Keynote Address at STF Meeting in Kannur Medical College

Keynote Address

 STF Meeting on 10/03/2011 at Kannur Medical College.

Respected Chief Guest, STF Chairman, members, faculty and students,

It is indeed a pleasure to be here to attend the STF meeting..I am thankful to the state task force for considering me for this key note address. I want to emphasis the point that I always endorse RNTCP and whenever possible propagate its message.

Today in India RNTCP is a lifestyle. At least for the thousands of health workers involved in this programme, it indeed is a life style. We fought hard for one and a half decades to cover the whole country, to save millions of life, to reduce poverty and to alleviate sufferings. Now we know that all the 662 districts in the country are covered by RNPCP.

I enjoyed my stint at RNTCP. I had good support from STO’s office, by all medical colleges,DTOs, WHO consultants and workers. The staff of RNTCP unit was an enigma to me at that time. With negligible help from most of the departments the few workers of RNTCP showed immense potential and an untiring resolve which really was a motivating factor for me. The extraordinary commitment and dedication shown by the programme’s large contingent of NGO workers, who work with the patients to make DOTS services available and accessible even in the most remote corners of India is an extraordinary feat.

I thought that the doctors were a little hesitant to accept DOTS. There were many doubts, most of them irrelevant and baseless. Private practitioners were more suspect.

. I felt that those who are criticizing DOTS are those who are not practicing it. It is very simple, involve in the programme, start practicing and then try to find out the defects. Programme is flexible and any genuine doubts can be addressed. For that all of us especially doctors should believe that DOTS strategy is cost-effective and is today the international standard for TB control programmes. To date, more than 180 countries are implementing the DOTS strategy. RNTCP has consistently achieved treatment success rate of more than 85%, and case detection close to the global target.

It is important that to maintain the success there should be committed workers. Job satisfaction and job stress are two important parameters which decide the motivational level of these workers. I have tried my level best to focus on these parameters during my tenure. Each stratum of workers needs different scale to assess their motivational level and different strategy to improve that. When I look back I feel that I had fairly an easy journey and I particularly remember my colleagues who earnestly put in their effort to make my life easier.

In 2009, the Programme reached the key milestone of 70% case detection and 85% cure of new smear positive patients. This milestone was reached by the concerted hard work of thousands of committed TB workers both within and outside government system, and they deserve hearty congratulations. The ultimate goal of the programme remains a “TB-free India”, with reduction of TB burden till it is no longer a major public health problem in India. From 2010, the programme will seek to achieve universal access of TB care for all. This means early and complete detection of all TB cases. All health providers who undertake evaluation and treatment of a patient with tuberculosis must recognize that they

are assuming an important public health function that entails a high level of responsibility to the community, as well as to the individual patient. Hence the need of a strong public private partnership in TB controls efforts.

TB control efforts in the last decade in the country have been tremendous and the achievements of RNTCP make us, quite correctly, very proud. Of paramount importance is the sustained political and administrative commitment to the cause of TB control, quality supervision and monitoring of the programme at all levels and effective partnerships with other sectors including NGOs, private sector health providers, patients and community.

While maintaining the current status, the prime task for the next decade is to achieve the

Millennium Development Goals (MDGs) and related Stop TB Partnership targets for TB control. Meeting these targets requires a coherent strategy that enables existing achievements to be sustained, effectively addresses the remaining constraints and challenges, and underpins efforts to strengthen health systems, alleviate poverty and advance human rights.

RNTCP is essential in order to maintain the international standards for the management of TB cases. It is necessary that professional bodies endorse the International Standards for TB Care (ISTC) and pledge that all health care providers shall give care to their TB patients as per these Standards. The Indian medical practitioner community should commit to provide the best possible care in managing patients with tuberculosis, in accordance with international guidelines and standards and ensure rational use of first and second line anti-TB drugs.

RNTCP is building partnerships with civil society organisations and other sectors to reach out to larger sections of society through them. In addition, the MDR-TB management needs to be scaled up under the RNTCP DOTS PLUS strategy while promoting rational use of second line anti- TB drugs in the country. An important component of this is the scaling up of laboratory capacity to diagnose MDR-TB. In the longer term, the success of new diagnostics, drugs and vaccine, currently under research and development, will determine the pace of TB control efforts globally and in India.

