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Rapid Responses: Rapid Responses published:
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Polypill underhand to indigenous peoples
- Stephen J Redmond (22 August 2003)
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Chronic disease spectrum in indigenous peoples
- Jeffrey J. Segall (25 August 2003)
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Traditional Indigenous Health Providers
- Elizabeth S Mattock (2 September 2003)
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Health of Indigenous People of India
- Dr. Sindhu Singh Singh, New Delhi-110029 (4 September 2003)
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Unhealthy attitude of ‘healthy people’ towards health of Indigenous people
- Dr. Vikas Dhikav Dhikav (4 October 2003)
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Stephen J Redmond, GP principal Ellergreen Medical Centre, L11 2YA
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Dear Editor, It is a sadness to me to see in an issue devoted to the health needs and burdens of indigenous peoples, largely as a result of the Western tradition of avuncular superiority that a reference to the Polypill article should find its way in as a potential solution to the excess cardiovascular mortality of these populations.As well as being, at this point in time, speculative and unproven, they would also seem to be a further instance of Western insistence on knowing what is better for people than they themselves, taking scant notice of their beliefs or wishes, and hence at variance with what I read as the main thrust of the rest of the issue. These people are at risk because of the life style thrust at them and their lack of purpose and self determination. Surely it is even more futile not to tackle the underlying causes in this situation than it is in the UK, which I believe to be the case. Yours sincerely Competing interests: None declared |
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Jeffrey J. Segall, General practitioner (retired) 308 Cricklewood Lane, London NW2 2PX
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Ring and Brown are incorrect in generalising that “indigenous peoples tend to have higher mortality right across the disease spectrum, including “circulatory conditions”, [1] as this does not apply to coronary heart disease (CHD).[2] American Indians have lower age-adjusted mortality rates for cardiovascular disease than the US population as a whole[3]; Alaska Indians and Eskimos have lower cardiovascular mortality and less severe and extensive coronary and aortic atherosclerosis than Alaska whites[4]; and CHD is relatively uncommon in South Africa’s black population[5]. An explanation offered for this reverse disparity is that, in comparison with non-indigenous people in a population, a low prevalence of persistent lactase activity in adulthood and an associated lower intake of lactose from milk are protective.[2] This does not apply to hypertension and its complications, so the term “circulatory conditions” conceals the reverse disparity with CHD. A single report on Australian Aborigines gives a prevalence of persistent high lactase activity of 16%. We need to know their mortality rate, not from “circulatory conditions”, but from CHD separately to that of hypertension and consequential heart failure, stroke and renal failure. References 1. Ring I, Brown N. The health status of indigenous peoples and others. BMJ 2003;327:404-05. 2. Segall JJ. Digestive and nutritional factors may explain lower prevalence of coronary disease in indigenous peoples. BMJ 2003;327:449-50. 3. Lee ET, Welty TK, Fabsitz R, Cowan LD, Le N-A, et al. The Strong Heart Study. Am J Epidemiol 1990;132:1141-55. 4. Newman WP, Middaugh JP, Propst MT, Rogers DR. Atherosclerosis in Alaska Natives and non-natives. Lancet 1993;341:1056-57. 5. Seftel HC. The rarity of coronary heart disease in South Africa Blacks. S Afr Med J 1978;54:99-104. Competing interests: None declared |
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Elizabeth S Mattock, locum remote area nurse various in remote Australia
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Dear Editor, I would like to comment on part of the article regarding Indigenous practitioners being trained in Western methods. While this may be broadly true, there are many members of staff in remote health services in Australian Indigenous communities (Aboriginal and Torres Strait Islander Health Workers and Nungkaris, etc.) who are trained in, and practice, traditional medicine. I recall an incident in a communtiy several hundred kms SW of Katherine in the Northern Territory where I was a Remote Area Nurse (RAN) a long time ago. A young woman was fitting and all the paraldehyde and other western intervention we tried would not stop the fit. In came the Nungkari (witch doctor) and worked his magic and the fit stopped. In the back room of another clinic - this time in the Kutjungka Region of the SE Kimberley there was kept a collection of bush medicine which was used regularly. Even the RAN used some of the herbs. In the Torres Strait one of the Torres Strait Islander Health Workers spent a lot lot of money to travel down to Cairns to consult a traditional healer as she knew that western medicine wasn't going to fix her up. There are many other examples. This is one of the many facets of being a RAN that makes it so addictive.... Yours faithfully Liz Mattock. Competing interests: None declared |
