Skin Cancer strikes Kirdalli Hamlets due to ?Arsenic poisoning

Skin Cancer strikes Kirdalli Hamlets due to ?Arsenic poisoning
Diligent observation detects association with impure drinking water.

Deligent observation of three patients of Squamous Cell Carcinoma (Skin Cancer) occurring at the region of heel and all of them suffering from skin lesions evoked my inquisitiveness. It couldn’t be sporadic or coincidence.

Cancer patients are not normally seen arising in localities. Interestingly, here they all belonged to a tanda (Hamlets belonging to Lambani tribe of nomads). In almost 20 years of surgical exposure such an association especially with respect to a malignant disease was never seen. Hereditary occurrences might occur.

On this instance, which occurred recently, I realised that some interesting correlation exists. Skin Cancer was established by an edge biopsy but the exact predisposition and diffuse skin lesions were unidentified.

Immediately, I drew the patient to a dermatologist. Dr. Guruprasad diagnosed the skin lesion to be of chronic Arsenic poisoning. In fact, these lesions are premalignant leading to Squamous Cell Carcinoma or Basal Cell Carcinoma.

Apart from discussions to have an academic paper, my mind moved to think about the larger issue. Establishing the cause and remedy striked me. Unsure of the receptivity of press in general, I called Shri Jayateerth Patil, Chief Reporter, Vijay Karnataka, Gulbarga to broach this detection. I continued conveying that this is first time an association with drinking water and cancer involving a group of people exists and thus remediable. Further I added, let the coverage concentrate on remediable social health issue rather than personal coverage to draw the attention of administration.

Thereafter, he immediately arrived, covered it on the front page of all Karnataka Edition without my name anywhere. The rest is history.

Today, the district administration & district health officer are pursuing the matter. Water samples collected and sent for analysis. They are committed to taking care of the issue so that the whole tanda is free of contaminated water. Unfortunately, it seems to be taking political hue. That apart, a sense of elation and satisfaction is creeping in me that a large group of about 600 people will be benefited.

Visit to Tanda
We decided to visit the spot to have the feel of ground reality in spite of the scorching summer. Travelling along with journalist to the far end of the district in Shorapur tanda was a mixed experience, rich in information and poor on body. Almost 175 kms away, negotiating the long stretches of potholes was tough.

On arriving at the tanda, the people were elated with hope glowing on their face. They looked familiar, as they were my patients as stated later by them. 20% of the population having 60 hamlets were suffering from full-blown skin lesions. They might turn malignant anytime. Children seem to be spared with manifestation as of now.

Most of the adult working population had easy fatigability, suffered open wound on foot leading to amputation of leg as well in one instance. It took away their livelihood. The lady with amputation will remain handicapped for life. Actually, they were ailing yet ignorant of the underlying cause.

While returning, another peculiarity associated with this region striked us and that was the uranium belt. Gogi Village in neighbouring Shahapur taluka is known place of uranium reserve. Mining of uranium is taking place. Since, uranium isotope radiation is known cause of Cancer, we decided to see that place.

Just on the sides of Gogi – Kembhavi Road is situated the uranium exploration area. It was marked as restricted area. Armed with Press identity and my professional identity, we talked to the contractor whose job is just mine and hand over the raw material to Uranium authority of India. He elaborated that the mining activity is something like drilling a core of a size of 10 feet diameter by the core machine. While depths of 120 mts are bored to get the material, they have approached about 110 mts. It doesn’t involve any manual labour activity.

With this information, we returned. On the whole, it was a moving experience.

More on this will follow,

Sharad

Photographs of Kirdalli Tanda & Patients

View of the Kirdalli Tanda, Shorapur Taluka
Amputed leg of one inhabitant showing skin lesions also

Patient with cancerous ulcer on the heel associated with skin lesions on the palms

Photographs related to clinical manifestations of Chronic Arsenic poisoning

Yashaswini Health Insurance

Hello,

We confess our inability to maintain the date with you as thought while commencing the blog. The weekly ritual & deadline couldn’t be kept for various reasons, the foremost being my inability to narrow down to a particular issue for lack of specific feedback. Secondly, my intent is positive, constructive and communicative. If these aren’t met, there would be no reason to write. Not being discouraged, let us be dynamic, adjust according to the stream and the ambience while retaining the intent.

Yashaswini will soon become another bleeding white elephant.
Generally speaking Health Insurance is a no win situation over long period.

The write up ‘Yashaswini Insurance beset by nepotism, infrastructure snags’ in The New Indian Express dated 18th May 09 has brought to light the inadequacies in the presently popular health insurance scheme of Karnataka in cooperative sector.

Commenced in the year 2003 the Yashaswini Health Insurance Scheme had three stakeholders. A trust board managed by the pioneer Dr. Devi Prasad Shetty, Government of Karnataka and the farmer cooperative body. Each farmer belonging to the cooperative body pays a subsidised premium every year matched with equal amount by government of Karnataka.

In the beginning, it was presumed that it would be win win situation for all concerned. For doctors and cardiothoracic surgeons specifically it gave clientele. For Government they got a populous programme that they could drum up and for the farmers they got hope of getting the costliest surgeries done for a paltry subsidized premium. While the programme was in its infancy claims were minimal making it profitable as a business venture as well. But now, the ills of the scheme seem to manifest.