New Initiatives and Future Plans

1.Role of Medical Colleges in RNTCP Training

In India, out of the 286 medical colleges as on 30^th October 2009, 273 medical colleges are involved (formation of core committee, DMC and DOT Center) under RNTCP’. State OR Committees have also been constituted under the STF of each state in most of the states to facilitate, process and refer the selected OR proposals from various medical colleges in the state to the Zonal or Committee. STF in Kerala is one of the best state units and all medical colleges in the state are enrolled. Every three months STF meeting is held in one4 of the medical colleges and review the programme for the quarter.This gives an opportunity to analyse the strength and weaknesses and to plan for the future. Kerala also has two DOTS PLUS sites and is achieving good outcome in managing MDR TB.

  2. Co-ordination of TB-related and HIV/AIDS Training with the National               AIDS Control Organization.

This is another area where RNTCP has shown good progress especially in identifying and treating tuberculosis among HIV infected. There is a reasonably well managed network for coordinating the activities of DMC and ART clinic.

  3. Managing Information for Action (MIFA)

  4. Training in Advocacy, Communication and social Mobilization

ACSM is an important component of RNTCP. ACSM strategy has carefully addressed the communication needs and interventions as per the programme objectives. Prior to 2006 (before achieving full coverage of the country under DOTS), focus of ACSM was as per the implementation status of DOTS in the states. It focused on restricted use of mass media, however, decentralized planning and implementation has been central to all ACSM initiatives.

The goal of ACSM is to support TB control efforts for:

• Improving case detection and treatment
• Adherence.
• Widening the reach of services
• Combating stigma and discrimination.
• Empowering people affected by TB,
• Mobilizing political commitment and resources for TB.

        5. Practical Approach to Lung Health (PAL)

This is a comprehensive plan to prepare treatment protocols for common respiratory illnesses and to make available mostly used drugs in all peripheral health institutions. This will standardize treatment at national level at the same time provide free and comprehensive health care to all needy persons across the country.

        6. Engage all Health Care providers

This is another area of focus where in all health care providers are bought under single umbrella and to entrust them with public health activities including TB control

        7. IMPAC t –Indian Medical Professional Association Coalition against TB

This enables all professional associations to endorse health programmes like RNTCP so that the members of the body can work together to achieve the desired outcome.

        8. Enable and Promote operational Research

For the future of health system we need quality research, both epidemiological as well as clinical. It is our duty to find out operational research areas and involve in quality research.We need to formulate newer and rapid diagnostic methods, newer drugs and treatment protocols.

            Dear friends, it is our duty to see that RNTCP and DOTS are practiced by all doctors, both in Governmental and corporate levels. We use this opportunity to pledge our commitment to TB control activities in the country.

Thanking You, Good bye.

Inaugural speech

CME in Obstetrics & Gynaecology

05/03/2011

Respected chairperson, faculty members and dear delegates,

I am extremely delighted to be with you today for the inauguration of this CME. I am happy that you have organized a wonderful CME on complimentary topics which probably students may not be exposed to, even though they have to study those things.

I am wondering how you are managing these academic activities. A hospital attending to24000 normal deliveries per year  and almost 25-30% of this figure in the form of caesarian sections, it really is a herculian task. It is not that easy to find time for classes and discussions. But being an academic institution we have to. With proper planning and time management you can do it, I am sure.

The science and art of providing quality health care to women has made tremendous strides in recent years. In the subspecialties

of Obstetrics and Gynaecology, recent advances in laboratory techniques and in clinical diagnostic, surgical and laparoscopic skills have improved the prevention and early detection of disease. New frontiers have been established in Maternal Fetal Medicine, Reproductive Medicine and Gynaecological Oncology. Maternal request for elective Caesarean delivery is always a clinician dilemma. The litiginous nature of our society has resulted in record indemnity subscriptions by Obstetricians and Gynaecologists. It is time to ponder on the absurd situation in which the Obstetrician is placed when deciding on a patient’s request for an elective Caesarean delivery for non-medical reasons. Another Obstetric issue that constantly perplexes clinicians is the issue of which test to use to screen for chromosome abnormalities in pregnancy. The plethora of tests, both ultrasound and biochemical, that can be used in the first and second trimesters of pregnancy are clearly evaluated. Another much debated area is cervical cancer screening which has been shown to decrease the incidence of invasive cervical cancer.

Another point to mention here is the lack of an advanced unit for managing infertility. I understand that this subspecialty has grown much faster than any area of Gynaecology. With so many accomplished clinicians we could not establish a modern infertility clinic. I am not ignoring the contributions of individuals in this field. But the next aim of this department should be to establish a laparoscopy unit and infertility clinic. I am sure you can do that and that will definitely bring more glamour to the Dept.