The socialized system of healthcare delivery and financing, a relic of the British colonial era, still practiced in Sierra Leone has glaringly failed and any efforts at resuscitating it without implementation of major structural and systemic reform will only serve to prolong the inevitable.

Throughout the world, total state control and management of industries, services, markets and the means of production are gradually becoming a relic of the past. This model as practiced in the Sierra Leone healthcare system has empirically been proven to have served only to stifle innovation, growth, productivity and quality output with a resultant decline in overall living and healthcare standards of the citizenry. The current state of the hospitals and health centers glaringly highlights the systemic problems endemic in the entire government owned, managed, financed and operated health care system.

The continued operation of such a decadent and dilapidated delivery and financing system, lacking in even the basics of a modern healthcare infrastructure continues relegating Sierra Leone to the very bottom of the human development index.

The transformation thus of the medical healthcare delivery and financing system into a private insurance or a national insurance based system offers opportunities not only for insurers to develop market-based medical insurance plans and policies but also serves to effectuate the Ministry of Health & Sanitation’s desired policy goals, as espoused in the 2002 National Health Policy Paper.

Both policy and regulatory officials, healthcare providers, the insurance industry and other stakeholders must be engaged to effectuate implementation of fundamental systemic reforms if the country is to avert an even greater catastrophe.

Privatization:

Under the proposed privatization plan, the Ministry of Health & Sanitation will be transformed from ownership and management of hospitals, clinics, and employer of last resort for all physicians, nurses and ancillary healthcare providers into a health agency with only policy and regulatory functions.

The goal will be for the health agency to serve as a policy and regulatory watch dog mandated with ensuring that adequate and quality medical care is provided at the various private hospitals, clinics and pharmacies that will inevitably be established with the break-up of the current government owned facilities.

With the break-up and subsequent purchase or leases of these hospitals, clinics, health centers and other facilities, investors and entrepreneurs in an effort to realize maximum returns on investments, will economically be compelled to upgrade quality and standard of care, introduce state of the art equipment and technologies and engender a type of market forces competition which will inure only to the betterment of health consumers in the country.

A much needed infusion of capital into the health care industry by such a privatization plan will clearly spur additional economic activities in ancillary industries, as the dynamic forces of privatization and market mechanism forces of demand and supply will ensure competition for the healthcare pie.

Divestiture of Government Ownership:

The dismantling of the current mammoth and highly inefficient government owned healthcare delivery and financing entity must from a public policy perspective be designed and restructured to ensure governmental ownership and management divestiture from hospitals and other health care facilities.

Under such a scenario the government’s current enormous but woefully mismanaged capital outlay for health services will be substantially decreased as inefficiencies of corruption, salaries of providers, infrastructure maintenance, costs of medications and diagnostic equipments and other overhead operating costs will no longer be recurrent expenditures from the nation’s depleting coffers.

A system based entirely on a private market-based national health insurance plan with private enterprise and market competition at its core appears the most logical reform policy route to ensure a future sound, efficient and profitable health care infrastructure.

 Health Insurance Plans:

The cog which the proposed new system must revolve around is a nationwide network of affordable health insurance plans creatively designed to ensure a greater pool participation of a majority of the population. In such a system health insurance companies and provider organizations will be established to market various health plans, with minimum services and premiums based on market conditions. The responsibility for monitoring compliance by the various plans would fall under the ambit of both the Ministry of Health and Sanitation and the Sierra Leone Insurance Commission.

Multi-Payer System:

A major plank in this proposed health care delivery and financing privatization hinges on the enactment of health insurance legislation providing for employers to provide health care for their employees and dependants as part of a standard benefits package with concomitant tax incentives and governmental subsidies to ensure compliance. With such legislation the virtual free socialized medical care system, the costs of which have been borne exclusively by the government will now be based on a multi-payer system in which government, employees and employers will all participate.

With the system as currently structured however, only the government has a financial interest and stake and when other programs conflict with the financing of health care, politicians have only been too willing to sacrifice the health of their citizens on he alter of their greed and personal aggrandizement.

