Citizens

Health care practitioners are a worried lot these days…. The magic bullet, penicillin discovered in 1929 by Alexander Fleming and many more life saving antibiotics after that are turning to sawdust right in front of our eyes… Antibiotics the edifice on which modern medicine is built- from transplant medicine, to cancer therapy, to general surgery to myriad bacterial infectious diseases may soon be rendered useless- laying to waste  all the epic, ground breaking  medical advances. An epic battle has been fought between man and bacteria and believe it or not man is set to lose. What does it mean? It means we may soon enter the post antibiotic era, and live very much as our forefathers lived and health as we know it now may just become stuff dreams are made of. You don’t have to look very far behind. Just look at the period before 1929. Naturopathy will be back big time along with mantras and tantras and shamans and God save us voodoo and what not. I am beginning this series because I am increasingly becoming convinced that the general public has to be empowered to become custodians and stake holders of its future health. The mantra is: SAVE ANTIBIOTICS NOW!

So what is the problem statement? The problem is that some bugs (bacteria) have become superbugs. Some of them have become resistant to all known safe antibiotics. So in this dire situation what was done by the health care practitioners? To counter the onslaught of drug resistant bacteria in the last decade, colistin which had been discarded in the 1960’s due to its unacceptably high toxicity, was resurrected to be used as a life saving drug. As if using a toxic drug was not bad enough (damages the kidneys- patient may be relegated to dialysis for life) the intrepid bacteria are losing no time in developing resistance to this drug of last resort! It will be good to bear in mind that, unlike mankind these bacteria are very generous- they share their arsenal of antibiotic  resistance left right and centre- and with great facility. They do not check out the race, religion or region of the fellow bugs- their mantra is “ Have it, will share it.”

Bad Bugs are Global Citizens The overgenerous nature of the bacteria is big reason for us losing the battle against the bugs… The drug resistance is not limited to India or China- although these countries do grab the headlines. These bugs are international hiflyers. New Delhi Metallo beta lactamase (NDM ) producing bacteria may have originated in India, but are much respected global citizens now- note NOT ‘immigrants’! Even the jingoistic Trump Administration can’t oust them!  

This makes me believe in a divine justice of sorts. If the developing world loses antibiotics (due to rampant indiscriminate use) so too will the developed world….Strange right? The bacteria are very fair indeed…

A new thought is slowly emerging. Now that it is clear that these life saving antibiotics have to be handled with care and indiscriminate use to be aggressively curtailed. One solution is to try to prevent infection in the first place. No infection, no need of antibiotics- less chances of bacteria acquiring resistance. If we glance at history, life expectancy improved in the West before the advent of antibiotics. How? It happened because standard of living improved, water and sanitation facilities got better- the bugs found it increasingly difficult to find a receptive host. With improvement in socio-economic indicators, poverty came down, nutrition improved – immunity got a boost and the going got even tougher for the bugs. Governments would do well to decrease expenditure on defence and increase expenditure on sanitation, nutrition, infrastructure, education. Job creation will reduce poverty and malnutrition. Poverty and squalor should become the number one public enemy.

So what is the message? Since antibiotics are severely under attack by the superbugs, since antibiotics are becoming increasingly ineffective, we need to try to urgently put in steps to REDUCE INFECTIONS. The west should stop exporting armaments to developing countries and export ways and means of curtailing worldwide poverty and disease. This will be their only effective self defence.

No Infection-no bugs-no disease-reduced burden-on-antibiotics. What should the Junta do? Don’t Fall ill! Here’s how…

Wash hands often- cheapest most effective vaccine

Our ancestors got it right even though they did’nt have a clue about bugs- We should adopt Namaste or Adab or Ram Ram or Sat Sri Akaal and say NO to hand shakes

Want to sneeze/ cough? Sneeze in the elbow- very difficult to pass bugs from elbows!

Somebody has a flu? Meet them by all means, just keep a distance of 3 feet. Wash hands too

Drink clean water.

Salads are great but wash them well.

