Medical Commission: Boon or Bane? | Medical Commission Bill 2017

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CNBC-TV18
Published on 2 Jan 2018

Why is IMA protesting against the proposed National Medical Commission bill. Here’s a special debate with IMA President Ravi Wankhedkar & Former Health officials.

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Heed the patient

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National Medical Commission Bill must address the needs of the consumer rather than the interests of medical practitioners and quacks.
indian expressWritten by Shailaja Chandra | Updated: January 5, 2018 8:28 am

The nexus between the unqualified practitioners or RMPs (Rural not-Registered medical practitioner) is apparent from the virtual absence of action against thousands of quacks. (Illustration: Subrata Dhar)

The National Medical Commission Bill 2017, well-intentioned and forward-looking, has unfortunately stirred a hornet’s nest. It has brought to the fore a disturbing aspect of an ongoing controversy — the activities of medical lobbies that have persistently thwarted efforts to put consumer interest above their own. Parliament needs to face some unsavoury facts.

Two lobbies are at work backing the professional interests of the allopathic community on the one hand and AYUSH practitioners (mainly ayurveda, unani and homoeopathy physicians) on the other. There are some 10.4 lakh private medical establishments with hospitals accounting for under 8 per cent of them. Most are lone practitioners running small nursing homes and clinics. Most do not possess a medical qualification. A 2016 WHO study has brought out that only 58 per cent of urban doctors had a medical degree and only 19 per cent in rural areas. Only 31.4 per cent of allopathic doctors were educated to the secondary school level and 57.3 per cent did not have any medical qualification. NSSO reports show how barring the metros and large cities, there are more unqualified practitioners than regular doctors.

The interests of all allopathic doctors, regardless of their competence, are looked after by the Indian Medical Association (IMA), a voluntary registered society with state chapters which register doctors as members and lobby with the government, resorting to agitations and strikes whenever doctors’ interests are affected. An all-India membership of over two lakh gives the IMA immense clout so that most chief ministers and even the Union health ministry avoid confrontation.

Many of the IMA’s members are single practitioners and they run their clinics with the assistance of young school dropouts engaged as helpers. They train them to handle acute illnesses and treat acute medical conditions with antibiotics, IV fluids and steroid injections. Once sufficiently skilled, these assistants set up independent practice using the prefix “doctor”. They run a lucrative business charging a fraction of a qualified doctor’s fees. When patients do not respond to treatment, they refer them to a known qualified medical practitioner who remunerates them with a 30 per cent commission.

The IMA and the Medical Council of India, both at the apex level and in their state units, are aware of what is happening. While their public position is that quackery must be stopped, covertly, both organisations look the other way. The nexus between the unqualified practitioners or RMPs (Rural not-Registered medical practitioner) is apparent from the virtual absence of action against thousands of quacks. The IMA, instead, targets ayurveda, unani and homoeopathy practitioners who hive off their business. Since RMPs are part of the business and generate referrals, action — when taken — is perfunctory.

The National Medical Commission Bill 2017 and for that matter the National Health Policy 2016 overlook this countrywide phenomenon altogether. Under law, the Medical Council of India and the state medical councils are enjoined to take action against those who practise allopathic medicine without being enrolled on the allopathic medical register. As consumer safety is at stake, this is a serious omission from a bill which seeks to replace the medical council.

The practitioners of Indian medicine also constitute another powerful lobby. The National Integrated Medical Association (NIMA) lobbies forcefully in favour of “ integrated practice”. At two national events, the prime minister publicly stated that ayurveda practitioners practise modern medicine and very few use traditional medicine. Even his observation does not seem to have had the required impact.

While the propagation of traditional medicine is publicly pursued with passion, the preponderance of treating with modern medicine is ignored. Authentic ayurveda is now confined to Kerala and western Maharashtra, other than a few government-run universities and colleges in different states. In North India, it is difficult to find even 10 practitioners of pure ayurveda excluding doctors employed by government establishments and colleges.

