Contents of section 9: Health.Chapter 1-Facts and figures on Health.1.1-F&F - Child Health in the developing world. 1.2-F&F - Global Health Scenario – Hunger and Mortality rates.1.3-F&F - The Millennium Development Goals.1.4-F&F – All are responsible for upholding human dignity. 1.5-F&F – MDG - Eradicate extreme poverty and hunger. 1.6-F&F – Causes of malnutrition and the changes that we can expect with VPA – MV –- MN. 1.7-F&F – MDG - Reducing poverty.1.8-F&F – MDG - Achieve universal primary education.1.9-F&F – MDG - Promote gender equality and empower women.1.10-F&F – MDG - Reduce child mortality.1.11-F&F – The path of post independence health programmes in India. 1.12-F&F – Under five mortality in the south East Asia region; 1.13-F&F – Low birth weight rate of the world.1.14-F&F – MDG – Improve maternal health.1.15-F&F – MDG – Combat HIV/AIDS, malaria and other diseases. 1.16-F&F – MDG – Develop a global partnership for development.1.17-F&F – MDG - Principles of good developement.1.18-F&F – ILO – Child labour.1.19-F&F – Some facts on Poverty, Malnutrition, Anaemia.1.20-F&F – Death due to inadequate health care. 1.21-F&F – Financial stress due to hospitalization.1.22-F&F – Causes for Maternal death.1.23--F&F – Maternal death in India.1.24-F&F – Survey data on Maternal and child health 2005 – 2006.1.25-F&F – Perinatal mortality.1.26-F&F – Cycle of Illness and Poverty.1.27-F&F – Few Economic indicators of India.1.28-F&F – Infant mortality.1.29-F&F – Neonatal, Infant, under – 5 mortality rates.1.30-F&F – Causes of child mortality (Under 5 mortality).1.31-F&F – Life expectancy at birth.1.32-F&F – Good health services are available, is it for all? 1.33-F&F – Medicine and man.1.34-F&F – Medicine and the people of medicine.1.35-F&F – Medicine – medicines (drugs) and instruments.1.36-F&F – Economy and Health.1.37-F&F - Delayed recognition of simple health problems and poor school outcome.1.38-F&F - Nutrition (Un affordability / unaware) and health of the children.1.39-F&F - Trial of labour where there is no facility to do caesarean section and ending up- with many complications. 1.40-F&F - Influence of the Economy on the patient care givers.1.41-F&F - Poor housing leadings to varieties of ‘bites – burns’ and they coming to the -health facility for treatment.1.42-F&F - Poor infrastructure predisposing to life threatening injuries.1.43-F&F – Money is the decision maker for the treatment.

iews to ma e this World developed and thisV k ‘ ’ arth as the lovely place for every uman .‘E ’ ‘H ’

SECTION 9HEALTHTargeting for long life:

Why we need to target only for 100 to 150 years of life, why not 200 to 300 years of healthy, active, productive life as we read in our ancient epics.

Try to achieve the state where there is health for everyone, everywhere, all the time.

Chapter 1: Facts and figures on Health.1.1. F&F - Child Health in the developing world. [Approach to child Health in the developing world:

Traditionally, efforts to improve child health in the developing world have focused on primary health care. This approach concentrates on improving public health and basic health care at the community level, usually by training village health workers to recognize and manage childhood illnesses such as diarrhea and pneumonia. The primary health care approach is essential in developing countries, where access to basic medical facilities and trained health care professionals is often lacking, and where the majority of childhood diseases are preventable. However, the primary health care approach includes teaching village health workers to recognize and refer sick patients to acute health care facilities. Currently, there are inadequate resources devoted to training health professionals

and establishing such referral centers in most developing countries; they often do not exist and, therefore, sicker children suffer or die. Depending on the resources available and the socioeconomic situation of a given country, these outcomes may be unavoidable. However, as the public health infrastructure improves in a developing country, it becomes increasingly important to train local child health specialists. These child health specialists provide referral care to individual children and serve as the backbone for long term improvements in child health by providing local expertise and knowledge for the formulation of child health policy in their own countries.

Pediatrician and child health professionals can contribute to improving both primary health care and higher levels of medical care for children in developing countries. The field of pediatrics has excelled at integrating primary health care and preventive care in to the practice of curative medicine. Pediatricians have long recognized the need to provide comprehensive care to children and to use any point of contact as an opportunity to assess the overall health of the child and family. These principles are being implemented by WHO on a global level through the program Integrated Management Of Childhood Illness (IMCI). In the past, many health programs in developing countries took a single - condition approach (sometimes called a vertical approach), for example, achieving specific immunization goals or eradicating malaria. This very focused approach fails to adequately address the health care needs of children. A visit to the vaccine clinic that does not address a child’s malnutrition or diarrhea is a lost opportunity to prevent illness and promote health for that child. IMCI is a positive step towards providing higher quality, comprehensive care for children in the developing world. The IMCI health care algorithms are written at or slightly above the level of a village health worker, and they target children younger than 5 years old, the group with the highest death rate from common childhood diseases. However, the

broader guideline of integrating curative and preventive care for a child is appropriate at all levels of health care provision. For infants 1 week to 2 month old, IMCI has assist clinical priorities that assessment of the main signs and symptoms of bacterial infection, diarrhea, feeding problems, low weight, and immunization status. For children 2 months to 5 years old, the IMCI priorities of management emphasize cough and breathing difficulties, diarrhea, fever, ear problems, nutritional status, and immunizations.

In most settings, it is difficult to separate the health of the child from that of the family and the broader social context in which the child lives. This is particularly true in the developing world. Maternal heath practices strongly impact child health, particularly in the Perinatal period. Perinatal care, neonatal resuscitation, maternal nutrition, breast feeding and weaning practices, and maternal depression all may have profound effects on a child’s well being. Economic conditions and family resources drive health care decision – making. For example, do we pay for our sick child’s medication or buy food for our other children? Environmental conditions limit the effective treatment of preventable illnesses, such as diarrhea and malaria. Political instability and violence interfere with the establishment and maintenance of health care systems. Cultural and religious practices may limit or counteract the effectiveness of medical therapies. Child rights abuses may underlie presenting illnesses. Much of the childhood disease burden in developing countries may right rightfully be seen as the medical manifestations of social illnesses, such as lack of education, poverty, and other forms of injustice. Source [93]

