Working together for health

The theme of the World Health Organization (WHO) for the year 2006 is 'Working together for health.' WHO has defined 'human resources for health' as 'all people engaged in actions whose primary intent is to enhance health.'[1] It includes all those who promote and preserve health as well as those who diagnose and treat disease. Health management and support workers - those who help make the health system function but who do not provide health services directly - are also included under this group. The total expenditure on health in India was 4.8% of GNP in 2003. It was less than what we spent in previous years.[1] There are 6 doctors and 8 nurses per 10,000 people in India, which is deplorably low.[1] Neurological disorders account for a major proportion of the life years lost due to disability in India. Government, legislators and the professional bodies need to take urgent steps to bridge the wide gap between the desired density and the deficits of professionals in neurological sciences. Several medical institutions in India do not offer courses in neurology. We need more number of advanced neurological centers in our country. Our academy probably needs to set up special task forces to recommend the minimum standards for neurological training in our country. We also need to devote more time to improve the standards of our neurophysiological laboratories in terms of equipments, infrastructure and human resources. At present, there are only a limited number of EEG and EMG laboratories and fewer polysomnography units that meet the essential technical standards. Training of paramedical staff and neuronurses is another important link in improving the standards of patient care in our country. We have crossed the middle of the year 2006. The second half of each year is busy with several neurological group meetings at the national and international levels. The journal is trying to catch up with the rapid changes. We have opened another new feature under 'Technical Reports'. The purpose of this column is to bring out technical reports of good quality on some of the commonly used electrophysiological protocols. In this issue, we have discussed the electrophysiological approach to Carpal Tunnel Syndrome, a very common referral to neurophysiology laboratories. We hope that these reports would help practitioners who are establishing new laboratories to set up proper standards for the protocols. Several lakhs of persons undergo coronary artery bypass graft (CABG) every year. The precise counts for India are difficult to obtain, but the numbers are undoubtedly increasing rapidly in our country also. CABG and coronary angioplasty have provided a new lease of life for the vast majority of those who undergo these procedures. Yet they are not free of neurological complications. Nearly 5% of these patients can develop stroke and 1% can die after CABG. The late cognitive effect of CABG is being increasingly recognized. Neurologists are often called upon to evaluate the decline in cognitive functions in some of these patients. This issue carries an excellent review on the diverse aspects of cognitive impairments that can follow CABG. Viral encephalitis continues to be one of the most important disabling, if not lethal, group of infections of the nervous system. Rabies accounts for nearly 30,000 deaths in India every year! Recently there had been epidemics of encephalitis in Chandipura and Siliguri due to a relatively uncommon virus. Japanese B encephalitis and herpes simplex virus encephalitis continue to be common types of sporadic encephalitis that affect children and adults in India. HIV infection of the brain can cause several syndromes in human beings. This issue carries an important article that discusses the Nipah virus encephalitis in India. The authors have elaborated well on the epidemiology, clinical features that distinguish it from other encephalitis and the treatment options. Neurological disorders during pregnancy constitute important problems for women in the reproductive age group. Every neurologist in India is called upon to handle or manage such cases regularly. Yet most of these gender-specific neurological problems have escaped serious scientific attention. Epilepsy, stroke, inflammatory demyelinating diseases, other immune-mediated neurological disorders and infections are of particular relevance to pregnant women. A paper in this issue has tried to ascertain the magnitude of such problems in one of the larger neurological centers in India. Further systematic studies, preferably from several centers, are necessary before we can attempt to develop uniform strategies to manage these complications.