It is envisaged that health insurance providers will introduce concepts and plans, such as Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO), through alliances of health providers and insurance companies and marketed to employers, labor unions, governmental ministries and corporations on an annual premium basis.

The competition engendered by such health organizations for the medical insurance pie will subsequently result in competitive rates, coverage, deductibles, co-payments and premiums to make health care costs affordable for all.

The Unemployed:

As unemployment and underemployment are perennial problems in the Sierra Leonean economy, the provision of health care benefits to this category of the population must remain the responsibility of government. Medical services provided to this category of citizens in a private enterprise environment must be reimbursed by the government on a negotiated and pre-determined fee schedule or an insurance mechanism established in which government negotiates with providers and carriers for the provision of services.

As an example a fund established by levying taxes on the private health care providers, envisaged to emerge with such privatization, could be instituted and utilized to pay for these indigent services.

Further, since the hospitals, medical clinics and other medical facilities will be operated as businesses, either for profit or as non-profit organizations, the market forces of demand and supply will certainly ensure that patient quality care, improvements in diagnostic technologies, competent personnel and a general responsiveness to the demands of the clients will drive the new marketplace. The lethargic and inefficient atmosphere witnessed at most government hospitals today with customer service virtually non existent would be a philosophy of the past.

The economic viability of healthcare businesses will depend largely on the clientele they can attract and maintain utilizing the above yardstick. Providers of lousy health care plans and services will inevitably loose business to competitors as every year participants will have an opportunity to change health insurance plans.

Since a large population of Sierra Leone resides in rural areas, the proposed privatization plan will ensure the expansion of health care facilities into areas currently inadequately serviced. This plan will ensure that clinics and doctors put up shop in every part of the country in order to tap into the healthcare services available in these rural areas.

Challenges to Insurance Companies:

Designing an insurance system and plan to cater to the needs of the rural population who often are self employed in farming and mining activities posses a challenge to insurers in Sierra Leone, who in the past have been largely passive and unimaginative in policy design to meet the challenges and risks confronting the nation’s socio-economic landscape.

Proactive and creative underwriting of risks must be undertaking by underwriters, actuaries and marketing specialists to design, tailor and price health insurance coverage to meet the diverse needs of the insuring public. For example, the creation of pools by occupational categories could be one method by which insured’s, engaged in similar trades could be encouraged to form co-operatives for purposes of obtaining health insurance coverage at affordable rates for themselves and dependants. Premium payments through the pooling together of the co-operatives commodities can be an alternative payment method for the medical services. Health insurance companies could possibly establish subsidiary or ancillary companies solely for the handling of payments made by cash crops.

The current system under which nearly all doctors and related health care providers are employed by the government while at the same time owning private practices would be changed with a concomitant government savings on salaries, productivity and other fringe benefits. As privatization takes over in the hospitals, physicians, nurses and other providers will no longer be on the government’s payroll but will rather be independent contractors with their own practices.

Conclusion:

Whilst a micro version of the proposed reform has mushroomed in an ad hoc manner over the years with some large companies and corporations contracting with individual physicians and clinics for the provision of health care to their employees and dependants, the kind of systemic and structural overhaul needed to forestall a total collapse of the system and extend similar services to all could only be realized by a comprehensive approach along lines of reforms proposed in this policy paper.

The socialized system of healthcare delivery and financing, a relic of the British colonial era, still practiced in Sierra Leone has glaringly failed and any efforts at resuscitating it without implementation of major structural and systemic reform will only serve to prolong the inevitable.

Throughout the world, total state control and management of industries, services, markets and the means of production are gradually becoming a relic of the past. This model as practiced in the Sierra Leone healthcare system has empirically been proven to have served only to stifle innovation, growth, productivity and quality output with a resultant decline in overall living and healthcare standards of the citizenry. The current state of the hospitals and health centers glaringly highlights the systemic problems endemic in the entire government owned, managed, financed and operated health care system.

The continued operation of such a decadent and dilapidated delivery and financing system, lacking in even the basics of a modern healthcare infrastructure continues relegating Sierra Leone to the very bottom of the human development index.