The development and propagation of the ayurveda system is left to a handful of committed researchers and faculty members in institutions like the Banaras Hindu University, Gujarat Ayurvedic University and Arya Vaidya Sala at Kottakkal and Amrita Vishwa Vidyapeetham in Kerala. The faculty in these institutions is worried. “If AYUSH graduates are allowed to practise allopathy, where does the status and the future of ayurveda stand? They should not be allowed to practise allopathy as otherwise the AYUSH systems will die,” lamented all faculty members I spoke to.

The new Bill must take stock of and address what the country actually needs. The first need is for thousands of community-level accredited practitioners — not full-fledged doctors — who after training should be equipped to provide the first line of care for acute conditions and to make referrals to a regular doctor within a GPS-supervised system. The realisation that neither allopathic nor AYUSH doctors will ever go to lakhs of villages — not even tehsils — must dawn on policymakers. That is precisely why a new system of community-based trained health workers (not government employees) who are enrolled on the state medical register is needed. This can only be done if the medical education law provides for it.

Second, the new Bill should promote integrative medicine enabling people to access multiple choices but available under one roof, particularly for chronic conditions or even as adjuvant therapy. The developed world has recognised that with an increase in life expectancy, chronic diseases, allergic syndromes and rare medical conditions cannot be cured — but the symptoms can be mitigated through traditional medicine. A quest for bridge courses to learn ayurveda has already begun in different countries. The new Bill should recognise the scope for integrative medicine but without mixing medical systems and practitioners.

Citizens are agitated over the mismanagement of both publicly-run and private medical education establishments. The government has done well to bring forward new legislation to replace the medical council. But unless the Bill confronts reality and addresses it, keeping consumer interest paramount, the new law will make little difference to people’s lives. The parliamentary standing committee has an opportunity to make a difference, if it shuns the rhetoric of self-interest professional groups and confronts reality.

The writer is former secretary, Department of AYUSH, government of India, and former chief secretary, government of Delhi.

A potential antidote

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Shailaja Chandra
Published on January 3, 2018

 

The Medical Bill is not as bad as IMA says it is

News that the Medical Commission Bill is to go before the Parliamentary Standing Committee has come as a relief. In its present form, the draft contains disturbing features. While it addresses many of the ills the 2016 Parliamentary committee had exposed, concerning decades-long mismanagement by the Medical Council of India, the new Act must overcome, not add to, the blunders.

To be fair, the Bill has taken care of three critically important drawbacks of the existing MCI Act. First it seeks to remove the stranglehold of doctors who for over 60 years have been deciding everything that affects their own professional well-being with absolutely no input from the very interests they profess to work for — the public. The 62-year-old MCI Act had given license to doctors to elect and appoint themselves to decision making positions — a situation which gave winnability precedence over professional competence and the need to confront serious public health challenges which go beyond clinical specialities.

By drastically reducing the elected element from the proposed Commission, the de-politicisation of the highest statutory standard setting body, greater transparency and responsiveness to the health needs of the country — not just of doctors — can be achieved.

Mandating an exit-exam is another progressive step in the Bill. It is of critical importance to test the proficiency of all graduating doctors through a common examination instead of relegating it to examining bodies with undulant standards. It would help reduce — might even end — the present mess created by partisan inspection systems, political interference and protracted litigation.

Yet, another plus in the new Bill is placing non-medical people on the Commission — a practice that prevails in many countries to safeguard public interest. It is essential to induct informed non-clinicians to bring balance and breadth of vision to decision making.

IMA’s vociferous rejection of all these positive strategies through mass representations by 3 lakh practitioners is nothing but an effort to sabotage the Bill; it shows how deeply embedded is the self-preservation instinct despite all the ills that exist. Comparisons with lawyers and engineers are mere red herrings; neither the curriculum nor the approval of colleges of those two professions are administered by their elected members.

