JNROnline Journal Journal of Natural Remedies ISSN: 2320-3358 (e) Vol. 21, No. 6(S1), (2020) ISSN: 0972-5547(p)

PUBLIC HEALTH AND MEDICAL FACILITIES IN DISTRICT Dr.T. GirijaBai, Assistant Professor of Economics, JayarajAnnapackiam College for women (Autonomous),Periyakulam Abstract has contributed much in the field of Medicine. The district is endowed by nature with several hills and mountains. In the current scenario, an attempt has been made to highlight the public health and the medical facilities available in Kanyakumari district. The hills and mountains are rich in herbs of medicinal value and minerals. Maruthuvamalai is a hill in the district located near Kanyakumari. This literally means medicinal hill, which is referred to by Therapeutics or Buddha Bikshus who belonged to the period of Emperor Asoka. This basically means as having medical and spiritual heritage. According to the tradition that the hill was a piece of the mountain GandhaMadhana dropped here while the mountain was carried by Hanuman to Lanka during the epic war between Rama and Ravana. Rare medicinal herbs are available here in abundance. Kanyakumari played an important role in the international medical field, even before the Christian era. Even today the district has many hospitals and health centers. Government Kanyakumari Medical College has been functioning since 20-03-2007 at Asaripallam. A new Government Ayurveda Medical College has been announced to be started at Kottar shortly by the State Government as well. Keywords: Medicines, Health care, Diseases, Medical centres, Hygiene Introduction There is a two-way link between health and economic development. On one hand, health conditions of the people through fertility, productivity and population size affect economic development and on the other through qualitative and quantitative change in population affect economic development. Rural population comprises more than 70 percent of the total Indians and has direct impact on health indicators. The Eleventh Plan insists on Integrated District Health Plans and Block Specific Health Plans by involving all stakeholders and emphasizing partnership with Panchayat Raj Institutions, local bodies, NGOs and the like. A major issue, especially in rural areas, where habitations are scattered and women and children continue to die en route to the hospital. The Eleventh Plan very enthusiastically recommends Public and private Partnerships. There are various initiatives taken by the government in various states, but the experience shows that such experiments succeed with NGOs which have charitable motives, but since the private partner operates with an eye on profits, such experiments hardly succeed. Herbal Medicines Kanyakumari District is endowed with several hills and mountains with rich herbs of medicinal value and minerals. Maruthuvanmalai – a hill located near Kanyakumari – in Tamil literally means an abode of medicinal plants, is referred to by Therapeutics who belonged to the period of Emperor Asoka, as having medical and spiritual heritage. According to tradition the hill was a piece of the mountain Chandra Maruda dropped here while the mountain was carried by Hanuman to Lanka during the epic war between Rama and Ravana. Rare medicinal herbs are available here in abundance. Sage Agathiya, the foremost of the Siddhars is believed to have lived in this lan’s end. There is also a village by name near Maruthuvamalai which owes its name to Agasthiar the Kurumuni. In this village, there is a temple dedicated to Agastheeswaramudaliar, which is believed to have been consecrated by Agasthiar himself. Besides medicine and grammar, Agasthiar was also adept in VarmaSastra. Agasthiar wrote several palm leaf records like ‘Varmani’ and ‘VarmaSastra’. Even today, this healing art of varmam, treatment is taught in Kanyakumari in the Guru-Sishya tradition, and treatment is also done by elders who are quite conversant with this method by applying native medicines in required proportion. This has proved successful in several

