Wednesday, October 15, 2008

2nd National Symposium on Beliefs and Faiths: A Challenge to Public Health

2nd National Symposium on Beliefs and Faiths: A Challenge to Public Health was held on September 13th, 2008 at Maulana Azad Medical College, New Delhi by the Department of Community Medicine in collaboration with Center for inquiry Delhi branch and Center for Media Study Academy. The symposium was attended by eminent public health experts, sociologists, psychiatrists and faculty members, residents and undergraduates of the various institutes of Delhi such as All India Institute of Medical Sciences, National Institute of Health & Family Welfare, University College of Medical Sciences, Lady Hardinge Medical College, Delhi University, Jawahar Lal Nehru University. The technical sessions highlighted the impact of beliefs and faiths on people’s behavior, lifestyle and health seeking patterns. The symposium emphasized the need for promotion of rational and scientific thinking.

On this occasion, the Guest of Honor and keynote speaker was Dr Paul Kurtz, Professor Emeritus of Philosophy, Committee for the Scientific Investigation of claims of the Paranormal (CSICOP), Chairman of the Council for Secular Humanism and Founder and Chairman of Prometheus Books, USA. Dr Paul Kurtz highlighted the significance of scientific thinking in public health. He accentuated that people hold various kinds of beliefs and faiths, which affect their way of thinking and health seeking behavior in particular. He called for the need of critical examination of these beliefs and faiths.

Dr Kurtz emphasized on public appreciation and understanding of science and scientific temperament. He put forth the need for scientific examination of religion as to how religion affects an individual’s life as a whole. He touched upon the issues of scientific naturalism, naturalistic methodology and ethnic naturalism. Dr Kurtz enumerated different kinds of alternative systems of medicine in different countries and emphasized that validity of such systems should be questioned by every civilized society before their acceptance. He highlighted that a huge number of people irrespective of their ethnic backgrounds seek treatment by these methods. Systems like acupuncture originated in China but are now spread world over. Other widely sought after methods are Reiki, Acupressure, homoeopathy, Unani, Siddha and Ayurveda. Besides these systems of medicine, people still rely on religious ways of tackling disease like prayer meetings, therapeutic touch, holy water etc. Dr Kurtz stressed on the need for scientific examination of such ways of dealing with disease. He said that practitioners of these systems should prove their claims according to the current scientific methods. He elaborated the list of achievement of modern medical science such as diagnosis by ultrasound, magnetic resonance imaging, PET’s Scan, PCR, immunization, immunomodulation, treatment by modern antibiotics, nuclear and chemotherapy therapy in various cancers, bypass surgery, etc. These developments are real and saving hundred of thousand lives everyday.

Many people worldwide engage in these activities for long periods of time and do not seek medical help timely, which leads to worsening of their disease condition. Dr Kurtz laid emphasis on in depth studies about these methods in order to find evidence of reliability and consistency of alternative systems of medicine in different countries.

Dr Kurtz affirmed the need of inculcation of scientific temperament and rational thinking as this will have a long term impact on people’s behavior about health and disease.

In the introduction speech, Dr. Jugal Kishore, Professor and Director of Center for Inquiry Delhi Branch has highlighted the urgent need of development of scientific temper and evidence based public health particularly in India. He spoke that beliefs, faiths, and religion are directly and indirectly affecting our day-to-day life therefore having impact on public health. He said that silently beliefs are penetrating our decision taking power and affecting our life style and health seeking behavior. If we are interested to develop Public Health in any society role of beliefs and faiths cannot be neglected whether it is bad or good. He also said that as a scientific body it is our duty to deliberate on such issues, which are neglected due to acceptance of religious sanctity of certain practices that could be harmful to the public. Role of Psycho-social issues in public health is already realized world over but meager attention has been paid in India.

REPORT - Session I

Name of the session: Epidemiology of Myths and Beliefs
Chairpersons: Dr CS Pandav, Professor and Head, CCM, AIIMS
Dr Saudan Singh, Professor and Head, Deptt of Community
Medicine, VMMC

Rapporteur: Dr Ravneet Kaur

Speaker I: Swami Agnivesh, Former Minister of Education Haryana Government, President Bandhua Mukti Morcha


Swami Agnivesh discussed in detail how religious faiths affect people’s behavior. People do what religion dictates them to do without thinking rationally because of fear of gods. He stated that religion instead of being a spiritual entity has taken the form of a multi billion soul saving industry. He narrated his own experiences of life. Being born into an orthodox Brahmin family, he also inherited the traditions of performing poojas for hours and hours and also practiced untouchability. He described how he used to treat bonded laborers as untouchables just because his family taught him to do so. He was curious but never dared to ask questions about God and Faith because of the fear of wrath of gods. It was only when he came into contact with Arya Samaj that he felt enough courage to question the religion and caste system. He realized that the spirit of pursuing truth without any compromise needs to be instilled. Common people are not given choice of a rational thinking. Children are born into a religion and a belief system. Swami ji emphasized that there is a need to break from these beliefs and develop the ability to doubt and question the faiths. Taking responsibility of one’s own actions is the real karma. Swami Agneewesh described the 3 Ds culled from Vedas that instigated in him the spirit of inquiry i.e. To doubt, to Debate and to Descent.

