The New Nation - Internet Edition

Medical physics education in Bangladesh

Eighty percent of the global population living in the third world countries hardly get the services of modern healthcare technologies and are unlikely to get in the foreseeable future if the development of appliances and their commercialsation is done only by the rich countries.

Professor K Siddique-e-Rabbani of Dhaka University in a lecture at the 16th International Conference of Medical Physics (ICMP) held at Dubai in April 2008 said ECG and the X-ray machines were invented over 100 years ago and still majority of the population in the third world countries are not get their proper benefits.

He said the only way to remove the disparity is to allow the third world people to design and manufacture the necessary equipment in their respective countries. This will make the equipment affordable apart from other advantages like better longevity, repair and maintenance scope. It will also allow innovation of new methods and devices to deal with specific health problems.

According to Prof Rabbani, with the existing knowledge of relevant science and engineering disciplines and the existing infrastructures, the third world technologists can design and make, in their own countries, almost 90 per cent of the equipment that are needed to deliver modern healthcare. But fear of unfamiliarity, lack of practical exposure and confidence bars them from making such attempts.

There is also a vested quarter that wants to serve the interests of the multinational manufacturers as they influence the policymakers in the third world countries.

Prof Rabban was highly acclaimed by the audience, including senior members of the International Organisation of Medical Physics (IOMP).

Dr. Rabbani said with 30 years of continued efforts in developing indigenous capability in Biomedical Physics and Engineering at Dhaka University and at Bangladesh Institute for Biomedical Engineering and Appropriate Technology (BiBEAT), Bangladesh is now ready to take the leading role in the Third World in this respect and plans to set up an international centre in Dhaka in this connection.

He also presented sample slides of a computerised ECG circuit trainer involving both

hardware and software, which he designed and fabricated from scratch. It was also used to train engineers from several countries at a short course and workshop organised by the Islamic University or Technology (IUT) in Gazipur last year.

The workshop was a great success and a few foreign and local participants purchased and carried home a few of these trainer kits to initiate the training in their respective institutions.

This particular training programme could be a beginning to trigger the technological confidence in the Third World, Dr. Rabbani said in his lecture.

He currently leads the research at the Biomedical Physics Laboratory. Department of Physics, Dhaka University.

The history of the above efforts in Bangladesh goes back to 1978 when Dr. A Sattar Syed, a senior Physicist at BCSIR at that time, took the initiative to take up research on electromagnetic stimulation for bone healing together with his friend late M Shamsul Islam at the Dhaka University Physics Department.

Professor Islam motivated and induced Dr. Rabbani, a fresh Ph.D. in Electronics, to help and join this research team, and thus was formed the pioneering group of Medical Physics research in Bangladesh.

This later grew manifold due to an academic link between 1983 and 1992 with Sheffield University through the efforts of late Professor Islam and Professor S.H Brown, and supported by the British ODA.

Over the years more than 80 students have done their Master thesis in Medical Physics under Dr. Rabbani.

Recently, A few have completed M. Phil and Ph.D. as well.

All necessary specialised research equipment were designed and fabricated locally. Some of these groundbreaking researches, particularly in Nerve conduction measurement and in electrical impedance methods for physiological study and diagnosis, have received international acclaim through both conferences and publications.

This brings a ray of hope and possibility for Bangladesh to serve the global humanity, particularly in the Third World, as a leader of appropriate technology in Medical Physics.

-News Network

Eucalyptus acts as anti-vermin agent

Dr. Jamayet Ali

Eucalyptus is a large tree attaining a height of 300 ft. or more, with a clean straight bole under forest conditions, but often tending to branch freely when grown in the open. It bears odorous long lanceolate glabrous leaves, axillary cone-shaped buds with operculum, and triangular seeds, planted as aforestation plantations all over Bangladesh. It was introduced in the sub-continent as a fuel tree in 1843. A cool, moist, equitable climate and deep fertile soil, which is not calcareous or saline, are favourable for the growth of Eucalyptus. The bark of this tree yields a material which has been found suitable for making paper. The leaves and young shoots yield an essential oil used in the preparation of the much-advertised 'Eucalyptus Soap'. It is also said to be employed as a substitute for 'Cajeput oil.' The oil is largely used as a mosquito and vermin repellent and as an ingredient of germicidal and disinfecting preparations. It is an ingredient of deodourising and asepticising compositions for use in theatres. The timber of Eucalyptus is utilised in Australia for a variety of purposes. Availability of long planks, immunity to insect attack and durability under- water are the main considerations which render the timber useful for shipbuilding. It is fire-resistant and is used for the construction of godowns, sheds, stations and platforms.