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Journal of Natural Remedies Vol. 21, No. 6(S1),(2020) cases. From the period of Agasthiar to the present day, the Siddha system has been preserved carefully by the people of Kanyakumari.1 Another native system is Chintamani, which formed part of Ayurvedic Science was also prevalent in the district. This system describes the means of ascertaining diseases by examining the pulse. Since this system needed more care in the preparation of the mineral drugs, the number of practitioners is very limited. The growth of allopathic system of medicine in Kanyakumari District is also an interesting one. The early Protestant Christian Missionaries were considered pioneers in the field of allopathic medicine in the district. By establishing a hospital at , the London Missionary Society now known as Church of South has laid the foundation for the modern allopathic system of practice in the district as early as 1838. In due course, the allopathic system was adopted as the State system of medicine. From the beginning, the allopathic system of medicine had to meet organized opposition of the indigenous schools of treatment. Despite this opposition, the London Missionary Society established a hospital in Neyoor in 1830 and began its services. Another milestone in the medical history of Kanyakumari District was the establishment of the Salvation Army’s Catherine Booth Hospital in 1892 at Vadasery in Nagercoil. To encourage the practice of allopathic medicine by private agencies, a system of sanctioning regular medical aids to them was started by the Government of in 1895-96. Different Systems of Health Care After independence the district witnessed development of a good network of Government health care services: district hospital, taluk hospitals, primary health centers and health sub centers. An assessment of the situation in the district shows that the organized health care services cater to the needs of the majority of the population especially people from the poor and lower middle class. For a good number of people, private hospitals and practitioners provide the health care services and the balance split between home medical care and indigenous medical practitioners.2 Though one can observe an overall gradually vanishing trend of the traditional systems, at certain pockets one could observe rejuvenation of these systems, as people are more concerned about the adverse effects of chemical drugs and the escalating costs of conventional health care. Morbidity and Mortality The health status of the citizenry would inter alia be dependent on adequate nutrition, safe drinking water, basic sanitation, a clean environment and primary education. The unsatisfactory health indices are in turn an indication of the limited success of the public health system in meeting the preventive and curative requirements of the general population. The community diagnosis is based on collection and interpretation of the relevant data. The absence of s systematic and scientific health statistics data base is a major deficiency in assessing the scenario of the district. Influenza, HIV/AIDS, Diarrhoeal diseases, Tuberculosis, Malaria and Measles are the six maladies account for 90 percent of the deaths from infectious diseases worldwide. Spread in different ways and influenced by different factors they continue to resist control. Due to aggravating social, economic and political instability these diseases have increasingly become a threat to global security. Densely populated areas of developing countries are especially vulnerable and so in Kanyakumari District. It is encouraging to note that most of the killer diseases are effectively controlled by the apt strategic control programmes. But it is disturbing to see the number of cases of respiratory infections. These are probably due to the environmental pollution, and need careful monitoring in the coming decades. Coming to maternity care, in 2004, a total of 26345 children were born, of which only 7152 were born in the government hospitals. During April to June 2006, 1288 deliveries were conducted in the government hospitals in Kanyakumari District. It is estimated that about 20 percent of the deliveries take place in the government hospitals. The people approaching government services for maternity care are on the decrease. Regarding family planning, the couple protection ratio is 65.3 which are higher than the state average of 50.1. During March to June 2006,

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Journal of Natural Remedies Vol. 21, No. 6(S1),(2020) a total of 2507 sterilizations were conducted in government hospitals of Kanyakumari District, which is almost double of the deliveries conducted during this period and account for about 45 percent of the estimated total sterilizations during that period. It indicates that family planning services of the government sector have better acceptance from the people.3Though infant mortality rate is less in Kanyakumari District compared to the national and state average, it has to be brought down further. The present status in the rural area is really a high percentage while comparing the urban areas. This is probably due to the inadequate medical facilities, non- availability or reduced basic facility which is to be taken care of. Another area of grave concern is the persistent incidence of macro and micro nutrient deficiencies, especially among women and children. In the vulnerable sub category of women and the girl child, this has the multiplier effect through the birth of low birth weight babies and serious ramifications of the consequential retarded growth both mental and physical. Yet another concern is the status of health of the senior citizens. Geriatric medical facilities are not well developed in this district. There are eight homes for the aged managed by the Non- Governmental Organizations. The change in the culture, values coupled with mobility and migration calls for more facilities to cater to the needs of the senior citizens. Mosquito Borne Diseases (a)Filariasis During recent years filariasis has been spreading dangerously in some locations in the district. For controlling its spread, the National Filaria Control Programme has been implemented in Kanyakumari District since 1985with one control unit at Nagercoil and 3 night clinics at , and Kuzhithurai.4The control unit functioning in Nagercoil town is carrying out anti-larval measures against the mosquitoes responsible for the transmission of filariasis. Besides, anti-larval measures, night blood survey is also being carried out to detect the micro filarial carriers. Thus detected, micro filarial cases are given treatment with tablets to eliminate the reservoir of infection. Mosquito larvicidal oil, baytex and abate are used as larvicides. Besides the control unit, the night clinics mentioned also carry out night blood survey and detect the micro filarial carriers and treatment with tablets. Yet the disease is spreading and is causing concern to the people (b) Malaria Malaria is endemic in India and reported from almost all areas except those above 2000 meters sea level. Out breaks so occur after an interval of several years depending on immunological, environmental and meteorological factors. The National Malaria Control Programme was launched in 1953 and National Malaria Eradication Programme in 1958.5 Currently Malaria control activities are organized under National Vector Borne Diseases Control programme in Kanyakumari District too, Malaria Eradication Programme is implemented, yet the malaria endemicity remains basically unchanged and the incidence during the past one decade more or less static. Though it is endemic, the magnitude of the problem is great and the associated loss is also large. (c) Chicken Gunia An epidemic outbreak of Chicken Gunia was witnessed in this district in the mid of 2006. The resurgence of Chicken Gunia nearly after four decades caused considerable morbidity among the public. The way it was managed by the public health departments exposed the total unpreparedness of the health sector to handle emergencies and epidemics. Air Borne Diseases Among the various airborne diseases, Tuberculosis is known to be a major public health concern for centuries. It affects both pulmonary and extra pulmonary tissues. In India, about 5 lakh people die of Tuberculosis every year which implies every minute one dies of Tuberculosis. The spread of HIV/AIDS increased the incidence of Tuberculosis as a co-infection. The disease is usually chronic with varying clinical manifestations. The district TB centre is functioning at Asaripallam, Nagercoil. There are four TB centreAsaripallam, Government primary

