Understanding The Pattern Of A Disease Iis The First And Crucial Step In Combating It.
People were getting ready for yet another day in Kherwadi (Bandra East). In Fatimaís house the most important early morning chore was done. The big was drum had been washed and filled. Fatima was pumping the stove in preparation for the morning tea when Akmal, her 10 year old son woke up.
"Ammi, you had promised to give me money for the school fees today. "
"Child, you know that your younger brother Alam has been ill and had to be taken to Dr. Abuja last evening. It cost me Rs. 15/-. Canít you explain to your teacher that there have been unexpected expenses at home and that you will pay the fees in a few days time," said Fattier.
Akmal glared resentfully at the sleeping Alam. "Whatís wrong with him again ? Last month too you had said that money had been spent on the doctor for him and that there was no money left for this and no money left for that ."
"Alam has a bad cough and fever again, " explained Fatima. " But this time the compounder has said that the medicines are stronger and will work better. As an older brother you should be more understanding. I have spent money on your colds and coughs too. "
" My younger brother falls sick and I am scolded at home and at school," Akmal wailed, and ran out with his schoolbag.
"Whatís all this noise about ," demanded Mohsin, Fatimaís husband, sitting up. Fatima explained the problem.
"Didnít you remind the doctor that Alam has been sick with the same thing twice in the last one month ?" asked Mohsin.
" I wanted to. But when my turn came after two hours of waiting, I was too tired . And the doctor seemed busy. But this time the medicine will be more effective. "
UNDERSTANDING COUGHS : BRONCHITIS AND ITS CAUSE
A sore throat accompanied by fever in its advanced stage, called bronchitis, is one of the commonest illnesses in Bombay city. Bronchitis is caused by a germ and carried by the air. The air that we breathe in Bombay city is contaminated and this makes the problem worse. One of the causes is the smoke and dust from factories and workshops which just throw their waste matter into the air. Another cause is the smoke from cars, buses, trucks and authrickshaws. Yet another cause is the dirt, dust and garbage that generally lie all over the city. Since Bombay is humid , i.e., damp, round the year, it becomes possible for the pollulants to make the air heavy and stay close to the ground. This makes it easier for this polluted air to enter our lungs when we breathe.
Those who work inside factories and workshops, on road construction or repair work, continuously breathe in the small particles that are thrown into the air by all this smoke and dust. They are probably the worst affected by the polluted air in Bombay city. But air does not stand still. It moves and carries pollutants with it. Alamís cough is a reaction to this polluted air.
And all of us who live in this city and breathe the same air are in danger of reacting the same way. Which is why coughs and colds, which affect small children particularly badly, are so common in Bombay. The fever which accompanies them is not in itself a problem. It is a signal that the bodyís own soldiers are working to fight the germs which have entered it.
People like Fatimaís family who live in zhopadpattis or chawls where the houses are packed closed together and the air inside the house gets hot and stuffy, especially at night when everyone has to sleep inside one small room, have no escape from the chances of falling ill due to this reason.
"Thatís the second time youíve said that. What are those medicines ?" Mohsin wanted to know.
" A bottle of mixture and two sets of pills, one round and pink and the other long and green, " said Fatima as she took them down to show to her husband.
"And the last time ?"
" Iím not sure," said Fatima as she tried to remember what Dr. Adhuja had given her. " I think it was a mixture and some different pills. It sounded like somebody was visiting ; loud greetings were being exchanged outside Fatimaís hut. Fatima heard her sister Jamilaís voice and ran to receive her. Jamila, the youngest in the family, had studied upto SSC. She and her husband Suleman lived in Lamington Road where Suleman, an SSC pass, worked in a medical store.
"What, Alam sick again ! Is it the cough ?" she exclaimed.
"Why does the cough come again and again and again ?" cried Fatima.
"It must be the air pollution, " said Jamila thoughtfully. " I thought that Lamington Road was congested enough but Kherwadi with its tightly packed huts is just as bad. Have you noticed that in Bombay so many more people seem to be coming down with coughs and cold than before ?"
MOST COLDS AND COUGHS ARE SELF LIMITING
Most colds and coughs are self limiting, i.e. pass away on their own. This process can be held by generally trying to stay healthy and taking some measures to relieve the cough, i.e., remove the soreness. Some colds and coughs are a reaction to pollutants to the air. Others are caused by viruses, invisible organisms, for most of which no cure has been found so far. Quite a few of them cannot survive in a healthy body for more than three or four days. Therefore, general body resistance is crucial. That is why the medicines that the doctor gave Fatima and Kamala, on which they spend ill affordable money, provided only an illusory cure.
Fatima and Jamila were chatting outside the hut when they were joined by Kamala.
" Kamalaís daughter Laju has the same problem as my Alam except that she doesnít come down with it as often, " Fatima was saying to Jamila. We were together at Dr. Ahujaís clinic yesterday. It seems her husband has started coughing, too."
She turned to Kamala, " Jamila says that all this cough in Kherwadi, Lamongton Road and other parts of Bombay is caused by the bad air we breathe in the city. "
" Well, we canít stop breathing, can we !" laughed Kamala.
"Whatever the reasons, doctors have to cure us. "
" But why are their cures so temporary ?" asked Fatima in a puzzled tone. " Why donít they give us medicines which will put an end to these coughs and colds? Also, why do they make poor people like us to wait for hours in their dispensary ? Imagine ! Yesterday when I was waiting three men entered and went straight into the doctorís office as though queues were meant only for the poor. Just because they
WHEN SHOULD ONE GO TO A DOCTOR ?
