WAR ON DISEASE

( By Radhika Ramasubban, Bhanwar Singh & Nigel Crook )

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Arunachalamís Warning On Typhoid

Arunachalamís Warning On Typhoid


Why You Must Take Your Full Course Of Medicines.

It was Sivaratri and at the Shiva temple in Dharavi people had come to offer prayers. A little group of people clustered outside. Arunachalam was breaking some bad news. (Arunachalam was a teacher, just retired from the local municipal school ).

" Hema is dead, Subbannaís wife. I am rushing to their house. If any of you want to come with me you should be quick, " he said. (Subbanna worked at a local raddi depot and his wife was well liked for her helpful ways).

"But she was not old !" exclaimed someone in the crowd. "What was it that killed her ?"

"Typhoid," replied Arunachalam sadly. " She had the symptoms a few days earlier - a fever which was getting higher for some days - and had been to the doctor. But inspite of the medicines she never recovered." He added, half to himself, " Who knows whether she took her medicines properly and observed all the precautions. People tend to be so careless. !"

"But brother, Radha my daughter-in-law has the symptoms you described. She went to the doctor and started taking medicines. She was feeling slightly better this morning. It canít be serious, can it ?" asked Lakshmi anxiously.

"The newspaper says there is a typhoid epidemic in Bombay, " said Arunachalam gravely to the group. " It is likely to spread if the rains do not reappear soon. When I pass by the Municipal dispensary yesterday, Muthu the compounder told me that the notification has come from the Municipality . With all this rotting garbage lying around in Dhavari and in this humidity, people will start dying like flies if they donít take care." Turning to Lakshmi he said ;

"Once youíve got typhoid, taking the prescribed course of medicines is the only way to get well again. Is Radha taking her medicines at the proper time every day without break for the number of days that the doctor has laid down ? Is she resting at home ? All that is important, you know."

Lakshmi looked confused. " But we bought medicines only for three days, thinking weíd see how they worked. After taking them she started feeling somewhat better, so she has gone to Ghatkopar for her sisterís sonís mundan ceremony. And, she has no medicines with her. In any case , brother, if one is feeling better doesnít it mean that the illness is over ?"

"My son has also come down with typhoid but his problem is similar to Radhaís," said Ramu, an old widower who spend much of his time around the temple. " Before getting fully well he has gone back to work to the bicycle repair shop and I can see that he is becoming weaker day by day. But he just doesnít listen. The doctor has given him a prescription but he takes the medicines as and when he remembers to. When I scold him he answers back, Ď I have to finish taking the lot, havenít I? Donít worry. I will. What does it matter whether I take the whole lot at once or spread it over many days. Ď Thatís wrong isnít it, Arunachalam ? Please come to my house and explain it to him. "

"It is not right for your daughter-in-law to go without medicine because she is feeling better on taking the partial course, " said Arunachalam to Lakshmi. "What I have said about taking the full course of medicines applies to all serious illnesses. The early signs of feeling better must not be mistaken to be a complete cure. Yes, we must talk to your son about it, " he added turning to Ramu, "and, Lakshmi, your daughter-in-law, too, should not risk her health by adopting such a gradual attitude towards medicines. "






WHEN AND HOW TO TAKE A COURSE OF DRUGS

It is only when one is seriously ill that one needs to take a course of drugs. Typhoid is an illness that is due to germs, which can cause serious weakness and even kill is if the infection is not controlled effectively. When you are prescribed a course it is important to listen to instructions about dosage, timings, duration and other precautions regarding diet and rest and to follow them carefully. The medicines prescribed, antibiotics, which help the bodyís own soldiers to fight major invasions of germs, are specific to the set of organisms that they are meant to kill. Each set of organisms takes a certain number of days to get killed. Each tablet or capsule contains only a certain amount of the drug and the effect wears off after a few hours. For that number of days, therefore, a certain amount of the drug has to be constantly in the body. Soon after the organisms start getting killed, one starts feeling better. If the medicines are stopped at this stage , the remaining organisms do not get killed and one can start feeling unwell again after a while. Also, with a low dose of drug exposure, the remaining organisms get used to the drug and stop being affected by it. Then the disease becomes stronger, and different stronger medicines are required to control it.


"Radha, how do you feel ?" asked Lakshmi anxiously when her daughter-in-law returned the next day. " I feel a little weak. But otherwise I am okay," replied Radha.

"Arunachalam says that medicines for a big illness like typhoid must be taken without breaks. You have already been without medicines for two days. Go and buy the medicines for the whole course as written down by the doctor. We canít afford to be careless.

Look, Hema was a young as you but she died because she had neglected herself. "

"Donít take all this doctors, seriously, " laughed Radha. "they keep prescribing everything under the sun. And make us bankrupt buying them. I feel I will be all right in a few days time. "

"Itís true, we donít have money to satisfy the doctor all the time," Radhaís father-in-law agreed. "But since Arunachalam has got Lakshmi all worried you can go and buy one or two of the medicines in the prescription, enough for two more days. Weíll see after that. "

Radha took the money from her father-in-law and was about to leave for the chemistís shop when Arunachalam entered.

", how do you feel ? Have you resumed your course of medicines ?" he enquired. Radhís father-in-law explained their problem of where to go for the money for such an expensive treatment.

"Donít you find the money somehow or other when there is a religious ceremony or social function ? Donít you even borrow on such occasions? Is sickness such a small thing that you can afford to sit back saying there is no money?" demanded Arunachalam. Right now, the most important thing is to buy the medicines for Radha. But perhaps it might be possible to buy only the most essential ones."