The transformation thus of the medical healthcare delivery and financing system into a private insurance or a national insurance based system offers opportunities not only for insurers to develop market-based medical insurance plans and policies but also serves to effectuate the Ministry of Health & Sanitation’s desired policy goals, as espoused in the 2002 National Health Policy Paper.

Both policy and regulatory officials, healthcare providers, the insurance industry and other stakeholders must be engaged to effectuate implementation of fundamental systemic reforms if the country is to avert an even greater catastrophe.

Privatization:

Under the proposed privatization plan, the Ministry of Health & Sanitation will be transformed from ownership and management of hospitals, clinics, and employer of last resort for all physicians, nurses and ancillary healthcare providers into a health agency with only policy and regulatory functions.

The goal will be for the health agency to serve as a policy and regulatory watch dog mandated with ensuring that adequate and quality medical care is provided at the various private hospitals, clinics and pharmacies that will inevitably be established with the break-up of the current government owned facilities.

With the break-up and subsequent purchase or leases of these hospitals, clinics, health centers and other facilities, investors and entrepreneurs in an effort to realize maximum returns on investments, will economically be compelled to upgrade quality and standard of care, introduce state of the art equipment and technologies and engender a type of market forces competition which will inure only to the betterment of health consumers in the country.

A much needed infusion of capital into the health care industry by such a privatization plan will clearly spur additional economic activities in ancillary industries, as the dynamic forces of privatization and market mechanism forces of demand and supply will ensure competition for the healthcare pie.

Divestiture of Government Ownership:

The dismantling of the current mammoth and highly inefficient government owned healthcare delivery and financing entity must from a public policy perspective be designed and restructured to ensure governmental ownership and management divestiture from hospitals and other health care facilities.

Under such a scenario the government’s current enormous but woefully mismanaged capital outlay for health services will be substantially decreased as inefficiencies of corruption, salaries of providers, infrastructure maintenance, costs of medications and diagnostic equipments and other overhead operating costs will no longer be recurrent expenditures from the nation’s depleting coffers.

A system based entirely on a private market-based national health insurance plan with private enterprise and market competition at its core appears the most logical reform policy route to ensure a future sound, efficient and profitable health care infrastructure.

 Health Insurance Plans:

The cog which the proposed new system must revolve around is a nationwide network of affordable health insurance plans creatively designed to ensure a greater pool participation of a majority of the population. In such a system health insurance companies and provider organizations will be established to market various health plans, with minimum services and premiums based on market conditions. The responsibility for monitoring compliance by the various plans would fall under the ambit of both the Ministry of Health and Sanitation and the Sierra Leone Insurance Commission.

Multi-Payer System:

A major plank in this proposed health care delivery and financing privatization hinges on the enactment of health insurance legislation providing for employers to provide health care for their employees and dependants as part of a standard benefits package with concomitant tax incentives and governmental subsidies to ensure compliance. With such legislation the virtual free socialized medical care system, the costs of which have been borne exclusively by the government will now be based on a multi-payer system in which government, employees and employers will all participate.

With the system as currently structured however, only the government has a financial interest and stake and when other programs conflict with the financing of health care, politicians have only been too willing to sacrifice the health of their citizens on he alter of their greed and personal aggrandizement.

It is envisaged that health insurance providers will introduce concepts and plans, such as Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO), through alliances of health providers and insurance companies and marketed to employers, labor unions, governmental ministries and corporations on an annual premium basis.

The competition engendered by such health organizations for the medical insurance pie will subsequently result in competitive rates, coverage, deductibles, co-payments and premiums to make health care costs affordable for all.

The Unemployed:

As unemployment and underemployment are perennial problems in the Sierra Leonean economy, the provision of health care benefits to this category of the population must remain the responsibility of government. Medical services provided to this category of citizens in a private enterprise environment must be reimbursed by the government on a negotiated and pre-determined fee schedule or an insurance mechanism established in which government negotiates with providers and carriers for the provision of services.

As an example a fund established by levying taxes on the private health care providers, envisaged to emerge with such privatization, could be instituted and utilized to pay for these indigent services.