With VPA – NHS – MV – MN, the people will have direct access to the healthcare professionals, and with this we can avoid the time delay in patient visiting the health care professionals, as they were following the instructions given by the easily available village health workers, as he may not be always correct or he may not be able to recognize the problems early. Public health and basic health care at the community level, becomes better with NHS – VPH, as these are managed by the skilled & qualified people in these fields even in the villages through VPA. Village health workers may not be

available in all the villages, they may change their place of living, they may not be updated with the changes in the field of medicine, thus the children may suffer or may die and this will not happen with the VPA – NHS - MV – MN. The main signs and symptoms of bacterial infection, diarrhea, feeding problems, low weight, and immunization status can be easily recognized by the pediatricians working at the VPH and can be treated. Perinatal care, neonatal resuscitation, maternal nutrition, breast feeding, weaning practices, and maternal depression can be well addressed by the concerned specialty of the VPH, in the VPA, through NHS. Economic conditions and family resources can be made better with VPA. Better environment in the village can be made with VPA, so that, the diseases like malaria and diarrhea can be prevented to the maximum extent. Political instability and violence will not arise with the modified system of democracy, as it is mentioned in the section of ‘democracy’. Bad cultural and religious practices will vanish as the education of the people improves and as good health services are available within the reach of the common people. The overall childhood burden will decrease with better education, eradication of poverty and injustice, through VPA.

1.2. F&F - Global Health Scenario – Hunger and Mortality rates.[Global Health Scenario:

A. 9.2 million U5 deaths.

B. Four million neonatal mortality.

C. More than half a million MMR.

D. 150 million children live with hunger.

E. 50 million children are stunted.

F. India & Nigeria together account for one third of maternal deaths due to pregnancy related causes and child birth worldwide. Source [94]

The various causes for these types of mortality are noted in the previous few paragraphs. With the establishment of VPA – NHS – NES – MV – MN, it is possible to achieve the good results in all these data’s, as there is better care – nutrition – education – housing – vaccination – and sustainability of all these commitments.

1.3. F&F - The Millennium Development Goals.[The Millennium Development Goals (MDGs) were adopted by 189 member states in the Millennium Summit of United Nations in 2000. These states have pledged to achieve the MDGs by 2015.

1. Eradicate extreme poverty and hunger.

2. Achieve universal primary education.

3. Promote gender equality and empower women.

4. Reduce child mortality.

5. Improve maternal health.

6. Combat HIV/AIDS, malaria, and other diseases.

7. Ensure environmental sustainability.

8. Develop a global partnership for development.

Note: Six of the eight goals relate directly to children.

The MDGs are:

1. A set of targets

2. Quantitative nature

3. Time-bound

Meeting the Goals is most critical for children: They are the first to die when basic needs are not met. Source [94]

It is necessary to understand, that, we may not be able to achieve all these targets, in a quantitative nature, in the mentioned time bound of 2015, as we are very close the year specified. We progressed very slowly in all these past years and thus we are not in the speed to reach the target except in few districts like Dakshina Kannada in Karnataka. With VPA – NHS – NES – MV – MN, these types of targets can be achieved in a better way, far before the expected or bound time.

1.4. F&F – All are responsible for upholding human dignity. [“We have a collective responsibility to uphold the principles of human dignity, equality and equity at the global level. As leaders we have a duty therefore to the entire world’s people, especially the most vulnerable and, in particular, the children of the world, to whom the future belongs” Millennium Declaration, 2000. Source [94]

Upholding the principles of human dignity, equality and equity, becomes possible with the establishment of VPA – MV – MN.

1.5. F&F – MDG - Eradicate extreme poverty and hunger. [The Millennium Development Goals:

Goal 1: Eradicate extreme poverty and hunger.

Target: Halve between 1990 and 2015, the proportion of people whose income is less than one dollar a day.

The proportion of people who suffer from hunger.

Source [100]

150 million childern in developing countries are still malnourished. More than half of underweight childern live in south Asia.

South asia 78

Subsaharan Africa 32

East asia and Pacific 27

Middle east and North Africa 7

Latin America/Carrbbean 4

CEE/CIS & Baltic states 2

Source: UNICEF, 2001 Figures are in millions

Source [94]

This says that most of the malnourished / underweight children live in South Asia, including the country of ours, India. We can easily eradicate this problem of malnutrition through VPA, where everyone gets good share of income for their work and good education to the present and future mothers in the VPA and in VPS, to prepare the balanced, nutritious diet.

1.6. F&F – Causes of malnutrition and the changes that we can expect with VPA – MV – MN.

Conceptual Framework of the causes of malnutrition.Source [94]

With VPA – NES – NHS – MV – MN, it is possible to change all the terminologies present in this framework.

Present frame work of the causes of malnutrition.

The change that we can establish with the VPA – NES – NHS – MV – MN.

Basic causes:

Potential resources. Resources become better which are generated at the local level, then resources need not come above down, instead the VPA will generate the resources and will give it the nation.

Economic structure, which is not strong and not supportive to the full extent due to the name ‘lack of fund’.

Economic structure becomes better, and the VPA itself can support any type of programmes inside its VPA limit.

Political and ideological super structures, which are not working well till the grass root level.

The political system becomes more scientific and efficient even at the grass root level, with the modified system of democracy.

Formal and non formal institutions.

All the institutions will be recognized and they will work scientifically. Even the non formal education will also be in a scientific way and this work will be done by the qualified and skilled people in the field to their non qualified semiskilled and routine assistants.

Inadequate education. All the segment of people will get adequate education through NES.

Under lying causes:

Inadequate access to food.

Adequate access to food through VPA.

Inadequate care for mothers and children.

Adequate care for mothers and children through NES & NHS, supported by MV - MN.

Insufficient health services and unhealthy environment.

Sufficient health services and healthy environment by NES – NHS – MV - MN.

Immediate causes:

Inadequate dietary Adequate, balanced,

intake. nutritious, health promoting diet.

Disease. Positive health.

Outcome:

Mal nutrition and death. Keeps the continuous state of physical – mental – social well being, with the absence of disease and infirmity, with Long, healthy, prosperous, and productive life. Cooperation and coordination in work in the form of VPA will easily achieve these targets.

1.7. F&F – MDG - Reducing poverty.[Reducing poverty starts with childern;

Helping childern reach their full potential is also investing in the very progress of humanity.

In the crucail first years, interventions make the biggest difference in a child’s physical, intellectual and emotional development. Source [94]

It is necessary to reduce the poverty at least to help our future generation to progress to the full potential, thus all our future generation, which is our present children will achieve the good physical, intellectual and emotional development. This is possible with VPA – MV – MN.

