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Friday, November 23, 2012

Article of Ghooi sir www.ehospice.com

Ghooi sir has written an article for www.ehospice.com. The original link of the article can be found here - http://www.ehospice.com/ArticlesList/CancerPainandMorphineinIndia/tabid/3471/ArticleId/1894/language/en-GB/View.aspx#.UK8yZeQ3uGN

I am reposting the article here.


Cancer, Pain and Morphine in India

Author: Professor Ravindra Ghooi (Ph. D)
23 November 2012
  • Image: Ingimage
    Image: Ingimage
Image: Ingimage
Professor Ravindra Ghooi (B., Ph. D) is Professor of Drug Discovery and Clinical Research at the Symbiosis School of Biomedical Sciences, Symbiosis International University, Lavale, India. Prof Ghooi writes for ehospice, recounting his personal experiences of facing cancer pain with those closest to him, and documenting the process of lobbying the Indian government for equal and adequate access to pain medication for all Indians. 
The diagnosis of cancer in a member of the family severely affects all the members. In addition to limiting the life of the affected member, it drastically alters the life of others. And it reminds the rest of their mortality. It is easier to accept another person’s imminent death than our own. That man is mortal is an undeniable fact, but most ignore it and feel that they are an exception.
Cancer is a life modifying disorder; it reduces both the quality and quantity of life. When it first attacked my family, it left us shattered. When it hit us again, we were no better prepared. My mother was diagnosed with breast cancer 16 years ago. She was physically not the best case for aggressive therapy, and she opted for palliation. Palliative care, then, was in its infancy in India and effective pain killers like opiates unavailable.
Pain is among the most common complaints of cancer patients and its incidence is reported to between 50 and 80 percent. Most studies have demonstrated that morphine is the best and the cheapest drug for the treatment of cancer pain. It is also a part of the WHO pain control ladder. It’s supply, sadly, has been severely curtailed in India since the passing of the Narcotic Drugs and Psychotropic Substances Act, (NDPS) in 1985. The Act was passed in order to stop trafficking and abuse of drugs. Instead it reduced the medical supply of morphine.
With over 2.5 million patients of cancer living at any given time in India, there is a large requirement of morphine. Our requirement is to the order of 2500 to 3000 kg of morphine annually. But what is available is a mere tenth of that. When my mother’s cancer was detected, we had no access to morphine to treat her pain. Many oncologists and palliative experts we met, told us that the laws in the country needed to be changed to get morphine for our mother. How do you get the government to change laws? A humongous task.  
The government of India comprises three branches: the executive headed by the President, the legislative– represented by the two houses of the parliament, and the judiciary headed by the Supreme Court. India is the largest democracy in the world. Unfortunately, the common man has little faith in the executive or legislative branches. Experience has shown that if changes have to be brought about, then the judiciary is the best option.  We chose to put our fate in its hands and approached the Delhi High Court in 1998. We requested the court to make morphine available to patients in need of it.
The judicial process in India is slow, often petitioners die before the court gives a judgement. In fact our mother died before the hearings of the case began. Yet our fight for morphine showed us the better side of the bureaucracy and judiciary. Officers we met were sympathetic and helpful.  Court procedures were fast and the High Court passed an order in 10 months after our filing a Public Interest Litigation in the court. It directed the Central and state governments to modify the rules to provide access to pain killers to patients in need.
Under the NDPS, the cultivation of poppy, collection of opium and manufacture of morphine is controlled by the central government. The sale and distribution of morphine is controlled by the state governments. The response of the central government to Delhi High Court’s orders was swift, but the state governments were extremely slow in reacting. By 2006, only about 8 states (India has 28 states and 7 Union territories) modified the rules, relaxing the requirements for supplying morphine to patients. Kerala led at the forefront by making palliative care available in every part of the state. Today India has 233 palliative care centres of which 193 are in Kerala.
