Drugs and Alcohol Abuse

Smoking

Smoking of tobacco dried and cured leaves of plant ‘Nicotiana tobacum’ and N. rustica in the form of cigars, cigarettes, bides etc. is very toxic to the body. Smoke of tobacco contains about 300 compounds. The main compounds are nicotine, CO, HCN, polycyclic aromatic hydrocarbons, certain other stimulating products etc. Nicotine in the blood stimulates the nervous system, relax the muscles, release adrenalin hormone and increase the rate of heart beats. In pregnant ladies growth of foetus decreases and loss of weight may takes place.

Tobacco : The tobacco was first smoked by Red Indians in America. It then spread to European countries in the early 1600’s, and today a large part of the world population smoke tobacco, while some others chew it.

Effect of Nicotine : Smoking was reported to produce a feeling of tranquility (calmness) and in some cases made people alert and active. Since in its early days the use of tobacco was socially accepted and no harmful effects were obvious, the addiction became widespread. But scientific research indicates that use of tobacco is harmful. Nicotine is the major stimulatory component of tobacco products including cigarettes. It is highly poisonous. The amount present in one cigar can be fatal, if it is injected intravenously into a person. When smoked, about 10 percent of the smoke is inhaled. Nicotine has a number of effects on the human body. It stimulates passage of nerve impulses, causes muscles to relax and causes the release of adrenaline, increasing both blood pressure and heart beat rate. The increased blood pressure caused by smoking leads to increased risk of heart diseases. In pregnant women nicotine causes retardation of the growth of the foetus.

Other Harmful Components of Tobacco Smoke : Besides the nicotine the tobacco smoke contains carbon monoxide, polycyclic aromatic hydrocarbons and tar.

Diseases Caused by Smoking : Smoking causes the following diseases.

(1) Cancer : Benzpyrene present in tobacco smoke is carcinogenic. About 95% victims of lung cancer are due to smoking. Reverse smoking causes oral cancer. In reverse smoking the burning end of the cigar is kept in the mouth. Reverse smoking is common in the villages of Andhra Pradesh. Bidi smoking causes cancer of tongue, pharynx (throat), larynx, tonsils and oesophagus. Lip cancer is caused by cigar and pipes. Tobacco chewing leads to oral cancer.

(2) Cardio-vascular Diseases : Tobacco smoking causes increase of adrenalin secretion which increases blood pressure, heart beat rate by constricting the arteries. High blood pressure increases the chances of heart diseases. Nicotine damages the bicuspid valve (mitral valve) of the heart.

(3) Emphysema : Tobacco smoke may break down the walls of alveoli of the lungs, decreasing the surface area for gas exchange, causing emphysema.

(4) Coughing and Bronchitis : Tobacco smoking irritates the mucous membrane of the pharynx (throat) and bronchi causing coughing and bronchitis.

(5) Pulmonary Tuberculosis : Smoking can spread bacteria of pulmonary tuberculosis from infected person to healthy persons.

(6) Gastric and Duodenal Ulcers : Smoking increases the secretion of gastric juice containing HCl. Excess of HCl causes gastric and duodenal ulcers.

(7) Effect on Immune System : Smoking reduces immunity of the body.

(8) Decrease in Oxygen carrying Capacity : Carbon monoxide of tobacco smoke rapidly binds haemoglobin of RBC and causes co-poisoning which reduces oxygen carrying capacity of haemoglobin.

(9) Other Effects of Smoking : Tobacco smoking has other effects.

(i) Effect on other Persons : Tobacco smoking annoys non-smokers. It may prove even more harmful to nonsmokers.

(ii) Effect on Personality : Lips of the smoker may get coloured. Teeth and fingers may become stained and breath becomes foul.

(iii) Effect on Economy : Tobacco smoking also affects economy of the smoker.

Alcoholism

Regular consumption of alcohol either in low concentration (beer, wine, etc.) or in high concentration (brandy, whisky, rum, gin, Vodka, etc.) causes dependency on alcohol which is called alcoholism. The person who has become a habitual drinker is called an alcoholic.

Ethyl alcohol is consumed as fermented beverages with low content of alcohol (beer, wine, toddy) and as distilled beverages with a relatively high alcohol percentage (brandy, rum, whisky, gin, vodka). This alcohol is rapidly absorbed from the wall of stomach and enters the blood stream within minutes of ingestion. In the liver alcohol is converted into a more toxic substance – acetaldehyde.

