PICs are an integral part of healthcare systems in most parts of the world. The first PICs were established nearly half a century back in Europe and USA; currently, most of the countries in the world have well-established PICs. In the U.S., approximately 4 million poisoning cases occur every year; more than 55 certified PICs handle about 2.3 million calls per year. Poison Centers in the U.S are rated next to immunization in their cost effectiveness.
The basic function of such a PIC is to provide information and advice concerning the diagnosis and management of poisoning in acute emergencies, which helps in reducing morbidity and mortality. By providing information to the public, unnecessary visits to emergency departments of hospitals are reduced. The center improves patient care by educating physicians, nurses, paramedics and other healthcare professionals in areas like poison management and medical toxicology. Such centers can also provide a broad range of information on toxic chemicals such as pesticides, industrial and household chemicals, including data on risks to the human health and environment.
Every emergency room in an Indian hospital admits acute poisoning cases on a daily basis; data on the number of poisonings every year, however, remains unreported. In India, treatment of poisoning continues on an empirical basis; medical and clinical toxicology (leaving aside forensic toxicology) is yet to be recognized as a discipline in India.
Is it still unclear as to why health authorities do not recognize the need for PICs in India. The few centers which are functional (only four in a vast and populated country like India) have been set up due to the personal commitment of individuals, without any systematic support from the Government of India (GoI). It is high time that GoI intervenes with some concrete steps in this direction.
Pesticide poisoning surveillance system
Pesticides are responsible for the largest number of acute poisoning cases in India. Facilities for intensive medical care are often not available at primary health centers or even district level hospitals. By the time such cases are transferred to tertiary care hospitals, most patients succumb to poisoning. Even if patients are able to reach some of these well-equipped hospitals, the economic cost of managing these cases is very high.
A case of acute Organophosphorus poisoning may need to be kept on ventilator for days or weeks, thus posing a huge financial burden on the patient or health care facilities. There is no proper centralized surveillance system to record pesticide poisonings; this results in gross under-reporting of occupational poisonings among formulators and farmers. Despite the high morbidity and mortality, toxic pesticides are easily available over the counter to illiterate citizens. There is a strong need to develop a Pesticide Poisoning Surveillance System for India to estimate the magnitude of the problem. Only then, preventive measures can be taken.
Ethylene Dibromide (EDB) continues to kill people in Rajasthan
EDB is a grain fumigant. The Pesticide Registration Committee of India has banned its use. Nevertheless, cases of poisoning due to this highly toxic compound continue to occur in Rajasthan where this pesticide is available in grocery stores. Many such cases are being admitted to various hospitals in Ahmedabad and most of them are fatal and death occurs due to hepato renal failure. The Government of India (GoI) should take a serious view of this and immediately stop the sale of this pesticide
Heavy metals in ayurvedic medicines in India
Alternative systems of medicines, such as those derived from Ayurveda, are still popular in India. Most people use one or the other forms of household remedies for common ailments, underpinned by the belief that herbal preparations are safe and do not have any side-effects.
Even the urban elite prefer such herbal preparations in the form of dried plants, powders, and pills, all of which are freely available in the market.
A number of pharmacies, some of them highly reputed, sell ayurvedic preparations for different ailments such as arthritis, diabetes and asthma and even as simple tonics.
In recent times, physicians in Ahmedabad have detected many cases of lead poisoning due to the use of ayurvedic drugs.
The National Institute of Occupational Health (NIOH) has detected high levels of lead in ayurvedic preparations like Brahmvati, Vasantmalti, Nirmaya, and Chintamani. br Since facilities for analysis of heavy metals are often not available in most laboratories, even in big cities, many more cases go undiagnosed. Some unusual cases of lead poisoning have been found in children who have been given Sindoor (a red powder containing red oxide of lead used for applying on the deities) by priests in temples.
Health Science Authority of Singapore has recently warned against the use of four Indian ayurvedic medicines that have been found to contain excessive amounts of lead and mercury. These medicines are Annai aravindh herbals rheuma-7 capsules, Himalaya diabecon tablets, Laurel's diabecs capsules, and Goodcare diabet guard granules.