V.D. CONTROL

by Major. M. P. Vora

Maharashtra Medical Journal

Volume No - XXIV, Number – 10 of January 1978.

Page No. 417 to 420.

SYPHILIS AND GONORRHOEA, THE MOST IMPORTANT AMONG VENEREAL DISEASES ARE UNIQUE in that the sufferers, transmitters and the reservoir of infection are all human beings, who are alone responsible for their continued spread and existence in an epidemic form. These infections differ markedly from other infections in that patterns of human behaviour are directly related to the infectious process and are in conflict with moral standards and often provoke adverse reactions in the society. Because of their close link with human sexual behaviour, they are sometimes called behavioural diseases. Ignorance of the facts that they are preventable and that they can be present without apparent signs and symptoms, promotes their spread. Formerly, their presence used to be attributed to poverty, insecurity, war etc., but the recent recrudescences have more usually been associated with growing prosperity and relative peace. They are preventable and curable. They are not inevitable nor beyond control. They are most thoroughly studied and amenable to modern treatment especially in the early stages. It is not that these diseases are spreading by themselves; nothing significant is being done to control them scientifically. Adequate knowledge and effective technics are available for their control, but they are totally ignored. Meticulous screening only of high risk groups at all health services (i.e. to establish the presence or absence of V.D.) by proper laboratory tests can accelerate V.D. control. So long as we remain unconcerned, and refuse to employ effective technics, these diseases are bound to rise and spread.

The most instructive but rather difficult task of the health administrators is to collect health statistics, study them, find current trends of various diseases, evaluate measures and find effective solutions to the public health problems.

It must be admitted that there are no accurate venereal diseases statistical data except some scanty reports from Madras, Bombay and Himachal Pradesh. Even the well organised Employee’s State Insurance Scheme does not consider it necessary to give figures of V.D. in their regular reports, which can be of educational value. Hence one has to depend per force on the study carried out over a period of several years and covering many countries by the W.H.O.; it has revealed from time to time very disquieting figures, ‘An appreciable upward trend of V.D. can again be noted against which urgent control measures must be taken.’ This wording has been found in reports dating back as far as 1950 and remains unchanged in subsequent reports. It is estimated that there are about sixty million new cases of V.D. a year and a yearly rise of ten percent in the country. The prevalence rate must be still higher than this. But this does not seem to disturb any one. The attempts of the writer to focus the attention of the health authorities in the State and the country, during all these years, have been a mere cry in the wilderness.

Though enormous technical advances have been made during the last two decades in the field of diagnosis and treatment, psychologic and social aspects of these diseases, educational methods and their usefulness established, much of this knowledge and technics have remained heaped up and ignored in the country. There is in fact enough knowledge and known technics for the V.D. control. What is lacking consistently is willingness to understand the subject with imagination, and activity to use known and effective principles in actual practice. There is no reason to feel powerless or helpless to face the problem of V.D. On the contrary, there is every assurance, that inspite of some teething difficulties, these diseases can be effectively tackled and their spread checked. There is already a supporting evidence to this effect in Himachal Pradesh, where sero-positivity rate was brought down to 14% in 1973 and 4% in 1975 as against 55% in 1958. It is a matter of great pity that there is no awareness of the problem in many States in the country even to this day. Many countries in the world especially England, Hungary, France, Sweden have adopted and applied with success the new co-ordinated and integrated approach, calling on the community participation.

In 1975, the General Assembly of the United Nations advocated the setting up of a new type of international co-operation and invited the W.H.O. and related agencies to intensify the international efforts in favour of health conditions throughout the world, giving top priority to disease prevention and provision of basic health, including family health services to communities. It stated clearly that a harmonious development of health services necessitates an integrated socio-economic approach, i.e. the co-ordination of policies on economic development, education and health. Over the years, the W.H.O. has strongly emphasised the necessity for a multidisciplinary approach for the betterment of world health, on importance of integrating prevention, treatment and control methods at all levels and above all, on the absolute necessity to extend the same to rural population which is often neglected. This is sure to extend and accelerate the health programme.

