Drowning: Prevention needed to save lives

What is drowning?

Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid with outcomes that are classified as death, morbidity, and no morbidity.

What is the problem statement?

• Worldwide, drowning is the 3rd leading cause of unintentional injury death (7% of all injury-related deaths)
• Around 320 000 drowning deaths occur annually.
• Children, males, and individuals with increased access to water are at high risk of drowning.
• > 90% of drowning deaths occur in low- and middle-income countries.
• China & India together contribute 43% of the total drowning deaths in the world.

What are the risk factors?

• Age: Highest drowning rates are among children 1–4 years, followed by children 5–9 years. Drowning is one of the top 5 causes of death for people aged 1–14 years for 48 of 85 countries with data meeting inclusion criteria.
• Gender: Males are at risk of drowning, with twice the overall mortality rate of females due to increased exposure to water and riskier behavior such as swimming alone, drinking alcohol before swimming alone and boating.
• Access to water: Individuals with occupations such as commercial fishing or fishing for subsistence, using small boats and children who live near open water sources, such as ditches, ponds, irrigation channels, or pools are especially at risk.
• Flood disasters: Risk of drowning increases with floods particularly in low- and middle-income countries where people live in flood-prone areas and the ability to warn, evacuate, or protect communities from floods is weak or only just developing.
• Traveling on water: Journeys on overcrowded, unsafe vessels lacking safety equipment or are operated by personnel untrained in dealing with transport incidents or navigation or under the influence of alcohol or drugs are also a risk.
• Other risk factors: Infants left unsupervised or alone with another child around water, alcohol use near or in the water, medical conditions such as epilepsy & tourists unfamiliar with local water risks and features.

How to prevent drowning?

We can prevent drowning by the following methods:

• Installing barriers (e.g. covering wells, using doorway barriers and playpens, fencing swimming pools, etc.) to control access to water hazards, or removing water hazards entirely greatly reduces water hazard exposure and risk.
• Supervised child care for pre-school children.
• Teaching school-age children basic swimming, water safety, and safe rescue skills.
• Setting and enforcing safe boating, shipping, and ferry regulations.
• Building resilience to flooding and managing flood risks through better disaster preparedness planning, land use planning, and early warning systems.
• Developing a national water safety strategy to raise awareness of safety around water, build consensus around solutions, provide strategic direction, and a framework to guide multisectoral action and allow for monitoring and evaluation of efforts.
• Creating and maintaining safe water zones for recreation.
• Covering of wells or open cisterns.
• Emptying buckets & baths, and storing them upside down.

 Reference:

1. https://www.who.int/news-room/fact-sheets/detail/drowning
2. https://www.who.int/health-topics/drowning#tab=tab_1
3. file:///C:/Users/Dr%20PREETI%20USHA/Downloads/9789241511933-eng%20(1).pdf photo credit
4. file:///C:/Users/Dr%20PREETI%20USHA/Downloads/9789241564786_eng.pdf photo credit
5. https://www.who.int/violence_injury_prevention/global_report_drowning/WHO_Infographic_A4_1PAGE_ToWeb_REV1.pdf photo credit

Health Management: Modern Approach

Introduction:

It was developed around the year 1950 & recognized the organization as a system that may be multidisciplinary and dynamic, which means it should adapt to environmental changes. This approach was an improvement upon both the classical and neo-classical approach to management.

Characteristics of the modern approach:

• Multimotivated
• Probabilistic 
• Multidimensional 
• Adaptive

There are three categories/ basic pillars:

(a) Quantitative approach/ Operational Research/ Operational Analysis 

(b) Systems approach

(c) Contingency approach

(a) Quantitative approach/ Management science approach/  Operational Research/  Operational Analysis :

It was propounded by C. W Churchman and his colleagues around the year 1950. It proposed the managers to solve their problems with the help of the mathematical and statistical formulas for example theory of probability, sampling analysis, correlation/regression analysis, time series analysis, ratio analysis,  variance analysis,  statistical quality control, linear programming, game theory, network analysis, break-even analysis, waiting line or queuing theory, cash-benefit analysis, etc.

Here the focus is on managerial decision making & can be further studied as 

1. Operational research: Advanced techniques like linear programming, waiting line, routing & distribution models are used to improve the effectiveness of decisions.
2. Management information system (MIS): By providing meaningful information about its business process using computerized information systems, organizations can bring about effective management.

Advantage:  It solves complex problems quickly. 