Further, since the hospitals, medical clinics and other medical facilities will be operated as businesses, either for profit or as non-profit organizations, the market forces of demand and supply will certainly ensure that patient quality care, improvements in diagnostic technologies, competent personnel and a general responsiveness to the demands of the clients will drive the new marketplace. The lethargic and inefficient atmosphere witnessed at most government hospitals today with customer service virtually non existent would be a philosophy of the past.

The economic viability of healthcare businesses will depend largely on the clientele they can attract and maintain utilizing the above yardstick. Providers of lousy health care plans and services will inevitably loose business to competitors as every year participants will have an opportunity to change health insurance plans.

Since a large population of Sierra Leone resides in rural areas, the proposed privatization plan will ensure the expansion of health care facilities into areas currently inadequately serviced. This plan will ensure that clinics and doctors put up shop in every part of the country in order to tap into the healthcare services available in these rural areas.

Challenges to Insurance Companies:

Designing an insurance system and plan to cater to the needs of the rural population who often are self employed in farming and mining activities posses a challenge to insurers in Sierra Leone, who in the past have been largely passive and unimaginative in policy design to meet the challenges and risks confronting the nation’s socio-economic landscape.

Proactive and creative underwriting of risks must be undertaking by underwriters, actuaries and marketing specialists to design, tailor and price health insurance coverage to meet the diverse needs of the insuring public. For example, the creation of pools by occupational categories could be one method by which insured’s, engaged in similar trades could be encouraged to form co-operatives for purposes of obtaining health insurance coverage at affordable rates for themselves and dependants. Premium payments through the pooling together of the co-operatives commodities can be an alternative payment method for the medical services. Health insurance companies could possibly establish subsidiary or ancillary companies solely for the handling of payments made by cash crops.

The current system under which nearly all doctors and related health care providers are employed by the government while at the same time owning private practices would be changed with a concomitant government savings on salaries, productivity and other fringe benefits. As privatization takes over in the hospitals, physicians, nurses and other providers will no longer be on the government’s payroll but will rather be independent contractors with their own practices.

Conclusion:

Whilst a micro version of the proposed reform has mushroomed in an ad hoc manner over the years with some large companies and corporations contracting with individual physicians and clinics for the provision of health care to their employees and dependants, the kind of systemic and structural overhaul needed to forestall a total collapse of the system and extend similar services to all could only be realized by a comprehensive approach along lines of reforms proposed in this policy paper.

Public Health is the science and art of preventing disease, prolonging life and promoting  health through the organized efforts and informed choices of society, organizations, public and private communities and individuals. However, as individuals we must take an active role in maintaining our health by leading healthy lifestyles and making sure that we are using proper nutrition daily. Nutrition is the science that studies how people eat and how eating affects their health and performance. This includes foods or food components that cause diseases or deteriorate health such as eating too many calories. This is a major contributing factor to obesity, diabetes and heart disease. Personal health depends partially on the social structure of one’s life. Healthy eating is a choice but not much of a choice for those who simply lack the knowledge, awareness and clear understanding about healthy cooking. Health is a positive concept emphasizing social and personal resources as well as physical capacities. Health represents the amount of damage a character can take before death.Healthy people should have the right to boost their brains with pills, supplements, herbs and vitamins like those prescribed for hyperactive kids or memory-impaired older folks.  Health care is the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical, nursing, and allied health professions.Health research builds primarily on the basic sciences of biology, chemistry, and physics as well as a variety of multidisciplinary fields, i.e. medical sociology.  Health care is further the prevention, treatment, and management of illness and the preservation of health through the services offered by the medical, dental, nursing, and allied health professions.  Health care embraces all the goods and services designed to promote health, including preventive, curative and palliative interventions, whether directed to individuals or to populations.  Health care in Venezuela is probably the most extensive and given the country’s fortunes in oil wealth, expenditure has recently increased greatly, starting with mass vaccinations under the Plan Bolivar 2000. While health care in Africa is usually non existent or highly limited and under resourced.  Here in the United States health inspectors are conducting fewer inspections of nursing homes, restaurants and adult day care sites because of budget constraints and the inability to train and keep inspectors and officials. For this reason it is imperative that you take control of your health care issues and become active in resolving them.Health system problems aggravated a cholera outbreak in Zimbabwe 10 December 2008 — A widespread cholera outbreak and inadequate access to safe drinking water and hygiene are threatening the well being of thousands of Zimbabweans.  Because of the on-going importance of health — customers are never more than a single click away from ordering products online and referring their friends and associates who are ready to join a membership program.  Customers spread around the world can be attracted by a health business and take notice. You will see that other people will also be interested in marketing a vitamin or natural health business by noticing that others will easily sign up underneath you.  Online store owners, entrepreneurs and small businesses who e-sell their own products find that they have money rolling into their accounts in no time soon after taking action because shoppers readily kick into high-gear.  There are many resources to help you and your family stay healthy. Products classified as dietary supplements are not required to meet any Food and Drug Administration standards which makes it easy to promote a natural health business.  Making extra income can’t get much easier in the booming health industry especially when you don’t have to look after any products or logistics. Health and wellness spending is continuing as companies seek new marketing channels for their advertisements and employers look to control healthcare spending.

