Re: National AIDS Control Project III (NACP III): World Bank Integrated Safeguard Data Sheet

[Guest guest]

Friends,

The World Bank's Integrated Safeguard Data Sheet for India's national AIDS

Control Project III avers that infection control is in good shape in India (para

IIA4): " NACO commissioned a study to focus on the risk of HIV transmission in

health-care facilities owing to inadequate and unsafe infection control and

waste management practices, and to assess current infection control and waste

management practices. Through primary and secondary qualitative and quantitative

data and a field based survey in three states, it was found that awareness and

implementation of infection control practices are reasonably good. "

Although this statement is in a section dealing with environmental issues (read:

waste management), the term " infection control " includes behaviors related to

injection safety, sterilization, and other precautions to prevent

patient-to-patient transmission of HIV.

The World Bank's statement conflicts with findings from IPEN's 2002-03

Assessment of Injection Practices in India, which reports -- after a national

study involving more than 900 researchers -- that 31.6% of injections are a risk

to transmit bloodborne viruses

(see p viii, http://www.ipen.org.in/).

I would like to hear an explanation from World Bank staff about how their

assessment of infection control practices appears to be at odds with findings

from the IPEN study. Also, in what way were the IPEN findings considered- if at

all- in the design of the project?

Best regards,

e-mail: <david_gisselquist@...>

[Guest guest]

Friends,

It is really amazing to say that infection control appears OK in India! There

cannot be anything farther from the truth.

It is well known that 35 to 50 % used palstic syringes come back in circulation

as new injecton equipment. It is also true that no worthwhile nation wide

research has been undrtaken in India to measure hospital acquired infection,

specially transmission of infection due to improper management of infectious

hospital waste.

The statement that infection control is OK in India also conflicts with WHO

studies on injection practices & safety in India. Moreover there is no national

policy on use of antibiotics, and intravenous procedures in India.

It is well known that more than 50 % of injections are unnecessary, and a large

proportion of Intravenous procedures could have been avoided. Under these

circumstances how can one surmise that infection control in India is in good

shape?

Lalji K Verma

MBBS, PGD (Env & Ecology), psc, FRSA

253, AFNO Enclave, Plot-11, Sector- 7, Dwarka

New Delhi - 110075

Tele - +91-11-25094702, 9312626462

e-mail: <lkv2005@...>

[Guest guest]

Dear FORUM,

I do agree Dr. Vama's comments and it is a cause of major concern for our

patients who are the worst affected. The medical profession should learn to

adapt to the changing scenario due to sudden rise of Blood born infections and

must follow a strict infection control practice with carefully segregated waste

disposal as per the standard guidelines available. As undergraduates, about 26

years back, not much emphasis was put by our medical college teachers. But now,

we are facing newer challenges and must study and learn these things properly by

attending CMEs or going to back to ones medical college to aquire the knowledge.

What's wrong in learning things you do not know?

In fact, there is a huge community of family physicians from various 'pathies'

who show total disinterest when such CMEs are held.

Today, at our Jyothis AIDS charitable trust, we had organised an HIV-AIDS

awareness workshop free of charge. Out of the 35 G.P.s 17 signed the circular

for attending it but not a single doctor turned up. And when you see the

mis-management of the HIV patients by them(they do not refuse any patient

whether they are capable of treating them or not), your heart bleeds. No

pre-test / post-test counselling, no diagnosis,treatment of opportunistic

infections, straight ' TRIMUNE 1 BD' Is it not scary?

The medical counsil of india should make it compulsory for all doctors to appear

for required examinations from time to time to test their knowledge in the

field. If the doctor fails, his lisence should be cancelled. This way we can

overcome lots of problems faced by the patients. But, it does not look like that

anything similar might happen in the near future. so, till that time, all the

best for the common man who does not question his doctor as to why he is being

poked and what has been pushed in his body.

Dr. Divya Mithel,

M.O. Jyothis Care center, Kalamboli

E-MAIL: <d_mithel@...>

[Guest guest]

Dear Forum,

I agree with Dr. Lalji K Verma's observation " It is really amazing to say that

infection control appears OK in India!There cannot be anything farther from the

truth " .

Same is the case with Blood and blood products. With our experience it seems

people are afraid of talking about these issues as this opens up a can of worms.

Medical fratenity is an organized union and a forum and every body will join

hands if any one approaches them or questions them.

With our rich experience of working in the hospitals like AIIMS and other

Tertiary institutes, Infection control with in a hospital is a issue of concern.

Have you ever heard of sterilizing 150 women under the family planning programm

in merely two hours with only two laproscopes available to the implementing

staff?.

We have still saved that article which appeared in Today and Week as it was a

footage done in districts where we lived and worked. After a small protest the

issue was supressed in the files and the practice continues across the

districts, state and the nation. Reason: The targets has to be met. It brings

Hepatitis B, HCV or HIV, no one is bothered. The targets are met.

It is basically a situation where we want to change the scenario of HIV AIDS but

cannot make structural changes and only want to stick to awareness and training

programmes without making anyone responsible or discuss all these issues at the

national and international forums and workshops.

I will thank again for raising this issue but most of us will say " I know this

happens, but what can I do in this " . The same thing was once said by the very

senior health secretary at the National level behind the closed doors.

Alternative is someone has to fix the responsibility of someone and not bent to

the political pressures at the Gram panchayat, block, district, state or at the

national level if we all want to see the changes in the scenario.

We have to make some structural changes or live with the situation.

Regards,

Sanjeev Jain

e-mail: <sparshaids@...>