The organ which is most affected by alcohol, is Liver.

Intoxication begins from the first sip of drink containing alcohol but early signs are not visible. With the increase in its dose the body loses its control and, gradually, the individual loses his consciousness and in extreme cases death may occur. People who get into the habit of drinking begin with a small dose, but soon many of them become addicted and they start consuming alcohol frequently and in large quantities. When they come to realize that they have become the victims of the hazards of alcohol, then it is too late for them to give up the habit.

Research studies have revealed that the people who resort to drinking offer one or more of the following reasons: (1) Social pressure, (2) Feeling of independence, (3) Liking of the taste, (4) Desire of excitement, (5) Desire to escape from such realities of life as disappointments and failures, and (6) hardships and monotony of everyday life.

When a person drinks alcohol, it passes to the stomach. Some amount of alcohol is also carried to the small intestine. Alcohol is quickly absorbed in the stomach and upper part of small intestine and is transferred to the blood. This blood carries alcohol to the liver. Liver synthesises fat from alcohol. The excess fat reduces the formation of glycogen, enzymes and structural proteins. The liver is an important centre of carbohydrate, fat and protein metabolism. But due to excess of fat in the liver makes the liver only a store house of fat. From the liver alcohol follows the following route through blood. Liver $\to$ heart $\to$ lungs $\to$ heart $\to$ various body parts (tissues). Its oxidation starts so that a some amount of energy is produced which gives false impression of warmth in the skin.

Many people think that alcohol is a stimulant. But alcohol is not a stimulant. Actually alcohol acts as sedative (lessens functional activity), analgesic (relieves pain) and anaesthetic (causes loss of sensation).

Effects of Alcohol : It has been proved that the intake of alcohol affects individual health, family life and ultimately creates several community and social problems.

(1) Effects on Individual Health

(i) Effect on Nervous System : Many people drink alcohol for some “stimulation”, but in reality it depresses the nervous system, thus acting as a sedative, analgesic and anaesthetic agent. It reduces the efficiency of every tissue of the body. In a chronic alcoholic the axons of the nerve are inflamed, thus causing neuritis. The prolonged effect of alcohol on the nervous system causes various mental and physical symptoms.

(ii) Effect on Heart : Alcohol no doubt provides more energy and produces heat in the body, but, at the same time, it dilates the blood vessels. Thus, the heat generated is quickly lost. Due to constant dilation, the arterial walls soon become brittle and rigid. Such a change in the property of blood vessels and deposition of alcoholic fat affect the working of the heart.

(iii) Effect on Stomach : A small quantity with low concentration of alcohol stimulates the secretion of gastric juice. But an increased quantity with higher concentration has the opposite effects. Alcohol affects the lining of the stomach and causes inflammation. In most cases, the drinkers (specially those who drink on an empty/stomach) become the victims of gastritis.

(iv) Effect on Liver : The most important organ which is damaged by alcohol is the liver. The liver is the storehouse of glycogen but alcohol causes the storage of fat in the liver. It causes fatty liver syndrome. Gradually, the liver hardens and dries up as its cells are replaced by a fibrous tissue. This kind of liver degeneration is called cirrhosis. Once the liver is damaged, it affects the other organs of the body also.

(v) Effect on Kidneys : Kidneys are overworked in eliminating the excess water often taken with alcohol.

(vi) Effect on immunity : The users of alcohol neglect their health and soon the body loses its resistance to infections. The alcoholics are in most cases victims of malnutrition and are easily susceptible to disease like pneumonia.

(vii) Effect on level of sugar in blood : Lowering of blood level. (Hypoglycemia)

(2) Effect on the Family : The consumption of alcohol not only creates problems to the drinker but directly or indirectly affects the family and community life. Alcoholic drinks are costly and most drinkers, because of their selfish habit, deprive their children and other members of the family of the basic needs. Thus, they create health and other problems.

(3) Effect on Society (Community) : The drinking of alcohol is invariably associated with social crimes and dissolution of moral and cultural inhibitions. Violence and other corrupt practices in the community are often directly or indirectly due to the consumption of alcohol. The intake of alcohol increases the rate of industrial accidents and decreases production. Traffic accidents are often due to drunken drivers. Illegal activities like production and selling of illicit liquor increases antisocial activities.

Driving and drinking do not go together : It is due to the following facts :

(1) Alcohol affects judgement : A person’s ability to judge distance is distorted.

