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Make Treatment of Parkinsons More Affordable, Doctors Plead

A team of doctors led by Mona Raghothaman of the National Institute of Mental Health and Neuro Sciences, Bangalore in southern //India, has made a strong plea for all out nationwide efforts to detect the Parkinsons Disease at an early stage.

They have suggested that doctors working at primary health care centers and district hospitals be educated to identify Parkinsonism and refer the patients to specialty centers.

In a paper titled Direct Costs of Managing Parkinson’s Disease in India - Concerns in a Developing Country, Dr. Ragothaman and others note that the cost of treatment of debilitating disorders is prohibitive.

In the absence of universal health insurance, efforts could be made to improve the quality of Parkinson’s patients by early detection and necessary follow up treatment to the extent possible.

The Parkinson's Disease occurs when certain nerve cells in the brain, called the substantia nigra, die or become impaired. These cells produces dopamine, a chemical, which allows smooth, coordinated function of the body's muscles and movement.

When approximately 80% of the dopamine-producing cells are damaged, it results in the Parkinson disease.

Though the disease is more common in adults, even the younger lot could be affected. Take the case of Balachander of Bangalore, a 16-year-old school student, who is struggling to cope with the trauma of it all.

The disease struck him when he was in the seventh standard. Doctors put him on the drug levodopa. He was coping as best as he could, but the drug was taking its toll. He had become subject to severe tremors and hallucinations.

The tremors that shook his fragile body on the last day of his SSLC examinations proved too much for the poor Balachander. He had to be carried out.

"My school had got permission for me from the government to have an aide for the exam. I would dictate and someone else would wri te. I did most of the exams well. But I could do nothing during my Kannada paper," recalls the despondent student.

He now has to undergo a surgery – deep brain stimulation – that would reduce his tremors and make the quality of life that much better.

The surgery involves the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain.

But it would cost upwards of Indian Rupees five hundred thousand, something the lower middle class parents of the boy cannot afford.

Prevalence of the Parkinson's disease in India is considered lower. 60-100 per a population of one hundred thousand, while in the Western countries it is 116-197.

The relatively low incidence notwithstanding, it has been proven that at least 25 per cent of the disease is not diagnosed even in neurology clinics.

In many cases the symptoms just don't show up, other doctors have pointed out. But even in those who have obvious symptoms, the disease is not treated. Sample this, the NIMHANS study shows that 17.8 percent of the people living in old age homes had the disease but less than four per cent knew about their status. This despite doctors visiting many of these homes.

Worse, caretakers of elderly assume tremors, slowness and forgetfulness is all part of the aging process.

Neurodegenerative diseases place significant finanancial burden on patients living in developing countries, the NIMHANS team says.

An improved life expectancy among Indians has increased the number of elderly and the number of individuals with age-related diseases, such as the Parkinson’s.

India could be growing rapidly, but still its per capita income is very low, it varies between US dollars 450 and 540.

Treating the Parkinsons’ disease is expensive, while medical insurance covers only 3 per cent of the Indian population.

Th e NIMHANS study also notes that patients who come to the hospital have incomes higher than the average GNI.

Clearly then poorer patients are even less likely to receive care and medication, as they are unable to make it to the hospital.

In the circumstances, the treatment of the Parkinson’s needs to be addressed by appropriately changing India’s health policies, the team has urged.

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