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Dr. Sindhu Singh Singh, Resident All India Institute of Medical Sciences, New Delhi-110029
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Health of the indigenous people has remained a low priority at most times. This is because of the poor allocation of funds, apathy and due to a number of technical factors as well. This leads to the growing disparity between the health of indigenous people with the people living elsewhere. The startling fact that 75% of the Indian people still live in the villages but receive just 10-25% of the total health expenditure surprises us all. Moreover, due to the presence of rampant poverty and illiteracy; people adopt ways and means, which are not only useless, but may actually be harmful. Quackery is one menace that takes its roots in such circumstances. In India, the number of qualified medical doctors is easily less than that of the quacks. These people exploit indigenous people and the result is more morbidity and may even be mortality. The doctors posted in rural and the underprivileged area hardly ever attend their duties regularly. Moreover, the health facilities in the hospitals constructed for these people remain in a dingy and bad shape. So what can we do to improve the health of such people? The need is to recognize and encourage the unconventional modes of treatment such as exercise, yoga, and unconventional medical pathies such as Ayurveda and Homeopathy. These can be used cheaply and effectively to manage at least the self-limiting conditions and to promote a healthy life style in general. An important area, which requires attention, is the mental health of such people. The medical doctors should make sure that they attend their postings and see the patients on regular basis. Administrators need to allocate more funds and maintain a strict vigil so that they are utilized properly. In summary, the need is to have a comprehensive health program; which may be a part or separate from the main one-to promote healthy and disease free society of indigenous people. To achieve this, faith healers, local “practitioners”, self-proclaimed “doctors”, and quacks can be trained to deliver such package of health care. Some countries like Nepal has trained the “local” or “traditional doctors” to be a part of the health care delivery. These can be useful and cheap source of healthcare if they are trained, supervised and carefully and regularly monitored. Competing interests: None declared |
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Dr. Vikas Dhikav Dhikav, Resident All India Institute of Medical Sciences, New delhi-110029, INDIA
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Sir, Health of Indian tribal people represents one of the examples of shear neglect and utter ignorance. These are among the poorest, most illiterate and underprivileged people of the world. They suffer from untold morbidity and mortality. Unfortunately, there are no published reports of their health concerns and other epidemiological details. Having lived in a tribal area for over two decades, I am aware of this harsh reality that these people are remembered only when their political representatives need votes. Else, they are left on their own to struggle and die. Most of the people, whom I know have rarely sought allopathic treatment. Most go to "charitable" dispensaries opened by some magnanimous people. This is because, they dispense them medicines without charge. The fact that medical education in India is getting increasingly technical has adverse effects on health of indigenous people. Medical doctors over here want postgraduate seats first, rather than serving people. The forceful requirement that doctors here should serve underprivileged people for 5 years has been a fiasco. Even the proposal like "serve in the underprivileged and get reservation in postgraduatation" has met dismal successes. Proposal by Ian and Brown1 is unlikely to be successful in India. This is because, most such people are illiterates and those who among them are educated, consider them no less than animals. New risks and diseases such HIV\AIDS are emerging in this population now. This class exports their children for labour and young girls for trade. Unfortunately, the message of prevention has not reached up to them. In Andhra Pradesh and Tamilnadu; the states hit the hardest, have started some ‘preventive messages’ in local languages, but this remains restricted to some villages only. No reach of mass media, language barrier and the scale of problem remain few of the many problems in ensuring delivery of health care in this population 1. Ian Ring and Ngiare Brown. The health status of indigenous peoples and others BMJ 2003; 327: 404-405 Competing interests: None declared |
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