Say NO to antibiotics for common cold, respiratory infections unless it persists for more than 5 days. Have hot fluids, paracetamol and rest

Say NO to antibiotics for diarrhea. Don’t forget to take oral rehydration solution and zinc though.

Say NO to medicated soaps. It is crazy but the more we try to suppress the bugs the stronger they get.

Tell your Doctor/ Nurse to WASH their hands before they examine you or do a procedure.

Say YES to vaccines

Say YES to educating one lay person a day on hygiene and infection prevention.

The world (all the citizens) will have to join hands and fight antibiotic drug resistance together. No walls can keep the bugs away! The developed world cannot follow isolationist policies with bugs. While many health care practitioners are becoming aware of rampant drug resistance, this awareness is not translating to rational antibiotic use. The societal pressure and the competition stakes on the doctors are far too high for the doctors to do the right thing. You can almost see their thought process : The future will take care of itself, lets manage the present. Can’t blame them…. We all know doctors are easy victims of public anger. The only problem is our grandchildren may not have the security blanket of antibiotics and human life expectancy may plummet down to forty again….the same as pre-World War 1 life expectancy.

Antimicrobial resistance (AMR) containment efforts have begun worldwide but I am persuaded that it cannot succeed unless you and I, the general public becomes part of the movement. Believe me the importance of the junta was never as much as it is now. We are a power to be reckoned with- if we are able to tap it successfully. General public means you and me, aam janta- the rag picker, poor vendor, the sweeper, the rickshaw puller, the driver, the farmer, the dairy owner, the Gujjar, the fisherman, the veterinarian,  the teachers, students, health care practitioners, chemists, pharmacists, pharmaceutical companies, engineers, entertainment industry, media, the big corporates, administrators, politicians and governments worldwide. This movement should not end with the Indian junta, it should be a cascade effect where it sweeps the whole world. Let us be known not as the motherland of the infamous New Delhi metallo betalactamase producers but as the INDIA MODEL of AMR containment

The flapping of a butterfly’s wings in the mighty Andes can generate a Tsunami in the Indian Ocean… Sounds incongruous?  Yet this is the emerging thought these days. A tiny action somewhere in a remote part of the world can have a magnified echo in some distant land. Our Gola (planet) is gol (round). Actions reverberate. This concept holds true for weather, definitely politics and even health.

An outbreak of a deadly viral infection can spread like wild fire if active surveillance activities are not carried out. Surveillance can nip the outbreak in the bud and prevent it from spreading worldwide. Tom Frieden, former director of the CDC, warns that “like terrorism,” epidemic disease cannot be fought “just within our borders. You’ve got to fight epidemic diseases where they emerge.”Recent public health funding cuts in high income countries means surveillance systems will die in some of the world’s hot spots for emerging infectious disease like Haiti, Rwanda, Congo and China.  There will be no warning. Frieden famously said “The US can’t be safe if the world isn’t safe”. One world indeed. Where does that leave us -the Low and Medium Income Countries (LMIC)? At the epicenter of the outbreak- with limited finances, huge population and little or no preparedness for such an eventuality. Time to think globally and act locally.

Most new/deadly infections originate in poor low middle income countries/war torn societies/high concentration of displaced / refugee communities. Can such societies organize surveillance activities? Decidedly no. The US has previously played a big role in surveillance yet recently  public health funding cuts threaten pandemic readiness. Congress and the current administration have cut $1.35 billion from the Prevention and Public Health Fund over the next 10 years, including a 12% budget cut for the CDC, forcing the CDC to reduce its public health efforts in “some of the world’s hot spots for emerging infectious disease,” including China, Pakistan, Haiti, Rwanda, and Congo. These cuts have prompted global health organizations to caution that “critical momentum will be lost if epidemic prevention funding is reduced, leaving the world unprepared for the next outbreak.”

Things have come to such a head that if you really want to reduce antibiotic resistance, you need to reduce the burden of infectious disease. No infection- no need of antibiotics – lower incidence of antibiotic resistance. The bottom line thus is:  IMPROVE STANDARD OF LIVING, REDUCE DISEASE, REDUCE ANTIBIOTIC PRESSURE AND REDUCE RESISTANCE. Policy makers are you listening?

