29th June was observed across the globe as World Scoliosis Day to increase the level of awareness and highlight the importance of treatment of the disease.
Affecting 2-3 percent of the entire US population, scoliosis, or a spinal curve, is one of those medical conditions whose etiology is yet to be understood completely.
Often, due to lack of awareness and information surrounding scoliosis, people tend to ignore the symptom and sometimes even the treatment options.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, of every 1,000 children, 3 to 5 develop spinal curves that are considered to be medical condition (i.e. scoliosis) which require treatment. If not treated properly, scoliosis could lead to other complications linked with unnaturally curved spines.
“Scoliosis often goes unnoticed and untreated, if at all patient report the disease, they do at quite advanced stage, and this is all because of ignorance around the disease. It is unfortunate that despite having advanced treatment modalities, including surgical options effective enough to properly treat the disorder, people hardly recognize scoliosis as a treatable disorder. Most of the time, it is assumed as a part of physiology or is linked with postural issues. This not just worsens the disease itself but also affects internal organs, if not treated timely,” says Dr. Bipin Walia, Director Neurosurgery and Head Spine Surgery at Max Super speciality Hospital, Saket, New Delhi.
Experts explain scoliosis as a disorder that causes an abnormal curve of the spine, or backbone. While a typical spine is straight when viewed from the back, in case of scoliosis the spine can curve in one of three ways -a single curve to the left (shaped like the letter C), called levoscoliosis, a single curve to the right (shaped like a backward letter C), called dextroscoliosis, and two curves (shaped like the letter S).
As far as treatment of scoliosis is concerned, patients nearing skeletal maturity with comparatively lesser degree of abnormal curvature usually do not require any treatment. However, in case of younger patients with significant curve who are yet to grow, it is quite likely that they continue to develop further curve and therefore require treatment. In such cases, where scoliosis is left untreated, it can progress to a stage where it limits the space in the ribcage. This space is vital for the heart and lung to function normally. A diminished space for lungs and heart might lead to respiratory problems and cardiovascular problems.
Exercise or physiotherapy has proved to be of little help in scoliosis management, even if it the case of mild curve. Experts point out that though no particular exercise has been found to reduce or prevent scoliosis, it is still very important for scoliosis patients to keep their back muscles strong and flexible. For mild scoliosis, treatment options primarily include back braces, while for higher degree of curvatures, surgery is the best solution.
Explains Dr. Walia, “In surgical options, spinal fusion is specifically recommended for severe curves that are greater than 45 degrees and for curves that have not responded to non-surgical intervention like braces. Spinal fusion involves placing graft material between the affected bones in the spine to fuse, or join them together.”
During this type of surgery, the surgeon attaches a metal rod to each side of the patient's spine by using hooks or screws attached to the vertebral bodies. Then the surgeon fuses the spine with a piece of bone - a bone graft.
The bone grows in between the vertebrae and holds them together and straight. This process is called spinal fusion. The metal rods attached to the spine ensure that the backbone remains straight while the spinal fusion takes place.
“With recent advances in technology, patients are sometimes released from the hospital within a week of the surgery and do not require post-operative bracing. Many patients are able to return to school or work in 2 to 4 weeks after the surgery. Many are able to resume all pre-operative activities within 4 to 6 months,” says Dr. Bipin Walia.
World Scoliosis Day is an excellent opportunity to spread awareness about the disease as well as to focus attention on advanced treatment modalities which possess the potential of rooting out the problem effectively.
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Dearth of skilled and trained personnel is one the biggest challenges the healthcare delivery system of India faces today, according to the Third Annual Wellness Conference report 2011 brought out by the Federation of Indian Chambers of Commerce and Industry (FICCI). The debate is likewise centered on the improper utilization of existing resources which is making matters worse.
According to data published in the Indian Journal of Medical Research in April 2013, seventy per cent of the posts of specialists like surgeons, physicians, paediatricians and gynecologists at Community Health Centers (CHCs) across the country are currently standing vacant1.
“As far as the talent crunch in healthcare goes there are two major issues leading hospital chains are facing today - inadequacy and underutilization. Not only are we faced with a massive shortfall of trained medical professionals, we are also having a tough time putting the available talent to use. Optimum utilization of available resources is a big issue”, says Dr. Vishnu Panigrahi, Group Head, Medical Strategy and Operations, Fortis Healthcare Ltd, New Delhi.
Experts believe that improper utilization of resources needs to be looked at in the context of the huge shortfall of medical professionals in India. According to WHO there are not even seven physicians per 10,000 patients in India. As of now, there is a net shortfall of 600,000 doctors in the country.
“The current underutilization of skilled people in the healthcare industry is undoubtedly a concern about the evolution of healthcare delivery in the country. The sad reality is that healthcare professionals are many times placed inappropriately, not in accordance to their fit for the role. This needs to be addressed immediately”, says Arvind Pandit, CEO VIA Health Resources, a specialist healthcare focused executive search firm.
Although to combat the projected shortage, India plans to establish 200 more medical colleges, experts feel there is a lot more that needs to be done as the problem cannot be sorted out only at the primary health level. Moreover, the perception that there is no problem in the urban areas, and it is only the rural areas that need work is not entirely correct.
Dr. J. Kumar, a senior Neurosurgeon, and Practice Head, VIA Health Resources says, “It’s not just the rural areas, urban areas too face a critical shortage of doctors. Of course, the infrastructure is mostly in place in the urban areas but there are just not enough trained professionals to put it to proper use. The absence of a mechanism to put right people in the right roles complicates the situation further”.
So what’s the solution? Experts agree that in the long term the processes that have already been set in motion by the government will go a long way in helping deal with the problem. However, they point out that in order to provide infallible solutions it is also important to identify channels which could ensure that the proficiencies of existing healthcare professionals are utilized properly. In that context the development of a proper recruitment channel could bring about enormous benefits.
According to Swadeep Srivastava, CEO Via Media Health, “It’s not just about the talent crunch and the problems hospitals face in functioning smoothly. There is also the important question of hiring the right professionals so that healthcare delivery mechanisms function smoothly. Executive search channels which provide sustainable solutions to suit the needs of both the hospitals and the professionals coupled with optimum utilization of resources are the need of the hour.”
Ref:
2. India’s health workforce: Current status and the way forward, S. GARG, R. SINGH, M. GROVER,The National Medical Journal of India 2012
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