1.8. F&F – MDG - Achieve universal primary education.[Goal 2: Achieve universal primary education.

Target: Ensure that by 2015, childern everywhere, boys and girls alike, will be able to complete a full course of primary schooling. Source [94]

With VPA – NES – MV – MN, it is possible to make all the children to reach their pre university education and it is also possible to make the norms for literacy like ‘those who completed their SSLC (Secondary School Leaving Certificate, 10th standard) will be considered as literate.

1.9. F&F – MDG - Promote gender equality and empower women.[Goal 3: Promote gender equality and empower women.

Target: Eliminate gender disparity in primary and secondary education to all levels of education, no later than 2015. Source [94]

This will be easily achieved and it will go without saying as both male and females get the equal opportunity in VPA – NES – NHS.

1.10. F&F – MDG - Reduce child mortality.[Goal 4: Reduce child mortality.

Target: Reduce by two thirds, between 1990 and 2015, the under five mortality rate.

Please note: Most deaths occur at home, before reaching health facilities, Implications for programming?

Picture source [100] , Source [94]

With the establishment of VPA – MV – MN, all the people will be living closer to the better health care facility – VPH, so, the time consumed in reaching the hospital, the various reasons for delay in reaching the hospital, and the economy related aspects will be solved to the full extent.

1.11. F&F – The path of post independence health programmes in India.

Source [94]

There are many health programme which came in the way in the post independence period like family planning programme prior to 1971, Medical termination of pregnancy act in the year 1971, starting of Family Welfare Department in the year 1977, Extended Programme of Immunization in the year 1978, Universal Immunization Programme and Oral Rehydration Therapy in the year 1985, CSSM (Child survival and safe mother hood) in 1992, Reproductive and child health 1 in 1997 and RCH 2 in 2001, the present NRHM (National Rural Health Mission ) from the later part of 2002 has decreased the Infant mortality rate, neonatal mortality rate and post neonatal mortality rate. But this achievement is not appreciable as compared to the data’s of the some of the developed countries. That means there is some gap in achieving these goals as that of the developed countries

and this gap will be filled by the VPA – NHS – NES – MV – MN, and the data’s become better than the developed countries with the complete establishment of the VPA – NHS – NES – MV – MN.

1.12. F&F – Under five mortality in the south East Asia region;

Source [94]

We are above the level of HFA (Health for All) 2000 target of Under 5 mortality rate of 70. India’s U5 MR in 2006 was 76. This can be effectively decreased with the establishment of VPA – NHS – NES – MV – MN.

1.13. F&F – Low birth weight rate of the world.

Source [94]

Low birth weight rate can be prevented with better maternal nutrition, which is possible with VPA; better education to the mothers, which is possible with NES.

1.14. F&F – MDG – Improve maternal health.[Goal 5: Improve maternal health.

Target: Reduce by three quarter between 1990and 2015, the maternal mortality rate. Source [94]

Since all the mothers comes directly to the VPH, which is close to their residence in the MV, all the mothers gets the care from the specialist in the field (obstetrician).

1.15. F&F – MDG – Combat HIV/AIDS, malaria and other diseases.

Source [94]

With VPA – MV – MN, the spread of the HIV / AIDS can be brought to zero, as all the families will live in their house in their own village, as they will not get the work to do in any place other than their village as VPWM. Even the elected members and the officials who go to the district head quarter for some work will be coming back to their native village by evening. Only those who go to state and national head quarter, those who drive the vehicle across different states, will be given suitable education and thus the spread can be prevented.

1.16. F&F – MDG – Develop a global partnership for development.

Source [94]

All the programmes with the global partnership and the funds generated by it, can be well utilized with the VPA – NHS – NES – MV – MN.

1.17. F&F – MDG - Principles of good developement.[Principles of good developement:

1. Universal coverage, reaching the unreached, especially the poor.

2. Home and community based stratergies.

3. Essential knowledge and commodities (Vaccines, treated bednets against malaria etc.)

4. Seek maximum impact on human development (eg. Health and education) and on poverty reduction.

5. Evidance based dicision making.

High impact, low cost interventions.

Source [94]

With the establishment of VPA – MV – MN, universal coverage becomes easy, there is nothing like unreached will arise, because all will be living in the MV and all are reachable any time and the poverty will disappear with VPA.

We need not create many strategies telling different locations of homes and communities targeting more than six lakh villages and millions of haphazardly situated single digit houses, and it is possible to create only one strategies targeting VPA which are less in number, may be sixteen to twenty thousand covering the entire nation.

VPA – VPH – VPS can provide the essential commodities on an accurate basis, based on the need.

Health and education becomes completely free and thus everyone will get good health and education, by the VPH and VPS, through NHS and NES, respectively.

Poverty will vanish with VPA.

All the events will be recorded and they will act like the evidences in all the fields like agriculture, industry, health and education. For example all the treatment given by all the doctors will be available for comparison in MV, and if we look in to it, it will tell us which is better and which in not better. This helps to choose the best practice and for decision making.

The cost in imparting the programmes becomes less as the people becomes reachable at one sitting and the impact is becomes good as the acceptance by the people becomes better with better education and understanding of the long term benefits of the programmes.

1.18. F&F – ILO – Child labor.[Child labour:

1. ILO (International Labour Organisation) estimates that 218 million childern were involved in child labour in 2004, of whom 126 millions were engaged in hazardous work.

2. 1104 lakh child labour in the country (SRO 2000 Self Regulatory Organisation).

3. The world’s highest number of working childern is in India.

4. WHO estimates that almost 53000 child deaths in 2002 were due to child homicide.

5. Across different kinds of abuse, it is young childern, in the 5 – 12 years group, who are most at risk of abuse and exploitation.

Most childern did not report the matter to anyone. Source [94]

With the establishment of VPA – MV – MN, children need not go for any type of labor and they will be free to study in the VPS, as all their parents will be getting good income through the VPA.

1.19. F&F – Some facts on Poverty, Malnutrition, Anemia.[Poverty, Malnutrition, Anemia.

1. Every third malnorished child in the world lives in India.

2. Every second Indian child is underweight.

3. Three out of four childern in India are anaemic.

4. Childern born with low birth weight are 46%.

Childern under 3 years with naemia are 79%.

Source [94]

All such problems can be solved as all the families will have good economy, good store of all the varieties of nutritious diet. It is possible to eradicate the nutrition related malnutrition and anemia.

1.20. F&F – Death due to inadequate health care.

Source [94]

Women and children dying because of inadequate health care will not happen with VPA – NHS – MV – MN.

All the people will have easy access to the specialist care in the MV. No people will be staying outside the MV limits.