Medicinal Properties: The leaves yield a strong pungent essential oil, valued in medicine as an antiseptic, febrifuge, and anthelmintic. In South Africa, an infusion of the leaf is used as a spray for vermin infested places and is said to dislodge them effectively. Steam from water in which the leaves are boiling is inhaled as a respiratory antiseptic. Among the very poor, both European and Native, the finely powdered bark is employed as a dusting powder. The root is considered purgative. In the Transvaal, Europeans apply a poultice of the bruised leaves to draw abscesses to a head. (Indian Medicinal Plants, KR. Kirtikar & B.D. Basu, Vol. IT)

Medicine: The leaves yield an essential oil used in medicine, and sometimes as a substitute for Cajeput oil. "Eucalyptus was originally recommended as a remedy in intermittent fever, but experience has failed to establish its value as an antiperiodic. Whatever medical virtues it possesses beyond astringency reside in the volatile oil. This when applied locally, acts as a powerful irritant. As a stimulating narcotic, the oil of Eucalyptus has been used with asserted success in migraine and other forms of neuralgia. As an antispasmodic it has been highly lauded in asthma. In chronic or subacute bronchitis it may often be employed with advantage, especially when there is a tendency to spasm." (U.S. Dispens., 566.)

Special Opinions: "I have used 3ss doses of the leaves infused in an inhaler in cases of chronic thickening of the mucus membrane of faces and throat with marked good results: one case of over 3 years' standing quite recovered under its use." (Honorary Surgeon Easton Alfred Morris in Medical charge, Tranquibar.) Prof. Lister has lately made use of the oil as an antiseptic dressing in place of carbolic acid. It is used undiluted. It is largely employed in the form of ointment, and as antiseptic fauze. The oil, with hot water, as an inhalation has been used with the best effects in diphtheria, in America." ( E. G. Russell, Superintendent. Asylums at Predency General Hospital, Calcutta.) " Dose of the oil from 10 to 30 minims for true leprosy with good effect" (Apothecary Thomas Ward, Madanapalli, Cuddapah.) ( "A powerful antiseptic, and used by Prof. Lister in preparation of antiseptic gauze." ( S. Westcott, AM.D.) " Much used in antiseptic surgery as a dressing. Also in diphtheria in the form of blue-gum stem. The tincture is much lauded by some for ague" (G.B.) "The inhalation of the essential oil is useful in bronchial and phthisical cases. The oil can be supplied from the Nilghiri plantations." (Surgeon General William Robert Comish, F.R.C.S., C.IE., Madras.) " Used as an antiseptic." ( Brigade Surgeon G.A Watson, Allallabad.) " Also employed in intermittent fever on account of its antiperiodic properties." (Civil Surgeon I. Anderson, M.B., Bijnor.)" An infusion of the leaves, or 10 to 20 drops oil in a pint of boiling water, excellent for steaming the throat when ulcerated." (Surgeon-Major W. Farquhar, M.D., IM.D, Ootacamund.) (Dictionary of the Economic Products of India, Watt, Vol. ill)

Medicinal Values: Eucalyptus oil is largely used as a mosquito and vermin repellant and as an ingredient of germicidal and disinfecting preparations. It is an ingredient of deodourising and asepticising compositions for use of theatres. The oil is used locally as an antiseptic, especially in the treatment of infections of the upper respiratory tract, and in certain skin diseases. Mixed with an equal amount of olive oil, it is useful as a rubefacient for rheumatism. It is also used in ointment for burns.

Intemally it is used as a stimulating expectorant in chronic bronchitis and asthma. It is frequently given by inhalation; a few drops of the oil may be added along with menthol, oil of pine and Compound Tincture of Benzoin to boiling water and the mixed vapour and steam inhaled. Cases of eucalyptus oil poisoning have been sometimes reported. The symptoms are epigastric burning with nausea and vomiting; dizziness and muscular weakness also occur. One of the earliest symptoms is a feeling of suffocation. In some patients with idiosyncrasies, ordinaty therapeutic doses give rise to dermatitis (Wealth of India, Raw Materials, Vol. III, 213)