Swami ji accentuated that God is nothing but Truth, Love, Compassion and Justice. To love god is to relate to His creations. Pollution of Earth, Air and Water are equivalent to defacing God. Hence, if one wants to relate to God he has to love His creatures and preserve the Earth. Instead of falling blindly into a pre formed belief system, one’s behavior should be guided by rational thinking. An analytical mind is the best gift that God has given to human beings.

Speaker II: Dr RC Jiloha, Director Professor and Head, Deptt of Psychiatry,
GB Pant Hospital, New Delhi
Dr. Jiloha congratulated the Department of Community Medicine for organizing this symposium and expressed that it is a step towards mental health literacy.
He discussed beliefs from psychological perspective.
He defined beliefs as pre existing notions that have got strong personal endorsements. These beliefs affect people’s behavior, their relationship with other human beings and ability to cope with stressful situations. He emphasized the fact that beliefs require no inquisitiveness.
He discussed common beliefs associated with mental illnesses. These are:
- Mental illnesses occur due to curse of gods, invasion by ghosts or punishment of past sins.
- Nothing can be done in mental illnesses
- These kinds of illnesses are fatal
- Mental illnesses have nothing to do with doctors
- Since ghosts are invoked as agents of these diseases, these can only be treated by jhaar - phoonk and tantra – mantra
Dr Jiloha called attention to the fact that a lot of stigma is associated with mental illnesses. There are feelings of shame, dishonour and disapproval among the victims. The methods of treating such patients are also very tortuous and unscientific. The victims are beaten up, chained, kept in dark rooms and treated badly.
Other important issues discussed were:
- Beliefs regarding possession states: Neurotic symptoms occurring in young female patients are labeled as possession states by common people and these patients are thought to be under the influence of a bad spirit. Instead of consulting a psychiatrist, treatment is sought from tantriks in such cases.
- Beliefs about sexuality and generalized weakness: It is believed that semen is very precious and that one drop of semen takes 80 days to form. This one drop of semen is equivalent to 80 drops of blood and is formed by eating 80 ser of grain.
Dr Jiloha added that though most of the beliefs have a detrimental effect on the health seeking behavior of people, they also have a positive side. Beliefs sometimes help in better coping in stressful situations. Since many happenings are attributed to super natural causes, feeling of guilt and helplessness is less in people who hold such beliefs.
He emphasized that it is high time to reinforce mental health literacy by making general people aware about mental illnesses, equipping them with knowledge about their causes and risk factors and importance of professional help in these cases. However, it is a challenging task because this process overlays beliefs and thus may become unacceptable. These challenges in addressing the belief system need to be tackled carefully and concerted efforts to eliminate harmful beliefs are needed.

Speaker III: Dr Vivek Kumar, Professor, Social Studies, JNU, New Delhi
Dr Vivek Kumar discussed beliefs from social point of view. He highlighted that beliefs are an important aspect of an individual’s social life as they are prevalent in the society before one’s birth and remain in the society even after his death.
He brought forth that beliefs are a way of putting constraints on one’s behavior. Not living in accordance with the belief system can invoke ridicule, ostracism and punishment from the society.

Dr Kumar emphasized that health is based on social structure. Dissections could not be performed on cadavers because of strong religious and social beliefs. This hampered the study of human anatomy in the past. He cited many examples where beliefs have posed resistance to the development of modern medicine.

He also highlighted that health is largely based on social status. In Indian society, many occupations remain restricted to certain castes, so there is a pattern of health practices in the society. Health construction is also based on social beliefs and social roles assigned to different individuals based on these beliefs. Finally, Dr Kumar stressed the need to have a social engineering process in the health system.

