Rural Living News

Social Justice Through Health Care

SOCIAL JUSTICE THROUGH HEALTH CARE

We hardly come across a person who may be fully satisfied with the health care delivery system run by either the government or the private sector. This is true not only for developing but for all the developed countries as well. Every law abiding, contributing individual has some legitimate expectations from the state. Disenchantment with present dispensation of health care compels people to seek better options across the borders. Even the present flow rate of patients from developed to developing countries has assumed the proportions of Medical tourism. Medical tourism is not a one-way traffic. Poor from India are known to visit Rashid Hospital at Lahore for kidney transplants. Medical tourism will definitely bring in world class equipment and services in our corporate hospitals. These corporate tertiary care hospitals can act as excellent referral hospitals. Lack of enough clinical material, as the patients are often referred to in medical parleyences is prompting the doctors from developed world into medical adventurism. Very recently two NGO’s headed by renowned plastic surgeons of Indian origin were in India, claiming to their credit hundreds of cleft lip and palate surgeries conducted in one week. During my brief interaction when I asked them one basic question that how do you justify single step surgery by a single specialist for a clinical entity that require 3-5 set up surgeries by 10 specialists over a period of 20 years, there was no answer. On record local doctors conduct all these surgeries. These NGO’s bring in a battery of trainee resident doctors for hands on training. Dumping of questionable services and drugs continues unabated in the absence of stringent regulations. Clear-cut up to date guidelines by health authorities have yet to be issued to safe guard the health interests of this nation. Most of the drugs banned in developed countries are still being dumped in the Indian market. Commerce alone dictates the policies of multinational companies in health sector of developing countries. State and national medical councils, the watch dogs of our national health interests are controlled by elected representatives from among the doctors. Competitive populism for being elected to these high offices takes away the very sting off these regulators. In this ‘market forces’ driven health sector, apart from other factors, size of the population, economic prosperity and literacy levels dictate the out look of key players. Subjective as well as objective assessments of the health care operations leave people confused with huge piles of data and endless interpretations. At the tail end of govt. health care delivery system is the Rural dispensary or the slum revamping center, and the end user an illiterate or semi literate villager or a slum dweller. Dispensary is the humane face, the welfare state can present to its people. In yesteryears the service providers were from among the same social class they used to serve. Doctor can be a friend, philosopher and guide to the locals. Unfortunately the economic and social disparity between the service providing doctors and the service user population has grown enormously. Ad-hocism in health care delivery should be done away with immediate effect. Doctors and paramedical staff appointed on yearly contract basis are not showing any interest in the national programmes. Established private health care providers also have not shown any meaningful commitment for national programmes. Middle class itself has fragmented. Now it is fashionable to assign economic values to any issue like gender, but for social responsibility and justice. In this era of fast paced growth, the unorganized, silently suffering millions can not be wished away. Once reading on biodiversity I stumbled upon a very interesting quote, “only the species with economic importance will survive”. In our active pursuit for magnetizing economy, we assigned economic values to any thing except for morals. Commercialization of education has produced a new breed of professionals who have scant regard for professional ethics. Privatization is the buzzword with governments, because it takes away government responsibility. Private sector players are eyeing many ‘viable’ health institutions. There are no takers for commercially non-viable rural institutions. Rural Health institutions dispense social medicine. Very recently one of the key players from private sector health care quoted the cost of developing one bed in corporate hospital at Rs. 30-60 lacs. These corporate health services are definitely out of each of the common man. These type of hospitals are definitely required