Propetties and Uses: Eucalyptus is a powerful antiseptic used all over the world for relieving the coughs and colds, sore throats and other infections. Its essential oil is used in aromatherapy, atld also as an antiseptic and disinfectant for the treatment viral conditions, skin and other infections, and as a decongestant. Extract of aerial parts is diuretic, febrifuge, atltimalarial, carminative, stimulant, expectorant, diaphoretic and antiseptic. Extract of the leaves also increases the flow of saliva, gastric and intestinal secretions and the rate of heartbeat, respiration atld volume of urine and milk. Eucalyptus is used in the treatment of bronchial catarrh,fevers, croup, dyptheria, whooping cough, wounds and ulcers. Leaves when chewed harden spongy and bleeding gums. Methanolic extract of the leaves possesses strong antimicrobial activity. Essential oil from leaves and fruits possess strong antibacterial antifungal activities (Medicinal Plants of Bangladesh, Abdul Ghani, Second Edition, 191).

Traveller's diarrhoea - the common illness

Travel broadens the mind, but loosens the bowels". Traveller's diarrhoea is the most common illness among those who travel to tropical locations and in many parts of the world it is merely a case of when, rather than if. Any food or water from an infected source can cause traveller's diarrhoea. Symptoms of traveller's diarrhoea usually begin about three to four days after arrival. It can continue for up to ten days after return. The risk of traveller's diarrhoea is very much related to the destination, level of accommodation and travel habits of the traveller.

Those who only go to 5* hotels will be at a lower risk of traveller's diarrhoea than those eating and living in local accommodation and restaurants. There is some evidence to suggest that those who travel frequently (at least every six months) to developing countries - do build up a limited defense against Traveller's Diarrhoea. However, this is not a life long immunity.

How to Avoid Traveller's Diarrhoea

While in some destinations traveller's diarrhoea will be inevitable to the traveller, some steps can be taken towards prevention and it is important to understand how traveller's diarrhoea is transmitted.

Make sure that meat eaten is well cooked. Avoid seafood and abide by the "cook it, boil it or peel it" rule when eating in local restaurants. Wash salads with a good source of clean water - in fact when eating out avoid salads at all costs in high-risk locations! Avoid any food that has been re-heated and left at room temperature.

Apply strict hygiene while away especially after using the bathroom and before you eat food - never use communal, damp towels in public conveniences! Use disposable paper towels, antibacterial wipes or hot air.

Care with water is essential and this includes ice in drinks at the bar. As well as drinking soft drinks from cans it is good practice in developing countries to use sealed, bottled water, not only for drinking, but also for cleaning teeth and washing fruit.When swimming avoid swallowing water in swimming pools, lakes or the sea.

Causative Agent of Traveller's Diarrhoea

Bacteria

Staphylococcus aureus, Salmonella(non typhoid), Shigella, Listeria, Escherichia Coli, Bacillus Cereus, Campylobacter, Clostridia,Vibrio Parahaemolyticus

Protozoans

Cryptosporidium spp. , Entamoeba histolytica , Giardia lamblia

Viruses

Hepatitis A, Rotavirus, Norovirus (Norwhalk)

Self Treatment of Traveller's Diarrhoea

The first rule when traveller's diarrhoea attacks is to try to get some rest and drink plenty of clear fluids. It is important, especially in hot climates, that you do not become dehydrated. If you feel like eating, good foods are bananas, salted crisps, rice or clear soups. Avoid alcohol at all costs. In most cases, traveller's diarrhoea is self-limiting and with a little rest and rehydration you can be on your way again.

Taking an over-the-counter anti-diarrhoeal medication such as Loperamide will stop the diarrhoea, especially if you have an important meeting or flight to catch. While it is important not to take more than the recommended dose, some people can feel constipated after taking this medication. The reason people may believe they are constipated is that Loperamide works by slowing down the movements of the gut and restoring natural balance. Therefore people may then not need to go to the toilet for a while afterwards until the gut movements have been restored to 'normal'. It can take a while for food to reach the gut again (as most or all of the existing gut contents have been rapidly removed as diarrhoea).

This medication should not be taken if you are passing blood or have a history of bowel problems; in this instance you should discuss an alternative treatment with your doctor before you leave for your trip.

Antibiotics (such as Ciprofloxacin), as advised by your doctor, should be taken if the condition does not improve or worsens. Diarrhoea treatment packs can be purchased at most travel clinics and contain a single dose of antibiotic, which can be taken if a fever accompanies the problem.