The Bill has, however, got into muddy waters by alluding to the possibility of a bridge course in case a joint body of the medical regulatory councils decides to utilise AYUSH doctors to augment medical services. The mere inclusion of an intent has rung alarm bells. At two national events the Prime Minister himself has talked about the propensity of AYUSH doctors to practice modern medicine instead of using time honoured traditional medicine systems in which they have been trained. Any move to legitimise modern medicine practice by all Vaidyas, Hakims and Homeopaths would devalue the systems and demoralise genuine traditional medicine practitioners.

To even keep a window open to legitimise the practice of modern medicine by AYUSH practitioners negates the prescient goodness of the traditional medicine systems. From a public standpoint what India needs is a core curriculum for all students of recognised systems of medicine, to overcome the present ignorance and caste based divide that exists between different systems.

The writer is a former Secretary at the health ministry

IIC DELHI MATTERS: A New Lecture Series

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 First in the Series: How prepared are you to Tackle a Medical Emergency?

 Indian International Center (IIC) launched a series of lectures on things that affect the well-being of Delhi ‘s citizens. Titled the  ‘Delhi Matters Series’ and starting on  18th December, 2017 the first discussion in the series focused on medical emergencies and trauma.The Series will be taken forward for the next 12 months. The discussion on the 18 th December was aimed at providing a holistic view on different kinds of Health Emergencies the available operational structure and precautionary measure to prevent and deal with emergencies at home, ,at the workplace and while commuting.


Shailaja Chandra as Chair: Introduction to Medical Emergencies of the Delhi Matters Series

The talk was led by a Panel of distinguished professionals which included Dr. M C Misra, former director of AIIMS and a trauma expert; Mr. Tamorish Kole; Chairman of Institute of Emergency Medicine India; Ms. Monika Bhardwaj, IPS  who heads the operations of PCR vans and 100 helpline; Mr. Rana in-charge of the Centralized Accidence Trauma Services (CAT); and Mr. Mukherjee, the Lawyer who assisted in drafting the new Motor Vehicle Act (MVA) for the government. ( Awaiting Parliament’s approval).

Source: National Crime Records Bureau (2015)

Dr. Tamorish Kole started the discussion by narrating stories of different kinds of  patients who underwent trauma and the preventive steps that the families could have taken to avoid the emergency situations. Dr. Kole mentioned a case of 76 year-old man who had had a fall in the washroom and was rushed to emergency. It was later diagnosed that the reason for his fall was low lighting and cataract; something that could have been prevented. He suggested that elderly people should be encouraged to do physical exercises and families should avoid using carpets and slippery mats when there are old people in the house.

Similarly, while emphasizing on the importance of mental health, Dr.Tamorish cited a case of a patient who complained of discomfort and high blood pressure and assumed it was a gas problem. But later found as a minor heart attack. Likewise an 82 year visited the hospital thrice, each time with three different problems and was subsequently discharged the same day every time. After a detailed conversation with the man, he was diagnosed of severe depression. Dr. Kole thus concludes that no symptom should be ignored and must be examined for better survival and follow 5 simple rules.

“People must be encouraged to CONNECT with each other, BE ACTIVE, TAKE NOTICE  and KEEP LEARNING of minute changes in one’s body and GIVE time to yourself to curb mental health problems. Because, mental health is as important as physical health” – Dr.  Tamorish Kole


Dr Tamorish Kole: Panelist on Doing Your Part :Lessons Learnt from 5 Case Studies

In confronting acute medical conditions and providing urgent attention and care, Dr. M C Misra narrated several experiences he had encountered He highlighted some of the emergency cases that he had seen first hand.  He stated that no bodily symptoms can be termed as minor unless proved. No symptoms can be ignored and should be treated immediately irrespective of the time of day.

It is important to know the facilities available in the hospitals in your vicinity, he asserted. While discussing acute diseases irrespective of the age and trauma due to road accidents, he concluded with applaud about the work and efficiency of 800 PCR vans in evacuation of individual emergencies and mass causalities in the past. But, hopes for significant improvement to meet the international standard.