This led to a curious situation; a patient in Kerala would have access to morphine, but one in UP or Bihar (where the rules remain unchanged) would not. Both, citizens of the same country, were treated unequally in the eyes of the law, which violates the fundamental rights granted to all Indians under article 14 of our constitution. All Indians must get equal protection of the law, but here is an instance of a state law coming in the way of equality of our citizens.
On this basis we approached the Supreme Court of India in 2007. Our petition was admitted in 2007, but the first hearing took place only in 2010, and it is now being heard by a bench of this Court on a more regular basis. We know not how many of our citizens will die horrible painful deaths before the Supreme Court gives its judgement. In our case, we were just lucky, our mother was one among the few patients of cancer who did not suffer any pain and required no morphine. She passed away in a relative painless way, but there are many mothers in India whose children just don’t have the wherewithal to put up a fight with the government.
An ordinary citizen, or even an organization like the Indian Association of Palliative Care (who are the main petitioners in the case in the Supreme Court) is too small and too weak to fight the government. The petitioners (those of us asking for change in laws) in this case have three lawyers representing them. While for the respondent governments there are 97 lawyers arguing their side in the court. The individual petitioners do not have the resources to go to Delhi for every hearing, but 97 lawyers are probably flying to Delhi for every hearing, at the tax payers’ expense.
Despite all this, it gladdens me to know that I was a small cog in the wheel of the fight for morphine for cancer patients. When I filed the PIL in Delhi High Court, little did I know that morphine would once again touch my life. In 2010 my wife and co-author of our paper, was diagnosed with pancreatic cancer. The day the diagnosis of cancer came in, it broke me. The experience of living through my mother’s malignancy did not cushion the shock.
The median survival in pancreatic cancer is 3 months, and a 5 year survival rate is less than 5%. That meant we were racing against time. There were a few optimists who insisted on seeking opinion after opinions. After four opinions from the best in the field I put a stop to it. I chose to go by the advice of a senior physician that accepting the inevitable is not cowardice.
The surgeons had concluded that the lesion was inoperable and that chemotherapy would do no good. The surgeon summed up his recommendation in a single word ‘Palliate’. Maharashtra, the state where I now reside, was one of the few states to simplify the rules for morphine availability. The Pharmaceutical Company Cipla has been operating a Palliative Care and Training Center in Pune, the city where I live. I am ever grateful to the Cipla and the government of Maharashtra for allowing easier access to opiates for patients such as my wife.
There are stories of people who have conquered this disease– but many have not. These are the statistical outliers, who defy all odds and survive. One can’t base ones judgement on these cases. Rational judgement must be based on those cases which lie near the median of the series. In pancreatic and many other cancers the median survival is very poor, instead of trying Heroic Medicine, palliative therapy would provide more comfort to the patient.
A friend, on being diagnosed with cancer remarked “So I am on a one way ticket!” This talk took place about 18 years ago. I haven’t forgotten it. His words come back to me, again and again.  Recently when I gave it a deep thought, I realized that life itself is a one way ticket! The journey from the cradle ends only in the grave. Some travel faster and some slower. Some have a good journey while others may not. The time enjoyed in this journey depends on our attitude and that of our fellow passengers. If during this journey we can help a fellow passenger, bear his or her burden with ease, then the journey is successful.