Disadvantage: It offers an alternative to a decision and cannot take decisions.

(b) Systems approach:

It was developed by Chester I. Bernard, Herbert A. Simon and their colleagues (1960).  

• This approach means a group of small inter-related units. 
• It is a group of different units that forms a complete unit called system. 
• The small units are themselves independent, but somehow or the other is connected with the sub-systems of the related system. 
• All the sub-systems influence one another in one or another way and if one of them fails the whole system stops working. 
• For example- a bike is a system that has many sub-systems in the form of engine, shaft, gear, wheels body, etc.
• Therefore, the success of the system depends on the cooperation and efficiency of the sub-systems.  
• The organization is also a system and its various departments are its sub-systems & if some decision is taken regarding a particular sub-system, the defect of a decision on the other sub-systems should also be considered.

Components of a system:

• Individual
• Organization (formal/ informal)
• Physical environment &
• Behaviors

Three basic elements of the organization:

1. A system: May consists of some functions, processes & components.
2. Linking process: This ensures coordination & correlations of subsystems. The process includes "decision making, balance, and communication".
3. Goals: There is a specific goal that every system is set to achieve.

Chief characteristics of the System Approach:

1. Sub-Systems: Every system is a combination of many sub-systems.
2. Holism/ Holistic: Every organization is looked upon as a whole. All the sub-systems are kept in mind while making a decision & no decision is possible in respect of any particular sub-system alone. 
3. Synergy: The organization is greater than the sum of its components.  If a work is performed collectively rather than individual, it is certainly well-performed with better results. 
4. Closed and Open System: Closed System: It remains unaffected by environmental factors. Open System: It remains constantly in touch with its environment and is influenced by it. An organization is considered as an open system. Environmental factors enter an organization as Input, converted into products through the process of various activities, walk out of the organization in the form of output ( goods, services, and satisfaction) 
5. System Boundary: A certain dividing line separates a system from its environment. In a closed system, it is rigid while in an open system, it is flexible.

(c) Contingency approach/ Situational approach:

This theory was developed by J.W. Lorsch and P.R. Lawrence (1970). 

• As per them, every type of problem in an organization cannot be solved by a single set of rules. 
• It is important to analyze every problem individually, study the various aspects & then devise different ways to solve it. 
• It is a mixture of all theories & appropriate theory is used depending upon the situation.

Features of Contingency Approach:

• Managerial action influences the environment.

• The managerial action changes according to the situations.

• There is essentially coordination between the organization and the environment.

Limitations of Contingency Approach:

• It is not sufficient to say that managerial action depends on the situation but it is essential to say what action should be taken in a particular situation. 

• A situation can be influenced by many factors and it is difficult to analyze all these factors.

References:

1. Kadri, A., 2019. IAPSM's Textbook Of Community Medicine. 1st ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd, p.1221.
2. https://www.economicsdiscussion.net/management/modern-approach-to management/31912
3. https://www.yourarticlelibrary.com/management/modern-management-theory-quantitative-system-and-contingency-approaches-to-management/25621 

Health Management: Neoclassical Theory/ The Human Relations Approach

Introduction:

It was first set out by Alfred Marshall. George Elton Mayo (1880-1949) is considered as founder of neocassical theory. It is also known as behavioural science approach as it led after Hawthorne experiment. 

• It was an attempt at incorporating the behavioral sciences into management thought in order to solve the problems caused by classical theory practices. 
• In this theory, human relations & behaviors of individuals and groups are given the importance.

• It was based on the idea that the role of management is to use employees to get things done in organizations. 
• Rather than focusing on production, structures, or technology, the neoclassical theory was concerned with the employee. 
• It concentrated on answering questions related to the best way to motivate, structure, and support employees within the organization.

Principles: 

High morale values increase productivity more rather than good working conditions alone. Hence, an informal organizational structure was introduced with the following principles:

• The individual: An individual is identified as a social entity with goals & aspirations in the organization.
• The workgroup: Social interactions within the group are also emphasized & given importance.
• Participative management: It encourages the participation of workers in the process of decision making.