With NES, and the seat matrix as per the population distribution will generate the specialists locally, these specialists with their parents – family – property will lead a happy life in their own village and the life style facility, education for their children will as good as that of any where in this world. So, specialists moving out of the MV, will not arise. Better infrastructure, health universities analyzing the demand of the doctors in the society, providing the seats according to the population distribution and according to the work load will solve all infrastructure and trained medical person related issues.

1.21. F&F – Financial stress due to hospitalization.[Hospitalization – Financial stress:

1. Only 10% Indians have some form of health insurence, mostly inadequate.

2. Hospitalized Indian spend 58% of their total annual expenditure on health care.

3. Over 40% of hospitalized Indians borrow heavily or sell assets to cover expenses.

Over 25% of hospitalised Indians fall below poverty line because of hospital expenses. Source [95]

With VPA – VPH - MV – MN, all the people will get free health services, and there is no necessity to go for health insurance and the nation becomes strong enough to support the free health and education to its people with VPA – MV – MN.

1.22. F&F – Causes for Maternal death.

[Maternal death

Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2000, the United Nations estimated global maternal mortality at 529,000, of which less than 1% occurred in the developed world. However, most of these deaths have been medically preventable for decades, because treatments to avoid such deaths have been well known since the 1950s.

Maternal Mortality definition; According to the WHO, "A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes." Generally there is a distinction between a direct maternal death that is the result of a complication of the pregnancy, delivery, or their management, and an indirect maternal death that is a pregnancy-related death in a patient with a preexisting or newly developed health problem. Other fatalities during but unrelated to a pregnancy are termed accidental, incidental, or non obstetrical maternal deaths.

Maternal mortality is a sentinel event to assess the quality of a health care system. It is well recognized that maternal mortality numbers are often significantly under reported.

Reducing the maternal mortality by three quarters between 1990 and 2015 is a specific part of Goal 5 -Improving Maternal Health - of the eight Millennium Development Goals; its progress is monitored here.

Major causes;

The major causes of maternal death are bacterial infection, variants of gestational hypertension including pre-eclampsia and HELLP syndrome,

obstetrical hemorrhage, ectopic pregnancy, puerperal sepsis, amniotic fluid embolism, and complications of unsafe or unsanitary abortions. Lesser known causes of maternal death include renal failure, cardiac failure, and hyper emesis gravid arum.

As stated by the 2005 WHO report "Make Every mother and Child Count" they are: severe bleeding/hemorrhage (25%), infections (13%), unsafe abortions (13%), eclampsia (12%), obstructed labor (8%), other direct

Causes (8%) and indirect causes (20%). Indirect causes such as malaria, anaemia, HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggravated by it.

Forty-five percent of postpartum deaths occur within 24 hours.

Maternal Mortality Ratio (MMR);

Maternal Mortality Ratio is the ratio of the number of maternal deaths per 100,000 live births. Lowest rates included Iceland at 0 per 100,000 and Austria at 4 per 100,000. In the United States, the maternal death rate was 11 maternal deaths per 100,000 live births in 2005.

"Lifetime risk of maternal death" accounts for number of pregnancies and risk. In sub-Saharan Africa the lifetime risk of maternal death is 1 in 16, for developed nations only 1 in 2,800.

In 2003, the WHO, UNICEF and UNFPA produced a report with statistics gathered from 2000. The world average per 100,000 was 400, the average for developed regions were 20, and for developing regions 440.

Associated risk factors;

High rates of maternal deaths occur in the same countries that have high rates of infant mortality

reflecting generally poor nutrition and medical care.

Low birth weight of the child is correlated with maternal death from cardiovascular disease. Subtracting one pound of infant birth weight is correlated with the doubling of the risk of maternal death. Conversely, heavier child birth weight is correlated with lower risk of maternal death.

Another issue that is associated with maternal mortality is the distance of traveling to the nearest clinic to receive proper care. In Third World countries, as well as rural areas, this is especially true. Traveling to and back from the clinic is very difficult and costly, especially to poor families when time could have been used for working and providing incomes. Even so, the nearest clinic may not provide decent care because of the lack of proper staff and equipment such as ones in the Guatemalan highlands.

1.23. Maternal death rates in the 20th century;

The death rate for women giving birth plummeted in the 20th century.

The decline in maternal deaths has been due largely to improved asepsis, use of caesarean section, fluid management and blood transfusion, and better prenatal care. Recommendations for reducing maternal mortality include access to health care and emergency obstetric care, funding and intra partum care. Moreover, political will and support play a major role and without it reforms to reduce maternal mortality cannot be made. Source [96]

Maternal mortality rate in India: 200 deaths/100,000 live births (2010). This number of MMR, tells that quality of health care is not good in India. It is also necessry to not the sentence that ‘ maternal mortality numbers are often significantly under reported’, and thus this number may be still more, as our nation poorly organized in terms of housing, hospitals / clinics, place of delivery and its influence on the reporting. Usage of sterile sanitary napkins in the place of traditional pieces of cloth, better education on perinea hygiene even at the secondary education through NES will reduce

the incidence of uro genital infections. Complications like gestational hypertension including pre-eclampsia and HELLP syndrome, obstetrical hemorrhage, ectopic pregnancy, puerperal sepsis, amniotic fluid embolism can be recognized early and managed well in the VPH by the specialists. The blood banks in the VPH can provide the necessary components at the right time. It is also possible to maintain the blood group list of the whole population of the VPA, apart from the blood bag availability, as it is maintained as on today by the drug controllers. This web will tell the blood groups of the population of entire nation, apart from the presently available blood bag availability in the blood banks. All the abortions are done in the hospital and they are done safely when it is indicated in the VPH by the specialist. Medical illness complicating pregnancy, pregnancy leading to exacerbation of medical illnesses can be managed well with the multidisciplinary approach in the VPH. VPH will have good Operation theater set up for doing all the obstetric surgical emergencies with blood bank, laboratory backup.

Poor maternal nutrition, from her in utero life to her child hood to her adolescence to her child bearing age leading to poor maternal and offspring out comes can be overcome with better availability of nutritious diet to all by the VPA. It is worthy to note, that those female new borns delivered with low birth weight will have high risk for maternal death as they become the pregnant women and also they are at higher risk for developing cardiovascular disease.

Distance travelled by the pregnant women for ANC, by the pregnant women in labor for delivery, and for checkup in the follow up period will decrease as they are staying closer to the VPH in MV.

Access to health care, emergency obstetric care, intra partum care becomes better with VPA – VPH - MV. Political will and support becomes more strong with the modified system of democracy, where every political leader will be looking for better care, man power and infrastructure, as parties and misunderstandings are not coming in the way of work, which are done as the routines all across the nation through programmes and protocols.