for a nation with the present rate of growth but ‘bharat’ definitely needs different kind of hospitals. There are very strong social under currents against the exploitive private healthcare, inadequate government sector health care resources and the indifferent approach of welfare state. Health for all is a very lofty but expensive proposition. There are ways and means to reduce the pressure from government institutions. Private-public partnership, health insurance, monitoring and regulation of private sector health care can all make the things bit easy. Preventive health care education can go a long way in improving the public health. Community participation in health care has produced few but wonderful examples. Complementary community participation can make up for minor but critical deficiencies in the government run health care system. Setting up of health system corporations with World Bank assistance has already improved the working of govt. sector health care institutions considerably. Community participation through NGO’s can still improve the system, but most of the meaningful NGO’s turn their back on govt. run health care institutions because of their doubts on the integrity of government officers. Government health care institution are increasingly seen not as caring hospitals but like police stations, where medico legal reports are written and postmortems conducted. Most of the government doctors’ time is spent in courts appearing as medico legal experts witnesses. Emergency, post mortem, and then the VIP duties in addition hardly leave the doctors free for any meaningful job at government hospitals. There is an urgent need to have separate curative, preventive, legal, administrate and health intelligence wings. Government hospitals attract the poorest of the poor, mostly people from the unorganized sector. Their contribution to national GDP is by no means small. With the present growth rate, upward social mobility is seen in every strata of society. Many segments of this unorganized sector can be organised so that they also enjoy the patronage of welfare state in the form of health insurance policies. Apart from direct benefit to these segments of society, the state will benefit from the ‘off loading’ of burden from government run health care system and loading it on insurance driven private sector health care institutions. Poorest of the poor will repose faith in welfare state. Sanjivini, health insurance policy with the Punjab Milkmen Cooperative Societies is already a big success. ECHS (Ex servicemen Contributory Health Scheme) is an other success story. These success stories can be replicated with countless groups like, panwallas, dhabewallas, autorikshaw drivers etc. Simply organize the unorganized sector. There is no dearth of role models from among government doctors also. Their inclusion rather than drift after dissent from the present dispensation of health care will immensely improve the system. Stability of tenure is an excellent incentive government can give to its doctors without costing anything to exchequer. Yet tenure beyond decades should be discouraged as it leads to Development of vested interests of the old incumbents and denial of chance to the youngsters. Resource mismatching is a major problem in the govt. run health care system. There are dispensaries where specialists are posted and still many more civil hospitals where non-specialist are posted. These mismatching result in defective and inefficient health care. Nodal Hospitals can be created for round the clock emergency services by cannibalizing defunct and sick institutions where equipment worth crores is lying unused and salary bills are bleeding the exchequer white. Most of the medical officers retire in the same administrate rank. This undue stagnation has forced many a brilliant doctors out of service. By simply seeking options for place of posting, honestly implementing with minimum displacement on merit can also revitalize the govt. doctors’ cadres. Private sector health care delivery system is a totally market driven commercial enterprise. So called ‘market forces’ have least respect for ethical and moral value systems. Multi level marketing chains have evolved in the name of referral systems. End result is exploitation of the unsuspecting common man, who still regards his healer a holy person. This ‘incentive’ system is strengthening the hold of unqualified, unscrupulous and unregistered medical practitioners on illiterate masses. Not many qualified doctors are unscrupulous. A large section of private health care providers feel genuinely threatened by blackmailers of all sorts. Consumer protection act is a very convenient beating stick in the hands of their tormentors.

