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India: Why Social Context and Family Relationships Are Important in Diabetes Care

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Representative Photo: Gyan Shahane / Unsplash

  • India has an increasing number of diabetic patients which is paying increasing attention to the individual choices and lifestyles of the people who make them sick.
  • However, people’s relationships with others and social forces shape their health and their experience of illness, as well as the occurrence of chronic illnesses.
  • “My ethnographic research on nursing and diabetes among the urban poor in Delhi has shown that nursing was never an individual choice,” writes anthropologist Emilija Zabiliūtė.

Kalavati1, a woman in her 60s, lives in an urban slum on the outskirts of Delhi. She no longer has insulin to inject every day. Every month she receives a free monthly supply of medication from the city’s All India Institute of Medical Sciences after being examined and tested there.

“I couldn’t go this time,” she tells me. “Nobody in the family would come with me.”

As in many other cases, our conversation about her diabetes concerns turns to her family – the challenges and happiness it brings. The importance of family relationships in the experience and care of patients with diabetes raises questions not only about access to health care, but also about the limits of medical approaches that focus on self-care and lifestyle when it comes to chronic disease.

India has an increasing number of diabetic patients which is paying increasing attention to the individual choices and lifestyles of people that make them sick and make them difficult to cope with their conditions. However, people’s relationships with others and social forces shape their health and their experience of illness, as well as the occurrence of chronic illnesses. And if medical practice is to take people’s relationships seriously, it must also be careful not to stereotype and pathologize them.

Over the past decade, more and more people have been diagnosed with diabetes in India. The International Diabetes Federation has forecast that the number of people with diabetes will have exceeded the 77 million mark in 2019 and that this number will almost double by 2045 – to 134 million2.

The disease is not new to the Indian subcontinent – it is even mentioned in native Ayurvedic medical writings – but the number of diagnoses and the awareness of chronic diseases together have marked a new era in Indian public health.

In this scenario, practitioners, media professionals and policy makers were more likely to focus on people’s lifestyles and their self-care practices3. As a complex and opaque category in itself, commentators use the term “lifestyle” to refer to specific habits that people maintain in their daily lives. The equally complex and ubiquitous term “self-care” – popularly, in the social sciences and in biomedicine – generally refers to what people do to manage their chronic illnesses and wellbeing.

Taken together, lifestyle and self-care are often perceived as choices that result from the exercise of free and rational will, in accordance with practices that conform to biomedical advice: healthy eating, exercise, introspection, and the proper use of medication.

However, we need to see both self-care and lifestyle choices in the context of social and cultural processes and historically conditioned socio-economic structures.

The turn in the public health system and in general medical discourse towards the increasingly important chronic diseases is rooted in the widespread acceptance of the legendary epidemiological transition theory. The theory holds that the leading causes of mortality will shift from infectious diseases to chronic diseases as countries’ economic development accelerates and the life expectancy of their populations increases.

The simplified approach that this transition implies has been criticized several times. Diseases such as cancer and diabetes have long coexisted with several infectious diseases, but the transition itself has a complex history4. Indeed, the transition makes the distribution of disease more unequal – because it emerges from colonial violence and the economic and racial domination of the global North and colonial powers5.

For example, sugar plantations and colonial labor management have resulted in some world populations suffering disproportionately from diabetes6. Similarly, a theory proposed by Indian doctors suggests that deprivation and maternal malnutrition increase the risk of diabetes7. This idea not only contradicts the myth that diabetes is a “middle class disease” that saves India’s poor from a “disease of the modern age”; it also shows a direct link between social and economic conditions and chronic diseases.

Another example of the influence of economic and social contexts on people’s lifestyles concerns unhealthy eating habits. It is known that foods that are considered unhealthy from a biomedical point of view are often cheaper, more readily available and aggressively promoted by the food processing industry. These facts reveal direct links between lifestyle and self-care on the one hand and social, political and economic forces and the environment on the other. And as such, we cannot reduce the reality of the people who consume these foods to individual choices.

So there are limits to how much we can determine the importance of lifestyles and choices when it comes to the incidence, prevention, and care of chronic diseases.

