DOES THE PROBLEM OF V.D. NEED AN URGENT ATTENTION?

By Major M.P. Vora, M.B.B.S, D.V.D., I.M.S. (Rtd)

Hon. Sr. Venereologist, St. George’s Hospital, Bombay

Indian Medical Record

A monthly journal of Public Health, Tropical Medicine & Surgery etc.

Volume LXXXVII, Number -10 of October 1967

Pages 181-184

This article was solely contributed to Indian Medical Record

Of all the social ills of man, the least confined, the least manifest and the least likely ever to be static are venereal diseases, which constitute the most dangerous hazard to public health and happiness, with heaviest impact on our economy. Accurate statistics regarding V.D. are non-existent in India. However, some idea of the wide prevalence of this scourge can be obtained from different authentic sources.

At the St. George’s Hospital, Bombay, where the O.P.D. is conducted thrice a week and accurate records are maintained, the figures clearly show a steady rise in the incidence of these diseases during the last four years.

Do not these figures show alarming state of things with regard to venereal diseases? The prevalence rate of syphilis alone for the country as a whole could not be under 10%; besides there are other venereal diseases such as gonorrhoea, chancroid etc. the incidence of which often exceeds that of syphilis. Most of the cases are in a highly infectious condition and fall in the age group of 10-35. Recently, this staggering fact was confirmed and grave warning was sounded about the further increase in the not too distant future by Dr. T. GUTHE, W.H.O. Chief Medical Officer for communicable diseases. He aptly described the condition as an iceberg, of which a small fraction is visible. The prevalence rate of V.D. in Western Countries like U.K., U.S.A. and France is often less than one percent. The economic loss to the country from these diseases is beyond estimation. However, no one wants to talk about them.

Need Urgent Attention

Patients with venereal diseases and their problems need urgent attention. Venereal diseases are most potent and a frequent cause of illness; they usually pass on from person to person frequently without knowledge. Their influence on good breeding, national health, economy, premature deaths, disablement is not sufficiently known to the larger section of the public. It is therefore, of utmost importance to plan in an organised way for their control at the national, state, district and town levels. Haphazard measures are bound to fail miserably. To neglect these patients as is now done is to neglect national health and happiness.

It is essential to establish a separate venereal authority, the Directorate of Venereology and entrust it with all problems connected with V.D. such as planning, establishment of clinics, deciding the minimum criteria regarding equipment, accommodation and staff for a clinic, teaching, posting of personnel, supervision of clinics, adoption of uniform policies and their application all over the country, collection of statistics and a provision of services tailored to the needs of a particular area and situation and finally to advice the health authorities. And each State must set up a venereal division, the Deputy Directorate of Venereology as a part of the Central Health Organisation for the purpose. To encourage the organised and planned growth of V.D. institutions and clinics and to ensure their smooth running, such a step is of prime importance. Without such a central authority coordination of efforts, adoption of uniform policies and their enforcement throughout the country can never be possible. It will be possible then to establish rapport and understanding which would give a unity of purpose and sense of direction both to the Centre and the States alike. Importance of such a central authority capable of enforcing uniform policies with regard to V.D. throughout the country cannot be minimised.

Strong Plea

Venereology and dermatology must not be combined in one unit. x Two separate chairs and departments for these two branches of medicine need to be instituted in every teaching medical colleges and its attached hospital. Every general hospital ought to have a separate department of venereology with adequate staff, equipment and accommodation. This is the only way to provide specialised medical services to venereal patients and to ensure proper training in venereology for medical students. Experience of the past years has amply proved that the work for venereal patients, and the training of medical students to attend to them is totally neglected generally in the hospital where there is a combined department for V.D. and skin. The way patients are dealt with herein is nothing short of quackery. The reliable diagnosis, correct treatment, education of the patient with regard to his disease, contact-tracing caseholding, follow-up test and record-keeping to ensure complete and permanent cure etc. are rarely done even in the so-called teaching institutions. This is very shocking but absolutely true. To remedy the situation, it is all the more important to recognise venereology as an important branch of medicine and to institute a post-graduate degree or diploma in venereology. In consonance with this basic principle, Universities of madras and Delhi have already instituted a separate post-graduate qualification in venereology. For the sake of national interest and uniformity, it is necessary to follow the same policy everywhere. The need to remove this somewhat glaring inconsistency in medical education does not seem to have received the attention it deserves. This is an age of specialisation and students of medicine ought to get all facilities to equip themselves properly in venereology. Equally important is that venereal patients get specialised medical services; for, unskilled medical services are not only useless but also dangerous from the point of patients’ health and public health as well. There is a strong case of expediting decisions on venereal policy. There is a stalemate in our medical education and services today that bold decision alone can pay rich dividends.

