious due to inadequate number of educational institutions and disproportionate number of seats for the high cut off marks for unreserved candidates , hence depriving the meritorious their right for higher education . This tough scenario does not give any time to a youngster for health related activities such as games, physical exercise play and free air (no… no polluted air) breathing even, mental tension and suicides are high what it does in terms body defense mechanisms…. lowering of immunity and hence malignancies — result….we shall read in bottom lines( Medical Reference Available).
The Business Community with its FICCI standard businessmen , politicians and the judiciary the : One produces the carcinogen Gutkha, panmasala and kahinee -the tobacco aricanut industry and growers , one protects its existence is the politician and one justifies it ………. and its statement on Gutka ban in state of Maharashtra….before its abrupt withdrawal the central law of ban could have been implemented first just to make Maharashtra ban automatically null and void and effective centrally!!!! The much publicized laws like any other public welfare laws have poor or no implementations. Putting the posters or statuary warning does not mean its compliance. The main victims are children who once again have freedom to carry Gutkha and panmasala packets in their school bags.
The film and media industry with its provocative sexual presentations and there to are their justifiers “ if you think or youth thinks that it is bad they should not go to see such movies …. oft repeated medial presentation of a film director- producer and father of an actress who displayed her nudity with her fathers concurrence. But most media channels call him while he keeps stating hum to banayenge nangi filme Aur dikhayenge bhi jisko naheen dekhna hai vo na jave sinema hall mein, ghar baithe !!!! Albeit it adds to sex crimes such as minor’s rapes. Industry does not care to fix up a taskforce to find out the societal aberration caused by its misdeeds.
The Provocation that culminates into a sexual adventurism and later into rapist attitudes . Interestingly , with the recent spate of rape episodes , the protestors and the leaders who engineered the protest and related discussion did not talk about what media instigates that culminates into rapist like attitudes .
The Impact of media advertising/ surrogate advertising :The present scenario: increasing number of usage of tobacco and areca nut product( mind you Aricanut too has carcinogen and not the way the famous panmasala company is advertising that every thing is pure and shudhha in their panmasala. The increasing incidences of promiscuity and pair formations in schools with introduction and reintroduction of HPV or exchange for that matter rapes of minors at its best.
Increasing number of presentation with leukoplakia ,sub mucous fibrosis in children who start consuming low cost pouches of sweet supari as their counterpart from the rich class consumes chocolates and toffees to add to their weights and become future victims of Breast and Prostate cancers.
The Chemicals we eat and make our children eat. Chemical revolution in harvest and post harvest products . Agriculture with industrial affluent and sewer of the city. The increasing incidence of bone and muscle tumors in form of sarcoma, lymphomas and PNETs( Lymph node cancers, . The closeted living with no physical activity leading to lower immune competence and hence leukemia( a Study).
The Media and its role: The illiteracy, lack of awareness, lack of prioritization by the media towards time slot of cancer related topics. Rather giving importance to scams, politics glamour, nudity and flesh and last but not the least the advertising of eatable carcinogens. The indifference of parents towards their children- female in particular, lack of literature to educate them even though there are writers for such literature the apathy towards sponsorship and financial help to have them broadcast, telecast or published. No antidotal programs for carcinogenic programs and commercials mentioned above .
The pharmaceutical companies who earn big chunks of profit from cancer patients and the their bankrupt family members are not interested in the continuing education of the relatives side by side selling their pharmaceutical products. While they have funds unlimited and have no hesitation in spending on curries and alcohols which flow along with their product launching parties in five star hotels
The NGOs: The attitudinal indifference of several nongovernmental organizations towards the printing and publishing or video making for cancer awareness material as the integral part of their motto. Although their much publicized working on cancer related issues such as palliative care or medicinal or financial support for the cancer patients is limited to very few child victims of cancers.
May be thorough single man’s army effort to celebration of National Childhood Cancer Day by Adhar Charitable trust and alike , some day some reprieve may be given to the future victims of cancer in child age group.
Summary Of What We Can Do for Indian Childhood Cancer Prevention
1- Pulse Polio Day
istribution of Cancer Preventive Awareness material from Pulse Polio Booths.
2- Annual Health Check up in schools like the novel concept founded and implemented by Prof. K.N. Aggarwal 50 years back in Varanasi Schools and Colleges.
3- School Cancer Education: Teach the children, Reach the Parents Through School Cancer Education Books.
4- Ophthalmic Awareness similar to Chile, Argentina and Brazil( WHO Patronised now) to harvest early Retinoblastoma Cases. A similarattempt by DHS of Delhi Govt. on its way.
5- Introduction of Self Nodal Examination to the adolescent under the parental guidance and knowledge of lympho haematological malignancies through illustrated readables.
6- The Media and Children: E.g. Two forum available at DD Delhi that also goes to DTH – Kids Island and Youth Express where this can be discussed—- the whole media methodology that has been communicated to you all on previous awareness date.
7- Health Channels such as Shakti TV and other Regional Health channels
8- DD Health Programmes: Total Health, Health Show and Healthy India of LS TV, Village population of Krishi Darshan Health Segment
9- All India Radio Aadha Asman the Mother’s programme. Uthiye swasthy ke saath and Science magazine.
10- Articles in children’s magazines
11- Chat shows in Other satellite channels wherever the pressure can be formed to do such “ not so commercially benefitting programmes”
12- Hereditary Profile in the school admission application form.
13- Can Italian Attitude help prevent hereditary paediatric cancers? The amniocentesis for chromosomal abnormality and not for the sex determination. Therefore diagnostic amniocentesis and then therapeutic abortion that
14- will help economise management for poor patient and ill funded institutions?
15- Total ban on Tobacco and Tobacco Products: SOS and Indian Childhood from tobacco.
16- Introduction of Lifestyle Diseases as a subject in schools and inclusion of same in National Rural health Mission ( The Exemplary Pioneering Initiative of Govt. of NCT of Delhi Under the expertise of Doyen like Prof. Shridhar Dwivedi) and Sarva Shiksha Abhiyaan- Education for All.
17- All those in Medical Colleges and Institutes to start Paediatric Oncology unit incorporating radiation, medical, surgical and preventive oncologist as the pillars.
The report highlights some very important facts which I think are relevant for us
1. More than 85% of all newly diagnosed children with cancer and 95% of deaths in children with cancer occur in low and middle income countries.
2. For children aged 5-14, cancer is the third leading cause of death
in upper-middle, fourth in lower-middle, and eighth in low income countries.
3. A child diagnosed with cancer who lives in one of the poorest countries has an 80% probability of dying, compared to less than 30% in one of the wealthiest countries
The report identifies a set of candidate cancers and compelling Cancer Care and Control opportunities for immediate action to expand prevention and/or treatment. Among these are cancers in children which are ideal targets for advocacy and action in low and middle income countries.