Under the constant threat of being blackmailed, the private health care providers are becoming more defensive in attitude. More patients are being referred to tertiary care institutions for this reason only, thereby flooding the referral institutions. People have a common feeling that sickness is an invitation for exploitation at the hands of private health care providers. Even the charitable hospitals are charging as heavily as fully private hospitals. Medical profession is fully responsible and capable of self-correction. Medical councils and associations can jointly evolve a fail-safe mechanism to keep their black sheep under check even without government help, but the buck stops with the government. Welfare state is duty bound not only in providing health care delivery system but also proper health care administration and social justice through its health care delivery mechanism.

Name : Dr. Pardeep Kumar Sharma

Email-ID : omfspardeep@yahoo.com.

(M) : 0988456296

Date of Birth : 12.02.1962

Education Qualifications : BDS (Bachelor of Dental Surgery)

MDS (Master of Dental Surgery in Oral and Maxillofacial Surgery)

Educational Institutes Attended

Govt. High School Bargari : Matriculation (1969-1977)

Distt. Faridkot, Punjab, India

DAV College Chandigarh : Pre-University (1973-79)

(Punjab University)

Barjindra College Faridkot : Pre-Medical (1980)

Dental Wing, Medical College : BDS (1981-1986)

Patiala

Dental College and Hospital : MDS (2003-2006)

Amritsar

Professional Experience

House Officer, Christian : 1987-1988

Medical College & Hospital,

Ludhiana

Research Officer, All India : Jan. 1989 to June 1989

Institute of Medical Science

AIIIMS, New Delhi

Dental Officer, Indian Armed : July 1989 to August 1994.

Forces in the Rank of Capt.

3

Medical Officer (Dental) : w.e.f. Nov. 1995 till date

in Punjab Civil Medical Service

(PCMS)

Research papers Published

“Role of Programmed cell death in dental anomalies associated with cleft lip and Palate”. “Medical Hypotheses” Churchil Living Stone Publishers London-1991

Post traumatic polatoglossal adhesion, a case report stomatologica India (1990).

Research Project Undertakes

“Malocclusion and associated Factors among Delhi Children” a study sponsored by Indian Council of Medical Research (ICMR).

Areas of Interest : Environment, Health, Defence, International Affairs and Rationalism

About the Author

author is an oral and maxillofacial surgeon working as programme officer with civil surgeon ludhiana,punjab ,india

Gateway Rural Health Research Institute

Rural Nursing: Concepts, Theory and Practice, Third Edition $52.38 Designated a Doody’s Core Title! “[T]his extended text on rural nursing is a significant contribution to the knowledge base on a phenomenon that is of significant importance to nurse educators, researchers, policy makers, and clinicians.” –Dr. Angeline Bushy, PhD, RN, FAAN University of Central Florida College of Nursing (From the Foreword) Thoroughly updated and revised, this new ed…

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The 2010 Decennial Census: Background and Issues – CRS Report $0.99 The 23rd decennial census of the U.S. population began on January 25, 2010, in Noorvik, AK, where the Bureau of the Census Director, among others, traveled by snowmobile and dogsled to enumerate the residents. Most U.S. households-about 120 million-received their census forms by mail in March, ahead of the official April 1 Census Day, and 74% of the households that received forms mailed them back….

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”Redeeming the tropics”: Public health and national identity in Cuba, Puerto Rico, and Brazil, 1890–1940. $49.99 After the United States became a world power at the end of the Spanish-Cuban-American War of 1898, it also inaugurated its first successful overseas disease eradication efforts against yellow fever in Cuba and hookworm disease in Puerto Rico. In the 1910s, these initial campaigns were replicated in Brazil through the international health services of the Rockefeller Foundation.;This dissertation examines the consequences of these campaigns in order to understand the ways in which public health transformed the racial and national thinking of early twentieth-century Cuba, Puerto Rico, and Brazil. American and local physicians used public health concerns to bolster state building and define national belonging. In Cuba, public health officials, social scientists, and policy makers exploited the success of the yellow fever campaign to police racial boundaries, generally to the detriment of people of African and Asian descent. In Puerto Rico, the campaign against hookworm mobilized tens of thousands of peasants and offered a platform to expand medical research and training. In Brazil, the missions of nationalist sanitarians and the Rockefeller Foundation converged in the campaign of rural sanitation and altered ideas about regionalism, nationalism, and imperialism.;Furthermore, my research demonstrates that as state authorities implemented disease eradication programs, social thinkers replaced older doctrines of race and environment with less tangible explanations of soul and culture to reassess national identity in the tropics. In Cuba, Puerto Rico, and Brazil public health ideas also had a profound impact on key intellectual figures of the 1930s who redefined the national community in writings influenced by their ambiguous relationship with the United States.;My analysis draws on U.S. military records, medical journals, ethnographies, autobiographies, novels, popular images, and documents of the Rockefeller Foundation to reconstruct the circulation of public health

