It’s been over 2 weeks now, and I’m trying to make use of the time I have left in India. I have been spending the past week at PHFI reading up and brainstorming measurable research possibilities, and have been familiarizing myself further with health systems economics, medicines, and universal health care coverage in India. I should have a set topic by the end of next week or following week (the latest). I am also drafting my case management paper on the health voucher scheme and will have that completed by early next week.
An area i’ve been spending a lot of time reading and understanding is access to medicines, vaccines, and technology. Medicines are a major component of modern health systems and have been developed to reduce death and diseases around the world. India produces enough drugs to meet domestic consumption, and is one of the largest exporters of generic and branded drugs, it has been deemed the ‘global pharmacy of the south.’ Many life-saving drugs to developing countries and supplies of quality drugs to rich nations at decent prices come from India. Nonetheless, millions of Indians themselves do not have access to drugs; cost of drugs and lack of public health facilities are factors contributing to the problem. About a third of drugs prescribed in hospitals during the mid-80s were given for free. Free drug supply has dropped from 18 percent to around 5 percent in outpatient care. Not to mention, Indians rely on private chemists for medicine purchase. This raises a thought….many chemists (essentially a shopkeeper of drugs) you see on about every corner, give away drugs without prescription, guidelines for dosage, and there seems to be a natural culture of self-medication. I guess that’s not too far off from the states, I mean a lot of us use WebMD or treat ourselves, but I see it more of a way to know what’s happening to you, and then you have the doctor confirm the medication/diagnosis. We also have many restrictions to accessing drugs, we need the proper referral and there’s a gate-keeping mechanism to follow. I’m curious to see if self-medication is commonplace for many.
Another factor that plays into to barriers to medicines is a lack of regulation of drugs and diagnostics. There’s poor enforcement of the Drugs and Cosmetics Act of 1940, making regulation in the health sector ineffective. The Central Drug Standard Control Organisation (CDSCO) of India has the task of approving new drugs and clinical trials, importing controls, setting standards, and overall coordination of state drug control authorities. State drug control authorities are only responsible for regulating the manufacture, distribution, and sale of drugs. Inadequate drug regulation leads to the production of forged and substandard drugs. The quality of drugs is also touched and the medicine on the table is questioned on whether or not it is efficacious or safe. There were recent deaths of pregnant women in the city of Jodhpur due to contaminated IV fluids brought on by the manufacturers. Drug quality has really become an issue in India in recent years with claims of ineffective drug production administered and produced by small drug manufacturers. In 2005, drug manufacturers in India became tied to a mandate which made them abide and comply with Good Manufacturing Practice (GMP) regulations, and harmonious global standards to create quality drugs. Yet, quality of Indian drugs is still questioned over and over again.
PHFI has several data sets in the area of medicine and vaccines, so I will be working with the evidence they have accumulated to write a research paper within the realms of drug regulation and barriers to accessing medicine.
Moving away from my research possibilities, I’ll update on some new happenings. Last weekend, my roommate, a couple of her friends and I went to Kashmir. Kashmir is in the northwestern region of India and today is part of the Indian-state of Jammu and Kashmir, the Pakistan regions of Gilgit-Baltistan and the Azad Kashmir provinces, and the Chinese-administered regions of Aksai Chin and Trans-Karakoram Tract. Kashmir is really one of the most beautiful places in the world, but it has been troubled by disputes. Kashmir wants to be an independent state. Maharaja Hari Singh, the ruler of Kashmir from 1925-1952, was Hindu while his people were mainly Muslim. Therefore, he was unable to decide which nation Kashmir should join, making Kashmir a neutral region. In 1947, Pakistan sent Muslim tribesmen to the capitol, Srinigar, and the first war over Kahsmir began between India and Pakistan. India took the dispute to the United Nations, the UN called for Pakistan to remove its troops and for India to withdraw its forces. Once this happened, it allowed Kashmir to have the freedom to decide their future, but that did not play out as planned. Pakistan ignored the UN mandate and continued fighting for part of Kashmir. In 1949, there was an agreement made with 65% of the territory given to India, and the rest to Pakistan. Again, fighting broke out regardless of many more agreements. In 1989, there was a massive genocide which drove out all the Hindus in the valley before the troops reached them. The ongoing fighting and bloodshed has been going on for more than 5 decades. In 2002, credible elections took place which favored negotiating with the separatists. A couple years later in 2004, the prime ministers of India and Pakistan held a meeting and discussed steps their countries are taking to ease the conflict. Since the 2004 peace talks, violence has lessened, but the tension over whose territory it belongs to still stands. It really remains an unresolved conflict.
When we arrived to Srinagar, the capitol of Kashmir, it was absolutely gorgeous – it has been compared to the Swiss Alps.It was quiet, the air was fresh and felt like somewhere far off. My roommate has a family friend who had us over for breakfast – his cooks made us delicious omelettes, and he spoke of his shawl business. He sells very expensive pashmere and wool shawls that run up to $7,000 US dollars. After breakfast, he drove us to the houses where the shawls are made (both hand made and machine) and we saw the workers in the room quietly sewing and weaving, it was really something. Mid day, we drove to where we were going to stay, which was on Dal Lake and were given a house boat for the weekend. The house boats at this place are well known, and many prominent people have stayed there including Ambassadors and musicians like George Harrison. The house boats were surrounded by Kingfishers and Maple trees and a staff that made the place feel like a home. One of the mornings we woke up at 4am to take a shikara (boat) out into the water to engage in the morning market. We sat in the shikara and bargained with the local people who were selling saffron, vegetables, jewelry, and sweets. It was so interesting to buy and sell goods on water. We also stopped and watched bread being made for the morning round. I really loved Kashmir and didn’t feel any of the political unrest that has had such a history there. We went to the countryside and had a horseback ride in Phelegum through the mountains – I missed riding. Overall, it was pure beauty and I felt lucky to have had the chance to be there. Kashmiri people are known to feed you and feed you and feed you!! So, even if you’re full, they will put more food on your plate. Kashmiri’s are incredibly hospitable and warm. In Kashmir we were surrounded by lots of mosques, being that the majority of the people are Muslim. It felt comforting hearing the prayers at 5am and they have someone live on the loud speaker 5 times a day, so no matter where you are you can hear it.
Anyhow, I’ve said a lot. I intend on reading more this weekend and I attended a German-Indian outdoor music festival with an Indian star percussionist (who was amazing, his name is Sivamani) and a German solo percussionist at the park last tonight. This festival was part of a series of events to celebrate the year of Germany and India. On a side note, it was interesting to find out that government public elementary schools here teach their children how to speak German. They also teach them Spanish too. I think we should really require Spanish to be taught to our elementary kids.
I’ll write again in a few days to update you some more. MISS you all!
MUCH MUCH LOVE!!!
Enjoy the pictures —