India: a land of rich cultural heritage, diversity
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by Andrea P. Summer, M.D.
This month’s feature is India, the world’s most populous democracy with more than 1 billion people.
Graduate student Tejas Tirodkar highlights cultural practices observed by expectant Indian mothers and describes the impact of these rich traditions on the developing fetus. Her narrative complements Natalia Davila’s account last month of improved maternal outcomes related to enhanced prenatal programs in Colombia. These stories underscore how the elements of physical, mental and spiritual well-being are necessary to ensure the optimal health of an individual.
Motherhood leans on traditions, valuesby Tejas S. Tirodkar
Student, College of Graduate Studies
The tests are positive and the doctor has confirmed your suspicions—you are being blessed with a baby! Advice begins pouring in, leaving you as confused as ever. Amidst all this chaos, however, most Indian women find refuge in an old friend—tradition. This article discusses a few commonly observed prenatal care traditions in India known as Garbha Sanskar.
First, the news of conception is kept secret during the first trimester so that the baby is protected from the “evil eye” in order to develop normally. From the fourth month of pregnancy, two Ayurvedic ghees made from cow’s milk and herbs—the Kalyanakam Ghruta and the Thanka sree ghruta are ingested to prevent maternal anemia and aid in the normal development and delivery of the baby*.
In India, the mother is regarded as the first guru and her teachings begin at the womb. Hence, the expectant mother is encouraged to read scriptures and biographies of great men and instill the values of spirituality, ethics and duty in the fetus. This also uplifts the spiritual and mental health of the mother and strengthens her bond with the baby. She is pampered and kept happy and her whims, Dohale, are taken care of to encourage positive thoughts. This pampering culminates into a Dohali jevan or Godh bharai, which is a feast given in the seventh month to honor the mother, much like a baby shower. Her every fancy is catered to, and the feast is full of sweets, tangy pickles and spicy chutneys. Her motherhood is enhanced by the fragrant flowers adorning her hair, wrists and neck. She wears a crown and resembles a goddess in all her finery. Thus, armed with a combination of spiritual, mental and physical health care, the Indian mother shares her love with her child prior to giving birth.
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Clinician’s cornerA 5-year-old boy who recently traveled to rural India with his parents to visit relatives presents to the emergency department with fever, malaise, abdominal pain, and headache. He had diarrhea while traveling, which has resolved. He had no pretravel vaccines but did take the appropriate antimalarial medication. Exam is significant for T 105F, a pulse of 90, a mildly enlarged liver, and a faint macular rash on his trunk. No jaundice noted.
The most likely diagnosis for this patient is:
A. Typhoid fever
B. Hepatitis A
D. Japanese encephalitis
The correct answer is A.
The most likely diagnosis is typhoid fever. Symptoms typically noted with typhoid fever include high fever, abdominal pain, weakness, headache and sometimes a rash of flat, rose-colored spots. A relative bradycardia or disproportionately slow pulse for the severity of fever is often observed.
More than 20 million cases of typhoid fever and 200,000 related deaths are estimated to occur globally each year. Typhoid fever occurs in most of the developing world. Risk to travelers is extremely high in India, Bangladesh, and Nepal. Treatment is with antibiotics. Choice of antibiotics should be based on antimicrobial sensitivity data due to emerging antibiotic resistance, especially in South Asia. Two typhoid vaccines are available in the United States, each with an efficacy of 60-75 percent.
Friday, Sept. 26, 2008