P.C. Sen Best Paper Award (2002). Profile of care providers in five blocks of Nasik Maharashtra. A window on rural health services in Maharashtra.

Five blocks of Nasik district in Maharashtra were surveyed in 1999-2000 for distribution and academic degrees of doctors of all kinds. The five blocks have 84 % villages without any health care provider (read doctor) no matter qualified or quack. All the 555 doctors including Govt. doctors are concentrated in 16 % of villages, mainly in small townships and market centers. Physical access to any doctor is thus tedious. Often it requires travelling and hidden costs like loss of wages for the accompanying person. It also involves a hidden cost of deferred treatment. To ensure access to rational medical care at affordable cost a major overhaul of the existing health services is necessary.

Human heat tolerance in simulated environment.

The heat tolerance of 11 male volunteers were examined under seven climatic conditions in a climatic chamber. The conditions were 38 to 49 degrees C dry bulb temperature and 45 to 80 per cent relative humidity, i.e., 32.3 to 40 degrees C effective temperature-basic [ET(B)]. The ET(B) values were equated to other heat stress indices, e.g., WBGT (Wet-bulb Globe Temperature Index) and Oxford Index. The subjects did ergometric work at an intensity of 60 per cent VO2max. The exposure durations were decided by the cardiorespiratory, body temperature and sweating responses. Of the climatic conditions studied, at 35.4, 38, 39 and 40 degrees C ET(B), the body core temperature (Tcr) reached over 39 degrees C and heart rates attained 172 to 182 beats/min, which were taken as the tolerance limit. The total oxygen demand significantly varied with the increase in environmental warmth, i.e., increase or decrease of one litre of oxygen demand was equivalent to one minute change in tolerance time. The volunteers were not susceptible to heat; only in extreme hot situations beyond 35.4 degrees C ET(B), were unacceptable levels of physiological and psychophysical reactions seen. The study suggests the acceptable and tolerable limits for human exposure in heat: (i) acceptable at 38 to 38.2 degrees C Tcr for a tolerance time of 80 to 85 min; and (ii) the tolerable limit of short duration (40-45 min) at 39 degrees C Tcr that corresponded to 31.5 and 36.5 degrees C ET(B).