MDMPA Editorial

Dr Deepak K Jumani appointed as a co editor for Mahim Dharavi Medical Practitioners Association News Bullettin since March 2010.

May 2010

Diabetes Care Center

Pranaam to all my respected teachers, guiding guides and all the members of MDMPA.

Optimism doesn’t wait on facts. It deals with prospects. Pessimism is a waste of time. Grey skies are just clouds passing over. Learning Avenues to earn  Revenues has become the buzz word. Last Sunday IMA Mumbai West Branch, had arranged a  Mediexhibit  “Hathiyaaron ka Mela” to offer all a opportunity to innovate to excel.

Let us now understand how a new avenue “ Diabetes Care Center” can add revenue.

Diabetes is a major health care problem in India with an estimated 41 million persons with diabetes; this has been forecast to rise to almost 80 million people by 2030 – an absolute increase of 150%. Every fifth diabetic in the world is an Indian and both native& migrant Asian race is genetically as well as environmentally vulnerable. The rapid urbanisation has leads to nutrition transition as well as physical inactivity coupled with mental stress & addictions like tobacco & smoking. The sheer number of people who suffer from diabetes indicates that the societal burden of diabetes far outstrips that caused by any communicable disease like AIDS or any  fever.

A equal proportion of people may have prediabetes which is may further increase if the norms for diagnosis is of fasting blood glucose is lowered from 110mg% to 100 mg%. The rate of progression from Pre Diabetic glucose intolerance to overt diabetes is possibly the most rapid in the Asian Indian race. Typically Type 2 Diabetes predominates though Type 1 Diabetes as well as Pregnancy related & Secondary Diabetes are also on the rise. Special Type of Fibrocacific pancretopathy (FCPD, Tropical Pancreatitis) are specific to the Asian Indian population. Type 2 Diabetes predominates more than 95% of all types of Diabetes seen among the Indian population. The real burden of the disease is due to the hidden undiagnosed Prediabetes, Vascular burden of complications and delayed diagnosis sometimes even upto a decade.

Every 8th adult Indian irrespective of sex can have this silent killer. About half the people who die because of heart or kidney disease; develop the condition because of diabetes. The problem with diabetes is that it doesn’t manifest or deteriorate as dramatically as other killer conditions like infectious diseases or road traffic accidents. The complications of diabetes in India a delayed, protracted and often malignant in their behaviour. The vascular complications the CAD and Hypertension predominate with Obesity, Dyslipidimia and Cerebrovascular with Peripheral Vascular disease not uncommon. The microvascular complications of the triopathy of retinopathy, neuropathy and nephropathy often see the endstage of the disease and need more vigilance to attempt to prevent them.

Despite the increasing prevalence of diabetes, and the general acceptance that it has become a major health problem, a clear correlation between good disease management and a decrease in disease burden is yet to be seen in India. The quality of care varies from place to place depending upon practices, expertise, attitudes and perceptions amongst diabetes care providers. Fair ignorance about the disease and severity of its complications adds to this alarming situation. An estimate based on sales of anti-diabetic pharmaceuticals reflects on an average 10-12% of diabetics receive modern pharmacological treatment in India. It is observed that half of the Indian patients had poor control of diabetes (HbA1c >2% above the upper limit of normal) and mean HbA1c was significantly higher (8.9 ± 2.1%) than the goal of tight glycaemic control

The average person with established diabetes undergoing treatment happens to be about 55 years old having been diagnosed about the age of 40 years with FPG ? 160 mg/dl, PPG ?200 mg/dl and A1c about 8.2%.

We as Family Physician must treat our Diabetic patients and not leave the control of hyperglycaemia to endocrinologists. In UK & Australia  Diabetes is the domain of every GP.

There are set guidelines to treat Diabetes. So many educative CME’s have been organised in our city, All one need is to set up a mindset, and some hathiyaars in the clinic  to makes your clinic a Diabetes Care Center.

