Review - October

So far I haev done a few updates on the blog, mainly about my work experience and some interesting articles I have found during braod research of my topic. Even though this is a good starting point I feel like I need to narrow down my search a bit more and find a particular focus which I would like to take my project towards. 

I have also had a brief meeting with my supervisor, during which we have had a small discussion as to what this focus could be and some very interesting ideas have come up. The possibility that I could fous on just one country such as India to write up about and analyse the healthcare system there. 

Furthermore, I have drwn up a simple timeline to aid in the sheduling of my project however i feel that this may be too rigid. But this is subject to change as time goes on and I see how the project is progressing. 

My aims for the next few months, leading upto the midterm review is to 

• Formulate a clear idea about the topic and the title of the project
• Review the timeline for the project and edit as necessary
• Continue with research - however with a more focused aim
• Transcribe the interview undertaken with the lead doctor during work experience
• Research the main facts about the healthcare system in India

A bit about my work experience [III]

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Another thing that was highlighted to me during the work experience placement was the challenges that the doctors faced to balance their hectic life with the very rich family and personal life and commitments. 

For instance, while I was shadowing Dr. Madhu I saw that on many instances during the ten days, relative would come and visit him and have a small leisurely chat. While Dr. Madhu was very accommodating, he also made sure, if there was heavy waiting, to return to work fairly quickly. 
Also when attending family events, he had to schedule his work and handover the whole responsibility of his hospital over to his fellow doctors, nurses and technicians.



Another challenge that the doctor faced was intensely simplifying medical terminology and translate them into a different language to the one that he originally learnt it in (English). In the many years of practice as a doctor, Dr. Madhu had gained a lot of experience in communicating to his patients in a very efficient way and in a method that they really understood their problem and the possible solutions. Perhaps that is why he was so quick with is consultations and managed to effectively run his "healthcare business" even with such an undercurrent of challenges. 

News article about surrogacy procedures in India

This article from the BBC is about the British couple (who do not want to be named) have travelled to India in order to "employ" a pair of surrogate mothers to have 2 sets of twin babies. 

However what I found really controversial was the fact that the couple "insist they have no intention of meeting either surrogate". In addition the wife said in an interview with BBC:
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"She's doing a job for us, how often do you communicate with your builder or your gardener?"

"She'll get paid…we don't need to see her. As long as she's healthy and delivers my babies healthily, she's done a job for us," says the wife.

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This I think is very morally invalid and the wife is not taking into consideration the feelings or attachment that the surrogates may develop to the babies. Furthermore, it would be very unfair if there is some sort of discrimination or prejudice involved here. 

Additionally having all 4 babies may, in the future, bring up complications in their care. The parents would need to take into consideration the financial problems they might face in supporting all 4 babies.

Lawyer Natalie Gamble says in response in the report, 

"It wouldn't be allowed here. Under the regulation of licensed fertility clinics, there are quite strict rules about how many embryos can be transferred and certainly you couldn't transfer embryos to two surrogates in the same cycle"

The article also raises an important issue:

"Medical experts believe twiblings represent a fertility phenomenon which has emerged as a direct result of India's estimated billion dollar surrogacy industry, an industry which critics say is driven by profit.

Surrogacy in the UK is a legal and ethical minefield. There are strict laws governing it and commercial surrogacy is banned.

Meanwhile, the Indian government is under increasing pressure to introduce laws to regulate the surrogacy industry."

http://www.bbc.co.uk/news/uk-24670212 - 28 Oct 2013

Short excerpt from the news article:

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The couple having four babies by two surrogates

By Poonam TanejaBBC Asian Network

Continue reading the main story

A British couple are to become parents of two sets of twin babies carried by two Indian surrogate women they have never met. Experts say twiblings - or children born to separate surrogates but created from the same batch of embryos - are not uncommon in India.

The four babies, all due in March 2014, are the result of a commercial surrogacy agreement with a clinic in the Indian city of Mumbai.

The husband, aged 35 and wife, aged 36, who do not want to be identified, travelled to India in May following two miscarriages and several failed attempts at fertility treatment in the UK.

"I thought to myself why wait and why waste any time and go through ups and downs and attempts again. We've had a long ten-year journey with this," he says.

There are no official figures, but Natalie Gamble, a lawyer who specialises in international surrogacy cases, estimates hundreds of British couples travel to India for surrogacy each year.

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Timeline

I have created a Gantt chart to show the rough timeline that I have set for my project. I have tried not to be too generous but at the same time not too optimistic about finishing early.

This was a new skill that I had to learn as I have never made Gantt charts before. 

I have used the following website in order to create a Gantt Chart:
https://teamgantt.com/gantt/home/

A bit about my work experience [II]

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During my short stay at the hospital I also witnessed how the social circumstances and political strife in the state was affecting the provision of healthcare in the area. The state that this town was situated in was being split into two and at the time I was there, there were numerous strikes and "bandhs" (closing stores, shops and blockading roads etc). This severely affected the number of patients coming through the doors. The strike action was especially worse on the 16th of August and as a result we hardly saw any patients. Dr. Madhu didn't even have 10 consultations in the space of 2.5 hours. This compared to the usual 18 or so consultations in the space of 2 hours was a drastic reduction. 

One of the nurses feeding a premature baby - naturalising to breastfeeding

These political movements not only impacted the hospital's "business" but also put the patients in danger who did arrive to consult the doctor. Additionally, if any ambulances had tried to move patients to this hospital or any other in the area, they could have possibly be stopped on the road, putting the patient in the danger. The prospective patients' conditions may worsen during the day that they weren't able to come to the hospital and seek help.