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Health Centers at Chenbakaramanputhur, Muttom and Kattakuzhi. In addition to these four treatment units, 18 microscopic centers are also functioning for TB control work. The District TB Control Society was registered on 2/1/2001. The District Collector is the chairman and the Deputy Director of Medical Services is the member secretary. The National Tuberculosis Control programme was launched in the year 1962. Directly Observed Treatment Short Course implementation began during 2001. However, with regard to the Tuberculosis, one could observe consistency in the prevalence and incidence. Water Borne Diseases There are many water borne diseases reported in this basin, which indicates water pollution. Some of them are seasonal and others are common in the most polluted areas. More than 170 fresh water ponds were leased out by the government for freshwater aquaculture and the active eutrophication by the fish farmers enhances the spread of water borne diseases.6 In spite of the reports from the pond users the action taken is practically nothing. (a) Fluoride Presence in Water The presence of Fluoride in ground water has been detected in many coastal hamlets in Kothaiyar Basin. Prominent among them are Anjugramam, Azhahappapuram and Kattuvilai. Fluoride pollution may become a serious threat to mammals, as it is capable of distorting the skeleton, which may change an individual into a useless hump of flesh and blood. (b) Water and Sanitation Organic wastes, sewage effluents, excreta, exudates and faecal matters support a rich population of microbes viruses, bacteria, algae, fungi, protozoan’s, helminthes annelids, larval stages of various insects, pests and the like. They thrive very well in degrading organic debris, and some of them are responsible for causing dangerous diseases of man, animals and plants. Some of them have resistant encapsulated stages, spores and cysts, which are difficult to eradicate. The problem of such infectious microbes which arises as a result of accumulation of biodegradable wastes has two important aspects such as • Contamination of water, food and edible materials caused by direct contact and • Development of a population of vectors or carriers of serious diseases. The Contamination of water supplies, food and water edible materials with sewage effluents and organic wastes is often responsible for the outbreak of a number of diseases, typhoid caused by Salmonella species and cholera, by Vibrio cholera are mainly spread through contaminated waters. Increasing gastroenteritis and dysentery in this basin is an indicator of contaminated water supply, especially to the coastal area. The substantial increase in population of aphids, mosquitoes, houseflies, rodents and others, physically carry the causative organism to hosts. Some viruses, bacteria and protozoans may enter the body of the insect pest, feed, breed, multiply and persist. The pathogen is transferred to other animals or ma with the salvia when the insects’ bites or the malarial parasite transferred by Anopheles, filariasis caused by Culexsps, dengue and Japanese encephalitis causing viruses by Aedessps are also identified and are problematic in this basin. Life Style Related Diseases (a) Cancer More than hundred kinds of cancer plague human beings. Of this more than 35 are prevalent in Kanyakumari District. However, oral cancer is the most common followed by cancer of cervix and breast. The most disturbing aspect is that over the years all forms of cancer seem to be increasing. (b) Diabetics and Heart Attacks It is sad to note that some of the life styles related diseases like diabetics, high blood pressure and heart attacks are on the increase.7It is estimated that about 10 years back nearly 5 percent of the population of the district had these problems and today 18 to 22 percent suffer from these diseases. By 2020, there will be about 40 percent of the people of Kanyakumari District may have one or more of these problems.