(2) Alcohol affects coordination : Coordination of the limbs, the head and the eyes are impaired affecting the driver’s control of the car.

(3) Alcohol affects alertness : A driver becomes less watchful and fails to observe objects outside his vehicle.

(4) Alcohol affects vision : Vision becomes blurred and unsteady. Often the field of vision is reduced (Tunnel Vision).

(5) Alcohol increases reaction time : The driver takes more time to react to unexpected situations, e.g., a child running across a street.

(6) Alcohol affects behaviour : Intoxicated drivers become rash, careless and erratic. They tend to speed and take risks.

Drug Addiction

Symptoms and Control

(1) Drugs : Drugs are normally used for the treatment of diseases. The prolonged use of drugs may lead to the dependence of the body on them. This is drug addiction. Some people without any medical advice, start taking drugs and soon become drug addicts. Certain drugs form habit, but some make the body completely dependent upon them.

(2) Addiction : Some persons are unable to bear tensions or think themselves unable to solve the problems of life or due to certain other curious factors start drinking, smoking and taking certain narcotic drugs and feel relief and peace. Gradually this becomes their habit and they are addicted to these things.

Thus addiction can be defined as a physical and mental dependence on any of the above mentioned factors and get temporary relief and feel pleasure.

The common factors are :

(3) Drug Addiction : The compounds used for the cure of the diseases are known as drugs. Certain drugs of specific category are nerve stimulants and depressants. Some of the drugs function as sedative and others act as hallucinogens.

The regular use of such drugs causes the drug addiction in human and they become habitual of these drugs. Drugs such as aspirin and antihistamines when taken with alcohol may have dangerous effects. Including death.

Types of Drugs : These are a large number of drugs on which people become dependent. On the basis of their mode of action on the brain, these drugs are of four types : Sedatives and Tranquillisers, Opiate Narcotics, stimulants and hallucinogens.

(1) Sedatives and Tranquillisers : These drugs depress the activities of the central nervous system. They give a feeling of calmness, relaxation or drowsiness in the body. Their higher doses induce sleep. Tranquillisers lower tension and anxiety without inducing sleep. Examples : barbiturates and benzodiazephines (e.g., Valium).

Barbiturates are synthetic drugs derived from barbituric acid and are called sleeping pills.

(2) Opiate Narcotics : These drugs suppress brain activity and relieve pain. They are called pain killers. Examples opium and its derivatives and some synthetic drugs (e.g., pethidine and methadone).

Opium and its Derivatives : Opium is the extract from the unripe capsules of the poppy plant (Papaver somniferum). It has bitter taste. The opium addict loses weight fertility and interest in work. Its derivatives are morphine, codeine and heroin. Opium derivatives immediately reduce respiratory and cardiovascular activity, constricts the pupils of the eye, reduce the visual activity and cause nausea and vomiting. An overdose leads to respiratory arrest and death. If the supply of the drug is not available, the addicts exhibit terrible “with-drawal symptoms” in the form of muscle cramps, running nose, vomiting and epilepsy.

(1) Morphine and Codeine : These are derived from opium. Morphine is a most valuable analgesic but it causes addiction. Codeine is a mild analgesic but causes no addiction so codeine is commonly used in many medicines and cough syrups.

(2) Heroin (Diacetylmorphine or Diamorphine) : Heroin is formed from morphine by acetylation. It is highly addictive and, therefore, considered most dangerous opiate. It is banned even for medical use. It is used in research. Heroin is taken orally or inhaled or injected. As the heroin addicts are careless about the needles and syringes so they can cause blood poisoning, serum hepatitis and AIDS.

(3) Stimulants : These drugs stimulate the nervous system make a person more wakeful, alert and active and cause excitement. The stimulants include caffeine, cocaine and amphetamines.

(i) Caffeine : It is an alkaloid derived from the leaves of tea plant (Thea chinesis), seeds of coffee plant (Coffea arabic) and seeds of Cocoa plant (Theobroma cocoa). Tea plants and coffee plants are shrubs while cacao plants are trees. Caffeine is a mild stimulant and is commonly taken as beverages – tea, coffee, coca and cola drinks. It increases alertness and thought. As it is mild stimulant, it is used in medicines as a cardiac stimulant. Its excessive use causes addiction.