1.23. F&F – Maternal death in India.

Maternal mortality rate in India: 200 deaths/100,000 live births (2010)

Maternal mortality rate in USA: 21 deaths/100,000 live births (2010)

One in every 7 minutes one woman is dying because of delivery related causes.

Five and half lakh women are dying in a year because of delivery related causes in the world.

Seventy eight thousand death per year due to delivery related causes only in India.

Causes for maternal death in India: Marrige at younger age, teenage pregnacies, inadequate and improper antenatal care, improper nutrition to the pregnat mothers especially in rural areas, gap between the two childern are less, lack of skilled people to take of the pregnacy and delivery especillay in rural areas, less blood in the women (Anemia).

45% fo maternal death occurs in women aged less than 24 years of age.

12% of maternal death are due to illegal madical termination of pregancy.

24% of maternal death are due to blood loss and nutritional deficiencies.

23% death due to infection acquired during delivery.

Maternal mortality is more in the states like Rajastan, Bihar, Uttar pradesh, Madyapradesh, Assam, Orissa, uttarkhand, Jarkhand.

53% of deliveries are conducted by the untrained nurses. Child marriage is one of the important cause for maternal mortality. India accounts for 40% of the child marriages in the world.

In about 27% of marriage in India the girl’s age will be less than 15 years. In about 58% of marriage in India the girl’s age will be less than 18 years. The maternal mortality rate will be five times more if they became pregnat before the age of 15 years as comared to those who become pregant after the age of 20years.

It is also suggested in the article like eradiction of the difference in accepting the girl and boy childern, eradiaction of child marriges, enforcing the strict law in marriages, better treatment and nutrition to the girl. Source [97]

Solution: All these things will be achieved with ease and will go without words as routine with the establishment of VPA - VPH – MV - MN.

1.24. F&F – Survey data on Maternal and child health 2005 – 2006.

Source [98]

With VPA – NHS – VPH – MV – MN, it is possible to follow the specialist’s advice as per the need, since all these services are free and the people are staying closer to the health delivery system (VPH) in the MV. So, it is possible to make, more than three ANC (Ante natal checkup – specialist examining the pregnant women during the pregnancy, before the delivery of the child) visits with the specialists to all the pregnant women (100%), all the deliveries will occur in the VPH (100%), all the children will get all the needy vaccines (100% vaccine coverage)

Dhakshina kannada district in Karnataka is doing a good work in this aspect.

1.25. F&F – Perinatal mortality.

[Perinatal mortality;

Perinatal mortality (PNM), also Perinatal death, refers to the death of a fetus or neonate and is the basis to calculate the Perinatal mortality rate. Variations in the precise definition of the Perinatal mortality exist specifically concerning the issue of inclusion or exclusion of early fetal and late neonatal fatalities. Thus the WHO ‘s definition "Deaths occurring during late pregnancy (at 22 completed weeks gestation and over), during childbirth and up to seven completed days of life" is not universally accepted. The Perinatal mortality is the sum of the fetal mortality and the neonatal mortality.

Fetal mortality;

Fetal mortality refers to stillbirths or fetal death. It encompasses any death of a fetus after 20 weeks of gestation or 500 gm. In some definitions of the PNM early fetal mortality (week 20-27 gestation) is not included, and the PNM may only include late fetal death and neonatal death. Fetal death can also be divided into death prior to labor, antenatal (ante partum) death, and death during labor, intra natal (intra partum) death. Fetal mortality can be decreased by good preconception health among women before they get pregnant.

Neonatal mortality;

Early neonatal mortality refers to a death of a live-born baby within the first seven days of life, while late neonatal mortality covers the time after 7 days until before 29 days. The sum of these two represents the neonatal mortality. Some definitions of the PNM include only the early neonatal mortality. Neonatal mortality is affected by the quality of in-hospital care for the neonate. Neonatal mortality and post neonatal mortality (covering the remaining 11 months of the first year of life) are reflected in the Infant Mortality Rate.

Perinatal Mortality Rate;

The PNMR refers to the number of Perinatal deaths per 1,000 total births. It is usually reported on an annual basis. It is a major marker to assess the quality of health care delivery. Comparisons between different rates may be hampered by varying definitions, registration bias, and differences in the underlying risks of the populations.

PNMRs vary widely and may be below 10 for certain developed countries and more than 10 times higher in developing countries. Source [99]

Neonatal mortality is affected by the quality of in-hospital care for the neonate. The in hospital care can be made better with VPH _ NHS. By making the nation a developed country, it is possible to bring down the mortality and morbidity rate, equalent or better than developed nation.

1.26. F&F – Cycle of Illness and Poverty.

Source [100]

VPH – MV – NHS will prevent the entry of illness to the people with poverty, through its effective public health interventions. Eradication of poverty will be done by the VPA, so that the illness will not attack the society where there is no poverty. Thus, this cycle can be effectively breaked with the establishment of VPA – MV – MN – NHS.

1.27. F&F – Few Economic indicators of India.

Source [101]

The economy of all the segment of people becomes better with VPA, the literacy rate will reach near 100 % for both males and females with VPS – NES – MV – MN.

1.28. F&F – Infant mortality.[World Infant mortality rate.

Infant mortality

World infant mortality rate 2007

Infant mortality is defined as the number of deaths of infants (one year of age or younger) per 1000 live births. The most common cause of infant mortality worldwide has traditionally been dehydration from diarrhea. Because of the success of spreading information about Oral Rehydration Solution (a mixture of salts, sugar, and water) to mothers around the world, the rate of children dying from dehydration has been decreasing and has become the second most common cause in the late 1990s. Currently the most common cause is pneumonia. Major causes of infant mortality in more developed countries include congenital malformation, infection and SIDS.

Infanticide, abuse, abandonment, and neglect may also contribute to infant mortality Related statistical categories:

Perinatal mortality only includes deaths between the foetal viability (22 weeks gestation) and the end of the 7th day after delivery. Neonatal mortality only includes deaths in the first 28 days of life. Post-neonatal death only includes deaths after 28 days of life but before one year. Child mortality includes deaths within the first five years after birth.

Infant mortality rate

Infant mortality rate (IMR) is the number of newborns dying under a year of age divided by the number of live births during the year. The infant mortality rate is also called the infant death rate. It is the number of deaths that occur in the first year of life for 1000 live births.