Repeated cold and coughs may come to young children in a city like Bombay. And there are several reasons why parents must be very vigilant.
were wearing smart clothes and carrying bags building with God knows what, they seemed to think they were very special ."
"There are no medicines to prevent us from getting affected by air pollution, " said Jamila. " And there are really no medicines that can permanently cure the kinds of colds and coughs that are carried by
RHEUMATIC HEART DISEASE
Heart disease in later life need not come only to the rich and need not be the result only of eating rich foods or too much salt in the diet or lack of exercise, among other things.
Heart disease may also come about due to untreated repeated attacks of sore throat and joint paints in childhood where the germs travel deep down into the chest and start affecting the heart.
In polluted and overcrowded cities like Bombay rheumatic heart disease is much commoner than most people realise.
Vigilance over young childrenís health is crucial to securing their robustness in adult life. One way to do this is to try and understand more about the body and about the environment in which we live, and about how cure works. Equally important is to ensure that children, both boys and girls, get adequate food at all times.
It is in the interests of all .. rich and poor ... to work to improve the cityís environment and to see to it that the air we breathe becomes cleaner and less dangerous to our health. In a person who gets adequate daily food and is well nourished, the body has some capacity to resist being invaded regularly by germs. Of it invaded, to prevent the infection from becoming too severe. For those whose bodies get less food and who live overcrowded, unhygienic surroundings, regular and severe infection and money spent on repeated visits to the doctor and on medicines, may become a vicious circle.
the air. My husband tells me that the shop where he works sells lots of medicines for colds and coughs. But people only keep coming back for more. "
"Surely, doctors who have been to college know that these medicines are useless. Then why do they ask us to take them and waste our hard earned money ." Fatima was almost shouting in anger. Kamala was agitated, too. " Are doctors always giving medicines even when we donít need them ? When should one go to a doctor and for what sorts of ailments ? Should one avoid medicines altogether ? Oh ! I am so confused. I used to feel so happy that I am in Bombay and can run to a doctor anything I need to. "
EARLY PREVENTION IS A FORM OF CURE
With their knowledge and ability to diagnose major diseases and treat them correctly, doctors are a valuable resource in society. But they are also victims of other social forces as , e.g. drug companies. IN order to avoid being dosed with medicines when our bodies do not require them, it is important for us to begin taking responsibility for our bodies and our health. One way is by being alert to early signals that our body gives out when it has been invaded by a germ. The most important way of responding to these signals is by doing things that do not allow these germs to multiply in our body and make us very ill and to try and stay healthy. Remember, adequate food is the single most important thing that can help us resist illness. Spending money on food is better than spending money on doctors. If you must seek cure it is better to go to a municipal or government hospital where the cure would be cheaper and where you would be recommended only those medicines which are necessary.
Jamila tried to calm down the two older women. " Doctors are necessary to us. In all the years they spend in college they learn many things, most importantly, how to identify what is wrong with us when we fall sick and what medicines to give us. "
"But just now you implied that they also give unnecessary medicines. If they know what is right and what is wrong, why do they do this ? I donít understand, Jamila," said Fatima.
UNDERSTANDING BEGINS AT HOME
Jamila explained patiently. " Fatima, youíre not the only one who is confused. Even my neighbours in Lamington Road with small children have talked about how confused they feel in this manner.
One of them came home to talk to my husband about it and from what I gathered, it would seem that you perhaps did the right thing by taking Alam to the doctor. But your visits would be more useful if you could also carefully record the pattern of Alamís frequent illnesses. Frequent colds and coughs accompanied each time by high fever can gradually lead to chronic diseases of the respiratory system like asthma or tuberculosis. If you keep a proper record of the colds and coughs afflicting children and show it to the doctor, he / she will be able to quickly grasp the problem and prescribe an appropriate course of treatment. IN showing the child to the doctor without presenting the full background of the case, you may not only have to make more trips than necessary but also allow the chronic infection to set in over time. "
As Fatima listened seriously, trying to absorb this new knowledge, Jamila turned to Kamala. "You should afford to take a more relaxed view of Lajuís cold and cough, Kamala. It seems to come only once in a while and the body should be able to fight it. Recourse to some home remedies should provide relief, like gargling with warm salt water and drinking plenty of warm liquids and avoiding cold drinks."
Jamila continued. " Since neither the government nor factories nor the municipalities nor anyone else is doing anything to cure air pollution, people like us falling sick. The first thing we do everytime this happens is to rush to the doctor. Partly it is our fault. With so many people willing to pay and doctors willing to prescribe, the drug companies are able to sell their medicines. They have representatives to visit doctors and medical stores to advertise their companyís medicines. The three men of yesterday whom you described, Fatima, were not patients but medical representatives. My husband says they come to his store regularly. They often go about in groups and carry big leather bags full of medicines. They give free samples of their medicines to doctors which they administer to their patients. Since there are many drug companies competing with each other to produce similar drugs, drugs for a single ailment take on different colours and shapes when produced by different companies.
The next morning in the water queue, Fatima and Kamala chanced to meet. They talked a little about the previous dayís doscission with Jamila.
Fatima began seriously, " It is our ignorance which puts us at the mercy of doctors and medicines. Kamala, if we did not rush to the doctor for every small ailment, we wouldnít be taking unnecessary medicines and spending money which is required for other , longer lasting things. Nor would we be ignoring the need for treatment because we donít understand the patterns in which ill health occurs !"
"Yes," Kamala agreed. " Let us try and understand better how our bodies work under the conditions in which we live here in Kherwadi."