”Redeeming the tropics”: Public health and national identity in Cuba, Puerto Rico, and Brazil, 1890–1940. $49.99 After the United States became a world power at the end of the Spanish-Cuban-American War of 1898, it also inaugurated its first successful overseas disease eradication efforts against yellow fever in Cuba and hookworm disease in Puerto Rico. In the 1910s, these initial campaigns were replicated in Brazil through the international health services of the Rockefeller Foundation.;This dissertation examines the consequences of these campaigns in order to understand the ways in which public health transformed the racial and national thinking of early twentieth-century Cuba, Puerto Rico, and Brazil. American and local physicians used public health concerns to bolster state building and define national belonging. In Cuba, public health officials, social scientists, and policy makers exploited the success of the yellow fever campaign to police racial boundaries, generally to the detriment of people of African and Asian descent. In Puerto Rico, the campaign against hookworm mobilized tens of thousands of peasants and offered a platform to expand medical research and training. In Brazil, the missions of nationalist sanitarians and the Rockefeller Foundation converged in the campaign of rural sanitation and altered ideas about regionalism, nationalism, and imperialism.;Furthermore, my research demonstrates that as state authorities implemented disease eradication programs, social thinkers replaced older doctrines of race and environment with less tangible explanations of soul and culture to reassess national identity in the tropics. In Cuba, Puerto Rico, and Brazil public health ideas also had a profound impact on key intellectual figures of the 1930s who redefined the national community in writings influenced by their ambiguous relationship with the United States.;My analysis draws on U.S. military records, medical journals, ethnographies, autobiographies, novels, popular images, and documents of the Rockefeller Foundation to reconstruct the circulation of public health

A Sustainable Future for the Mediterranean: The Blue Plan’s Environment and Development Outlook $16.44 * The only authoritative assessment of the past, present, and future of the environment and development of the Mediterranean basin and its 22 countries and territories, with research backed by the United Nations Environment Program (UNEP), the EU, and national governments * Information compiled by 300 researchers and clearly presented through hundreds of full-color maps, graphs, and tables* A must-have for all levels of government, NGOs, and libraries, as well as practitioners, academics, and businesses involved in economics, finance, environment, transport, water, infrastructure, urban and rural development, agriculture, fishing, aquaculture, conservation, health, and population.This is the definitive, authoritative assessment of the environment and development of the Mediterranean Basin and its 22 countries and territories, spanning five decades from thirty years ago to twenty years into the future. Produced by the Blue Plan within the framework of the Mediterranean Action Plan, and backed by UNEP, the EU, and national governments, the book brings together data from 100 researchers from dozens of national, regional, and local governments and research groups for the only comprehensive insight into sustainable development issues in the region. Core coverage includes water, energy, transport, cities, rural and coastal areas, as well as related issues such as climate change, population growth, geopolitical changes, unemployment and poverty, pollutions, economic and environmental policies, regional cooperation, and the Euro-Mediterranean Partnership. Information is clearly presented through hundreds of full-color maps, graphs, tables, and case studies. This is a must-have reference for all levels of government, NGOs and libraries, as well as practitioners, academics and businesses involved in economics, natural resource management, land and maritime transport, water, energy, infrastructure, urban and rural development, agriculture, fishing and