(ii) Cocaine : It is extracted from the leaves and young twigs of the South American shrub Erythroxylon coca. Cocaine is used as local anaesthetic and stimulant. The bad effects are lack of sleep, loss of appetite and hallucination which ultimately lead to damaged mental functions and insanity. The misuse may also produce severe headache, convulsion or death due to cardiovascular or respiratory failure.

(iii) Amphetamines : These are synthetic drugs, which are strong stimulants. Amphetamines are taken by truck drivers and night workers to keep awake. They do not remove fatigue. However, they impair vision and judgement of distance.

(4) Hallucinogens : These drugs change thoughts, feelings and perceptions of an individuals. Hallucinogens (drugs) cause hallucinations (illusion of seeing objects or hearing sounds, etc., not actually present). They include chemicals such as LSD. (Lysergic acid diethylamide), mescalin, psilocybin and products of hemp plant.

(i) LSD (Lysergic acid diethylamide) : It is derived from Ergot fungus. It is most powerful hallucinogen which causes horrible dreams, chronic psychosis, and severe damage to the central nervous system. LSD also brings about chromosomal and foetal abnormalities.

(ii) Products of Hemp Plant : Bhang (hashish), ganja and charas are three drugs obtained from the dried leaves and flowers of the hemp plant (Cannabis indica) commonly called bhang. Another drug Marijuana is derived from another species of hemp plant (Cannabis sativa). Immediately after the intake of these drugs, the pupils of the eye dilate, blood sugar level rises and frequency of urination increases. These drugs are often mixed with tobacco and smoked. Compared to the other drugs, these drugs may appear to be less harmful, but these may lead to the opiates (opium group) addiction. They are dangerous if taken along with alcohol. Some of these drugs (e.g., Marijuana) cause anxiety and may lead to psychosis.

$\bullet$ Marijuana is Hallucinogen.

Combinations of Drugs : Some drug addicts use mixtures of drugs to have immediate effect. Combination of alcohol and barbiturates causes increased depressant effect. Mixture of alcohol and antihistamines produces marked drowsiness. Combination of alcohol and valium causes increased sedative effect. Mixture of alcohol and marijuana produces decreased coordination and impaired judgement. Combination of alcohol and aspirin causes increased chances of damage to gastric mucosa.

Effect of Drug Addition of Family, Society and Addicts : The drug-users not only themselves suffer from the ill-effects of drug addiction, they also bring miseries to the entire family. Since they get the supply of the drugs from illegal sources, they encourage smuggling and other associated illegal activities, resulting in several other social problems. It is evident that all the drugs affect the central nervous system and their prolonged use causes permanent damage. The body fails to work without the drugs. Ultimately other organs also get damaged, and the drug-users become victims of various diseases. There are several reasons causing drug addiction.

(1) Curiosity : Frequent reference to drugs in newspapers, literature and on radio makes a person curious to have personal experience of the taste of a particular drug.

(2) Peer group pressure : Constant description by friends about the “good feeling” creates a temptation. Such inspiration from friends and peer groups acts as a pressure to start with drugs.

(3) To overcome frustrations and depressions : The desire to get solace or relief from personal problems initiates the use of drugs. The school children who take refuge in drugs are usually lonely, unloved and insecure.

(4) Excitement and adventure : It is natural for the young to look for some exciting work. The intake of drug being illegal satisfies that feeling of excitement and adventure.

(5) Looking for a different world : Some people believe that drugs open up a new world of perception. It increases the ability to appreciate the aesthetic beauties, helps in intellectual enlightenment and creativity.

(6) Desire to do more physical or mental work : Some people use drugs to increase their working power. Many students use drugs to work whole night before examinations. In most cases this leads to mental-breakdown.

(7) Persistent use to get relief from pain : People suffering from pain often take drugs for relief. Such persistent use is sometimes based on medical prescription. This practice makes them addicts.

(8) Family history : Examples of parents of members of the family using drugs act as the most natural stimulant.

Mental Health

There is a general feeling that if you are and not ill you are healthy. A truly healthy person is the one who has a sound body, lives in harmony with others, has the ability to face stresses and strains and holds certain moral and spiritual values. Body and mind are intimately related. Any disturbance in one has its effect on the other. Like the body, mind too can be come ill.

It is estimated that 1 percent of the world population suffers from serious mental illness and 10 percent from mild mental disorders. In India, there are 6 𠄷 million people with incapacitating mental disorders.

