Soumyadeep Bhaumik’s review of South Asian medical papers—January 2016

soumyadeep bhaumik“Study the past if you would define the future,” said the great Chinese philosopher Confucius, and what better way to start the year than to look back at what happened in the past year in South Asian research as we lay the foundations for 2016.

Last year saw quite a few papers on what has always been an open secret but seldom talked about: institutional ethics committee members in India have a very poor understanding of how ethics committees should function and of medical ethics itself. These studies (here, here, and here) are all based on small sample sizes, but they come from different regions and so capture an overall snapshot of the nation reasonably well. The situation in neighbouring Pakistan is not great either. A study from Khyber Pakhtunkhwa reports that most medical colleges in the province do not even keep a track record of the proceedings of ethics committees.

Talking about ethics, this commentary on ethical issues in humanitarian crises is a good read for all aid workers who often find their ethical values out of place in the field. It’s from the perspective of the Israel Defence Force medical team who worked in the 2015 Nepal earthquake.

A piece of good news came from Pakistan when the first set of studies from the Pakistan National Emergency Department Surveillance Study were published. The studies published so far cover a wide spectrum, ranging from paediatric diseases, chest pain, use of vital signs, ambulance use, the characteristics of dead on arrival patients, patterns of fall injuries, burn injuries, poisoning, and even bomb blast injuries. As the dataset grows, this will be an immense tool for researchers in the entire South Asian region.

A study that explored why the Indian polyvalent snake anti-venom for cobra bites is less effective in Sri Lanka (Sri Lanka procures it from India) found that the Indian anti-venom has a lower antibody affinity towards the Sri Lankan cobra venom. This year I would love to see more studies like this, in which bench research is so much in sync with clinical work.

The year gone by also saw a paper calling for the inclusion of medical humanities in undergraduate medical education in Pakistan, and another calling for the mandatory screening of all tuberculosis patients for drug resistance in India.

A bibliometric analysis from India, which mapped public health research, brought into the limelight the region’s growing capacity for public health research, but it also highlighted inequalities in terms of research output across regions and institutions.  Another paper, which examined training programmes on public health ethics, clearly showed that there is still a long way to go in niche areas of public health training in India.

There is now a lot of evidence on the epidemiological transition in the South Asian region from having a high burden of predominantly infectious diseases to a high burden of chronic non-communicable diseases (NCDs). However, the spotlight goes to Nepal, which published the results of its nationwide, WHO NCD STEPS survey (after a seven year hiatus). In a worrisome development for NCDs, the incidence for gastric cancer in the ”happy” nation of Bhutan was found to be twice as high compared to the United States in a study based on medical records from a five year period in the nation’s only referral hospital.

One of the long standing arguments of the tobacco industry in India and Nepal against increased taxation has been that a tobacco tax will have potentially detrimental economic consequences for the bidi (hand rolled cigarette) manufacturing industry. This claim fell flat with the publication of a paper demonstrating bidis’ minimal “economic footprint” in the manufacturing sector. However, according to another study the majority of frontline community health workers in Gujarat and Andhra Pradesh, despite being aware of the harmful effects of tobacco, did not inform patients about these harms.

This paper, which explores the capacity of community health workers in Afghanistan as the country moves towards universal health coverage, gave me hope in June, but the bombing of MSF hospitals just a few months later makes me worry whether research in the nation is able to keep pace with the scenarios faced by healthcare workers in remote locations. However, this qualitative paper on care-seeking behaviour of women who have been affected by gender based violence in Afghanistan is most appropriate as the issue was identified by the Ministry of Public Health just a few years back.

Soumyadeep Bhaumik is a medical doctor from India and he works on evidence synthesis. He is currently studying international public health at the Liverpool School of Tropical Medicine. All opinions are personal. Twitter @DrSoumyadeepB.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I currently serve in an editorial position at the Journal of Family Medicine and Primary Care and have previously had positions at other journals. I have no other relevant conflicts of interests to declare.