Aging and Diversity: An Active Learning Experience $1.99 This new edition has been completely rewritten and includes chapters that address key topics in diversity and aging: research methods, psychological aging; health beliefs, behaviors, and services; health disparities; informal and formal care for older persons; work and retirement; religious affiliation and spirituality; and death, dying, and bereavement. Taking a broad view of diversity, Mehrotra and Wagner discuss elements of diversity such as gender, race or ethnicity, religious affiliation, social class, rural-urban community location and sexual orientation. Including these elements allows them to convey some of the rich complexities of our diverse culture – complexities that provide both challenges to meet the needs of diverse population and opportunities to learn how to live in a pluralistic society.Throughout the book, Mehrotra and Wagner present up-to-date knowledge and scholarship in a way that engages readers in active learning. Rather than simply transmitting information, the authors place ongoing emphasis on developing readers’ knowledge and skills; fostering higher order thinking and encouraging exploration of personal values and attitudes. Distinctive features of the book include:Opening vignettes for each chapter that present a sampling of how the issues to be discussed apply to diverse elders.Active learning experiences that invite readers to interview diverse elders, conduct internet searches, and give an analysis of a case study.Quizzes at the end of the chapters help readers ascertain the extent to which they have learned the material; the key for each quiz includes details about correct and incorrect responses so that additional learning can occur.Aging and Diversity Online boxes interspersed throughout the book provide internet resources that readers may use to find new research and publications.Suggested readings and audiovisual resources given at

Agromedicine: Selected Papers from the First Ten Years of The Journal of Agromedicine $9.99 Quality articles from the one-of-a-kind journal that blends agriculture and medicine!Agromedicine: Selected Papers from the First Ten Years of The Journal of Agromedicine is a thorough compendium of the best selections from the first decade of the Journal of Agromedicine. Recognized by Index Medicus and MEDLINE, this authoritative international journal is dedicated to promoting rural health in the United States and abroad, blending the essential sciences of agriculture and medicine in a format that is not only informative, but also reader-friendly. Well-respected former editor Dr. Stanley Schuman has carefully chosen the highest quality contributions from ten years of groundbreaking research and superb articles by international leaders and experts in the field.This valuable reference uses a distinguished expert’s reflective judgment to choose and spotlight the most influential articles from ten years of innovation and research. Each article selection was based on several criteria, including the merging of the sciences of agriculture and medicine, a focus that allows a full understanding of the entire world’s health problems, and of course, the quality of the writing. Chapters are separated according to issue volume and number, while the articles discuss crucial case studies, important policy issues, incisive publication reviews, and more information of keen interest to researchers and medical professionals. Agromedicine explores:• acute and chronic pesticide poisonings• chemophobia• food safety around the world• health and safety issues in Maine’s fishing industry• child labor used in family-based farming• the revival of herbalism• nutrition• a summary of a conference on the health effects of exposure to odor wastes from large-scale livestock operations• the prevention of farm-related trauma• the role of primary care

Agroterrorism: A Guide for First Responders $8.83 “In many cases, the communities most ill-prepared to deal with . . . terrorism incidents,” Jason B. Moats writes in the introduction to this book, “are the rural communities that provide . . . food and crops.” Having conducted training across the country for first responders in cities, small towns, and rural communities, Moats for the first time gathers here the knowledge gleaned from research and nearly twenty years’ experience in emergency services and emergency training.Whether used in the field or in the classroom, this manual is designed to help rural communities prepare for an act of agroterrorism. It explains why the U.S. agriculture industry is a target for terrorists and how farms and farming communities across the country are vulnerable. The author lists known biological and chemical agents and their effects, explains model systems for supporting emergency response efforts, and lays out proven plans for gathering personnel and other resources in an orderly, coordinated way. In Agroterrorism: A Guide for First Responders, Moats spells out who should do what and when, providing a critically needed path through the bureaucratic maze of state, national, and interagency homeland security directives.With this book, Moats empowers those on the front lines in rural America, those charged with the responsibility of handling emergency crises in agricultural communities. Armed with the information they need, emergency response agencies, emergency managers, public health professionals, veterinary and animal health practitioners, as well as farmers and producers, will be able to answer the questions: “Where do we start?” “What do we do?” “Who is going to do it?” and “How do we pay for it?”Closing with a complete training program that includes practical exercises formatted for easy use, Agroterrorism: A Guide for First Responders contains resources vital for