Want to reduce antibiotic resistance? It is very simple- IMPROVE STANDARD OF LIVING, REDUCE DISEASE, REDUCE ANTIBIOTIC PRESSURE AND REDUCE RESISTANCE. Policy makers are you listening?

There are a myriad issues ailing our society and our world. The world is crying out for a champion, a messiah and we are all looking, waiting for that leader to emerge. Actually the buck stops with you and me. As Mahatma Gandhi said, “Be the change you wish to see in the world”. This phrase really resonates with me and I am sure it does so with you too. Very few of us are aware of the millions of children silently dying of diarrhoea  every single day. Millions more are dying of respiratory diseases. It is strange and a rather sad sign of the times we live in, that this does not make any kind of news. Is it because they are the poor and marginalised that their lives don’t matter? Today is global hand hygiene day and if the simple, act of hand hygiene is practiced effectively it can save millions of lives. Hand hygiene is so effective in preventing infection that its efficacy has been equated to that of a vaccine. It is literally the cheapest, most accessible and most easily implementable “vaccine” in society today. Hand hygiene after using the washroom, before cooking, before eating, after any contact which may have sullied the hand, after contact with ill patients effectively washes off the germs and prevents infection. It is important to appreciate that hand hygiene protects not only against diarrhoeas but also respiratory infections, skin infections, eye infections and many more. We need to devise innovative ways of disseminating this information through media, schools, NGOs etc.

The bugs are microscopic and one can’t see them. But our hands pick them up effortlessly or rather the bugs effortlessly tag along on our hands! They are smart folks. They have a deep intelligence and have researched us thoroughly and are intimately aware of our habits and lifestyles. They are perfectly cognisant of our propensity of not washing our hands at appropriate times…

They take advantage of our daily salutations like shaking hands and kissing and hugging. While we are warm exchanging greetings, we are exchanging bugs too! Hitching a ride on our unwashed hands gives the germs access to fresh hosts and a new cycle of infection and disease begins.  So in the flu season which is upon us, washing hands often is a good idea. At times it may not be possible to have access to soap and water. Hence it is a good idea to keep a hand sanitizer in the pocket , purse and in the children’s bags and teach everone to use it frequently.

During winter when the respiratory viruses are abuzz with fresh energy and vitality, it is a good idea to wish the Indian way, where we gently appose both our hands together and say “namaste” or elegantly raise our right hand midway in the air and say “assalaam alaikum”. In neither of these salutations do we touch other people’s hands. In this way we don’t freely exchange bugs while spreading cheer and sunshine.

 Now hand hygiene during the flu season is not as simple as our social handwashing. It was found that some parts of the hand are invariably left unclean if not done in the proper way. A lot of interesting research was done to identify the most effective technique of washing away microbes. It was found that the thumb, adjacent part of palm, finger tips and wrist were largely left untouched.  So effective hand hygiene includes wetting hands, lathering soap on the palms, between the fingers, tips of the fingers, thumb and wrist for a minimum of 20 seconds. How will you know when twenty seconds are up? Hum the birthday song, That’s how long it will take! By the way, happy birthday to all the readers who were born today!

To prevent flu, it is equally important to break the highly efficient, high speed transmission of viruses and bacteria through the medium of sneezing and coughing. We usually use our hands and tissues to break the onward transmission. This is not such a good idea as these hands are now contaminated and when we shake hands or touch something, we unknowingly pass on the germs to unsuspecting folk. You can see how intelligently the bugs work their way around our infection control efforts.  To work our way around their scheming stratagems, it is now advised to sneeze in the elbows.  The bugs find it difficult to jump on to another human from an elbow!

Having a good healthy breakfast is a simple way to keep our immunity strong. Very often we can’t prevent an exposure to the bugs but we can mount a vigorous immune response against them and prevent the disease all together. If you happen to visit or meet a person with flu, try keeping a distance of 6 feet from them. This way you won’t inhale the bugs. It goes without saying that washing hands is essential.