“Nowadays among adolescent and adults, leading cause of injury as motor vehicle crash has been noticed.40% of the injuries are due to road crashes and 50% of those injured are pedestrians followed by causes due to drunken driver and unskilled drivers.”- Dr. M C Misra


Dr M C Misra Panelist on : Warning Signals, Preventive Strategies-What People at Risk Need to Know

India faces the highest number of road deaths every year and is on its own a national emergency situation.

Mr. Suhaan  Mukerji who drafted the legislation and policy for the Motor Vehicle Framework spoke about the amendments made in the law and its impact of the citizens. He highlighted that the focus of the law has been safety and creating a systemic response adopting a 360 degree approach. As a part of the changes the government has taken actions to protect the citizen who helps the road accident victims, has mandated the use of statistics and systematic data collection to adopt data-driven decisions and lastly, increased fines for breaking road or traffic rules. He believes that this is a major structural shift in the law and defines how the government perceived transportation, mobility and safety of the all citizens in the country.

“Road accidents are also like a national emergency in a sense. We need a 360 degree approach to tackle this by looking at designs of a car, the inbuilt safety features, different types of offences and the systematic approach in case of emergency.” – Suhaan Mukerji


Mr Suhaan Mukherji Panelist on Improving Mobility/ Access Issues in Traffic and Transport

However, with a mission of saving lives officially and personally, Mrs. Monika Bhardwaj feels proud to lead the PCR Department, whose mandate is to provide quick police assistance and help people in distress with certain limitations. In her address, she explained the objective of the Police Control Room (PCR) and its functionality.

“PCR vans are equipped with ‘Phablets’ i.e; Phone and Tablets with internet connectivity, first aid kits, stretchers and trained staff. When the victim calls 100, the location of the victim is tracked and sent to the PCR vans to immediately start the assistance.  Now, more than 20 Green Corridors have been created to increase efficiency of the service and avoid traffic and other road barriers, Mrs. Monika Bhardwaj said.

“Anybody who is in distress or in medical emergencies in Delhi, we are duty bound to help them. But, PCR cannot be used to transport sick people or dead bodies which are one of the limitations.”- Monika Bhardwaj, DCP (PCR)


Ms Monika Bhardwaj (IPS) Panelist on : Management of Medical Emergencies -Lessons Learnt from 100

The talk continued with Q & A, Mr. Laxman Singh Rana enlightening the audience on citizen responses in situations of accidents, where someone is injured or badly hurt. He mentioned that firstly, one should never touch the broken limbs or try to remove any object that has gone into the victim’s body as it may aggravate the injury.

Every citizen should enroll themselves in an emergency training course. Speaking about CAT, he mentioned that helpline number 102 and 1099 are two key lines through which CAT operates.


Mr L S Rana Administrative Officer (Operations) Centralised Accident Trauma Services

Each ambulance is equipped with paramedics who take the patient to the desired hospital or any public hospital as a default. The role of CAT is critical in times of emergencies and is a large network across the capital.

Concluding the session with a round of question and answer session, the IIC host and chair Ms. Shailaja Chandra spoke about the future of the program and the upcoming lecture of Pollution, Congestion and Environment to continue the mission of discussing and making people aware of the serious health related issues that the capital faces.

 

 Written by Dr. M Shahid Siddiqui.

Difficulty Climbing Stairs?

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A Lift? A Wall Hugging Chair? A Wheelchair that can Climb Stairs?

Options, Costs, Pros And Cons.

As one crosses the age of 70 ( and we’re both on either side of 75,) the question of managing stairs crops up regularly.The conversation also surfaces each time someone suffers from arthritis, backache or has a fracture.You ask yourself:

“ Should you just wait for that day when one of you needs support to go up and down stairs? How do you propose to manage that?”

The prospect of developing a heart condition, experiencing a sudden fracture or being unable to climb stairs for whatever reason is an unhappy one.Suppose one is stuck on the first, second or third floor without any back-up? Can this become a default situation for you or your husband,wife, mother or father?”

The children come on their annual visits and bring more “what if” questions.

“ Have you thought of one of those chairs that goes up and down along the wall?“ Have you considered a lift?”

I decided to undertake a literature survey and follow up with some field foot work.I am sharing whatever I have learnt.