Urgent Needs

It is necessary to provide adequate and free diagnostic and treatment facilities for venereal patients. At present, there are very few diagnostic cum treatment centers for venereal patients even in cities like Bombay and in the country as a whole, though the incidence of V.D. is alarmingly high. It is a fact that authorities of many private, public and E.S.I.S. hospitals are generally very reluctant to appoint venereologists and to provide specialised medical services to venereal patients in their establishments, though this can be done without any additional burden. The crass apathy on their part must end the sooner the better. A venereologist must constitute a part of the comprehensive team of specialists for each and every hospital. Otherwise the preservation of this speciality will be in danger. The National Health Service in U.K. invariably includes venereologists in additional to dermatologists in its medical team but we shun, for no reason, to do so for E.S.I.S. and C.H.S. and general hospitals. A chain of laboratories such as central, district, town and field laboratory must be provided all over the country. This is an important step for neither an early and accurate diagnosis of V.D. nor its permanent cure can be established without the help of laboratory aids. Clinical impressions or assumptions are totally untrustworthy and often dangerous in V.D. General medical practitioners in private practice, who are the back bone of health services, usually lack in this facility and are in great want of laboratory aids, With the help of these laboratories, they can effectively share the responsibilities in the control of V.D. and help to reduce the load of medical work on the public hospitals. It is duty of the government and the civic authorities to cater for these urgent needs. To allow these patients to go uncared for or untreated creates a danger to society and the public in general. This fact needs to be realised very clearly by the people in authority.

Education and Legislation

Education of the public with regard to these diseases by means of press, radio, cinema, talks and posters needs to be undertaken right earnestly. It is a very useful weapon against the spread of these diseases. At present there is a good deal of ignorance, superstition, secrecy and prejudice on the part of the general public. Some type of legislation needs to be enacted making the blood test foe syphilis necessary as a part of routine physical examination or check-up before employment, marriage and for pregnant women. Deliberate transmission of infection to others has to be made a crime. Treatment of infectious cases must be made compulsory and defaulters in treatment brought to the book.

Each State should have an institute of venereology where medical and paramedical personnel can be trained in specialised work. The growing number of clinics would need trained personnel and institute can be relied on to prepare and supply them. xx It will be no exaggeration to say that more damage is done to the cause of public health by our sustained indifference to the interests of venereal patients. The havoc is grimmer and more distressing because of haphazard policy that is adopted by the government and some universities in regard to venereology. The need for national orientation in the development of venereal policy is urgent. The crisis of health services needs urgent attention. It should help to alert the public to the urgent requirements for more active planning and priority setting for health and medical services. It is the right of the public to demand the provision of specialised medical services for venereal patients, elimination of V.D. and protection against the risk to health. In the socialist pattern of our society, the Union Government had rightly pledged itself to the ideal goal of providing specialised medical services not only in the cities but also at district and town levels. How can this objective be achieved when we refuse to appoint venereologists on the teaching staff of medical colleges and on the panel of specialists for most of the genera hospitals? It would be very unfortunate if advances in medicine and chemotherapy bred complacency in dealing with venereal patients gave rise to the fallacy that venereologists are nor longer required. The pattern of medical services has throughout history been one of constant and continuous change. The existing pattern of diseases in the country and the health needs of the people at present and in the foreseeable future ought to form the background for training various categories of health personnel. The concept of comprehensive health services has come to stay even as a remote ideal and one has to develop resources, in a planned manner and on a phased basis, to coincide with our varying and growing needs. The increasing complexity of modern medicine demands a team work of many categories of health workers and special attention must be given to the training of venereologists and paramedical workers, who would be needed to man the growing number of clinics. Medical education for both the under and post graduates is of paramount importance in the development of comprehensive health services. There is an urgent need for improved education in venereology for medical students. It is incredible that medical students still receive no teaching or instruction about V.D. throughout the whole course of their training. An adequate and proper training of the undergraduates in the principles of diagnosis and treatment of V.D. and its allied problems and the recognised system of training for intending specialists in venereologists are still to be provided. There is a danger that trainees in venereology will cease to come forward, as it is found to-day, unless a policy of preservation of this speciality is adopted as soon as possible. It is no wonder that inspite of the growing number of new medical colleges, we could not have similar increase in the number of venereologists in the country. The obvious reasons are reluctance to appoint venereologists in the medical colleges and hospitals, lack of encouragement, incentive and official apathy. If we sincerely desire to fulfill the ideal goal of specialised medical services, there is no way but to recognise venereology as an important speciality, establish a separate venereal clinic at each hospital and appoint a qualified venereologist to offer specialised medical services to venereal patients. So long this basic need is not conceded, there is no hope of providing the right type of medical services to venereal patients, to improve standards of medial education and training of medical students both under and post-graduates.