Air Pollution and Health in Rapidly Developing Countries $9.98 * As many as 1 billion people, mostly women and children, are regularly exposed to indoor air pollution levels exceeding WHO guidelines by up to 100 times* Nearly three-fifths of total global exposure to air pollutants occurs in the rural areas of developing countries. Worldwide, this translates into as many as 3 million deaths a year At every level of economic development, ambient air pollution poses a serious challenge that cannot be left to the private initiative This book addresses issues of particular importance to developing countries where polluting activities have been growing, but local research and preventive and protective measures are still at an early stage. Recent decades have seen considerable advances in the epidemiology of air pollution, changes in the international air pollution guidelines, and the emergence of more systematic approaches to air pollution prevention and control. There is an evident gap in the literature on air pollution and health; this book will fill this gap with a coherent series of chapters commissioned from leading researchers in both the scientific and policy dimensions of air pollution and health.

An analysis of nurse anesthetist retention factors in rural eastern Kentucky. $49.99 Research and the media continue to report on the current and future nurse anesthetist shortage in the United States. As the aging population continues to grow, health care institutions are struggling to solve this health care emergency. A review of the current literature reveals both intrinsic and extrinsic factors of the work milieu as being influential in an organization’s ability to retain nurse anesthetists. The purpose of this study was to explore what nursing career criteria must be met by employers in order to retain nurse anesthetists in the profession. Surveys were distributed to all Certified Registered Nurses Anesthetists (CRNAs) in the Rural Eastern Region of the State of Kentucky to ascertain what employment or employer characteristics or incentives favor nurse anesthetist retention, and which characteristics are viewed as unfavorable, or not important to a nurse anesthetist in deciding to remain with a current employer or to seek employment elsewhere.

An analysis of nurse anesthetist retention factors in rural eastern Kentucky. $49.99 Research and the media continue to report on the current and future nurse anesthetist shortage in the United States. As the aging population continues to grow, health care institutions are struggling to solve this health care emergency. A review of the current literature reveals both intrinsic and extrinsic factors of the work milieu as being influential in an organization’s ability to retain nurse anesthetists. The purpose of this study was to explore what nursing career criteria must be met by employers in order to retain nurse anesthetists in the profession. Surveys were distributed to all Certified Registered Nurses Anesthetists (CRNAs) in the Rural Eastern Region of the State of Kentucky to ascertain what employment or employer characteristics or incentives favor nurse anesthetist retention, and which characteristics are viewed as unfavorable, or not important to a nurse anesthetist in deciding to remain with a current employer or to seek employment elsewhere.

Annual Review of Nursing Research, Volume 26, 2008: Focus on Rural Health $90 From reviews of the previous volume:”This volume should be quite useful to the target audience. It provides a good foundation for evidence-based practice and further research (4 stars).”–Doody’s Book Review ServiceThe nursing community is continually challenged with expanding the empirical knowledge base that informs rural nursing practice. This volume of the prestigious Annual Review of Nursing Research, Focus on Rural Health, addresses this challenge. Contributors have developed creative and effective strategies to identify relevant research and present them in the context of the rural delivery system.Topics include:Nursing Research to Meet Health Care Needs of Rural PopulationsImproving Systems, Quality of Care & Patient SafetyImproving Cultural Relevance of Rural Nursing Research: Methodological Issues, Constraints, and OpportunitiesAlso included: Contents of Previous 10 VolumesThe contributors, all noted nurse scientists, discuss the key problems they deal with on a daily basis, utilizing recent rural and general health policy reports. This approach allows readers to learn new techniques and strategies for rural nursing practice that are firmly grounded in the evidence. While the primary examples are drawn from American contexts, a special chapter on global perspectives highlights analogous problems and issues that rural nursing research raises across countries, particularly the availability of resources.About the EditorsThis volume is edited by Elizabeth Merwin, Associate Dean, Research and the Director of the Rural Health Care Research Center at the University of Virginia School of Nursing. The series editor is Joyce J. Fitzpatrick, who has received numerous honors and awards including the American Journal of Nursing Book of the Year Award 18 times, and is the Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing at Case Western