Arunachalam accompanied Radha to the chemist. Sadanand (the owner of the medicine shop) repeated what Arunachalam had said about the absolute need to take medicines for typhoid , but was sympathetic to the need to economise. He ran through the prescription. "You can drop the sedatives and fever tablets," he advised, " but make sure to buy the antibiotics. The next time the doctor gives you a long list, ask him which ones are essential and which ones can be avoided. Explain your financial problem to him.

Donít take your own decision on which ones on the list you should buy, because these may be the essential ones," he said.

The next day, Arunachalam again visited Lakshmiís house to enquire how Radha was progressing in her cure. Radha was in bed feeling unwell.






SIDE EFFECTS

While antibiotics have made it possible to prevent deaths caused by food and water borne disease by rapidly killing germs which have entered our body, they are so powerful that they set off many other reactions in our body as well. When we are anaemic, antibiotics weaken us further and creates side effects like nausea, burning sensation in the stomach, vomiting or diarrhoea. For those who are heavy drinkers or smokers, antibiotics interact with alcohol and tobacco to raise the toxic levels in their body.




  1. Tell your doctor about your present state of health i.e., if you are anemic, if you are pregnant, if you are breast feeding your baby, if you are already taking any other medicines.


  2. Tell your doctor if you are a habitual drinker or smoker.


  3. Tell your doctor if you are allergic to any drugs.


  4. Tell your doctor if you are suffering from giddiness, nausea, burning in the stomach, diarrhoea etc.


"Oh uncle," she moaned. " I listened to you and what did I get ! All my symptoms have come back. I donít feel like eating anything, my stomach hurts and I feel so weak."

"These could be side effects " said Arunachalam, thoughtfully, "Iím not sure, but it is best that you back to the doctor and tell him what the matter is. "

"She has been so weak and pale ever since the miscarriage six months ago," said Lakshmi with a worried look. "And she has become weaker still with this typhoid."

"Strong medicine like antibiotics create some side effects if our bodies are already weak and undernourished," explained Aurnachalam. "And sickness like typhoid and jaundice mostly come to poor people who live in slums like we do where food and water are likely to get contaminated. And the antibiotics, while they make us well from the disease, make us sick in other ways. "

Arunachalam was gong about advising the people in his area about the need to protect their food and water. He explained how important it was to wash all vegetables carefully before cooking, keep prepared food and water pots covered, clean away garbage and shit from around the house, wash hands carefully and keep nails clean, and wash feet throughly before entering the house. The struggle to protect oneself from the filthy environment and , if one did fall sick, from the weakening effects of the diseases and the medicines, seemed like a never ending effort. Ramu was at the temple as usual when he passed by.

"Howís your boy?" he enquired. "In bed" was the reply. "By pushing himself through his illness - going back to work before getting well, not taking his medicines properly - he has got a relapse of typhoid. Doctor says that it will take even longer this time for the disease to get cured. He has given another long list of medicines. "

Ramu was back at the chemist for anti-typhoid medicines for his son. Two boys were also there with their prescriptions. Sadanand the shop owner looking at the prescriptions thought to himself, "The epidemic must have spread into every hour in Dharavi. "

"So, both of you have typhoid," he said to the two boys. "I donít know," replied one. "I had loose motions yesterday and since everyone is talking about typhoid , I went to the doctor. And he told me to take these medicines."






WHAT IS A RELAPSE?

If a course of medicines for a major infection has not been followed properly, some of the live germs still remain in the body and start multiplying. In a person who is already weakened by the disease and who is undernourished, who does not take enough rest when the illness is on and for some time after the illness, and in those who are not careful about their food and water, the old live germs can multiply rapidly and bring about a relapse of the disease. Alternatively, new germs can enter the defenceless body. Thus the cycle of ill health is maintained.


"I have an upset stomach and feel feverish," said the other. "Went to a weeding yesterday. Must be something I age. "

On their way home the two boys compared their tablets and found that they looked exactly the same.

"But we have different illnesses, it seems," said one.

"Let us ask another doctor in the hospital where I work to see if these medicines are really the correct ones," suggested the other.

Later in the day the two boys stopped the doctor in the corridor and told him their story. He was quite serious and concerned.

"See, both of you have different ailments. But you have both been prescribed the same medicine. The two of you probably have only gastro-enteritis and this medicine will also cure you, but a milder medicine would have been more appropriate. This medicine is the strongest anti-typhoid medicine in the market. By taking stronger medicines than required and by taking an anti-typhoid medicine when you have no typhoid, your body is being loaded with chemicals which can harm you in the long run.

Radhaís son came home from school one afternoon, looking excited. "Grandma, Ma, one of my class friends who had typhoid came back to school before he became fully well. He attended class






DRUG RESISTANCE

The greatest danger of antibiotics is that they are unhesitatingly prescribed by doctors. Since serious water and food-borne diseases like typhoid and jaundice are common in Bombay, doctors often go ahead and prescribe the strongest available drugs without necessarily confirming the diagnosis through observation or tests. Often relatively minor illnesses are also treated with stronger drugs than necessary.

Sometimes it is to impress the patient with a quick cure. Often samples of the latest drugs in the market are more easily available and the doctors feels that he is prescribing the "latest" thing. But the latest drugs are more likely to be stronger than the older ones. This practice may compromise with the patientís health in the long run. Simpler medicines fail to work on a person whose body has got used to stronger drugs.

Germs which have got used to the strong drugs soon stop reacting unless even stronger ones are administered. In any case, medicines are no substitute for preventing disease by acting on our environment and keeping our bodies healthy.

Repeated illnesses can only trap us in more and more illnesses.


for only one day and feel sick again with flu. I told my teacher and my friends all about Maís sickness and of all that Arunachalam uncle said about how now taking sufficient rest can make us fall sick again and again," he announced proudly.

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