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(c) HIV/AIDS Given the nature of the infection, it would be almost impossible to have accurate data on the prevalence of HIV/AIDS. During 2006, there were 13 Integrated Councelling and Testing Centres (ICTC) and a few private laboratories test for HIV. The reports from the ICTC at the Medical College Hospital report high incidences of HIV infection. Based on the reported and projected figures one could conclude that the district has less prevalence than the projected state prevalence and very low compared to the neighboring district of Tirunelveli. It is noted with a sense of satisfaction that the Government, NGOs, educational institutions and other civil society organizations are involved in promoting awareness on HIV/AIDS as an effective way of preventing further transmission of the infection. Other Major Diseases in the District (a) Leprosy Leprosy has been prevalent in the district for a long time. Intense social prejudices have been, and still are, responsible for banishing the leprosy patients from all social contacts. Though leprosy hospitals and rehabilitation centres are being set up, humanistic treatment is an essential part. Reports show that the prevalence of the disease has significantly come down. Eradication of the disease should be done at the earliest. (b) Mental Health Mental Health disorders are actually much more prevalent than is apparent on the surface. While such disorders do not contribute significantly to morality, they have a serious bearing on the quality of life of the affected persons and their families. Available reports suggest that the mental retardation and cerebral palsied are on the increase. Kanyakumari District faces a unique problem of deserted mentally ill or mentally retarded or disoriented aged. People with psychiatric, severe neurotic and serious geriatric problems are deserted in places like Kanyakumari, Suchindrum and Nagercoil by the tourists and pilgrims from other parts of the state and country. Through there are some sporadic actions by the district administration, there are no proper and planned regular programmes to deal with the issue. The community mental health is another area, which needs attention. The health of a community is assessed by a few indicators like rate of suicide, homicide, alcoholism, substance abuse, rape, eve teasing and the like. In Kanyakumari District, the reports indicate an increasing trend in suicide. While more men commit suicide, the attempted suicide is high among women. Often men choose crude ways to commit suicide. (c) Liquor The consumption of liquor in the district is on the increase. Analysis of the figures over four years shows that the average sale per day is Rs. 6126049.2 and the per capita expenditure on alcohol per day is Rs. 3.6 which is very high. (d) Violence against Women Violence against Women and eve teasing are on the alarming increase. As part of the National Mental Health Programme, in Kanyakumari District, the Medical Officers, Nurses and Sanitary Inspectors are trained on identification of mental illnesses at the rural area. The PHCs are equipped to deal with minor mental illnesses and the Government Hospital in Padmanabhapuram has a separate ward with ten beds to treat the mentally ill patients. Psychiatric sections are attached to the Government hospitals which provide out-patient care to the mentally ill. The Government rehabilitation programmes are implemented by the District Disabled Rehabilitation officer. There are four rehabilitation homes run by the NGOs. However they are inadequate given the enormousness of the problem. The level of awareness of the public with regard to mental illness, mental retardation and issues related to mental health is very low.8There are many superstitions related to mental health and illness which need to be addressed. Conclusion The variables Unhygienic, less care, Food habits, and the Nature of job are the main reasons for causing diseases which are followed by the variables irregular eating, and improper treatment. Hence, the hygienic problems of the district should be taken care of to eradicate the frequent

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Journal of Natural Remedies Vol. 21, No. 6(S1),(2020) attack of diseases and to safe guard the people from the disasters.More awareness, Proper guidance, Proper counseling, Proper follow up, Proper treatment, and adequate assistance are the expectations of the people in improving the general health and to lead a successful life. Reference 1. District Profile, District Statistical Office, Nagercoil, 2003-2004 2. Ravikrishnan, K., “Human Population and Environment”, Environmental Science and Engineering, Sastha Printing System, Chennai, 2005. 3. Soil Atlas of Kanyakumari District, Soil testing laboratory, Nagercoil, 2003-2004. 4. Annual Credit Plans, Kanyakumari District, 2001 to 2010. 5. Benelt, Arul John, ‘An Economic Study of Sick Industries in Kanyakumari District’, - unpublished M.Phil, Dissertation submitted to M.K. University, Madurai, 1988. 6. Daniel, R.R., Sobana Raj, A.D., JezerJabanesan, M. and D. Thomas Franco, Citizen’s Report on the State of Development and Environment in Kanyakumari District, South Vision, Chennai, 2001. 7. Vision 2020, Kanyakumari District, Kanyakumari Resource and Research Centre, February 2007. 8. National Health Policy, 2002

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