GUEST COLUMN
Dr Gaurav Sanjay
The International Day of Disabled Persons (IDDP) is held on December 3 every year. Every year, the celebration focuses on the different issues of disabled persons across the world.This is the day to spread awareness, analyse the problems related to disability, prevent the disability, treat the disability, enhance their quality of life and remove the social stigma towards them.
Over 1 billion of 7.8 billion people of the world’s population -that is about 15 per cent have some form of disability. The National Sample Survey by the Government of India conducted from July to December 2018 showed that about 2.1 per cent of the total population is disabled in our country due to one or another problem. People with disabilities have the same health needs as physically fit people. Disability is thus, not just a health problem but rather a complex phenomenon reflecting the interaction between disabled person and the society in which he or she lives.
Being an orthopaedic surgeon, I will confine myself to disability related with locomotion and orthopaedic disabilities. I believe health of the limbs and locomotion are as important as health of the heart and the lungs. Whatever mankind has achieved by now is mainly due to locomotion, be it in war or in peace.
Our ancient Indian scriptures state that if there is birth, there is development, disease, degeneration and death. If we analyse the causes of disability, then all these four stages of life are vulnerable to disabilities depending upon the age of the individual. More people live with disabilities than ever before due to our aging population, as well as improved medical treatment. Some of the causes are clubfoot, hip dislocation, rickets and polio infection in childhood and diabetic foot, Burger disease and Parkinsonism which needs surgery at later stages in old age patients. In my experience, road traffic accidents are the major cause of disability in current scenario in all ages.
Road traffic accidents are causing havoc and producing significant disability in the society.Almost five lakh people are encountering road traffic accident in which more than a fourth are dying and at least a fourth are being disabled for their whole life inspite of the best available treatment in our country. Nowadays, these road traffic accidents are high energy injuries which are fatal and involve multiple bones and sometimes multiple organs. In such scenario, it is very difficult in general to give functional results which match the pre injury status in spite of the best possible treatment available in the country. If the road traffic accidents are treated well in time, then firstly the patient will not at all be disabled and even if he or she becomes disabled, in spite of the best possible treatment, then the level of disability will be significantly less.
Fractures of the spine (vertebral fracture) are producing serious lifelong permanent disability. Hundreds of thousands of people with paralysis of all four limbs (quadriplegic) or of both lower limbs (paraplegic) are living in bed with none or limited mobility in pathetic situations, in general in our country.This problem is more accentuated with the poor people in remote areas.
Another common cause of disability is infection which is preventable. The incidence of infection of bone and joint like septic arthritis or tubercular arthritis are getting reduced but the incidence of infection after surgery in patients with fractures after road traffic accidents is increasing proportionately in spite of taking all precautions before and after surgery including the use of antibiotic. People in general in our country are underestimating the consequences of infection. The bone infection is such a deep seated infection that it takes years to control. If it is not controlled in time then these non-healing discharging sinuses can also transform into skin cancer which is usually treated with amputation.
Many senior orthopaedic surgeons had taught me that 40-50 years back, amputation was almost a norm in emergency in the treatment of road traffic accidents. But now, the incidence of amputation has significantly reduced and it is now negligible in road traffic accident related amputations though the number of amputations after diabetic foot, Burger’s disease, atherosclerosis and other peripheral vascular disease has increased tremendously. This can be avoided if we become health conscious because most of the diseases are sedentary lifestyle disease. The awareness about late stage complications of obesity, diabetes, hypertension, hypercholesterolemia, smoking and alcohol abuse too should be spread among the general public.
Any disability does not cause only physical loss but mental, financial and social loss as well. Here I would like to cite an example of a 39 years old male presented with a painful deformed left forearm in 2010. He sustained a close fracture of both forearm bones 14 years back. It was treated with surgery which got complicated with infection. Since then he was having deformity and disability. He was separated from family because of disability. After surgery he has regained the full range of motion and is doing his car mechanic job.
Disability caused due to deformity can be reduced significantly with exercise, manipulation, orthosis and/or after undergoing various surgeries. I strongly believe that surgery has played an important role in the lives of persons with disabilities. Their lives have been changed significantly and they are not only developing or improving themselves but also contributing to the growth of society.
Therefore, like government and non-government organisations, I and my organisation are making the best efforts to spread awareness by organising free health camps, public awareness lectures and by writing such articles to reduce the disabilities and to make disabled people able through prompt surgical interventions. The deformities and disabilities caused due to any reason whatsoever should be corrected at the earliest. Hence, this author always advises the patient and the patient’s family that if surgery is needed, then, the sooner the better because a plant can be straightened but not a fully grown tree.
(The author is an orthopaedic surgeon based in Dehradun)
Thursday, 03 December 2020 | Dr Gaurav Sanjay | Dehradun
