THE new sunday express Voices MAGAZINE Pushpesh Pant Sathya Saran Rajat Chaudhuri Gautam Chintamani Sheila Kumar Mata Amritanandamayi Buffet People Wellness Books Food Art & Culture Entertainment JUly 25 2021 SUNDAY PAGES 12 The Other Side of Midnight The treatment of cardiovascular diseases, diabetes, respiratory disorders and cancer, among other conditions, has taken a backseat since the arrival of Covid-19, leading to a ‘syndemic’ with an unfortunately high mortality rate WHO data show that around 300 mn people are at risk of dying from NCDs in India. Cardiac diseases, respiratory disorders and cancer are the reason for more than 60% of deaths in the country, with 26% of this number belonging to the age bracket of 30-70 years. The pandemic has disrupted or halted critical mental health services in 93% of the countries worldwide By Noor Anand Chawla E ver since he was a child, Nanni Singh’s 25-year-old son has camped out at the Sir Ganga Ram Hospital in Delhi, every alternate Saturday The day is fixed for regular blood transfusions required to . supplement the defective Red Blood Cells his body produces. After Covid-19, these designated hospital visits have brought a fair share of worry for Singh, a Gurugram-based events industry professional, who is afraid to bring the virus home to her aged mother, and even more afraid that blood may not be available for her son’s needs every time. Mirroring Singh’s bi-weekly urban trek, Venkateshwaran’s family resi, dents of the Sitheri Panchayat in Dharmapuri district of Tamil Nadu, travel 50 km to the Dharmapuri Medical College Hospital for blood transfusions for his nephew, as that is the only facility with a dedicated ward for this purpose. Terming the lockdown ‘torturous’, he describes in detail the immense difficulties they faced in accessing treatment—from the unavailability of ambulances to blood banks drying up for lack of donors. Singh’s son and Venkateshwaran’s nephew were born with thalassaemia, a rare genetic blood disorder that requires frequent blood transfusions and regular monitoring for effective treatment. Thalassaemia is just one of many chronic, non-communicable diseases (NCDs), including the likes of cancer, kidney failure, Alzheimer’s disease, asthma, diabetes and fertility issues among others, that are being sidelined with increasing focus on Covid-19 care and prevention. Data collected by the World Health Organisation (WHO) show that around 300 million people are at the risk of dying from NCDs in India. Cardiac diseases, respiratory disorders and cancer are the reason for more than 60 percent of deaths in India, with 26 percent of this number belonging to the age bracket of 30-70 years. The Lancet medical journal, known for its in-depth analyses, conducted a Global Burden of Disease (GBD) study analysing 286 , causes of death, 369 diseases and injuries, and 87 risk factors in 204 countries and territories, to better understand underlying health conditions in a global population and their impact on Covid-19. This prompted Richard Horton, the journal’s Editor-in-Chief, to describe the problem as a ‘syndemic’, where the Covid-19 death toll was exacerbated by rising levels of pollution, high global rates of obesity and diabetes, and an unprecedented increase in the incidence of chronic lifestyle diseases. The reason for this ‘syndemic’? Delay in diagnosis due to fear of contracting the virus and unavailability of healthcare professionals who are diverted to Covid care, coupled with lack of access to Covid-free facilities and hampered treatment structures. Over the past year, anything that is not related to Covid has been relegated to the fringes of the healthcare system. The Root of the Problem Gouri Das of Khaira area in Odisha’s Balasore district received her first chemotherapy cycle in April, but has faced numerous hurdles getting the second one. The lack of testing facilities for stomach and lung cancer patients in Balasore forced this 49-year-old to travel 150 km to the Acharya Harihar Post Graduate Institute of Cancer at Cuttack. This facility refused to accept the RT-PCR test report of the District Headquarters Hospital asking for a fresh one instead. To add to her woes, she could not even find a place to stay at Cuttack for two days—the period required to get her tests done before being admitted to hospital. While many hospitals are turning patients away on the pretext of Covid tests, the ailing also refrain from seeking medical help for fear of contracting the disease. Unfortunately, this results in a chicken-egg situation, with those suffering from non-Covid chronic NCDs caught in the crossfire. “Since non-Covid patients are reluctant to visit hospitals out of fear, private hospitals are using all their beds for Covid patients. As a