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M. P. Ravindra Nathan

India is still a nation of villages. Although transformation from agrarian to urban life style is occurring, this has created additional health problems as well. One can see extreme affluence and abject poverty coexisting side by side.

During the “India Health Initiatives” segment of AAPI Silver Jubilee Convention, Dr. Thakor G. Patel, chairman, AAPI Public Health Committee U.S.A., gave a revealing and insightful presentation about diabetes mellitus (DM) and hypertension among Indians.

Dr. Thakor G. Patel, middle, and his team of volunteers.
An AAPI-funded project, this initiative was established for detection, evaluation and management of diabetes and hypertension in ‘Karakhadi’ village – a prototype for all rural Indians. These are two common and serious problems, which are eminently treatable or even preventable. The project was overseen by Patel and his team. The village, like any other in India for the most part, consists of makeshift huts, unpaved roads and limited drinking water and everyone lives and works in unhygienic surroundings, using community baths and toilets. Ignorance, a constant companion of poverty, is another problem.

Here are the results of his survey:

Total population screened above 18 years age 1681

Prevalence of hypertension BP >140/90: 26.1 percent

Prevalence of Diabetes Mellitus: 9.4 percent

Interestingly, several patients were unaware that they had these ailments.

The Indian newspapers gave a positive publicity for these efforts with bold headlines such as “AAPI Stir(ring) Diabetes in India.” The results of undiagnosed hypertension and diabetes can be quite serious – both in cost and in lives affected. “If you want to bring a definite impact in health care in India, it should start with villages,” said Patel. “And the backbone is education,” he stressed, since 70 percent of these illnesses in rural India are preventable. In addition, the incidence of asthma, TB, respiratory and other and infections also seems to be rising, probably related to the escalating pollution, smoke inhalation, lack of sanitation, etc.

At the end of September 2006, AAPI team visited many primary health care centers in India to set up and implement five health initiatives in villages. The local village health workers, physicians, nurses, deans and professors at the medical colleges as well as state administrative personnel, including two heath ministers, are cooperating with the project. This initiative will help in diagnosing and treating the five areas of health at the rural level. “We are convinced,” immediate past president of AAPI Dr. S. Balasubromoniam said, “by the ‘knowledge transfer’ and system set up with the expertise of AAPI members, there will be a significant decrease in mortality and morbidity in the five projects namely, heart disease, diabetes, carcinoma of cervix, carcinoma of prostate and deafness in children.”


There was a workshop and CME on Ayurveda too under the direction of Dr. Navin Shah, the Maryland urologist and a past president of AAPI. Shah has been spearheading the efforts to introduce courses in this ancient Indian system of medicine and, after many years, has been successful in establishing this in several medical schools in USA. He convinced the Government of India to send a senior Ayurveda specialist Dr. H.S. Palep, director of Palep’s Medical Research Centre, Mumbai, who will run several workshops for two months – in centers such as Harvard University and Johns Hopkins Medical Center.

AAPI is an energetic and credible organization now, deeply committed to health care delivery in America. It also has been at the forefront of empowerment for Indian American physicians, representing matters at the government levels and getting grants etc. The fact that AAPI has now great clout at the top level became evident during the keynote speeches of such high ranking politicians like U.S. Rep. Frank Pallone of New Jersey, always a friend of Indians, Democratic U.S. Sen. Jay Rockefeller of West Virginia and U.S. Rep. Steny Hoyer of Maryland (the Senate majority leader). These speeches usually revolved around the role of Indian physicians in the American health care. Steny Hoyer even joked that if Indian physicians struck work, the whole U.S. health system could be paralyzed.

Joseph Scadori, global chairman of Johnson & Johnson, who gave a generous grant for the convention, also was one of the featured speakers during the gala function. Clearly, we have the support of the medical industry and that was even more obvious with the many exhibit booths from leading medical, pharmaceutical and device companies displaying their products in the exhibition hall.

It looks like the dark clouds which hung around AAPI have lifted finally. AAPI was indeed resplendent with glory and power of Indian physicians during this Silver Jubilee Convention. Dr. Hemantkumar Patel, the convention chair and the incoming president, deserves credit. This was certainly an event not to be missed.

This concludes our series.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.

Payal Patel

If you look around these days, it is easy to spot a child who is overweight now more than in the past. Obesity was once considered an adult problem but now also affects children. Obesity has become a growing epidemic that is not only affecting the United States but also the world. It is considered a healthcare crisis that we as doctors, parents and teachers have to fight together. In this four-part article, I would like to start out by talking about what obesity is, and the causes and its associated risks. Next will be prevention, followed by two parts of weight management strategies.

Nearly 25 percent of children in the United States are considered overweight. The causes of obesity include genetic as well as external influences. We can blame our now sedentary lifestyle. These days, more kids spend time indoors playing videogames and watching TV then playing outside. Parents are responsible for this behavior because they are role models for their kids. Since we as adults work all day, we are too tired to spend outdoors time with our kids on a daily basis. Therefore, not only do we tend to become overweight, but so do our kids.

Another problem is the ease access we have to all types of food. It is convenient to go to a Burger King, McDonalds or a Taco Bell when parents are tired or on the go. These foods if eaten even 2-3 times per week can easily add to the weight gain. We have all been to the grocery store or a restaurant and realized that healthy foods come with a hefty price, which is difficult for middle- and low-income families to afford.

Parental obesity plays a large part in determining a child’s weight as an adult. Genes play a large role in determining obesity, along with external factors such as the parents eating behavior as well as their sedentary lifestyle which are psychosocial factors. Obese children less than 5 years old have a three times increased risk of being obese as adults. An adolescent (teenager) who is overweight has a 70 percent chance of being obese at 35 years of age.

The adult complications of obesity start much earlier in children who are at risk of obesity, and are already demonstrating signs and symptoms of weight gain. The complications include high cholesterol, hypertension, diabetes, accelerated puberty, sleep apnea, many types of bone-related problems, liver problems, emotional and psychosocial problems, etc.

It is our job as pediatricians, parents and teachers to educate our children, as well as take an active role in changing our own behaviors to influence our kids by implementing healthy eating habits, as well as exercise into our daily lives. Parents are the biggest role model for their kids.

Every child that comes to the doctor’s office should have their blood pressure checked and their weight and height plotted on a growth chart at all well visits/yearly physicals. If a child is determined to be overweight, then a BMI (Body Mass Index) should be calculated by the doctor and explained to the parents. Another important assessment for overweight or obese children is blood work to check for glucose, thyroid and cholesterol.

In my next article, I will write about prevention in detail.

Payal Patel, a board-certified pediatrician, is at Sunshine Pediatrics, (next to Cheval), 18928 N. Dale Mabry Highway, Suite 102, Lutz, FL 33548. She also can be reached at (813) 948-2679.

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