For women taking the pill it is important to recognise that absorption of the pill can be affected by traveller's diarrhoea. If this occurs always use alternative protection, such as condoms, as well as continuing with your normal oral contraceptive pill.

When to Get Medical Help

If after 24-48 hours the diarrhoea does not improve or worsens it is good to seek medical attention, as the diarrhoea could indicate other conditions. This should also be done if you suffer from a preexisting condition of the bowel or immune system, if you are passing blood or have a persistent temperature.

Traveller's Diarrhoea in the Returning Traveller

The returning traveller can also suffer from diarrhoea and it is important that you seek medical attention if you suffer on return, as this could also indicate other diseases that would need to be investigated by your doctor

-Easir Abedin

Patient ratio and 'national health policy'

ABM Moniruddin

The Ministry of Health & Family Welfare of Bangladesh claims that the country has a doctor patient ratio of 1:3169 (as declared by the health adviser on 06-04-2007 in the conference hall of that ministry), considering all the doctors (42,881) registered so far with the BM & DC. However, there is a gross error in the report of working Physicians (Govt. & Private) available for care & treatment of ailing patients. Because, many of the doctors (42,881) registered so far with the BM & DC have already expired (dead) & many of the doctors (42,881) registered so far with the BM & DC have left Bangladesh, working abroad (most of whom will not return as they have undertaken the citizenship of foreign countries), & many of the doctors (42,881) registered so far with the BM & DC are no longer involved in care & treatment, that is, they are either involved in business or some other profession, or retired, i.e., they are quite old & disable for involvement in care & treatment of people of Bangladesh. When all these factors are rightly considered, number of working, living Physicians (Govt. & Private) available for care & treatment of ailing patients would be probably less than 13,000. Thus there seems to be a gross error in the report of working Physicians available for care & treatment of people of Bangladesh.

This error needs to be corrected. It is very sad to state that as the Ministry Of Health & Family Welfare is run by bureaucrats who de facto possess no responsibility sincerely will take no step to correct the statistical errors of health. Still it is the prime responsibility of the Ministry Of Health & Family Welfare to correct all discrepancies in health statistics.

The Ministry Of Health & Family Welfare in collaboration of Directorate General of Health Services & BM and DC should first enlist the registered doctors who are living & working in Bangladesh. The BM & DC should enlist the registered doctors who have already expired. The BM & DC along with the Ministry Of Health & Family Welfare should also enlist the registered doctors who are no longer involved in care & treatment of ailing patients, that is, they are either involved in business or some other profession, or retired, i.e., quite old & disable for involvement in caring & treating people of Bangladesh. Moreover, a good number of registered doctors are involved in health administration, who are in no way directly involved in caring & treating patients. They should also be enlisted. The Ministry Of Health & Family Welfare in collaboration of Directorate General of Health Services & BM and DC should also enlist the registered doctors who left the country for job & also for job plus citizenship abroad. The Ministry Of Health & Family Welfare can't avoid its pivotal role in correcting all existing discrepancies in health statistics.

It has been learnt that at present there are 6,220 posts of graduate MBBS doctors & 2229 posts of qualified diploma nurses are lying vacant in the governmental sector. Not only that, a huge number of manpower amounting to 30,367 posts / personnels are lying vacant throughout the country.

It is the prime responsibility of the Ministry Of Health & Family Welfare of Bangladesh to take initial necessary steps to appoint manpower against these vacant posts. But it is very sad to state that the Ministry is quite careless & indifferent to perform its sacred duty. Rather the said ministry is engaged to promulgate a 'National Health Policy' based on very very weak foundation to vicimize the innocent working doctors.

The ministry abhors the existing labour rules & laws. It makes the EOC doctors bound work 24 hours in a day & 168 hours in a week, without any rest & pause. There is none in the government to see & to remove all these inhuman discrepancies in the health sector.

It is needless to say that when a country is having gross false statistics, all the plans, policies & programs based on false statistics are worthless. The Ministry Of Health & Family Welfare of Bangladesh is going to announce a 'National Health Policy' based on these false statistics, but empowered by the law & force of prevailing state of Emergency declared by his highness the hon'ble president. It is to be recollected that our population is increasing by 2.5 millions each year & the number of graduate et qualified doctors are not increasing proportionately.

Can we expect this CTG to extend its honest hand to solve these problems in the health sector for the greater interest of our beloved country & countrymen?