result, dialysis and other services are not being offered anymore at many private centres. In Rajapalayam alone, two private hospitals have stopped offering dialysis completely, as there are no patients. Most patients can manage with teleconsultation, but critical What is ‘syndemic’? A syndemic is a situation in which two or more interrelated biological factors work together to make a disease or health crisis worse. The term syndemic is used among medical and anthropological experts. The biological factors that contribute to a syndemic can be communicable (can be spread to others) or noncommunicable (can’t be spread to others) in nature. Syndemic is increasingly used in the context of sociological and economic factors that contribute to syndemics. In 2020, the term syndemic saw mainstream attention after the scientific journal The Lancet repeatedly used the term in reference to the Covid-19 virus. Definition: dictionary.com Around 180 mN Indians suffer from chronic lifestyle ailments such as cardiovascular diseases, diabetes and cancer, with the latter being of utmost concern. The World Cancer Report 2020 predicts that nearly one in every 10 Indians is likely to develop cancer at some point and one in 15 likely to succumb to the disease. non-Covid patients are really suffering,” says Dr G Ganesan, a private doctor based in Tamil Nadu. When 44-year-old Dinesh (name changed) started experiencing breathlessness, the resident of Tiruchy district assumed he had contracted Covid-19. His RT-PCR test, however, was negative. Ten days later, he experienced shortness of breath again, along with pain in his chest, which prompted him to call a doctor. As his doctor was being treated for Covid, he was referred to another professional who directed him to the nearest health facility, which in turn sent him to a multispecialty hospital in Tiruchy city That . was when he finally learnt he had suffered a heart attack. When he was told he should have come 10 days earlier, he blamed his delay on the fear of Covid. “Many diseases are poorly managed with patients avoiding visits to hospitals due to prevailing situations. Even doctors are promoting home management,” says the Chairman of the Research Cell of the Indian Medical Association, Dr RC Sreekumar, based in Kerala. The Health Management Information System, managed by the National Health Mission (NHM), tracks indicators on the utilisation of health services from over 2,00,000 health facilities. These include primary health centres and district hospitals in every district of the country, and are updated almost daily . Over the last year, their reports recorded a significant decline in patients utilising hospital facilities for maternity care, child immunisations and perhaps most worryingly, outpatient visits for treatment of serious conditions, including cancer and heart disease, with the number being as stark as 69 million visits less than the previous year. A 45 percent decline in the number of patients registered for treatment of tuberculosis and a 60 percent decline in the number of men being screened for HIV are other worrisome , indicators. The number of major and minor surgeries also fell by over half in this time period. Though no sharp increase in deaths is recorded through NHM numbers from NCDs, these figures do not account for the long-term impact of chronic patients missing out on essential healthcare. Dr Monica Bhagat, Medical Director, Bhagat Medicare Centre and Nursing Home, Delhi and Co-Founder of UV Pure, has treated 3,500 home-isolated Covid patients through teleconsultation in the last 15 months. While treating them for Covid, she came across numerous patients with chronic diseases. She says, “I have seen bedridden patients being cared for only by their domestic help, elderly patients dying at home due to lack of proper treatment, and those suffering from difficult diseases like Alzheimer’s without access to specialists who have been diverted to Covid duties. I have also seen many patients of chronic kidney disease deferring dialysis, and those terminally ill with cancer losing their lives.” Turn to page 2 “Chronic diseases need continuous monitoring as the treatment and medicines are lifelong. Yet, people with these conditions are at most risk, therefore sceptical to step into hospitals, labs or clinics because Covid-19 is a more immediate threat than their long-term conditions.” Aditya Kaicker Co-founder and Chief Programme Officer, Breathe Well-being, a digital treatment programme “Many diseases are poorly managed with patients avoiding visits to hospitals due to prevailing situations. Even doctors are promoting home management.” Dr RC Sreekumar Chairman, Research Cell, Indian Medical Association
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