Wednesday, October 31, 2012

PH207x

That is a course from Harvard University. The name of the course is - Health in numbers - Quantitative methods in clinical and public health research. We are learning two main subjects which we are learning over here. Bio-statistics by Prof. Marcello Pegano and Epidemiology by Earl Francis Cook. This course is a totally online course and it has started on 15th October 2012 and will end in Jan 2013. It is 12 weeks course. One will have to submit their weekly homework based on the lectures (video lectures) and will have to give and exam at the end of the course in Jan 2013. One will be able to get the certificate if he / she successfully completes the course. This course is absolutely free of cost and you can pursue this course from anywhere in the world.

This is the BEST course I have came across. I am enjoying it like anything. Will keep posting about this course in future as well.

Tuesday, September 4, 2012

Teacher

Pain as a teacher - Pain is a great teacher. Whenever we get pain, we should carefully listen to what it is saying to us. In haste we many a times miss what it has to say to us. If we will listen to it and will try to learn what it wants to teach us, our life will become easier. 

Importance of teacher - Teacher is an integral part of educational process. In Indian culture it is referred as 'Guru'. The role of teacher varies to a great extent depending on the subject to be taught and the students who are learning. A real teacher creates life long impression on the life of student. And then the student who follows those values becomes teacher one day. But becoming a teacher is a natural process and not an artificial one. Osho says that becoming Guru cannot be the aim! It is when others try to follow a person and then the person is called as Guru. We can always strive to be a good student, it is up to people if they want to follow us and want to refer to us as Guru.

Importance of student - As we cannot decide to be a teacher, we can try to become a good student. There is one more reason to strive to be a good student. And that is - many a times we cannot find a real teacher! A real teacher takes birth after many years and is difficult to find out. It may happen that we will loose much of our life time finding him. Access to a real teacher may be difficult. Though we will get access to him / her it is a big process to take knowledge from him and then applying it in life! As becoming a good student is in our hand, we should focus on that. 

Books as a teacher - In this process of becoming a good student, books prove to be a great teacher. I may not be able to see Mahatma Gandi or Veer Savarkar by my own eyes, but with help of books, I can understand their thoughts. I can listen to their voice and I can see their mighty acts! I can read the intense love for motherland in the life of Bhagat Sing. I can feel the pain of homeless Afagani Children in books and so on...... I can live many lives in such a way with the help of books. Hence books are a great teacher. Reading requires simple skills but it gives us treasure of emotions and wisdom in the world. 

Come... Let's try to be good students!

Saturday, August 18, 2012

Research in Ayurveda

Research in Ayurveda is the need of time I feel. It is dire need of today's world. At one side many diseases are there in the society and on the other hand many of the diseases are finding good care with the help of Ayurveda. But the problem is - lack of documentation in Ayurveda. Actually there are many problems but let us have a look at it one by one.

Documentation:
Documentation is extremely needed in Ayurveda. In clinical research it is said that "If you do it and if you do not document it, it is not done!" Such is higher level of evidence that is needed in a clinical trial to establish a point. In Ayurveda, there are many texts which have documented many observations and many Ayurvedic practitioners use it in their practice. But the problem is of validation. The texts which are written are being followed and some of the treatments get good results. It will be highly beneficial if we can validate this data.

Measurement: 
"How to measure?" is a favorite question of Dr. Abhay Bang. This question will come in mind when one will start doing research in Ayurveda. Lack of standardization is one more thing which needs to be addressed.

Language:
"Statistics is the grammar of science" - Karl Pearson 

Tuesday, July 31, 2012

Vapula

Vapula is a nice programme by Shabdagandhar in which some parts of books of va pu kale and pu la deshpande are read. It is a nice programme and makes you serious as well as laugh.

Monday, July 16, 2012

Kataraj Sinhagad trek on 15 July 2012

We were on a trek of Katraj - Sinhagad on day before yesterday. My body is still aching but I feel great when I remember that I did this trek.

I am now realizing that the trek is not limited to trek... It is something more. You use lot of energy and at the same time you gain lot of energy in it. You push your limits in this process and then you can repeat it in your respective fields of work. This is a process where you learn to push your boundaries.

Trupti and Pradnya decided about this trek and this trek was possible because of them. They planned for this. Swapnil also took it seriously. There were 10 people in the trek - Pradnya, Trupti, Swapnil, Prasad, myself, Santosh sir (sir of Trupti), Indrajit (Swapnil and Prasad's cousin), Techchand, Ashutosh (Trupti's gym instructor) and Rahul.

We gathered at Swargate ST stand. (I think this is because of Trupti's patent sentence: Vat pahin pan ST nech jain :P). We had breakfast there and then moved to Katraj by bus. At Katraj we took a jeep which dropped us at old Katraj Tunnel. I had done this trek one month back so I was knowing the route. We started our trek at around 8.30am.

Here are some of the snapshots in my memory.


Bhajji 
Some people (names not be disclosed) had to eat bhajji at sinhagad so we went on sinhagad as well. We were in a different mentality when we were going for bhajji. Everybody was tired and was thinking as when sinhagad will come. Traffic was jam near sinhagad so we were going slowly. Finally we reached there and we were talking as if we were drunk!. We were really exhausted. We were not able to understand as what we are talking and every sentence had to be repeated 2-3 times to make us understand it.  But it was enjoyable experience. We finally had bhajji, had  a photo session along with Sinhagad tower and we started returning back.