There is alleged large scale unwarranted claims processed consequent to the nexus between hospitals and the system. It is no longer restricted to nominal percentage of claims as seen during its height of popularity as novel scheme. Secondly, under the pretext that operative charges for non-cardiac surgeries are meagre, hospitals are charging the patient. Actually, no hospital in the scheme of network is supposed to collect any money. It’s a cashless health care delivery system.

The premium for the farmer has increased, consequent to the exponential increase in claims the Government contribution is increasing significantly as they cannot mar the populous programme. Finally, Dr. Devi Prasad Shetty has started commenting that most of the private hospitals are already overcrowded with patients, as Government hospitals are not coming forward to avail the benefits of Yashaswini scheme etc.

Deficiencies and ineffectivity of Government infrastructure is ubiquitous and thus well known. This scheme was incorporated so that poor farmers who have not been able to get treated in public sector or otherwise will be able to get them by subscribing to the insurance scheme.

The initial period is like honeymoon. Claims are less and patients get pooled. But sooner the ills of Health Insurance start becoming obvious.

A bleeding white elephant! It will not be the so-called progressive health insurance it was meant to be.

Meanwhile, let us look at the present situation of Health Insurance scheme of US, which is in place for many decades as a learning exercise. Today, the health insurance premium is approximately one third of the income of the individual. The burden of health insurance premium is so much that 10-12% of Americans cannot afford it and therefore are not covered by health insurance.

The insurance corporate body is doling out profits every year as medical practitioners crib of low professional charges and the common man suffers for the inability to pay the huge premium. You would ask, ‘Why would the doctor get less?’ The reason is the corporate insurance body would negotiate with the doctor community for the professional charges. If a patients needs regular appendectomy which costs $ 1,50,000/- approximately there, the insurance company fixes a rate of $30,000. All those doctors who are willing to operate at that rate will be on the rolls of the insurance company. The patients will have to choose from that list only. Finally, today, neither is the common man benefited nor the professional is. That speaks of the present insurance scenario.

Today, Karvy Stock broking people approached me for insurance subscription. They said ‘we would negotiate the premium with the insurance company and give you the lowest bidding’. This sounds the harbinger of things to come.

There is another instance, which speaks for itself. While you go to avail treatment at a corporate hospital, one needs to mention whether you wish to avail any cashless Health Insurance. A glance at the tariff is astounding. If you avail of the treatment against cash the cost of surgery would be Rs. 1,00, 000/-. While you avail it for the insurance card, the cost of the same surgery would be Rs. 3,00,000/-. If the hospital collects three times more, where will the company pay? It has to be from the increasing the premium!

I should confess that I am no financial expert but simple understanding reveals that Health Insurance programme is not as simple as saying, ‘I pay Rs. 5,000 as premium and get a treatment worth Rs. 5,00,000 some day’. There are many variables and uncertainties.

It’s not the final word.

Sharad

Low voting percentage – Stop whipping the urban middle class

The Missing Angle - Questionable electorate numbers

Consistently low voting percentage quoted in spite of every effort made this time to create voting awareness has kick started the debate on ineffectuality. The ground reality suggests active participation of the electorate, yet the figures quoted is dismal 40%-45%. In other words 55%-60% of enrolled voters have not participated. There are sufficient reasons to debate the authenticity of electorate figure itself, which has found scant attention during the debate.

All this time, the urban middle class was blamed for not participating in the electoral process. This time every effort was made to create awareness starting by the media (as part of social commitment), celebrities, Bollywood promotion documentaries, NGO’s and advertisement by election commission itself. Yet, all the 5 rounds found sustained low figures in both urban and rural areas.

Urban areas
There is high political curiosity amongst the average urban population as reinforced by the finding that every other person when enquired reassures his participation in the election. The urban streets look desolated on the Election Day except for the vote exercising activity. Yet the urban voting percentage mentioned at the end of voting is well below the mark. The employees of unorganised sector who hail from interiors avail forceful absence, as the lure of voting in villages is much more.

Rural area
The voter mobilization is much more organized in rural areas. They are enticed in various forms just before voting. In these days of costliest elections every vote is for commercial exploitation. People who have migrated to urban areas are brought back on the voting day. An article in The Hindu quoting the large migration from Gulbarga and arrangements being made by all political parties to bring them back is testimony to it. All arrangements are made to transport them locally also albeit with much less visibility than before to avoid the eyes of election observers. Having committed, non-participation in the election process becomes obvious to electorate mobilizers in rural area. Lastly, inflated voter registration gives the political parties increased manoeuvring space as 90% or more voting in any booth is scrutinized by the election commission.

System Contribution
The election commission doesn’t have the capability to verify the enrolment of large-scale bogus voters. Secondly, multiple enrolments in native & places of work continue.

The very fact that 10,000 – 15,000 votes are deleted at one stroke speaks volumes. Secondly, with such large scale unemployment & the ability to muster a crowd of 1-5 lakh people easily for a single political rally’s is taken into consideration the figure of 55-60% of enrolled voters not participating in the election process is hard to digest.

Consequently, there is need to look at the questionable numbers itself rather than whip the urban middle class for the ill as usual.

Sharad