Finally always remember prevention is better than cure. Vaccination is a wonderful way of protecting children from otherwise dangerous infections which have high mortality. We don’t hear of diphtheria, tetanus or pertussis because we are protected against them by effective vaccines.  If you remember recently there was a bad outbreak of measles in the USA… Now there is an effective  vaccine against measles. But people start under estimating the seriousness of the disease and the efficacy of the vaccine and took a decision to not vaccinate their children- with catastrophic outcomes. Play safe, play intelligent, vaccinate your children. The flu vaccine is available now. This vaccine protects all of us from flu. It should be definitely be administered to the elderly, people who have chronic diseases, children and all health care personnel.

It is time that we the citizens of the world fully comprehend and appreciate the importance of our involvement and whole hearted participation in matters concerning our health and well being. Let’s build a better world together. Happy global hand hygiene day! Have a happy, healthy, joyous fortnight!  Adios!

Remember prevention is better than cure. We have vaccines which can prevent polio, hepatitis B, measles, mumps, rubella, chicken pox, diphtheria, pertussis, tetanus, HPV, H. influenzae, Streptococcal and Meniningococcal meningitis, tuberculosis, yellow fever etc.

When the antibiotics were discovered in the early twentieth century, it was widely perceived that infectious diseases will soon be things of the past and the epic fight of man and microbes will soon be over. These were miracle drugs effective against practically any infectious disease- tuberculosis, leprosy, plague, malaria, cholera, pneumonia, meningitis, wound injuries, you name it and there was a cure.

However, the bugs have fought back spectacularly and it does seem that the wonder drugs may soon cease to be effective. While we had become complacent and spending less and less money on the development of new, more potent antibiotics, the bacteria were plotting… They organized multilevel secret talks and came to the conclusion that if they have to survive the onslaught of us clever humans, they would have to forget their differences and unite.  The bacteria exhibited spectacular solidarity- a trait which is becoming increasingly rare in mankind. Bacteria of one species  joined hands with bacteria of other species and of even different families and freely shared their secret weapons  with each other through conjugation, transduction and more importantly through transposons. Mankind is now standing at an unenviable vantage point where we can see the end of antibiotic efficacy on the horizon. In medical parlance we call it a “post antibiotic era.” The problem with this eventuality is that we will be willy nilly thrown back to the pre-antibiotic era- where simple infections could prove fatal. To ward off this catastrophic future as far as possible, we as a society have to take the responsibility to protect the antibiotics. When we say protect the antibiotics, it means we have to reduce the utilization of antibiotics. How can that be done? One method is to prevent infections all together. Is that possible? Yes indeed.

However, as you can see these are not many. There are a lot more bugs lurking there, waiting to cause disease. We must learn to protect ourselves from these bugs. If the incidence of infectious diseases fall due to participation of the society at large, the pressure on antibiotics will decline, resistance will be lower and…voila we save this precious resource for our future generations!

One simple method is to keep our immunity strong. Very often we can’t prevent an exposure to the bugs but we can mount a vigorous immune response against them and prevent the infection all together. Start your day with a good nutritious breakfast. Our body ‘s immune response is then well geared to fight the bug which you may encounter in the office or the school or in the cinema hall or a visit to the amusement park. So the first weapon is to have regular nutritious meals. By the way did you know that the food you eat has a direct relationship with your mood? We will discuss that some other time.

Now to win the hide and seek games with the germs, it means we should know how they are spread. They can be spread through air, water, food, contaminated surfaces, insect, blood transfusion, skin and sex. A large number of infections are spread through our hands. So interestingly the efficacy of hand hygiene has now been equated to that of a good vaccine. Indeed hand washing is a cheap, easily available and effective intervention to prevent infection. It is easily the single most effective measure to prevent infection. And yet millions of small children die of diarrhoea in Africa because of lack of awareness of the efficacy of hand hygiene in preventing infections. Hand hygiene after using the washroom, before cooking, before eating, after meeting an ill patient can wash off the germs and prevent infection. Do understand that hand hygiene can protect against diarrhoeas as well as respiratory infections. Our hands can touch contaminated surfaces which then can inadvertently touch the eyes, mouth or nose and voila one can get respiratory infection and even conjunctivitis.  Washing hands can prevent and reduce a whole lot of infections like skin infections, respiratory infections, intestinal infections, eye infections.