We are 10 in Number. 
We waited for some time at Sinhagad for six sitters or jeep to come, but we soon realized that there is lot of crowd and it will be difficult for us to go. So we started walking by road. We had decided to stop jeeps and board into it. Whenever we use to see a jeep going up - we use to stop it by coming in front of it and use to shout as - we are 10 in number. :P It was interesting game for us. Still 2-3 jeepwala refused to stop. Dont know why. And finally one jeep came. The drive did not believe us in the beginning as though we were saying that we are 10, only 3 of us were ahead. So he went ahead. And when people who were back also told him the same thing, then he realized that we are really 10. And finally he stopped. We all were so happy that we boarded the jeep as soon as it stopped. And then every one was smiling.

Pyare lal 
This was new term coined by us and mainly by Swapnil. Swapnil found out a trick by which climbing efforts are reduced on hill. He use to come by side of the hill when others use to come by climbing it. Naturally he had to use less efforts to go to next hill compared to people who use to climb and then get down. When asked about why he is coming by the side of the hill, he did not reveal this secret, instead he told us that you keep on climbing, I am coming by a parallel road. We did not understand the meaning in the beginning but then slowly we understood the trick. So now everyone was trying to go by parallel road. While doing so, we missed the road two times. Finally the word parallel was twisted and it became Pyare Lal. When we lost the road, we started reminding us that this situation is because of - Pyare lal

We lost the routes 2 times 
In pursuit of Pyare lal, we lost our track once. Everyone started going to a wrong road. We ended up going on a difficult road where there were valley and jungle. We were thinking as something is wrong but we were not able to spot it. Finally some sheperds told us that we has lost the path and guided us to the proper road. The structure of the hills is such that anyone can loose the track of it.

Even after this incident some of us were not demotivated for parallel road. So when we got a chance, we started using it. I, Santosh sir and Rahul were very much fond of parallel road. So we went by it. And we succeeded at it once. So we decided to follow it again and we got trapped. We started going from a very long road. Then again we climbed a bit and got to know that we were about to loose our track. We called the other team which was climbing the hill. Located our-self in their context and decided to meet at a point. Finally we were able to see them and then we felt better.

The steep mountain after the valley 
After the valley there is a steep hill. There is a nice view at the top of the hill and there are 2 stones put beautifully there, but climbing that hill really exhausts. We climbed the hill and just sat at the top. I sat with Techchand in shadow of a bush and we were not in a mood to stand or walk again. Swapnil came there to have water from us and he was also about to sit there. Pradnya cheered us to walk to finish the trek sooner. At that time we started getting up but Swapnil was not in a mood to walk. Pradnya was explaining us like a child as why it is important to start walking earlier.

Final bus 
Finally we were waiting for the bus at Atkarwadi. And a bus came. Within no time it got filled. It was a treat to eyes to see how it got filled within no time. But that means we wont be able to go though this bus. We were looking around to see other friends and to make sure that no one has climbed the bus. Suddenly Rahul started shouting that there is no bus till 2 hours after this bus. (Actually there was a bus nearly after one hour or so) And because of this shouting many people who were thinking otherwise started boarding the bus and bus was full upto its highest limit. I wondered about it and saw towards him and asked him that then why we are not boarding if it is true. He said in low voice to me that he is using this trick so that many people will go by this bus and next bus will be vacant. Then I also started saying the same thing that no bus till two hours  and as Trupti was unaware of this, she came to us and asked the same question to us as then why we are not going in this bus! I told her the reason and we all started laughing.

Tuesday, May 8, 2012

Prof. Narendra Naidu

This is a post to give information about Naidu sir. I was surfing on net and I found that there is no information about Naidu sir on net. I do feel that many people should know about him so am writing the information about him. Now I am writing only preliminary information. As time will permit, I will add more information.


Professor Narendra Naidu is a teacher of zoology from Modern College, Shivajinagar, Pune.
There are so many things about him to write that I am not able to decide what to write and from where to start.
Swami Vivekananda is his weak point (to describe in his own words). His other weak points include Baba Amte and Chinmay Mission.