Challenges Faced by Cancer Patients in Receiving Health Services During the COVID-19 Pandemic in a Tertiary Care Hospital in Rajasthan.

BACKGROUND: Amidst the COVID-19 pandemic, cancer patients may have faced difficulty accessing health care. This study explored the challenges experienced by cancer patients in availing of healthcare during the pandemic, as well as the vaccination status and prevalence of COVID-19 infection among cancer patients in the year 2021. METHOD: A cross-sectional study was conducted in a tertiary care hospital in Jodhpur, Rajasthan, to interview 150 patients from the oncology department using convenience sampling. Face-to-face interviews lasted for 20-30 minutes. The first segment of the pretested semi-structured questionnaire was directed at obtaining the patient's socio-demographic characteristics, while the second segment focused on the problems that patients encountered during the pandemic in receiving cancer care. The data were analyzed using Statistical Packages for Social Sciences (SPSS) software (IBM Corp., Armonk, NY). RESULTS: Several constraints, such as a lack of transportation services, difficulty in availing outpatient department (OPD) and teleconsultation services, long waiting times, and deferred surgeries and therapies, have hampered cancer care. COVID-19 mitigation measures further imposed additional stress and financial burden on cancer patients. Moreover, there was low vaccination coverage among cancer patients, which increases their probability of acquiring an infection. CONCLUSION: Policy reforms must prioritize cancer care in India to maintain a continuum of care by ensuring medication, teleconsultation, uninterrupted treatment, and complete vaccination to decrease the risk of COVID-19 infection and facilitate patient compliance with the healthcare delivery system.

Convalescent plasma, political narrative, and public health ethics in the Covid-19 pandemic.

Convalescent plasma therapy emerged as an early experimental therapy for the treatment of Covid-19. However, despite limited data regarding its safety and efficacy, the therapy was extensively publicised by multiple politicians as a cure. We analyse the impact of this political narrative around medical therapeutics on the pandemic using the coherentist model of public health ethics. The clinical benefits of the therapy are evaluated in terms of reduction in mortality and disease progression as compared to the potential transfusion-related adverse events. Political advocacy of therapeutics might hamper the autonomy and decision-making of individuals and institutions. Marketing and monetisation of convalescent plasma might cause inequitable distribution and unregulated use. It also creates an economic burden on the government and healthcare which should be justified by the additional cost/effectiveness ratio of the therapy. This article exemplifies the inadvertent effects and ethical challenges following political narratives about medical therapeutics and the importance of involving ethics in designing policies concerning public healthcare.

The importance of physical examination in primary health care provided by NPHW is being threatened in COVID19 times.

Physical examination has been one of the three pillars of diagnostic evaluation of illnesses. It has a larger role in the armamentarium of non-physician health workers. Due to prescriptions for social distancing in preventing COVID19, physical examination is being performed lesser than before. This poses a serious threat to the abilities of NPHW as well as to their relationship with the community.

Geriatric population in India: Demography, vulnerabilities, and healthcare challenges.

Global pandemic due to corona virus disease (COVID-19) has exposed vulnerabilities of the geriatric population all over the world. India has been adding progressively increasing number of elderly to its population. This is happening with increasing life expectancy and decreasing mortality. In comparison to children, the population as well as deaths in elderly are rising with changing demography. The elderly population has its own vulnerabilities based on education, socioeconomic condition, gender, place of residence etc. They are affected by various non-communicable diseases which form predominant cause of morbidity and mortality like cardiovascular diseases, stroke, cancer, respiratory illnesses etc. The elderly also contribute to various kinds of disabilities like movement, vision, hearing and in many cases multiple disabilities. They are also more vulnerable to mental health problems and cognitive impairment. The article also suggests a way forward in dealing with rising geriatric age group and its associated problems. The programs supporting this population are largely scattered which needs to be consolidated to include social security, pension and food security along with health benefits. The approach to health care of the elderly needs a comprehensive strategy instead of the present fragmented approach where different disease based programs for non-communicable diseases, cancer and mental health cater to specific health issues of the elderly. Greater awareness, training and skill building in geriatric health for primary care physicians need focus and energy. Prioritizing training and research in this field including the need for more geriatricians has been highlighted.

Clinical ethics during Covid-19: Plan for the whole health ecosystem.

During a pandemic, narrowing ethics into silos such as clinical and public health does not help the cause of ethics, which often gets neglected in desperate times. Our response to a recently published article in this journal, tries to take this discussion forward. Keeping medical ethics at the centre of our response to the Covid-19 pandemic would benefit healthcare systems at all levels. This would also help us be prepared for future pandemics. Strengthening healthcare systems would also provide an opportunity to improve non-Covid care.

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