Most people are already doing it but are going an extra mile- they are using medicated soaps like dettol or savlon. They are not needed in routine daily handwashing! They are doing more harm than good…They are contributing to antimicrobial drug resistance. We fall prey to aggressive marketing of disinfectant floor cleaners and medicated soaps and use it conscientiously not knowing that in the long run, we are unknowingly strengthening our microscopic foes.

   Respiratory infections are spread when we inhale the virus or the bacteria. An infected person can transmit the germs by coughing, sneezing and even talking.

Of course since we are talking about protecting ourselves, we should think of protecting ourselves from road traffic accidents too. Having a good night’s rest and waking up on time will prevent us from rushing to office- fewer accidents, fewer hospitalizations, less antibiotic consumption, presto we save some more antibiotics. Mind you, fewer hospitalizations also translates to lower incidence of health care associated infections (HCAI) . Now this is really important as management of HCAI really needs a cocktail of antibiotics

Several strategies are already in place to prevent the resistance from making further inroads.

You can help yourself and your loved ones stay healthy by washing your hands often, especially during those key times when you are likely to get and spread germs-i.e. before, during, and after preparing food, before eating, before and after caring for someone at home who is sick with vomiting, diarrhea or any infectious diseases,before and after treating a cut or wound, after using the toilet, after changing diapers or cleaning up a child who has used the toilet, after blowing your nose, coughing, or sneezing, after touching an animal, animal feed, or animal waste, after handling pet food or pet treats, after touching garbage etc.

The precious loss of the lives of dear ones in a gun shooting incident is heartrending. Sympathies of people far and wide are with the bereaved families.  A plane crash is sure to garner worldwide attention and sympathy. Are we aware that millions of children are dying of diarrhoea silently every single day? It is strange and a rather sad sign of the times we live in, that this catastrophe does not make any kind of news. Is it because they are the poor and marginalised that their lives don’t matter? Today is world hand hygiene day and if this simple, cheap act of hand hygiene is practiced effectively it can save millions of lives. Hand hygiene is so effective in preventing infection that its efficacy has been equated with that of a vaccine. It is literally the cheapest, most accessible and most easily implementable “vaccine” in society. Hand hygiene after using the washroom, before cooking, before eating, after any contact which may have sullied the hand, after contact with an ill patient, after coming home washes off the germs and prevents infection. It is important to appreciate that hand hygiene protects not only against diarrhoeas but also respiratory infections, skin infections, eye infections and many more. You see the bugs are microscopic and one can’t see them. But our hands pick them up effortlessly or rather the bugs effortlessly tag along on our hands. They are smart folks. They have studied us thoroughly and are aware of our habits and lifestyles intimately. They are perfectly cognisant of our propensity of not washing our hands at appropriate times and hitching a ride on our hands allows them access to a fresh host and a new cycle of infection and disease begins.  Washing hands can prevent and reduce a whole lot of infections like skin infections, respiratory infections, intestinal infections, eye infections.

They take advantage of our rituals like handshaking and

When the antibiotics were discovered in the early twentieth century, it was widely perceived that infectious diseases will soon be things of the past and the epic fight of man and microbes will soon be over. These were miracle drugs effective against practically any infectious disease- tuberculosis, leprosy, plague, malaria, cholera, pneumonia, meningitis, wound injuries, you name it and there was a cure.