Characters of Mentally Healthy Person

If potential conflicting instinctive drives. A mentally healthy person has (1) Self respect. (2) Knowledge of one&aposs capabilities and limits. (3) Independent personality but comfortably placed in hierarchy in work, family and society. (4) Feeling of friendship and trust for others. (5) A purposeful life with reasonable goals to achieve. (6) Potential to perform all the daily chores and not dependent on any other person. (7) No tendency in decision making to get swayed away by emotions, fear, anger, love or guilt. (viii) Ability to meet all the demands of life, solving problems as they arise. A mentally sick.

Mental illness

It is a state of mind in which a person is not able to think, behave and interact with others normally. On set of mental illness is exhibited by (1) Changes in behaviour and personality due to abnormality of thoughts, memory, feelings, perception and judgement. (2) Difficulty in adjustment with family members and colleagues. (3) Inability to carry on daily business, with signs of tension, trembling, depression, aggressive behaviour, fear, phobia, etc. There is thus social and vocational dysfunctioning.

Characters of Mentally Sick Person

(1) Inability to concentrate. (2) Absence of sound sleep. (3) Worrisome behaviour. (4) Short temper. (5) Unhappiness. (6) Mood fluctuations from depression to elation. (7) Tendency to get upset by a change in routine. (8) Apprehensive nature. (9) Bitterness. (10) Dislike of others. (11) Considering others to be wrong. (12) Children getting on nerves. (13) Feeling of pains / aches in different body parts without any actual ones.

Types of Mental illness

Mental illness can be grouped under three broad categories – psychosis, neurosis and mental disorders.

(1) Psychosis / Insanity / Madness : It is a serious type of mental illness in which the patient loses touch with reality. Psychosis may be caused by disease of central nervous system. In some cases it is associated with diabetes, hypertension and tuberculosis. The patient in not aware of illness and refuses to take the treatment.

(2) Neurosis : It is less severe form of mental illness where the patient is aware of the problem and tries to seek help. There is abnormal anxiety, fear, sadness, vague aches and pains. Neurosis develops due to stress and anxiety in patient&aposs environment. The patient shows excessive / prolonged reaction to a given stress, e.g., anxiety neurosis, hysteria, obsessional neurosis, reactive depression. All of us have tendency to become neurotic. Rather neurosis is mode of overcoming certain problems like worry, fear, anxiety, feeling of insecurity, etc.

(3) Mental Disorders : The disabilities are caused by physical, physiological and psychological defects like (i) Injury (ii) Infection from worms tuberculosis, measles, leprosy or encephalitis. (iii) Nutritional deficiency during development of infant. (iv) Radiation damage during neural development. (v) Toxicity of lead and mercury. (vi) Degeneration due to ageing. (vii) Tumours or neoplasms. (viii) Poor availability of oxygen glucose / blood supply. (ix) Excessive intake of alcohol. (x) Excessive use of psychotropic drugs.

(i) Epilepsy : It is a mental illness characterised by abnormal electrical discharge in a part of brain often leading to warning cry, fits of convulsions like jerking, stiffness, tongue biting sensory changes, loss of bladder and bowel control, ending in loss of consciousness falling down and sleep. The condition epileptic attack is called seizure. It may recur with biorhythum, photic stimulation, musical composition, tactile stimulation, reading, etc. Proper treatment can cure epilepsy in most of the cases.

(ii) Parkinson’s Disease : (Paralysis Agitans Parkinson, 1817). It is a sporadic disorder of middle and late life which is characterised by stooped pasture, stiffness and slowness of movements, fixity of facial expression and rhythmic tremor of limbs (most pronounced in hands) which subsides on relaxation or actively willed movement. Relief can be obtained through regular medicine, physiotherapy and surgery.

(iii) Alzheimer’s Disease : A progressive degenerative disease of brain which is caused by senile plaques and neuro - fibrillary tangles resulting in loss of choline acetyltransferase activity. First sings are subtle changes in personality, memory disturbance and trembling of hands. It is followed by progressive increase in dementia over next 5 – 10 years. The disease commonly appears after the age of 40, through it can occur in any age group.

Schizophrenia : It is a type of mental illness or psychotic disorder which is characterised by progressive deterioration of personality, shallowness of emotional life, auditory hallucinations, delusions, illogical thinking, sense of being influenced by others and feeling of being controlled by outside forces. Schizophrenia can be caused by excessive dopamine production, alterations in neuropeptides, increased ventricular brain rations and decreased frontal lobe activity. Recovery is possible with regular use of chlorpromazine alongwith psychosocial therapy.