The infant mortality rate is reported as number of live newborns dying under a year of age per 1,000 live births, so that IMRs from different countries can be compared. A good source for the most recent IMRs as well as under 5 mortality rates (U5MR) is the UNICEF publication 'The State of the World's Children' available at http://www.unicef.org/sowc/.

Comparing infant mortality rates

The infant mortality rate correlates very strongly with and is among the best predictors of state failure. IMR is also a useful indicator of a country's level of health or development, and is a component of the physical quality of life index. Some claim that the method of calculating IMR may vary between countries based on the way they define a live birth. The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat.

Another seemingly paradoxical finding is that when countries with poor medical services

introduce new medical centers and services, instead of declining the reported IMRs often increase for a time. The main cause of this is that improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area and not been reported to the government might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase.

Global infant mortality trends

For the world, and for both Less Developed Countries (LDCs) and More Developed Countries (MDCs), IMR declined significantly between 1960 and 2001. World infant mortality rate declined from 126 in 1960 to 57 in 2001.

Infant mortality is inversely related to per capita GDP.

Infant deaths per 1000 births (2007) vs GDP per capita (PPP) (2006). Data source: CIA World Factbook 2007 GDP.

However, IMR remained higher in LDCs. In 2001, the Infant Mortality Rate for Less Developed Countries (91) was about 10 times as large as it was for More Developed Countries (8). For Least Developed Countries, the Infant Mortality Rate is 17 times as high as it is for More Developed Countries. Also, while both LDCs and MDCs made dramatic reductions in infant mortality rates, reductions among less developed countries are, on average, much less than those among the more developed countries.

Infant mortality rate in countriesList of countries by infant mortality rate.

Nearly two orders of magnitude separate countries with the highest and lowest reported

infant mortality rates. The top and bottom five countries by this measure (taken from The World Fact book's 2008 estimates) are shown below.

Rank CountryInfant mortality rate, (deaths/1,000 live births).

1 Angola 182.31

2 Sierra Leone 156.48

3 Afghanistan 154.67

4 Liberia 143.89

5 Niger 115.42

218 Iceland 3.25

219 Hong Kong 2.93

220 Japan 2.80

221 Sweden 2.75

222 Singapore 2.30

Source [102]

Infant mortality rate of India is 53 in 2008. Infant mortality rate, Perinatal mortality rate, Neonatal mortality rate, Under 5 mortality rate are all can be brought down with the establishment of VPA – MV – MN.

Diarrhea leading to dehydration, pneumonia, Infanticide, abuse, abandonment, and neglect related death are all can be easily prevented with the VPA – MV – MN.

It is necessary to make a note on the relation between the GDP and the mortality rates. The GDP becomes better with VPA – MV – MN. It is necessary to make India as MDC.

1.29- F&F – Neonatal, Infant, under – 5 mortality rates.

Source [101]

Source [103]

Source [101]

Source [101]

Source [104]

Child mortality

9.7million globally.

2.1 millions in India alone (34%).

35% of the worlds under nourished children live in India

Causes of Child Mortality

According to UNICEF, most child deaths (and 70% in developing countries) result from one the

following five causes or a combination thereof:

acute respiratory infections

diarrhoea

measles

malaria

malnutrition

Child Mortality

Two-thirds of child deaths are preventable.

Malnutrition and the lack of safe water and sanitation contribute to half of all these children’s deaths.

Child Mortality Rate

The under-five mortality rate or child mortality rate is the number of children who die by the age of five, per thousand live births.

In 2007, the world average was 68 (6.8%).

In 2006, the average in developing countries was 79 (down from 103 in 1990),

whereas the average in industrialized countries was 6 (down from 10 in 1990).

Neonatal, Infant, Under 5 mortality rate decreases to the maximum extent. Better public health interventions, good ante natal – intra natal – post natal care to all the mothers, good nutrition, potable water supply, good sanitation, 100% vaccination coverage, good breast feeding practices, good education to the mother and the people of the family, and so on will contribute to the decline in these mortality rates. So, not only the health services will bring these rates to the lesser level, but it is due to the combined effect of the VPA – VPS - VPH – MV – MN. VPA acts as the economic back bone for the entire segment, MV – MN makes the health care facility accessible to all the people of the nation. VPS / NES educate the mother and the members of the family in the preventive aspects, VPH / NHS will give service to the needy people.

It is possible to eradicate the term called ‘Malnutrition’ and malnutrition related diseases. Better sanitation, drinking water supply will reduce the incidence of infectious diseases like diarrheal diseases. Better immunity and better vaccination status can make the state free from infectious diseases like measles and pneumonia. All these can be effectively done through VPA – VPH - NHS – MV – MN.

1.30. F&F – Causes of child mortality (Under 5 mortality).[Child mortality refers to the death of infants and children under the age of five.

The under-five mortality rate or child mortality rate is the number of children who die by the age of five, per thousand live births. In 2007, the world average was 68 (6.8%).

In 2006, the average in developing countries was 79 (down from 103 in 1990), whereas the average in industrialized countries was 6 (down from 10 in 1990).

Research and experience show that most of the children who die each year could be saved by low-tech, evidence-based, cost-effective measures such as vaccines, antibiotics, micronutrient supplementation, insecticide-treated bed nets, improved family care and breastfeeding practices, and oral rehydration therapy. In addition to providing vaccines and antibiotics to children, education could also be provided to mothers about how they can make simple changes to living conditions such as improving hygiene in order to increase the health of her children. Mothers who are educated will also have increased confidence in the ability to take care of her children, therefore providing a healthier relationship and environment for them.

According to the World Health Organization hunger and malnutrition are the biggest causes of child mortality in developing countries. In all most all cases of child mortality malnutrition is present majority of the cases (WHO). Source [105]

Most of the developing nations, including India, has high child mortality rate. Here the causes are written with the names of the diseases, but the origin for these diseases and their preventions is lies in terms of infrastructure and societal transformation like, safe water – good sanitation modes – prevention of hunger, thus malnutrition – good education to the mother for child care. Most of the Vaccines to all the children, antibiotics to the needy child at right dose and duration, children having the diet where there is no necessity for micronutrient supplementation, good insect free houses, improved family care and good breastfeeding practices by education the mother in her higher

secondary education are possible with VPA – NHS – NES – MV – MN and all these will be done without saying, as a routine.

1.31. F&F – Life expectancy at birth.Some relevant health statistics: Average Lifespan at Birth in (years) or Life expectancy at birth. World average 66.18; Japan, USA, UK, Australia82; India70.