However, the bugs have fought back spectacularly and it does seem that the wonder drugs may soon cease to be effective. While we had become complacent and spending less and less money on the development of new, more potent antibiotics, the bacteria were plotting… They organized multilevel secret talks and came to the conclusion that if they have to survive the onslaught of us wily humans, they would have to forget their differences and unite.  The bacteria exhibited spectacular solidarity- a trait which is becoming increasingly rare in mankind. Bacteria of one species  joined hands with bacteria of other species and of even different families and freely shared their secret weapons  with each other through conjugation, transduction and more importantly through transposons. Mankind is now standing at an unenviable vantage point where we can see the end of antibiotic efficacy on the horizon. In medical parlance we call it a “post antibiotic era.” The problem with this eventuality is that we will be willy nilly thrown back to the pre-antibiotic era- where simple infections could prove fatal. To ward off this catastrophic future as far as possible, we as a society have to take the responsibility to protect the antibiotics. When we say protect the antibiotics, it means we have to reduce the utilization of antibiotics. How can that be done? One method is to prevent infections all together. Is that possible? Yes indeed. Vaccination is a wonderful way of protecting our children from otherwise dangerous infections which had high mortality. We don’t hear of diphtheria, tetanus or pertussis because we are protected against them by effective vaccines.  If you remember recently there was a bad outbreak of measles in no other country than the USA! Now there is an effective  vaccine against measles. But people start under estimating the seriousness of the disease and the efficacy of the vaccine and take a decision to not vaccinate their children- with catastrophic outcomes. Remember prevention is better than cure. We have vaccines which can prevent polio, hepatitis B, measles, mumps, rubella, chicken pox, diphtheria, pertussis, tetanus, HPV, H. influenzae, Streptococcal and Meniningococcal meningitis, tuberculosis, yellow fever etc.

However, as you can see these are not many. There are a lot more bugs lurking there, waiting to cause disease. We must learn to protect ourselves from these bugs. If the incidence of infectious diseases fall due to participation of the society at large, the pressure on antibiotics will decline, resistance will be lower and…voila we save this precious resource for our future generations!

One simple method is to keep our immunity strong. Very often we can’t prevent an exposure to the bugs but we can mount a vigorous immune response against them and prevent the infection all together. Start your day with a good nutritious breakfast. Our body ‘s immune response is then well geared to fight the bug which you may encounter in the office or the school or in the cinema hall or a visit to the amusement park. So the first weapon is to have regular nutritious meals. By the way did you know that the food you eat has a direct relationship with your mood? We will discuss that some other time.

Now to win the hide and seek games with the germs, it means we should know how they are spread. They can be spread through air, water, food, contaminated surfaces, insect, blood transfusion, skin and sex. A large number of infections are spread through our hands. So interestingly the efficacy of hand hygiene has now been equated to that of a good vaccine. Indeed hand washing is a cheap, easily available and effective intervention to prevent infection. It is easily the single most effective measure to prevent infection. And yet millions of small children die of diarrhoea in Africa because of lack of awareness of the efficacy of hand hygiene in preventing infections. Hand hygiene after using the washroom, before cooking, before eating, after meeting an ill patient can wash off the germs and prevent infection. Do understand that hand hygiene can protect against diarrhoeas as well as respiratory infections. Our hands can touch contaminated surfaces which then can inadvertently touch the eyes, mouth or nose and voila one can get respiratory infection and even conjunctivitis.  Washing hands can prevent and reduce a whole lot of infections like skin infections, respiratory infections, intestinal infections, eye infections.

Most people are already doing it but are going an extra mile- they are using medicated soaps like dettol or savlon. They are not needed in routine daily handwashing! They are doing more harm than good…They are contributing to antimicrobial drug resistance. We fall prey to aggressive marketing of disinfectant floor cleaners and medicated soaps and use it conscientiously not knowing that in the long run, we are unknowingly strengthening our microscopic foes.

   Respiratory infections are spread when we inhale the virus or the bacteria. An infected person can transmit the germs by coughing, sneezing and even talking.

Of course since we are talking about protecting ourselves, we should think of protecting ourselves from road traffic accidents too. Having a good night’s rest and waking up on time will prevent us from rushing to office- fewer accidents, fewer hospitalizations, less antibiotic consumption, presto we save some more antibiotics. Mind you, fewer hospitalizations also translates to lower incidence of health care associated infections (HCAI) . Now this is really important as management of HCAI really needs a cocktail of antibiotics

Several strategies are already in place to prevent the resistance from making further inroads.