Assuming neighbours and family are fully cooperative- (often they’re not,) here are your options:

Regular Lift option

1. Buying and installing a regular lift is terribly problematic once a house is built and lived in. It would entail first selecting and buying the lift.( The smallest Schneider variety for 4 passengers would be more than Rs 9 lakhs.) Depending on its capacity and type it would need space for a pit ( think of hammering away the floor inside or outside the house) a machine room, a place for the ropes and traction to be provided – not to speak of the drilling, hammering, breaking doors, windows, walls and roof which will be decided by the sort of house you live in. The company will demand that you get the preliminary civil works done and that will be costly .

Advice: On account of the high cost the conventional lift is clearly a No- No.The only way it would work is if there is enough space and FAR and some others in the building agree to share the cost.

Pneumatic Lift option.

2. The trigger to find out more about this sort of lift was running into a former colleague living in a DDA duplex flat in Vasant Kunj. We met each other after years and her first question to me was, ” Remember you talked about a lift some years ago? Well we did tons of research and installed one three years ago. It’s marvelous! I call it my rocket. It is a pneumatic lift which goes up-and-down from the first floor down to the ground floor right inside the house.My husband and I never need to use the stairs anymore because it’s right inside the house and occupies just one square meter of space.”

I knew her husband had a heart condition but the thought of going up and down in a lift inside the flat sounded a little bizarre. But then on WhatsApp she sent me three videos of this “rocket lift” in motion and I must say I was impressed. I requested for a contact number of the supplier. It took just one call to a Company named Grand Prix to have a knowledgeable agent calling at short notice.Armed with two glossy catalogues containing beautiful pictures of high end glass lifts for indoor use, he inspected the options in our house.

The first huge deterrent was the stated cost.My friend had paid Rs 12 lakhs 3 years ago.Now it would cost Rs 18 lakhs with GST and would be imported from Italy or Dubai.The lead time would be 4 months. I would also need to hive off 1 square meter from the ground floor and have a diamond cutting drill excavate two circles of cement – concrete in the roofs on the first and terrace floors to make a passage for the pneumatic lift.

The thought of explaining all this to my brother who is in Bengaluru over the phone and getting him to agree to drilling a hole in his Ground floor portion of the house, besides persuading him to let me annex one square meter of space ( howsoever unused, )was something I knew was destined o fail. In any case I did not have Rs 18 lakhs to spend on such a futuristic project, saddled with so many imponderables.

Advice: Drop the idea of a pneumatic lift unless you have complete independence to decide on its installation.But even so, at that price I would not advise it.At half the price it’s worth it!

Hydraulic lift option

3. I happened to meet someone who said “ Just install a hydraulic lift outside the house.It would be far, far cheaper, quicker and less disruptive.”

Encouraged thus, I rang “Just Dial At 22222222” (repeatedly advertised by Amitabh Bachan) and instantly got a list of suppliers. Even before I could start making my first call, two suppliers contacted me ( the telemarketers pass on your number to everyone in the field BTW,) and 2 suppliers set up time to come to the house to give a feasibility and cost estimate – on the spot.Both callers came on time, inspected the area and said much the same thing about the cost, time and installation requirements.

I contacted our architect – a conservative septuagenarian who had helped build the ground floor of my mother’s house in 1972. The firm was no longer building houses and had moved to industrial architecture.Even so his team was horrified at the idea of a hydraulic lift . But I persuaded them to at least meet one of the suppliers if not both.

Among the two suppliers one appeared more serious about sticking to timelines. He was a burly Sardar wearing a white safa. Although he had told me he had no technical qualifications, he proceeded to answer every question with complete confidence. When there were no more questions to be asked, the conversation got down to the business of asking for specifications and then the final price.It was quite reasonable- Rs 3 lakhs for 2 floors- ground to first to terrace. Converting two windows into outlet doors for the lift would be my responsibility but Sardarji undertook to provide a platforms between the lift and the door for access.

It all sounded doable but in my mind many questions still remained unanswered. How long would it take to be erected?