You need the following hathiyaars in yr clinics:  A Glycated HB estimator: A Glucometer, A Weighing Scale with over 250 kg , A measuring tape, A ophthalmoscope, A Tuning fork, A percussion hammer, Monofilament to check for sensations. All these doesn’t require a big space or a huge investment.

Counselling Skills which I think we all family physicians are simply great at, is an added advantage,as counseling on early initiation of Insulin, Hypoglycaemia, foot care, diet,  delaying the onset of complication etc, self monitoring blood glucose etc  can create wonders.

If you maintain a good database of your patients, Most of the Pharmaceutical companies volunteer to arrange regular Blood Glucose estimation in your clinic, free of cost, If planned well all Diabetics can be called on those days and regular monitoring can be done. Also during these days all patients interact and this becomes a good environment for them to learn to live confidently with Diabetes and not die in bits.

For ambitious Family Physicians  there is a tremendous scope to become good diabetologists as there are recognised courses arranged by Indian Diabetes Association,  Mayo Clinic, Tunada, etc and become Diabetes Educators. By doing so, Some Family Physicans have also metamorphed themselves as Diabetologists.

On an average in  every family patient of yours, you will find some one or the other diabetic or prediabetic  and this situation is inevitable. There is a fantastic future in learning this avenue.

So besides your clinic be a Adult Vaccination Center  we can also have a Diabetes Care Center.

Opportunities multiply as they are seized. We should not permit our grievances to overshadow our oppurtunities. Apparently there is nothing that cannot happen today. The world is all gates, all opputunities.  Oppurtunity dances with those who are already on the dance floor.

With loads of love and light,

Dr Deepak K Jumani.

April 2010

Adult Vaccination Center

Pranaam to all my Respected teachers, guiding guides and all the members of MDMPA.’

To each of us, at certain points of our lives, there come opportunities to rearrange our formulas and assumptions – not necessarily to be rid of the old, but more to profit from adding something new. It takes some courage to realize that you can no longer live in the old way, when you can see that a new way wonderfully exists, but you must attempt to walk this royal road without demanding the security of foreknowledge i.e. Should I do the change ?or Could I do the change? , Will it work  ? Will something wrong  happen? and many such thoughts of fear and guilt. This change , my friends have to be made as a innate attitude..

In  this issue as promised herein we inform you about one of the best avenues for all Family Physicians  to earn revenues .i.e.” Adult Vaccination Center”

It has been observed that the Great gynaecologists and Patriotic paediatricians have rattishly squeezed in the domain of Family Physicians by giving all the kids the vaccinations, which are ought to be given by Primary Care givers, for reasons best understood by all. But still there remains a  great scope, with  our great communication skills and  refurbished attire one can start a Adult Vaccination Center in your clinic itself.

If the Grass is greener on the other side of the fence, you should probably water yours.

The Advisory Committee on Immunization Practices (ACIP), WHO which  annually reviews the recommended Adult Immunization Schedule, In October 2009, ACIP approved the Adult Immunization Schedule for 2010.

The Vaccines which adults require and can be kept in a Medical Clinic are as follows:

1.Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination

2. Human papillomavirus (HPV) vaccination

3. Varicella vaccination

4. Measles, mumps, rubella (MMR) vaccination

5. Seasonal influenza vaccination

6. Pneumococcal polysaccharide (PPSV) vaccination

8. Hepatitis A vaccination

9. Hepatitis B vaccination

10.AntiRabies Vaccine

How ever a guide by  Dr. Ketan Bharadva ,Dr. Vimal Jariwala &  Dr. Kirit Sisodia all members of COMMITTEE ON IMMUNIZATION of THE INDIAN ACADEMY OF PEDIATRICS SURAT recommends some Tips for better vaccine storage in domestic refrigerators:

Keep vaccine stock to a minimum by regularly ordering only the quantity of vaccine required for the period until the next delivery. Order vaccine sensibly; do not over order to get incentives.

Regularly check the refrigerator seals to ensure that a good seal is maintained.