Session-II on 13-9-08 on Dissemination of evidence based public health messages : Role of Mass Media

Chairperson Dr. N. Bhaskara Rao, Chairman, Centre of Media Studies, New Delhi
Dr. N. Innaiah, Director Center for Inquiry India,
Dr. TSR Sai, Professor and President of Indian Public Health Association
Rapporteur: Dr. Harsh Mahajan
Dr. N. Bhaskara Rao in his speech highlighted that there has been tremendous expansion of mass media in the last few years. He said that no other country in the world has 24X7 hour news channels as India. However, he observed that media focuses mainly on crime and sex with little emphasis on health. Only 0.65% of news channels time is spent on health. He also observed that media is governed by various factors like advertising, market researchers, media planners and corporate sector.

Mr. Pramod Joshi, Senior Resident Editor, Hindustan Times spoke on “Dissemination of evidence based public health messages: Role of print Media”. He observed that the sectors of public health, education and justice are not in good state in India. He highlighted that there are two types of Media in the country – Voluntary and Professional. He mentioned that the readership of all English newspapers combined is lesser than any Hindi newspaper. He also observed that greater focus of media is on health of urban and rich class population than the rural and poor population. Therefore, he advocated that media should project the public health interests of all sections of the society. He also advocated that medical fraternity and Media should cooperate with each other to pass on the health messages to the public.

Dr. Bir Singh, Professor of Community Medicine, AIIMS, discussed about the myths and misconceptions in sexuality and reproductive health. He highlighted that sexual and reproductive health is shrouded under a lot of myths and misconceptions. Some of them are universal and some are local and culture-specific. He observed that 80% of the sexual problems are psychogenic due to myths and misconceptions. He suggested the method of managing these myths and misconceptions by 6Cs – Communication, Correct (Information), Conception Onwards, Culture Sensitive, Careful and Continuous. He stressed that public health personnel and mass media can do a lot in removing these myths and misconceptions. He also shared with us the various initiatives taken up by the AIIMS Hospital in this field.

Dr. T. Mathiyazhagan, Professor, Department of Communication, NIHFW, discussed the findings of his study among the tribals in Mandla, Madhya Pradesh regarding their myths and misconceptions on health and health care delivery system. First of all, he highlighted the various myths among tribals regarding various diseases. He observed how the communication intervention reduced significantly the various myths and misconceptions among the tribals. He concluded his presentation by stressing upon the role of media in dispelling these myths and misconceptions.

Dr. Sanal Edamaruku, President of Indian Rationalist Association and Editor of Rationalist International, spoke on “Mantra Healing and other Magic Cures: How much media is responsible?” He recalled that there was a mantra healing center at MAMC in 1997. The healer, Janak Sahi chanted mantras to heal all diseases. He shared his experiences of working against the ojhas and tantriks on the visual media. He emphasized that media should not propagate false beliefs among the public. He stressed that public health facilities should reach the remotest regions.

The honourable chairperson Dr. N. Innaiah in his concluding remarks highlighted the salient features of Drugs and Magic Remedies Act, 1955. He advocated that media should work to remove the false beliefs and faiths among the people.

At the end, Dr. N. Bhaskara Rao suggested a five-pronged strategy to remove the common beliefs and faiths in public health –
There is need for more specialized agencies like Dept. of public health. There is a need to develop clearing houses to protect against propogation of beliefs and faiths.
NCERT Curriculum should have at-least one lesson on this subject.
Standardization by credible agencies
Enforcement mechanism
Longitudinal studies

At the end of the presentations, some questions/clarifications were asked by the delegates, which were attended and answered successfully by the presenters to the satisfaction of delegates. In the end, the mementoes were handed over to all the speakers by chairpersons. Mementoes were also presented to the chairpersons. This session was closed after thanks to the chairpersons, speakers, delegates and organizers.

Tuesday, August 5, 2008

J Kishore: Beliefs and perceptions about cancers among patients attending

Asian Pac J Cancer Prev. 2008 Jan-Mar;9(1):155-8

2nd National Symposium on "Beliefs and Faiths: A Challage to Public Health"

The Department of Community Medicine in collaboration with Center for Inquery and Center for Media Study is organizing 2nd National Symposium on "Beliefs and Faiths: A challenge to Public Health" on 13th Septermber 2008 in Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi 110002, India starting from 9AM till 4PM. Dr. Paul Krutz a world renowed humanist and rationalist has consented to deliver his key note address. Swami Agnivesh as also consented to deliver his talk on the topic. There are many eminent speakers from the institutions of repute are joining to share their experience. The program is going to be beneficals for the public health professionals, medical officers working in government and private sectors at higher level, social scientists, managers and workers of non-government organizations, etc. All interested people are cordially invited to attend this symposium. There is no fee.

