RAKSHA: March 2009

28 March, 2009

The male foreskin is dangerous- Circumcision protects .

Health information politicized

Doesn't the public have the right to know that male circumcision protects against HIV?

In 2007, the ethical landscape surrounding medical male circumcision (MC) suddenly lurched and shifted when the World Health Organization and UNAIDS declared unequivocally that the `efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt.The male foreskin has been shown to have a high number of cells that were targeted by the HIV virus

Interestingly, evidence that MC had medical benefits has been mounting for more than 20 years. Not only does the procedure reduce the risk of HIV infection, it also has been shown to prevent urinary tract infections, sexually transmitted diseases, and penile and prostate cancers.

Researchers have even found that MC reduces the risk of cervical cancer in current female partners . In spite of that growing list of medical benefits, the issue has hovered just below the radar screen until several large randomised controlled studies from Africa showed that circumcision offered a 60% to 70% protective effect against the heterosexual acquisition of HIV. The evidence was so compelling that three of the studies were stopped early, on the recommendation of Data Safety and Monitoring Boards

The Government of India has been reluctant to approach an issue that promises to be controversial among conservative Hindus. MC is considered a marker of religious identity since Muslims routinely circumcise their male children, and Hindus do not. It has been suggested that at times, circumcision status may even have been used to identify people`s religious affiliation during communal riots. Popular wisdom holds that even the mention of MC in some communities will trigger sectarian violence. Predictably, some opponents have argued that the greater good of society must be protected by withholding information about MC from the population.

This is a joke, surely?

They wont tell the benefits of circumcision because they want to use it to identify Muslims?

The benefits of circumcision include:

• Decrease in physical problems involving a tight foreskin [Ohjimi et al., 1995].

• Lower incidence of inflammation of the head of the penis [Escala & Rickwood, 1989; Fakjian et al., 1990; Edwards, 1996].

• Reduced urinary tract infections.

• Fewer problems with erections, especially at puberty.

• Decrease in certain sexually transmitted infections (STIs) such as HIV, HPV, genital herpes, syphilis and other micro-organisms in men and their partner(s).

• Almost complete elimination of invasive penile cancer.

• Decrease in urological problems generally.

Other proofs of advantages of circumcision

Removal of the foreskin of the penis (male circumcision, MC, C) is known to significantly reduce female-to-male HIV transmission through sex, which then decreases male-to-female transmission. Three recent randomized controlled studies from Africa have shown that circumcision offers a 60% to 70% protective effect against heterosexual acquisition of HIV. The protective effect of circumcision against HIV, known since the 1980s, has been confirmed by more than 30 studies before these three famous randomized controlled trials, which are the criterion standard of clinical research.

09 March, 2009

-Distance education in Medical and paramedical sciences

Image by interplast via Flickr

In a developing country such as India, where an optimal level of health service is a dream to many, there are far too few health workers in training and the number of training institutions is far too few. To understand the gravity of the situation, ther r r re are more than 365,000 doctors, 264,000 nurses and 350,000 allied health professionals which includes Multipurpose Health Workers, Village Health Guide, etc. Whereas, proper training facilities exist only at a few institutions like National Institute of Health and Family Welfare (NIHFW), State Health and Family Welfare Training Centers. With a limited number of available training institutions, it is nearly impossible to train large numbers of medical officers and paramedical workers. Nearly 47 Health and Family Training Centers (HFWTC's) and seven Central Training Institutes (CTIS) provide health and family welfare training to all categories of health functionaries in the country. These long-duration training programs attract a limited number of clients, and hence most of the institutions also organize in-house short-term training programs which has less than the desired impact on their functionaries.

Distance education is a relatively new concept which not only has the ability to train a large number of health care workers in a short time in a cost effective way but can also attend to skills of health care without diluting the quality.Distance teaching-learning often involves a multi-media approach to design, develop and implement independent learning programs through self-instructional materials, both in print and electronic media forms. Distance study allows self pacing for convenience and also facilitates learners having control over their learning. The various media used for distance education delivery include among others, print materials, audio and video programs, radio and television programs, tutoring and counseling, field visits, laboratory practicals, extended contact programs, and teleconferencing.

The following issues need to be addressed and considered for successful application of distance education programs for health professions:

1. Since health sciences deal with life and death and are therefore are more skill-oriented (rather than more knowledge-based), it is felt that providing basic beginning or early training in the field of health may not be feasible through distance learning. Being an innovative and flexible system, and having the ability to respond to emerging training and educational needs, distance education is more appropriate for inservice training of health personnel.

2. The academic programs have been confined to a limited area of health education and training. In order to meet the diversified and emerging needs of health workers, the programs and courses have to go beyond medical graduates to include a wide variety of need-based functional areas ranging from simple awareness programs to more complicated skill-oriented courses on epidemiology and health economics.

3. Application of sophisticated communication technology has to be done cautiously, keeping in view clients needs, cost, media behavior and infrastructure and facilities at the receiving end. In the developing countries including India, audio and television programs seem to be more feasible and promising. Furthermore, multi-media packages need to include a large amount of hands-on and field experience.

4. An issue to be deliberated is the provision of student support services for health workers and professionals. While compulsory counseling and extended contact increase the effectiveness of programs, these on the other hand pose problems to both providers as well as the receivers of health education. More practical-oriented courses need to have compulsory built-in face-to-face components; and work centers or practice centers at grassroots level with required instructional provisions would be more feasible than regular study centers.

In conclusion, it is worth noting that distance education has tremendous potential for providing education and training programs to different categories of medical and paramedical personnel as a means of helping achieve the goals of HFA. In addition to the national agencies such as the Ministry of Human Resources Development, the Ministry of Health & Family Welfare and Indira Gandhi National Open University, international agencies such as WHO and UNICEF need to play increasingly prominent roles in facilitating the achievement of national and institutional targets. Proper use of ISRO provided satellite communication facilities can make distance education courses an important aspect of ongoing medical education.