Source [106]

We know that we are not at the top in this aspect. We are somewhat in the middle. It is necessary to identify the cause for this and find out the solution for the same and improve the situation. Causes like poverty, malnutrition, contaminated water and food items, improper cooking techniques, frequent episodes of illness, harmful traditional practices, like this the list grows. We can get the solution for all these things through VPA-MV-MN. Only thing is we need to work together.

1.32. F&F – Good health services are available, is it for all?

Source [100]

In India good services are available to make health services better at many centers, but, it is not sufficient to cater the entire population or not accessible for all or not affordable by all.

Human Medicine works according to the economy of the people; In India, very good services are available, to make the health services better. But, not all the people are able to utilize these services. The reasons behind it, may be, Un affordability, Illiteracy and child labor, Unawareness, Strong belief in traditional practices and so on.

1.33. F&F – Medicine and man.[Human medicine, is the science of understanding the structure (Anatomy and histology), the function (physiology and biochemistry). It is the science, which makes this human machine Stronger (positive health) and longer (more age expectancy at birth). It is the science which, identifies the problems early (Pathology and microbiology), Provide suitable remedy to the individual who is suffering (curative medicine) and the individuals in the community (community medicine). It is the science which sees that the same problems shall not come back to the individuals (immunization) and to the community (Preventive and Social medicine).]

With VPA – MV – MN, it is possible to achieve positive health, more age expectancy at birth, possible to prevent the disease rather than making the people to suffer.

1.34. F&F – Medicine and the people of medicine.[Relation between, Human Medicine and the people who work with the human medicine, their life behind the screen. Voices from the medical professionals: Are we ready – to do this –yes we are ready; Are we ready to work day and night beyond our energy levels – Yes we are ready; Whether the Doctors are present – yes present; Whether the Nursing staff are present – yes present; Whether the Medical gadgets are ready – yes ready; Whether the Very best treatment options are available for this illness- yes available; Whether it is available at any time of the day – yes it is; Whether this service is available to all – yes it is for all; Whether these services are affordable by all - ?; Whether the doctors and nurses are well paid –Yes; Whether all the doctors

and nurses are well paid -?; So, what the less paid doctors and nurses do to compensate the deficiency? Who is compensating this deficiency? Who is the ultimate looser and sufferer?]

With VPA – MV – MN, answers to these unanswered questions can be provided in an acceptable way to all the people.

1.35. F&F – Medicine – medicines (drugs) and instruments.[Relation between the ‘Human Medicine and the medicines - instruments used in it: Whether the medicines and the medical gadgets that we use are good –Yes; Whether all the medicines and the medical gadgets that we use are good -? Whether all the medicines and the medical gadgets that are used in all the places are good -?

It is also ‘Human Medicine’ - Seriousness of the things.

If medicines are not good then what happens? Why drug controllers have to scratch their head so much? If medical gadgets are not good then what happens? Why quality control came in to existence? If a medicine or machine does not work who is going to suffer or die?]

Things can be made better with the establishment of VPA – NHS – VPH – MV – MN.

1.36. F&F – Economy and Health.Economy and Health:

Photography by Dr. Shivu.

Keeping two babies under one warmer. This may be right because if the baby is not given the care at least like this then this baby will be taken home and the parents will try some traditional practice on the baby because the baby is not sucking well at the breast. On the other side it is not the right practice because keeping two babies under one warmer can lead to cross infection, the temperature requirement be the different weight / gestation / day of life is different but we cannot set two temperature at one time in one instrument. There is only one skin probe in one warmer, to which baby we are going to connect it. Like this many issues will arise but still in places this may be practised because the parent are not ready to go to other hospitals because they feel going to the place which they do not know is not possible (Education play the solution here), they may feel going to other hospital at a different place is more expensive that is not possible to bear (Better economy play the solution here), finally the family will come to a conclusion that trying all these things and finally the outcome is not certain or they may get a handicapped child then they think we have to suffer life long, so not to try too much on the child, and any how both the mother and the father are young they can produce another healthy child.

With VPA – MV-MN all the possibilities can be discussed with the parents and all the possible services can be rendered to the family through VPH- NHS. The referral is done by the VPH only when the situation cannot be managed at VPH. VPH can be made in a such a way that till tertiary care the services can be given there only very rare case which are not common can be shifted to higher centre.

Photography by Dr. Shivu.

Problems like one baby puts it hand across the IV tubing’s of the other baby.

Photography by Dr. Shivu.

One baby holding the IV tube of another baby can be seen. If the baby moves its limbs then this baby may pull the IV tube of the other baby may lead to back flow, bleeding from the cannula.

Photography by Dr. Shivu.

One baby holding the hand of the other.

Photography by Dr. Shivu.

Like this many babies are kept under many warmers.Some people for public litigation may start asking the question like ‘who took these photographs? Where it was taken? Why they are keeping the babies like this? Who is the doctor treating these babies? Whether he knows these things should not be done? Why he is not referring these babies to other hospitals? Why he wants to keep all these babies in his hospital even the beds are not there? He did this type of mistake so what type of punishment we can give it to him according to the law?

Since these babies are treated by me, I can do one thing like don’t show such things to the people and thus I will become a very good person even in the minds of people who asks such questions.

If someone is interested in such types of questions then we will make the people especially the leaders to become unaware about this type of issues and they will thing everything is going well in the nation and the only thing left for them is to sit and enjoy.

These types of scenarios are common in present day hospitals, especially the government hospitals, where the people will not move out of the hospital due to financial reason. The hospitals will conduct the delivery but when the baby comes to the NICU admissions the hospital may not have adequate beds.

With VPA, NES, NHS we can go for better infrastructure, adequate beds, adequate qualified staff.

1.37. F&F - Delayed recognition of simple health problems and poor school outcome.

Photography by Dr. Shivu.

Poor performance in the school. Wax in the ear canal may be the cause.Causes like wax in the ear canal, refractory errors, minor colic’s due to worm infestation - intestinal infection and thus the child sitting in the class and concentrating on its abdomen and not concentrating on the lessons, skin infections and thus the baby is sitting and scratching are some of the problems that we see in children. Most of the child may not express it verbally but it is expressed in the form of poor school performance, parents may not be wise enough to identify it, teachers may not identify this problem instead they may punish the child for not showing the good performance.

In this generation it is not possible to train all the parents regarding the identification of common problems of the children, so, now it is better to target the teachers to identify the common problems in the children by incorporating the subjects like child psychology, growth and development, common ailment in children’s and its identification in their degree like ‘degree in primary education’.

1.38. F&F - Nutrition (Un affordability / unaware) and health of the children.

Protein energy malnutrition.

Source: Internet.