Suppose the Sardarji let me down midway? Suppose the whole business of breaking and converting two large windows into even bigger doors and erecting a platform above the sunshades to act as 15 and 30 feet high pathways into the lift looked or worse felt shoddy and unsafe?

After all you don’t live in a nice house to have some makeshift warehouse lift mucking up a clean and neat facade permanently! Besides I wasn’t sure that the MCD would take kindly to the contraption as it wouldn’t fit into their bylaws.

These forebodings apart, the price was so attractive and Sardarji’s enthusiasm so sincere that I too was convinced. A lift for three lakhs going all the way up to the terrace ! Imagine taking all my potted plants up in winter and down to the shaded portions in summer ! Imagine basking in the sunshine on the roof one minute and driving off to the market the next!The possibilities were enormous and very attractive.

It then struck me why not go and see a couple of lifts in actual use before clinching the deal?So I set up time to visit two homes in Rajouri garden and Jail Road after talking to the owners.Both had installed the lift for a mother and a wife both of whom were wheelchair bound needed to visit the hospital every now and then.They both expressed satisfaction. Armed with these telephonic assurances I met the Sardarji supplier at the Mayapuri metro station and was piloted by a him – he on a two wheeler and me in a car. I don’t think I would’ve found the addresses in 1000 years had Sardarji not zoomed ahead through umpteen turns and twists within rows and rows of houses.

The first house had rather a natty looking lift which was being used to transport the owner’s disabled wife from the first floor to the ground floor. The actual cabin and the pipe and trusses couldn’t be seen and the effect was of a smart but slow moving old Mumbai type lift.It was kept on a slow setting because the motor made a noise at high speed.

The second house I visited had made minimal investment and I could see the actual lift shorn of its smart interiors and cladding.It was like an open cage – sturdy without a doubt- but really quite ugly! Noisy too when the lift went up.Not noisy as it came down however.It was however safe and did its job.
I needed to sit down and work out all the details about the construction noise, cost, completion period , civil works, beautification and factor in all the appurtenances before taking a decision if I was going to pay a 30 % advance.

Sardarji had no place to offer except his own “office” which was in the heart of the industrial area. I followed him through the worst kind of metallic chaos coupled with deafening sounds of clanging metal, trucks dumping wares and dust and lethal fumes everywhere.We entered the factory- a large enclosure where it was impossible to make out what was gong on behind mountains of cylinders, poles lying alongside massive craters of iron scrap. Sardarji simply toodled up a rickety iron ladder which had 6 inch slats which perhaps qualified it as a “staircase”.He beckoned me to follow him with nothing to hold on to except the step above.I grasped each step above my head and climbed the 10 rungs up to his “office”. It was more akin to a metal machaan supported by a couple of angle irons. Sardarji’s spry father sprinted up and joined the discussion.Never having seen my house he too had a deft and convincing reply to every point I raised.I returned home all set to start on this project no matter what it took.But then it struck me that at least I should have a word with the tenants downstairs as the din the lift installation would entail could be insufferable.

Luckily we ran into each other late that night as I took our dachshund for her last pee under the lamppost. The couple had just returned after a late dinner and listened to me patiently.I told them my plans and requested them to put up with a lot of noise for a few days.They were unperturbed. They had no objection- except to enquire why I needed a lift in the first place!

“What is wrong with you? Why can’t you climb a few stairs?”Coming from complete outsiders it was a bit of a revelation- was I becoming unnecessarily paranoid with no plausible reason except to have a back up for a future emergency of unknown origin and uncertain timing?Had I overlooked some other option which would be less invasive and disruptive?I put the hydraulic lift idea on pause.