If lifestyle is determined by social forces, so is care. Looking at care outside the reach of biomedical self-care guidelines and from the perspective of social life serves to expand the narrow access to chronic diseases that hold individuals responsible for poor self-care.

For doctors dealing with chronic illness, a common problem is a non-compliant patient with a chronic illness who does not follow certain guidelines for self-care. Regarding individuals and their unique bodies, self-care counseling often neglects the fact that humans are fully relational beings8. People’s living and caring practices are associated with obligations and dependencies towards the caregivers in their lives.

My ethnographic research on nursing and diabetes among the urban poor of Delhi has shown that nursing has never been a matter of individual choice. In addition, care was not limited to practices directly related to the disease, such as B. following certain diets, exercising, and monitoring blood sugar levels. Instead, care encompassed various areas of life such as family finances, gainful employment and housework. These families saw many types of everyday activities as meaningful forms of caring for others and for themselves.

Self-care in the biomedical sense is only one form of care in this broad concept of care – and not even the most common.

People I interacted with thought of “caring” as an obligation to themselves and others that helps maintain their relationships and family ideals on a day-to-day basis. And their motivation to care for themselves and others could not only be traced back to their investment in their health, but based on their ideas about the relationships and the life they wanted to lead. In other words, patients and their family members generally did not (or did not) care for themselves and others, not because they consciously chose to do so in order to achieve certain goals, such as better health, but because they were entangled in complex social relationships .

For example, women often cited children and families as reasons to take care of their health. At the same time, some stated that family responsibilities leave them little time to deal with the demands associated with high sugar levels, for example. Kalavati also had to rely on her family for her hospital visits. For their family members, the challenges and willingness to respond to their needs depended on how time and financial resources were allocated in the family – and how this allocation was based on moral obligations to one another.

An emphasis on self-care that assigns responsibility to an autonomous individual creates a dissonance between medical advice and the everyday life of the patient. For example, think of an elderly woman worried about who will give her insulin shots after her daughter is married and lives elsewhere. Or think of a woman who feels that her diabetes is out of control when the family has other problems. In all cases, for these women it will not be a question of “how to live well with chronic illnesses” but rather “how to live well with others”. Illness is intertwined with their concerns about their relationships.

So how can doctors who deal with the chronically ill take advantage of the fact that people do things in life not just as autonomous actors, but because they share and live their lives with others? Of course, medical professionals do not completely ignore family care dilemmas. Research has shown that doctors, at least in India, pay attention to patient family relationships when diagnosing or defining mental disorders9.

While it is important to recognize the importance of social relationships, it is equally important not to reduce a patient’s relationships to a simplified scheme of social norms and expectations. In India, as in many other places, people have certain moral ideals regarding family welfare; however, they often remain too short and are challenged in everyday life10.

For example, family members do not always take care of one another, even when they want to and even when dominant societal norms expect it to be. However, a medical practice that pays attention to social relationships risks stereotyping and pathologizing them, especially if they do not meet societal expectations and moral norms. The challenge for medicine is to recognize the relationships of patients in certain situations and that their health habits and experiences are shaped by much larger contexts and factors than the autonomous will or the degree of adherence to biomedical guidelines.

The possibilities and constraints of patients and families to achieve good health and receive adequate care are profoundly social.

Emilija Zabiliūtė is an anthropologist working on public health, urban poverty and kinship issues in India. She works at the University of Copenhagen.

The research for this article is based on the University of Edinburgh funded by a Marie-Marie-Sklodowska-Curie Fellowship from the European Commission Research Fund (H2020-MSCA-IF-2017, Grant Agreement 798706).

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Investigating how the Massachusetts mental-health system was failing those who needed it most

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Spotlight editor Scott Allen looked through a window at the Globe office in Dorchester and saw protesters. There were dozens, maybe more than a hundred. And they were angry, not at the corruption or other outrage the Spotlight team had exposed, but at everyone and the reporters themselves. “I’ve never seen anything like it,” he says.

A few weeks earlier, on June 26, 2016, the Spotlight team released the first of a series of reports on how the Massachusetts mental health system is failing those who need it most. The article was invigorating and, as critics said, inflammatory. It was titled The Desperate and the Dead project and led with the agonizing report of Lee F. Chiero, a man with a mental illness who had killed his mother.