Photo by Dr. Shivu.

Conjunctival xerosis. A five year old boy with conjunctival xerosis, at kallahalli near chikmagalur on 29.06.2009.

Same boy with the picture of fruits and vegetables in the back ground as the teaching aid; Photography by Dr. Shivu. Children come to the school and teachers teach about the importance of eating the fruits and vegetable to the students even through the pictures, still this will not work out. This small child will not go and tell all these things to his parents. Even if the child tells it may be only one day that is the day this class was take and not every day, parents may bring some fruits and vegetable if the child insists, later the child eats whatever the parents gives and the parents brings the food items whatever is possible by them. That is the economy rules everything.

Nutritional deficiency diseases like conjunctiva xerosis, angular kelosis, and protein energy malnutrition and so on are seen commonly in the community.

With VPA all the families will get good economy and also the all the food grains and the vegetables through VPA in a cooperative basis. So all the family members will have good food and health.

In VPA educative classes can be conducted to all the village people who are involved in family food cooking and it will be easy for them to attend the class because all of them will be living close to the VPA office and the classes will be conducted at the convenient time. Classes like how to prepare

delicious food and maintaining the nutritive value, how to prevent the loss of nutritive value of the food items in the process of cooking, planning of food item shopping and so on are done in regular basis and things are updated.

The school syllabus will also contain the chapters on nutrition.

The degree in primary education and the related subjects will also have topics on nutrition, nutrition related diseases and its identification, and thus the teachers will identify the related problems early and will refer them to the pediatricians and nutritionists where the whole family will get the counseling.

1.39. F&F - Trial of labor where there is no facility to do cesarean section and ending up with many complications.

It is the healing fracture left femur – thigh bone of a new born. Home delivery was attempted and since it was not successful they came to the hospital. It was diagnosed as thickly meconium stained amniotic fluid, with severe foetal distress, oblique lie with fracture left femur. Caesarean was done immediately baby was resuscitated and the baby survived, but had prolonged hospital stay as the baby was on traction.

With VPA and NHS we need not allow people land up in such complication.

1.40. F&F - Influence of the Economy on the patient care givers:

Photography by Dr. Shivu.Economy plays a major role all the times. The attendees of the admitted patients many a times have spend time at the veranda of the hospital during night to take rest where animals like dogs (regularly) and snakes (occasionally) share the attendees resting area.

With VPA – MV – MN, all the attendees can reach their home at any time, because their houses are close to the hospital in the model village, they need not wait for the bus or other vehicles. Presently if they reach the hospital at some odd hours then they may not able to go back to their house which is present away from the hospital or it may be a lonely farm house to which they don’t get the transportation facility at odd hours and so on.

Facilities like attendees lounge will work out if the economy is better.

1.41. F&F - Poor housing leadings to varieties of ‘bites – burns’ and they coming to the health facility for treatment.

Source: News paper.

Frequently we read news like this. In our practice also we see many cases of snake bite and treated the cases.

Photography by Dr. Shivu.

It is an insect bite to the right arm of the child with swelling of the right arm (Cellulitis). Poor houses are also the residence of varieties of insects.

Photography by Dr. Shivu.

Another case of insect bite near the right eye with the Cellulitis around the right eye.

Photography by Dr. Shivu.

The case of ant bite. The baby presented to the OPD with continuous scratch and cry. The cause is the poor house.

Photography by Dr. Shivu.

We see many instances like this. Here is a baby presented to us with the history of accidental burns due to fall of kerosene lamp when everyone is at deep sleep. Most of the time many houses in the rural India will not have electrical connection and even if it is present the electricity will not be there. Thus many families depend on kerosene lamp for their activity and sometimes rat or some accidental pull or push in sleep can make the kerosene lamp to fall and will lead to such accidental burns and in this way this new born got the burn.

So poor housing due to poverty is a life with full of risks like snake bite, insect bite, and accidental fires so on. Creation of MV and MN will solve all the problems like this and every one can live happily provided a quality work is ensured from the beginning of creation.

1.42. F&F - Poor infrastructure predisposing to life threatening injuries.

Photography by Dr. Shivu.

Poor infrastructure like very narrow roads which contains things like electrical lines, water pipelines, drainage pipe lines, TV cables and so on. We can see the electrical poles with live wires very closes to the steps are seen. Even a minor lean while walking can invite the danger.

Photography by Dr. Shivu.

We can see the proximity of the electrical pole to the house.

Photography by Dr. Shivu.

Many a times the poles are also not in good condition.

Photography by Dr. Shivu.

People work in such a condition without knowing the serious problem that can come suddenly, like a woman putting wet clothes on a grill which is very close to the live wire.

Photography by Dr. Shivu.Finally people will land up in electrical burns and admit to the hospital or electrocution can occur.

1.43. F&F – Money is the decision maker for the treatment.Congenital diaphragmatic hernia:

Photography by Dr. Shivu.

Baby’s attendees will ask about the short and long term prognosis, if they get the answer by the doctor with 100 % guarantee with no sequelae in the future for the baby, then they will be ready to take the child to the higher centre if they have money in their pocket, otherwise this baby will not get further management – it is a case of diagrammatic hernia.

Congenital heart disease – Tetrology of fallot (CHD – TOF):

Photography by Dr. Shivu.

May not go for further management – CHD TOF

Premature baby with RDS:

Photography by Dr. Shivu.

May not go for further management – RDS.Money decides the treatment, even though the treatment is available somewhere. People are not strong enough to spend money for all the problems they come across in their life.

Sources:

[93] Nelson Text book of pediatrics, 17th edition, page.no.13.

[94] The Millennium Development Goals by 2015.

[95] Dr Jayaprakash Narayan, Presentation to Planning commission of India on behalf of National advisory council 9th December 2004, New delhi.

[96] Maternal death - Wikipedia, the free encyclopedia.mht.

[97] Kanndaprabha daily 2.3.2009. shivamogga edition, page no 8.

[98] NFHS – 3 survey Data on maternal and child health 2005 -2006 / Dr. Baliga, Mangalore.

[99] Perinatal mortality - Wikipedia, the free encyclopedia.mht.

[100] Dr. Baliga. Mangalore.

[101] The Millennium Development Goals by 2015 / Dr. Baliga, Mangalore.

[102] Infant mortality - Wikipedia, the free encyclopedia.mht.

[103] CIA world fact book 2007, Infant mortality rate of the world.

[104] The Hindu news daily, dated 23.01.2008.

[105] Child mortality - Wikipedia, the free encyclopedia.mht.

[106] CIA world fact book 2008 estimation.