Appraisal:

• This theory has been widely applauded due to highlighting the role of human values & emotions in managing the organization, in comparison to the older classical approach which was focused more on task, methods & rules.
• Behaviourists have enriched management theory through their contributions in the areas of group dynamics, motivation communication and leadership. 
• However, they have failed in developing an integrated theory of management as behavioural guidelines can be helpful and profitable, but care must be taken not to accept them as being completely valid and applicable to all situations.
• First of all, it lacks the precision of classical theory because human behavior is unpredictable. 
• Second, its conclusions lack scientific validity and suffer from a clinical bias, its findings are tentative. 
• Third its application in practice is very difficult because it requires fundamental changes in the thinking and attitude of both management and workers. 

Difference between classical and neoclassical theory:

The classical theory stresses on task and structure while the neoclassical theory emphasizes people aspect. 

References:

1. Kadri, A., 2019. IAPSM's Textbook Of Community Medicine. 1st ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd, p.1221.
2. https://study.com/academy/lesson/neo-classical-theory-of-management-the-human-relationsapproach.html#:~:text=The%20neoclassical%20theory%20was%20an,get%20things%20done%20in%20organizations.
3. https://www.businessmanagementideas.com/management/neoclassical-theory/neoclassical-theory-of-management/19763
4. http://www.iosrjournals.org/iosr-jbm/papers/Vol14-issue6/A01460105.pdf?id=7380 photo credit
5. https://www.toppr.com/guides/fundamentals-of-economics-and-management/evolution-of-management-thought/neo-classic-organization-theory/ photo credit
6. https://www.toppr.com/guides/fundamentals-of-economics-and-management/evolution-of-management-thought/neo-classic-organization-theory/ photo credit

Road traffic accidents: It's not just happen, it's caused

What is a road traffic accident (RTA)?

Any injury due to crashes originating from, terminating with, or involving a vehicle partially or fully on a public road.

What is the problem statement?

According to WHO, around 1.35 million people die each year as a result of road traffic crashes in the world. 

• More than half of all road traffic deaths are among pedestrians, cyclists, and motorcyclists. 
• 93% of the world's fatalities on the roads occur in low- and middle-income countries, even though these countries have approximately 60% of the world's vehicles. 
• Road traffic injuries are the leading cause of death for children and young adults aged 5-29 years. 
• Around 1.54 lake people die annually in India (NCRB-2019) in road traffic accidents.

What are the causes of RTA?

• Rapid urbanization
• Motorization
• Lack of appropriate road engineering
• Poor awareness levels
• Nonexistent injury prevention programs, and 
• Poor enforcement of traffic laws has exacerbated the situation.

Who are at risk?

• People with low socioeconomic status: Around 90% of road traffic deaths occur in low- and middle-income countries highest in the African region. Even within high-income countries, people from lower socioeconomic backgrounds are more likely to be involved in road traffic crashes.
• Younger age:  Children and young adults aged 5-29 years are more vulnerable
• Male sex: Males are more likely to be involved in road traffic crashes than females. 
• People with certain medical conditions: Sudden illness, heart attack, impaired vision, fatigue, etc.
• People with certain psychosocial factors: Lack of experience, risk-taking, impulsiveness, detective judgment, delay in decisions, aggressiveness, poor perception, family dysfunction, Heightened emotional tension, etc.
• People without body protection: Helmets, safety belts, and child restraints. 
• People who drive under the influence of alcohol and other psychoactive substances

What are the risk factors?

Environmental:

• Defective narrow roads
• The defective layout of cross-roads and speed breakers
• Poor lightening
• Lack of familiarity
• Bad weather
• Mixed traffic (slow & fast-moving, pedestrians and animals)
• Traveling in groups
• Inadequate enforcement of existing laws
• Inadequate post-crash care centers

Relating to vehicles:

• Excessive speed-Directly related both to the likelihood of a crash occurring and to the severity of the consequences of the crash.
• Old & poorly maintained vehicles- Safe vehicles play a critical role in averting crashes and reducing the likelihood of serious injury.
• The large number of 2 or 3 wheelers
• Overloaded vehicles
• Low driving standards
• Distracted driving: Drivers using mobile phones are approximately 4 times more likely to be involved in a crash.
• Use of stolen vehicles

What should be done to reduce RTA?

Accidents don't just happen; they are caused and it can be prevented. Governments need to take action in a holistic manner which requires involvement from multiple sectors such as transport, police, health, education, and actions that address the safety of roads, vehicles, and road users. 