The article and the project itself were born from the team that saw a disturbing trend. In the 2010s, Massachusetts saw a spate of murders in which mental health appeared to be a factor. Sometimes the killer suffered from severe mental illness. In other cases, the victim, who was often killed by police officers, was in a psychiatric crisis. Spotlight reporter Michael Rezendes has put together a database of examples. Then the team went on a mission to answer one of the most basic journalistic questions: Why?

Why did so many serious mental illness cases end in tragedy in a state that boasted world-class health care?

During more than a year of coverage, the team found that the Massachusetts mental health system was more or less gone. Decades earlier, the state was littered with inpatient psychiatric hospitals. But these institutions had often been brutal, inhuman places, and the state had closed them. The result: people who urgently need help without turning.

The seven-part series documented the consequences of this story of neglect: relatives who had to work as unskilled caregivers, police officers who step in where social workers were needed, prisons that fill the void left by closed hospitals. The series also examined the types of modern, evidence-based mental health programs that Massachusetts may have but had not previously implemented.

The team intended that the series should serve as a call to action to get distracted policymakers to focus on an issue they had been ignoring for too long. But that’s not how some mental health advocates saw it. “The headline is incredibly dramatic and fear-driven,” says Sera Davidow, who helped organize the protest at the Globe. Fear, Davidow says, can lead policymakers to force mandatory treatment on people with severe mental illness. Fear of mental illness can also lead police officers and ordinary citizens to jump to violence, says Davidow: “These attitudes kill us.”

Some members of the Spotlight team took the protest harshly. “It has been difficult for respected people to say you do harm,” says Spotlight reporter Jenna Russell.

But there were also strong voices that supported the team’s reporting. Some families reprimanded activists who opposed mandatory outpatient treatment programs. One man whose stepdaughter relied on a New York State program to take her medication and get off the streets said of the activists, “I have a feeling these people are trying to kill them.”

Allen went outside to speak to the activists on the day of the protest. He listened to them, but also stood behind what the team found in their coverage that would later be named a finalist for the Pulitzer Prize. “If you want to talk about difficult things,” says Allen, “you have to say the hard things.”

Send comments to magazine@globe.com.

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Fry Construction Selected for a Major Medical Imaging and Radiotherapy Addition by The Center for Cancer and Blood Disorders, Arlington, TX

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CARROLLTON, Texas, September 22, 2021 / PRNewswire / – Fry Construction, a specialist in the precision design and construction of cancer treatments, medical imaging facilities, and surgical centers, has announced the award of one of its most demanding multi-modal medical construction projects.

Fry Construction, Inc. logo

TrueBeam variant

TrueBeam variant

The center will include a Varian TrueBeam LINAC and a GE CT on the first floor of a multi-story building with little clearance for pillar drilling, with all shaping and casting of the vault required after hours. A further complicating factor is that the ER access is located directly outside the investigation area and is housed in such a way that constant access is guaranteed.

“We are used to delivering the most demanding construction projects in the shortest possible time and we are proud that Fry Construction is repeatedly selected to overcome these obstacles to completion. Our 38 years of experience specializing in this highly focused sector of medical construction has taught us how to get our jobs done on time, on budget, and to build to the manufacturer’s strict specifications to meet device warranties. The criteria required by the CCBD are no exception, “said Ben Fry, President of Fry Construction.

The Center for Cancer & Blood Disorders was recently recognized through national certification through the Quality Oncology Practice Initiative (QOPI®) certification program, a member of the American Society of Clinical Oncology (ASCO). This expertise was acquired through adhering to strict cancer treatment standards – matched by only 23 oncology practices in the country. The CCBD requires the same level of experience and professionalism from its medical contractor.

Alex Carr, Varian’s Radiation Oncology Medical Device Planner, said, “By selecting Fry Construction, a Varian Preferred Contractor, to complete this complex project, CCBD has reassured Varian that the site is also preparing to the highest quality standards is deemed to be compliance with Varian’s Site Readiness Specifications as required by Varian’s infrastructure planning processes. Fry Construction has an excellent history of working not only with Varian but also with our shared customer base of cancer control specialists. I look forward to continuing this complicated and challenging project with this great team. ”

About Fry Construction Company, Inc.