Thursday, January 24, 2008

Health Expenditure at House Level in DelhiPresenting

Authors: Surbhi Batra, J Kishore, GK Ingle,
Introduction: In the present era to allocate resources judiciously in the health sector the policy making bodies need to have a deeper understanding of the health seeking behavior of the common man, which has two components: 1) utilization of the available resources 2) expenses on treatment. Information on these issues is not extensively studied. Objectives: To study the health expenditure and utilization of resources by the people in Delhi Methods: 200 families chosen by stratified random sampling from 4 out of 9 districts according to socioeconomic status. After obtaining voluntary informed consent information on family size, loans, savings (total), insurance, expenditure per month on food, clothing, education, luxuries, housing, recreation and health including self-medication, indigenous medicine, treatment of chronic illness, was obtained using pre-tested questionnaire. The data was analyzed by using computer software package Epi-Info and ANOVA test and Mann-Whitney were used for statistical significance at 5% level. Results: A higher mean age of head of household and per capita income in posh and middle class colony was observed. There were significant differences in savings, insurance cover, per capita and total incomes, and expenditure on food, clothing, housing, transport, recreation in different areas of Delhi. Expenditure on smoking was more in middle class and posh colonies in spite of lower smoking rates. Both areas had more health seeking behavior and expenditure on health particularly over the counter medicine, on alternative system of medicine, private health care compared to slum and resettlement areas. It was also observed that upper strata of Delhi spent more for their chronic diseases whereas people from slum and resettlement prefer more government hospitals for tuberculosis, and other lung diseases. Conclusion: Residents of posh and middle class colonies spends more on their health which could be due to their higher per capita income, suffering from chronic diseases and preference to private health care set up. This study concluded that more expenditure does not ensure freedom from illnesses and special emphasis is required on preventive health services.

Beliefs and perceptions about cancers among patients attending

Authors: J Kishore, Irfan Ahmad, PK Mohanta, GK Ingle

Introduction: The prevalence of beliefs and myths amongst cancer patients is a reflection of the level of knowledge available in the community regarding cancer. Since a cancer patient has the capability of influencing opinions amongst others more forcefully. This information could be utilized in preparation of cancer awareness program. However, not much information is available particularly about Indian cancer patients.
Objectives: To study the belief system and perceptions of the cancer patient about the disease.
Method: A face-to-face interview was conducted among 95 patients of cancer attending the out-patient-department of Oncology & Radiotherapy, Maulana Azad Medical College, New Delhi, regarding their beliefs and perception about cancer and their outlook towards its treatment. The questionnaire was designed and pre-tested. It contained 42 items on various aspects such as patient’s own idea of his disease, about its causation, its early diagnosis and its prevention, the impact of treatment whether successful or futile beside demographic information. The data was analysed using Epi-Info software package.
Results: Majority of patients were misinformed about the cancer. 27.3% believed that cancer is contagious and can be transmitted by contact. People get cancer due to ill wishes (58%), spirit (48%), God curse (59%), evil eye (60%), past/present sin (38%), and immoral behaviour (34%). Only 15% of patients believed that cancer can be prevented. 48% believed that death is certain in cancer. Wrong views were significantly more in illiterate than literate patients.
Conclusion: Beliefs in myths are common which is associated with illiteracy. Such wrong views are hindrance in accepting proper health services and need to be removed through mass awareness program.

Lifestyle Diseases in School Children In Delhi (Aged 8-12 years): Prevalence, Risk Factors and Awareness

Research Question: What is the Prevalence and Awareness Levels with regard to Lifestyle Diseases amongst school going children (Aged 8 -12 years)?What are the associated risk factors? Objective: To assess the Awareness levels and Prevalence with regard to Lifestyle Diseases amongst the children and to study the associated risk factors.Type of Study: Cross sectional study. Participants: A sample of 293 children studying in Government and Public Schools (6th – 8th Std) in Delhi. Tool: Questionnaires inquiring about eating habits, physical activity, sleep habits, opinions on right living were used to gather the data. Result: 10% of the population was obese and 39% were underweight. 90% of the population opines that physical activity is needed for good health but as much as 45% rarely on never indulges in physical activity. The most preferred pastime activity of more than 70% falls under the sedentary category. Although the awareness levels with regard to right eating habits are high (90%), however 50% consume soft drinks, chips and chocolates as frequently as 3 times a week. 8% experience problems with sleep very frequently and 45% experience sometimes. Conclusion: The high prevalence of both obesity and underweight reminds of the predicament that a developing country like India faces. With the huge lag between awareness levels and actual practice amongst the children, the onus is on the family, education and the media to mould productive and healthy lifestyle patterns for the children.

Authors: Phalguna, J Kishore, N Bhagat