• Data collection: All accidents should be reported and investigated properly to know the risk factors, circumstances & chain of events leading to accidents.
• Road safety education: It should begin from the school children & all drivers should be trained in safe driving & proper maintenance of vehicles. 
• Promotion of safety measures: Seat belts, safety helmets, door locks, proper vehicle design, use of laminated high-penetration resistance windscreen glass, etc.
• Avoidance of alcohol & other drugs: As it impairs the driving ability & increases the risk of RTA. Strict laws should be enforced.
• Designing safer infrastructure: Incorporating road safety features into land-use and transport planning for all types of vehicles with taking pedestrians into consideration.
• Improving post-crash care for victims: Planning, organization & management of trauma treatment and emergency care services at every hospital or PHC.
• Setting and enforcing laws: To eliminate related to key risks & causative factors like improvement of roads, the imposition of speed limits, marking of dander points, safety measures, drunken driving, etc.
• Rehabilitation centers: Medical, social & occupational rehabilitation to prevent, reduce, or compensate disability & thereby handicap.
• Accident research/ accidentology: For new & better methods to prevent accidents.

References:

1. https://www.nhp.gov.in/road-traffic-accidents_pg
2. https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries
3. https://ncrb.gov.in/sites/default/files/Chapter-1A-Traffic-Accidents_2019.pdf
4. Park, K., 2019. Park's Textbook Of Preventive And Social Medicine. 25th ed. Jabalpur: M/s Banarsidas Bhanot Publishers, p.1000.
5. https://www.who.int/health-topics/road-safety#tab=tab_3
6. https://www.who.int/docs/default-source/infographics-pdf/road-safety/10-strategies-for-keeping-kids-safe-on-the-road-en.pdf?sfvrsn=968cba78_2 photo credit
7. https://www.who.int/violence_injury_prevention/road_safety_status/2018/1.35-million.jpg?ua=1 photo credit
8. https://www.who.int/violence_injury_prevention/road_safety_status/2018/1st-cause.jpg?ua=1 photo credit
9. https://www.who.int/violence_injury_prevention/road_safety_status/2018/8th-leading-cause.jpg?ua=1 photo credit
10. https://www.who.int/violence_injury_prevention/road_safety_status/2018/54-percent-deaths.jpg?ua=1 photo credit
11. https://www.who.int/violence_injury_prevention/road_safety_status/2018/Low-income-countries.jpg?ua=1 photo credit

Health Management: Classical approach

It focuses to increase production by improving organizational efficiency. It was developed during the 1880-1920s. Three theories come under this

(a) Scientific management theory

(b) Bureaucratic management theory

(c) Administrative management theory

(a) Scientific management theory: 

Given by FW Taylor (Father of Scientific management)

• Emphasized the need for the development of mutual trust between management & workers to increase productivity for the management of business organizations.

(b) Bureaucratic management theory:

Promoted by Max Webber (German sociologist). The basis for formal organizations based on the following principals

• Structure: Arrangement of positions within an organization should be based on a hierarchy, with each position having predetermined authority & responsibility.
• Specialization: Division of labor & tasks should be based on functions & specializations having its own chains of command.
• Predictability & stability: Formal rules & regulations which form the basis of the system that operates the organization.
• Rationality: Recruitment of the personnel should be impartial & rational.

(c) Administrative management theory: 

Henri Fayol (Founder of classical management theory) focused on management as a skill that could be taught, learned & mastered. He laid down the following "principles of management"

• Division of work: Should be based on the capabilities & aptitudes among the members of the team to ensure productivity.
• Authority: Managers should have formal authority so that they can ask the subordinates to complete the task.
• Discipline: Fair codes of conduct & periodic supervision should be there along with judicious use of rewards or punishments to help to develop a positive attitude towards discipline.
• Unity of Command: It is ideal that a junior employee should receive orders from their superior only.
• Unity of direction: All functionaries of the organization should work towards the same objective in one direction.
• Subordination of individual interest to the group interest: The interests & goals of the organization comes first & receives emphasis over the of the individual.
• Remuneration: A satisfactory & predetermined remuneration to different personnel should be there. It ensures productivity & avoids uncertainty.
• Centralization of authority: The important policy decisions and decisions regarding key matters should be centralized. Managers should be able to make decisions about how much authority has to be retained & can be given to the subordinates for decision making.
• Scalar chain: Line of authority should be a well defined and functional chain of senior-subordinate relationship from the top management to the lower levels.
• Order: Personnel and material should be in an appropriate position to ensure efficiency.
• Equity: The absence of bias & just treatment of all individuals removes conflicts while ensuring cooperation & compliance among all.
• Stability of tenure of the personnel: Due to this members find a sense of security, certainty & attachment to the job.
• Initiative: Personnel should be encouraged when they take initiative as it gives them a chance to build their confidence & hone skills.
• Esprit de corps (Teamwork): There is strength in unity. Team spirit, a feeling of kinship is essential for any organization to develop. 