Fry Construction is a leader in precision engineering of radiation therapy and imaging facilities throughout the Southwest. Fry pioneered the practice of precision medical engineering at the 1984 University of Texas Health Science Center and has since completed over 1,500 specialized facilities in nearly four decades. All have been signed with the major radiotherapy and imaging manufacturers in the United States while retaining their Preferred Contractor status.

Media contact:
Bruce Fry
[email protected]
214-334-3726

SOURCE Fry Construction, Inc.

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Here’s how to report your USA food problem directly to USDA or FDA

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Food Safety Month

Whenever you think you are seriously ill, see a doctor. And if you believe food caused your illness, make sure it is reported. Most foodborne illnesses are “reportable,” which means your doctor informs the local health department.

For example, if you had an outbreak in multiple states, you could become a “confirmed case”. Your confirmed test result will be reported to the health department, your name will be kept secret.

However, if you don’t want to take medical action, you can report your bad food experiences directly to federal regulators. Both the USDA’s Food Safety and Inspection Service and the US Food and Drug Administration welcome consumer reports of contaminated or adulterated food.

But how?
Both FSIS and FDA explain how on their websites. With Food Safety Month coming to an end in September, Food safety news forwards this information along with some explanations to help consumers find the right agency. The FSIS and the FDA are responsible for protecting various segments of the food supply. If you have a problem with a food, be sure to contact the relevant health authority.

To reach them by phone:

  • Food and Drug Administration (FDA) call 888-723-3366 (10 a.m. to 4 p.m. EDT. Closed on Thursdays 12:30 p.m. – 1:30 p.m. EDT.

Before calling FSIS or FDA, it is important that you understand how the responsibilities of federal agencies are divided among the various agencies. The FDA, which has the most authority in these areas, provides an overview of their breakdown.

In general, the FDA regulates foods and other products as follows:

  • Food supplements
  • bottled water
  • Food additives
  • Baby food
  • other foods (although the U.S. Department of Agriculture plays a leading role in regulating some meat, poultry, and egg products)

The FDA also regulates medications, including:

  • prescription drugs (both branded and generic)
  • non-prescription (over-the-counter) drugs

Biologics, including:

  • Vaccines for humans
  • Blood and blood products
  • Cell and gene therapy products
  • Tissue and tissue products
  • allergenic

Medical devices including:

  • simple items like tongue depressors and bed pans
  • complex technologies such as pacemakers
  • dental equipment
  • surgical implants and prosthetics

Electronic products that emit radiation, including:

  • Microwaves
  • X-ray machines
  • Laser products
  • Ultrasound therapy equipment
  • Mercury vapor lamps
  • sun lamps

Cosmetics, including:

  • Color additives in make-up and other personal care products
  • Moisturizers and cleansers for the skin
  • Nail polish and perfume

Veterinary products including:

  • fodder
  • Pet food
  • Veterinary medicines and devices

Tobacco Products Including:

  • Cigarettes
  • Cigarette tobacco
  • Roll tobacco yourself
  • smokeless tobacco

By subject and subject, the FDA also has “functions” that relate to these federal agencies:

  • Advertising – The Federal Trade Commission is a federal agency that regulates many types of advertising. The FTC protects consumers by stopping unfair, fraudulent, or fraudulent practices in the market. Consumers can write to FTC at 6th St. and Pennsylvania Ave., NW, Washington, DC 20580; Telephone 202-326-2222.
  • Alcohol – The Department of the Treasury’s Alcohol and Tobacco Tax and Trade Bureau (TTB) regulates aspects of alcohol production, import, wholesale distribution, labeling and advertising. Consumers can write to TTB, 1310 G St. NW, Box 12, Washington, DC 20005; Phone 202-453-2000 or visit the TTB contact page.
  • Consumer products The Consumer Product Safety Commission (CPSC) works to ensure the safety of consumer products such as toys, cribs, power tools, lighters, household chemicals, and other products that pose a fire, electrical, chemical, or mechanical hazard. Consumers can direct written inquiries to CPSC, Washington, DC 20207. CPSC operates a toll-free hotline at 800-638-2772 or TTY at 800-638-8270 to enable consumers to report unsafe products or receive product information and recalls.
  • Drugs of Abuse – The Department of Justice’s Drug Enforcement Administration (DEA) is committed to enforcing United States controlled substance laws and regulations, including the manufacture, distribution, and dispensing of legally manufactured controlled substances. Inquiries about DEA activities can be directed to the Drug Enforcement Administration, Office of Diversion Control 8701 Morrissette Drive Springfield, VA 22152; Telephone 202-307-1000.
  • Pesticides – The Environmental Protection Agency (EPA) regulates many aspects of pesticides. The EPA sets limits on how much of a pesticide can be used on food during cultivation and processing, and how much can be left on the food you buy. Public inquiries regarding EPA should be directed to the US Environmental Protection Agency, Office of Pesticide Programs Public Docket (7506C), 3404, 401M St., Washington, DC 20460; Telephone 202-260-2080.
  • Vaccines against animal diseases The Department of Agriculture’s Animal and Plant Health Inspection Service (APHIS), Center for Veterinary Biologics, regulates aspects of veterinary vaccines and other types of veterinary biologics. Public inquiries regarding APHIS’s Center for Veterinary Biologics should be mailed to Center for Veterinary Biologics, 1920 Dayton Ave, PO Box 844, Ames, Iowa, 50010; Phone 515-337-6100 or visit the APHIS contact page.
  • water The Environmental Protection Agency (EPA) regulates certain aspects of drinking water. EPA develops national standards for drinking water from municipal water supplies (tap water) to limit the level of contaminants.

The USDA’s Food Safety and Inspection Service regulates this the following:

FSIS regulates aspects of the safety and labeling of traditional (non-wild) meat, poultry, certain egg products and catfish. For a USDA investigation into an issue with these products, please provide:

  • The original container or packaging
  • Any foreign objects that you may have discovered in the product
  • Any part of the meal not eaten (chilling or freezing)

Here is the information the FSIS Hotline needs from you:

  1. Name, address and telephone number;
  2. Brand name, product name and manufacturer of the product
  3. The size and type of packaging
  4. Can or package codes (not UPC barcodes) and dates
  5. Establishment number (EST), usually found in a circle or sign next to the phrase “USDA passed and tested”;
  6. The name and location of the store and the date you purchased the product.
  7. You can complain to the store or the manufacturer of the product if you don’t file a formal complaint with the USDA.
  8. If an injury or illness is alleged to result from the use of a meat or poultry product, you must also inform the hotline staff about the nature, symptoms, time of occurrence and the name of the treating doctor (if applicable).

The FDA Center for Food Safety and Applied Nutrition, known as CFSAN, provides services to consumers, domestic and foreign industries, and other outside groups regarding field programs; Administrative tasks of the agency; scientific analysis and support; and policy, planning, and dealing with critical issues related to food, nutritional supplements, and cosmetics.

How to Report a Food Problem to the FDA

  • Please contact USDA for any questions or issues related to meat and poultry.
  • As a consumer, health professional or in the food industry, if you would like to voluntarily report a complaint or adverse event (illness or severe allergic reaction) related to a food, you have three options:
  • If you are a member of the food industry who is required to file a Reportable Food Register report when there is a reasonable likelihood that an article on food will cause serious health effects or death to people or animals, please visit the Reportable Food Register page.

How to Report Seafood Related Toxins and Sccombrotoxin Fish Poisoning Diseases

To help the FDA conduct effective investigations, remove unsafe seafood products from the market, and develop new prevention strategies, the FDA relies on disease reports from public health officials and health care providers. While most foodborne outbreaks are tracked through the FDA’s Coordinated Outbreak Response and Evaluation (CORE) network, seafood-related diseases caused by natural toxins have a unique reporting mechanism.

To contact the FDA by email:
US Food and Drug Administration
Center for Food Safety and Applied Nutrition
Mediation and information center
5001 campus drive, HFS-009
College Park, MD 20740-3835

The FDA requests that products not be sent to this address.

(To sign up for a free subscription to Food Safety News, click here.)

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