Electric Chair options

4. The next step was to look at the possibility of installing a chair like what dentists and doctors provide in their basement surgeries.This time I asked Google and sure enough found a company called Vin Grace and rang them up! A woman named Suchitaa answered. She sounded helpful and efficient and her answers were concise but knowledgeable.She gave the time and cost figures including for delivery and installation with the confidence that comes from having dealt with scores of customers.She came the next morning accompanied by a small wheelchair and an attendant. Wearing a smart winter coat and boots, she slipped into the wheelchair in a trice and was wheeled downstairs step by step and pulled back upstairs but facing downwards. At every step the attendant would let go and the wheelchair remained glued to the spot until a command was given by the attendant which decided what the wheelchair had to do- move ahead or stay put.It would cost Rs 3 lakhs plus GST of 5 %.

Having demonstrated the feat that this wheelchair could perform the well heeled lady went on to suggest that the wall clinging ( dentists’/ doctors’ chair) would suit our needs better as the wheelchair could not be self propelled.It would cost Rs 1 lakhs for each flight up and a separate chair would be needed from each landing up to the next.But having demonstrated everything and taken me through some impressive catalogues even Suchetaa proceeded to ask, “Why do you need anything right now? Why do you want to spend that kind of money when there is no apparent urgency?I can supply and install whatever you need in 24 hours flat. Right now I strongly advise you to use your legs!”

Advice: If someone is immobile the wall climbing chair is just the ticket.It’s not disruptive and installation takes a few hours.

Summary of Findings

  1. The regular lift idea is strictly avoidable if you are installing it in a built up house.It is just too costly and will need permissions, approvals and a license-all huge deterrents.
  2. A pneumatic lift is unaffordable and the 4 -5 month wait for it to be customized and installed negates the undoubtedly attractive idea of something sleek and user friendly.
  3. The hydraulic lift will work but you have to have immense time, energy and motivation ( plus money ) to get a really finished job.If breaking doors and windows is involved you might lose a lot of sleep and neighbors goodwill besides you might end up with an ugly eye sore which could disturb the aesthetics of the house howsoever much you beautify the exterior and interiors.That’s not part of the supplier’s responsibility so remember it’ll be your additional cost.
  4. A wall hugging chair is doable, affordable ( if you really need it )and can be ordered in a matter of a few days ( if not 24 hours as promised by Suchetaa of Vin Grace.This chair can carry one person up and down each flight.It’s safe, will work for sure and is the answer for someone who is unable to climb stairs but not an invalid ( as sitting down, getting up unassisted is required.
  5. The stair climbing wheelchair is an option if either the staircase itself or other inmates of the building restrict your erecting rails along the wall or the bannister. But this stair climbing wheelchair is also costly at Rs 3 lakhs plus; what’s more,it needs a trained attendant to give the command to move step by step. Although the battery lasts for years and the average maid can learn to operate it, it requires breaking her in to give her confidence.That depends on individual willingness to learn.

End note:

Please God let you and me not need any of these alternatives!But it’s good to know there are so many options which are available should the need arise!

मुकाबला : डॉक्‍टर और मरीज के बीच क्‍यों घट रहा है भरोसा?

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ndtv_logoप्रकाशित: दिसम्बर 16, 2017 08:00 PM IST

स्‍वास्‍थ्‍य सेवाओं की हालत हमारे देश में कैसी है इससे आप सभी लोग परिचित हैं. और जब से बड़े प्राइवेट अस्‍पताल वजूद में आए हैं तब से कई बार ऐसा लगता है कि यह एक व्‍यवसाय बन गया है. पिछले दिनों कुछ ऐसी घटनाएं भी हुईं जिससे यह सोचने पर मजबूर होना पड़ा. आजकल डॉक्‍टरों और मरीजों के बीच दूरी बढ़ती जा रही है. वहीं डॉक्‍टर कहते हैं कि उन्हें निशाना बनाया जा रहा है.

Guests: Shailaja Chandra (Former Bureaucrat) ; Dr. Girish Tyagi (DMA) ; Dr. Ravi Malik (CMD Malik Radix Healthcare); Saurabh Bhardwaj (APP) and Abhigyan Prakash, Anchor.

#MaxHospital, Shalimar Bagh loses licence.

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CNBC-TV18
Published on 8 Dec 2017 – 10:16 PM

We speak to @over2shailaja @DrKKAggarwal for more.