For this, a close co-operation and participation by all medical men who render medical service is essential to enable them to deal more competently with various complexities of health problems existing in the community. It necessitates on the part of health authorities and medical personnel i.e. doctors, nurses, health educators and visitors, social workers, technicians etc. a new conception of their roles in the Society and above all a revision of their attitudes and system of training and educating, which should be enlarged to encompass prevention, social medicine and social action. They have to adopt flexible attitude, acquire skills easily adaptable to the field conditions, ability to take initiation, maintain reasonable standards, organise joint team work, supervise personnel and stimulate interest and devotion to duty in the workers. By offering right education and information, at the same time, they have to assure community participation in the campaigns. They have to keep themselves well informed and up-to-date in knowledge and technics, method of diagnosis and treatment and are to be provided with necessary facilities and help so that they can discharge their responsibilities ably. But when it comes to planning and organisation, of health services the problem of V.D. is either forgotten or ignored invariably. The resultant insufficient or inefficient application or even total neglect of the principles in respect of V.D. contributes one of the main causes of persistence and rise in the incidence of V.D.

At the 28 th World Health Assembly held in May 1975, Dr. C. N. Sowmini, the Director of the Institute of Venereology, Madras rightly and strongly pleaded for ‘a better and more realistic approach to check the vicious spiralling V.D.’. But one finds unfortunately the same old level of unawareness of the problem and unresponsiveness among the health authorities and medical profession. This is the reason why they did not appropriate adequate efforts, funds and sanction personnel to check progressively menace of V.D. to the minimum level. Dr. Sowmini pleaded for:

• Collection of epidemiologic data on the incidence, spread and target groups involved.
• Obtainment of available resources in facilities, trained man-power and funds.
• Definition of cultural and behavioural patterns having a bearing on the spread and control of V.D.
• Outline of the scope, and limitations of currently available diagnostic, therapeutic, epidemiologic and educational methods under local conditions.

The practical application of this approach calls for:

• Integration and co-operation at all levels of health activities not only within the frame-work of national health service, the State health services, but also equal importance in the private sector and semi-government sectors.
• Continuous and never-ending proper education, training and information to all concerned. Principles of general medical training, often out of date need to be entirely revised to suit the community interests and depending on simple but reliable technology. Greater use must be made of existing facilities and idle man-power that are available in the country, the hospitals, medical colleges and private practice. ‘Stress must be on scientific training and adequate education.’ Refresher courses for the doctors in practice, and educational programme for the public with cassettes, tapes, slides etc. have to be used, for the community- oriented venereal diseases control activities. The experience thus gained would in turn be of immense help and guidance for future programme and stimulation of further activities.
• Health education should be aimed not only at the masses but also at those political administrators, and health leaders, at all levels to ensure overall participation by the entire community.
• Active research not only in the field of diagnosis, treatment and prevention, but also psychologic factors, behavioural patterns, contact tracing, the spread of V.D. etc.
• The application and extension of these priorities at all levels of the society covering the whole population. Absence of sophisticated method or equipment is not a valid excuse for neglecting the right of the rural population to good health. The application of simple but reliable technology, proper methods of diagnosis, administration of effective and standard methods of treatment and extending them to contacts with little firmness of purpose to rural areas by health auxiliaries- all these can be easily implemented.

V.D. is not an inevitable evil nor is it a scourge beyond control. These communicable diseases are better known than the many others and are easily curable as well as preventable. It is not that they are themselves spreading. The actual fact is nothing right is being done to control them. The out-dated and unimaginative adherence to the false ideas, conceptual faults, routines and vacillations must end; and we have to give due importance to the subject and recognise venereology as a speciality- as a national policy. V.D. control must be based on sound medical principles, namely careful examination and investigation, accurate diagnosis, effective treatment, careful follow-up, contact tracing and education.