Although all these principles are not mandatory & relevant to the current management practices, these are good for guiding in many situations.

References:

1. Park, K., 2019. Park's Textbook Of Preventive And Social Medicine. 25th ed. Jabalpur: M/s Banarsidas Bhanot Publishers, p.1000.
2. Kadri, A., 2019. IAPSM's Textbook Of Community Medicine. 1st ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd, p.1221.
3. Sathe, P., 2018. Epidemiology And Management For Health Care. 5th ed. Mumbai: Vora Medical Publications, p.508.
4. Bhalwar, R., 2009. Textbook Of Public Health And Community Medicine. 1st ed. New Delhi: Department of Community Medicine, AFMC, Pune in collaboration with WHO, India office, p.1302.
5. https://www.who.int/management/en/
6. https://www.mindtools.com/pages/article/henri-fayol.htm

गॉंधी-शास्त्री के जन्मदिन पर: पूछती हैं भारत माता

सिसक रहीं है आज बेटियॉं, चलना राह है मुश्किल हो गया;

डर ने है डेरा डाला, है नर-पिशाचो का पहरा बढ़ गया।

हर जगह हैं गिद्ध भटकते, महानुभावों के भेष में;

नारियॉं हर रोज घूंट रहीं, लक्ष्मीबाई के देश में।।

है कोई नहीं पूछनेवाला, पर...................................

पूछती हैं भारत माता, क्या ये धरती फिर से गुलाम है?

क्या हमारे भावनावों का, ये गहराता हुआ-सा शाम है?

झूल रहे भविष्य देश के,  लटक रहें हैं अन्नदाता;

पैरों में पड़ रहीं बेड़ियॉ, लुटेरे बने हैं भाग्य विधाता।

अर्थव्यवस्था चौपट हो गई, तिल-तिल करके देश बिक रहा;

समाजवाद के देश, है पूॅंजीवाद अब क्यों टिक रहा।।

नहीं रहें अब गाॉंधी-शास्त्री....................................

है कोई नहीं पूछनेवाला, पर..................................

पूछती हैं भारत माता, क्या ये धरती फिर से गुलाम है?

क्या हमारे भावनावों का, ये गहराता हुआ-सा शाम है?

पत्रकारिता मृत हो गयी, सर्प बैठे हैं भेष बदल के;

डस रहें हैं चैनल वाले, हिन्दु-मुस्लिम विष नाम पे।

अंधा कर दिया है देश को, जनता मूक-बधिर हो गई।।

दिनकर की भाषा भूल गये सब............................

है कोई नहीं पूछनेवाला, पर.................................

पूछती हैं भारत माता, क्या ये धरती फिर से गुलाम है?

क्या हमारे भावनावों का, ये गहराता हुआ-सा शाम है?

बहुत हो गया मौन तुम्हारा, सपूतों ऑखों की पट्टी खोलों;

आजाद करो अब जिह्वा अपनी, मुह खोलो कुछ तो बोलो।

आवाज बनो तुम, पिड़ित भारत की, गुलामी की बेड़ियॉ तोड़ों;

ना समझोगे तो, दास बनोगे,क्योकि..........................

है कोई नहीं पूछनेवाला, पर...................................

पूछती हैं भारत माता, क्या ये धरती फिर से गुलाम है?

क्या हमारे भावनावों का, ये गहराता हुआ-सा शाम है?

है ये देश गणतंत्र तुम्हारा, भविष्य न अपना बिकने देना;

नेता न चुनना गलत मनुष्य को, सोच-समझ कर वोट डालना।

गोडसे मार रहे हर रोज, कुचल-कुचल कर सच्चाई को;

लकवा मार गया है जैसे, समाज की अच्छाई को।।

तानाशाहों से तुम्हें बचाने, गॉंधीजी अब नहीं आयेगें;

तुम्हें खुद हीं ऑंधी बनना होगा, क्योंकि..................

है कोई नहीं पूछनेवाला, पर.................................

पूछती हैं भारत माता, क्या ये धरती फिर से गुलाम है?

क्या हमारे भावनावों का, ये गहराता हुआ-सा शाम है?

________डॉ प्रति उषा