Defrost refrigerator regularly, if required, to prevent build-up of ice which will result in unstable temperatures. Regular defrosting also aids in the efficient functioning of refrigerator.

When defrosting or cleaning the refrigerator, move the vaccines to a second refrigerator (which must be monitored during this time). Alternatively, store and monitor the vaccines in a cooler.

A vaccine vial monitor (VVM) is a label containing a heat sensitive material, which is placed on a vaccine vial to register cumulative heat exposure over time

A Cold Chain Monitor card (CCM) approved by the WHO is always packaged with each consignment of vaccine supplied by UNICEF.  All CCMs have temperature-sensitive indicators that monitor heat exposure throughout the entire journey of vaccine, from manufacturer to health facility. So, CCM indicates when the temperature limits of the cold chain have been passed, while the VVM shows the impact of any such temperature change on individual vial of vaccine. Thus CCM monitors the journey while the VVM shows how each passenger has fared.

Have a basic map of vaccine locations on the outside of the refrigerator door so people can go ‘straight’ to the vaccine when the door is opened. Keep refrigerator door openings to a minimum. Place the refrigerator out of direct sunlight

Store vaccines in their original packaging in labeled, enclosed plastic containers

It is essential that each domestic refrigerator storing vaccine has a Celsius digital minimum/maximum thermometer and a temperature.

Mark & block the power source clearly so the refrigerator is not unplugged or turned off accidentally.

Never store food/beverages/specimens/anything else in the same unit as vaccines. This interferes with temperature control & may contaminate vaccines. The refrigerator is a medicine storage not a Bar.

So friends  “Adult Vaccination Center”  is one of the avenues which if you venture on can get you unending revenues. All you need is a right mindset and right attitude.

With loads of love and light,

Dr Deepak K Jumani.

March 2010

My Pranaam to all my Respected teachers, my guiding guides and all the dear members of MDMPA.

The more we become, the more we are capable of becoming and the more we are capable of becoming, the more we become. That’s what is possible in a life of a Primary Care Physician.

We know now that just as our medical science can coax stem cells to take on the form of any cell in the body, creating heart tissue, bones and even brain tissue to replace the damaged body parts, so, too,   we  can coax our mindset to do a variety of things as Primary Care Physician in our clinics, which can bring in your life the  romance of a Great General Practice.

A Primary Care Physician, should do something more than putting a stethoscope  on the chest and a torch in the mouth, and be more interventional. He can do some thing like taking up any procedure in the field of Cosmetology,   ECG & Doing Ambulatory BP monitoring  in Cardiology,  Doing Sleep Studies & Spirometry in Pulmonology, A lots can be done for Geriatric population  like Giving RT feeds, Catheterizations etc  a lots can be done for our Diabetics, Obese patients , Counselling, Family Planning, Vaccinations  Paediatric and Adults,  and in fact pick up  any thing from any branch of medicine, which you are comfortable with or have passion to do, get your self adequately trained, gain all the experience and make that as your USP. Once you have opened up your doors of  innovation you will find a plethora of opportunities waiting for you to walk in your life to give you all what you wanted in life.  And we all truly believe that our real ultimate purpose in life is growth and peace. You really are the creator of your own reality, and we at MDMPA shall be  creating together the reality of being experienced by the lot of us. Using the power of Sixth Sense, Clinical acumen, being the Primary Contact  of the patient, the right attitude and mindset we shall find  Infinite opportunities to choose and make of ourself the Essential Energy for every patient who came to us.

Keep your hand and your heart in the Right direction and you’ll not have to worry about your feet. Don’t  sit back and take what comes.. Go after what you want. & Remember you are Unique, just like everyone else.  We should give meaning to life and not wait for life to give us meaning. This is the Unspoken truth spoken fully.

Watch out in the next MDMPA Bulletin, which shall highlight  “Learn  avenues  to earn revenues.”

With loads of love and light ,

I remain,

Warmly yours,

Dr Deepak K Jumani.

  1. No comments yet.
  1. No trackbacks yet.