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

Funny thing pain, if you’ve never had a severe pain then the suggestion of taking simple analgesia and resting the affected area all seems quite reasonable. I was reminded of this when I read recently of a doctor’s advice to someone who was suffering from sciatica. Having personally experienced sciatica, it’s a condition I would not recommend to anyone who wishes to walk, sit, laugh, sleep, or to just simply pull up your trousers. It’s a bit like a dentist drilling your teeth without an anaesthetic, but it affects your whole leg. In other words the pain is consuming, exhausting and without respite. Clinical studies do show that in the majority of cases the pain will eventually subside and surgery may not be necessary, but in the meantime the patient has to deal with the pain or deal with the medication required to dull the pain. Remember, pain-killers are not selective to the area affected. They affect the whole of the nervous system and elsewhere so there may be significant side-effects from these medications.

Dealing with severe pain can be a complex issue, but I suggest that you have to treat this sort of pain fairly aggressively as acute severe pain is relatively easier to treat than chronic severe pain. In the early stages of an injury or insult to an area of the body, most of the pathological processes are happening at the site of the injury or insult. Throughout time the brain begins to modulate this pain and so no only do you have the injured area to deal with, but you also have complex neural pathways within the brain to deal with as well. This often means a far more complex management plan and a far more protracted recovery time. Specialists are very skilled at dealing with these issues but they do rely heavily on the stories their patients give them. That means being honest in answering their questions and not being heroic with a grin and bear it grimace! Often the use of a pain scale is helpful with zero being no pain at all and a 10 being the worse pain you have ever experienced.

Another health issue we commonly down play is influenza. Over the years I have frequently heard people say that they would not have the flu vaccine because either they never get the flu or that they had it last week for a couple of days and then it was all over! Influenza is a serious debilitating disease that will usually last from 10 days to two weeks and often leave you flat on your back exhausted. It’s not a happy 10 days either as patients do not have the energy to read a magazine or even watch a DVD. You will literally feel ancient with every movement being a real challenge and that doesn’t include the aching all over or the fevers and sleepless nights. The influenza virus is also extremely contagious and most people are unaware that if you spread it to someone who is more frail than yourself that you may actually be putting their life at risk.

With the ‘flu the big challenge is to vaccinate as many people in the community as possible, including children, those employed and unemployed, the elderly and the infirm, to reduce the chance of an epidemic occurring. Recent research has also showed that vaccinating pregnant women in the last trimester of their pregnancy will help protect their new born infants born during the ‘flu season.

Medicine has evolved over the last 40 years, but the change has been fairly slow with doctors by nature being very cautious and conservative people. But we can’t leave the doctors to take all the initiatives. As patients we need to be good listeners in our approach to health by heeding all the great health messages that keep being given to us about vaccinations, smoking, alcohol, exercise and healthy eating. We also need to be good communicators and tell our doctors how we are feeling with conditions such as pain. If the team treating you doesn’t have the best information then it may be that you will not end up getting the best treatment!