The role of the doctor here was not only to provide the best care for their patients but also to simultaneously budget and also combat with the stress of the political situation in the area. 

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A bit about my work experience [I]

I was lucky enough to be able to arrange a work experience placement in South India for 10 days in a pediatric hospital.


The experience was the ultimate eye-opener... It highlighted to me how lucky we are to be able to have access to such high-tech medical treatment in the UK. I was struck by how we never have to travel miles and miles to get to a proper hospital and how healthcare is so easily accessible here in the UK.

The experiences at the hospital enabled me to deeply contemplate the way the social and economic factors of a country, and even more specifically in a town, can dramatically effect the quality and the quantity of the healthcare available.

The Lead-Doctor's consultation room

The town where the hospital is situated (population around 180,000) is of a fairly small size, that is, in comparison to other Indian towns. It is as chaotic and bustling as you could imagine any Indian town to be. The hospital looked more modern than one would have expected of a hospital in such a small town. 

I met Dr. Madhu, the lead doctor, in his consultation room. I learnt by talking to one of the nurses that Dr. Madhu was the owner of the hospital and that he managed both the medical and the financial aspect of the running the institution.

His day was completely filled with patient consultations, meetings with fellow doctors and nurses, ward rounds, and even some meetings with family members.

A premature baby with jaundice being treated with photo-therapy

Patient consultations included prenatal and postnatal check-ups, vaccinations, diagnosis and follow-ups after a test. It helped a great deal that all the necessary tests and test analysis could be done at the hospital by in-house specialist teams (or occasionally at the nearby government hospital establishment) and the test results were printed and sent directly to Dr. Madhu for him to easily discuss with the patient about the results and consider any follow-up tests or medication/ procedures required. Prescribed medication could be purchased at the medical shop in the hospital. I found that this made it especially easy for the doctor to show the patient how a particular medicine should be administered and also to explain and clear any doubts regarding the dosage. 

One of the challenges that faced this establishment was to provide such high quality care, at great availability (in terms of opening hours for out-patients and round-the clock care-staff) but at affordable rates. The main patient demographic consisted of the working class who would struggle to pay for their treatment elsewhere. However Shri Madhu Hospitals has managed to provide affordable health care which rivals more expensive competitors. Perhaps it is due to the meticulous inventory of all medicines and equipment in the hospital. Or perhaps it is due to the entrepreneurial thinking of Dr. Madhu which has helped this hospital survive not only as a very successful, neonatal care provider in the vicinity of around 20 or so miles radius. 

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Interesting article in the New Scientist...

This article in the New Scientist magazine definitely piqued my interest... 

Your skeleton could supply these (Image: Image Source/Plainpicture)

Main Points:

• Stem cells in the bone marrow could be engineered to develop into B-cells that make antibodies against HIV
• These B-cells could then be extracted and treated with a virus which inserts the genetic code for a new protein
• Testing has been carried out on mice
• When these cells were injected into mice, some migrated to the bone marrow 
• Where they began to manufacture the proteins (antibodies) they were "instructed" to make - antibodies against HIV
• However, they still need to look into the effectiveness on the wider scale and the effects of a wrong dosage (either a higher or lower dosage could prove to be fatal). 
• If successful they will be implemented onto HIV positive patients and then possibly on children with mucopolysaccharidosis. 
• Hamster cells can be harnessed to produce replacement enzymes, but the treatment costs around $250,000 (roughly £152,000) a year and involves regular injections.
• Matthew Scholz of Imunosoft says: "It might be possible to recreate the biochemical environment of youth," 

Engineering cells (Image: New Scientist)

Possible Points to Debate:

• How might this fit in in an economically challenged area of the world, such as in India, where the patients may not financially disposed to pay for such expensive gene therapy that may or may not work??
• To what extent can this animal trial assure us of the relative success that this therapy could have in the human body??
• Ultimately could it be possible to engineer B-cells to produce any kind of protein or drug that the body needs??
• The pros and cons of using this technology to keep the body "healthy" and the "biochemical environment of youth"?? Bypassing the natural selection?? Increasing global population?? etc

Reason and motivation for doing this project

My aim for this project is to essentially build up my essay writing skills and learn skills such as:

• creating a Gantt chart for my timeline for the project
• creating an evaluative bibliography
• writing literature reviews
• writing a dissertation style essay
• effective time management
• practical project management
• researching through various media and reviewing these sources

My topic I have chosen is to do with medicine and how healthcare is affected by factors outside medicine itself, such as social, political and economic factors.

I will be applying to do medicine at university, however the project I am doing doesn't look at the science behind medicine, rather it looks at the availability of healthcare and the ethical implications of the disparity of the provisions between different communities. 

This inspiration for this chosen topic stems from the conditions I witnessed and my experiences through my work experience placement in a paediatric hospital in India which has really motivated me to find out more about the reasons as to why things happened as the did and how problems could be minimized in such small communities and developing countries.

My first ideas about the EPQ...

My very basic and initial plan is to do the project around Medicine and pediatrics. As I have done volunteering and completed a work experience placement in a pediatric hospital in South India, in the summer, I can draw from my experiences and use it as part of my primary research.  

I want to include how socio-economic situations in a country or community can affect the kind of medical treatment the population have access to.... I feel that here, I can draw directly from my experiences in India this summer.

The day I started my project:

Today we had our first meeting about the EPQ. Learned about everyone’s plans and thought about my own. Discussed the learning objectives and the basic timeline of the project.

Found another medic in my EPQ group looking to do similar things with his EPQ. This could spark some interesting discussions/debates...