Causes of Mental illness : Mental illness is caused by a variety of factors acting singly or together. These cause are :

(1) Changes in Brain : See mental disabilities.

(2) Home Atmosphere : Fight, quarrel, cruelty and lack of warmth affection and accommodation in the family often lead to mental illness.

(3) Hereditary Factors : Tendency to develop mental illness is influenced healthy heredity. Chances of a schizophrenic child are 40 times higher from a schizophrenic couple than the normal one.

(4) Childhood Experiences : A balance of guidance, encouragement, affection, love discipline and companionship is a must for healthy mental development of a child. Lack of any of them and repeated unpleasant experiences lead to mental illness.

(5) Socio – Economic / Special Factors : A number of Socio – economic factors lead to mental illness. They include disparities, hunger, poverty injustice, lack of opportunities, cruelty, insecurity etc.

Treatment of Mental illness

Social Therapy : Mental health is governed to a large extent by adjustment of an individual in the community and the attitude of an individual towards the community. Sympathy shown by family members and community is extremely useful to an individual to overcome misery and adjust to stresses and strains. Curing a mental patient requires a lot of recreational opportunities, companionship, compassion and understanding by family members and society.

Psychotherapy : It is treatment involving psychological techniques like psychoanalysis, discussion, explanation, reassurance, etc. Psychoanalysis (founded by Freud) is method of reviving past and forgotten emotional experiences of a person so as to find out the reason for mental illusion and helping the patient to readjust attitude to causal experiences. Group psychotherapy is also resorted where a group of mental patients are allowed to speak out their problems before a psychiatrist. Suggestions made by the different patients help individual to understand one’s problems and their remedies.

(1) Drugs / Psychochemotherapy : A number of drugs are available to treat different types of mental illness, e.g., sedatives for promoting sleep, tranquillisers for reducing anxiety (e.g., valium or diazepam, larpose or lovazepam, sorapax or oxozepam, librium or chlorodazepoxide), antidepressants (e.g., trimpramine trazodone), antipsychotic (e.g., largactil or chlorpromazine, melleril or thioridazone, thiothixene, loxapine, clozapine, supiride) and antiepileptic (e.g., epilex, carabadac, carbatol, epitol).

(2) Shock Treatment/ECT (Electroconvulsive Therapy) The treatment is useful in curing acute depression, acute mania, stuper (confusional state) and some types of schizophrenia. The treatment given by expert psychiatrists involves placing of electrodes on the head of the patient and providing an electric stock for a fraction of second by passing a current of definite voltage. It produces convulsion.

Prevention of Mental illness

(1) Companionship where worries and unpleasant experiences can be discussed.

(2) Occasional review of one&aposs ideas in the light of experiences and vies points of others.

(3) Awareness of assets and liability.

(4) Time for the family and children.

(5) Proper relaxation and sleep.

(6) Routine physical exercise.

(7) Avoiding undue mental strain.

(8) Healthy pastime.

(9) Proper estimate of one&aposs potentiality.

(10) Creating small achieveable goals.

Community Health

The individual is a part of community. Community health depends on active participation of its members. you have just read how a person can be helped by the community to stay away from addictions. The mental health of an individual also depends to a large extent on the way he adjusts himself to the community and the way the community helps him adjust to stresses ad strains. The community plays a major role in the prevention and control of infectious diseases also.

Health centres

For community development and community health, the country has been divided (1st April, 1958) into 5000 blocks. On june 30, 1996, the rural areas of the country has 2424 Community Health Centres (each catering a population of 80,000 – 120,000 having 4 – 5 doctors, 30 bed hospital with laboratory and X-ray facility), 21854 Primary Health Centres (each catering a population 20000 – 30000, having a medical officer, one multipurpose female worker, one health educator, and supporting staff) and 132730 subcentres (one for 3000 – 5000 population, having one male and one female multipurpose workers). These health centres are operating under state governments.

A number of other health organisations are also providing basic health services like Central Government Health services (C.G.H.S.) dispensaries, Employees State Insurance (E.S.I.) hospitals, Indian Council of Medical Research (I.C.M.R.) Programmes, National Institute of communicable Diseases (N.I.C.D.) and a number of other national programmes/thrust areas like National Malaria Eradication Programme (N.M.E.P. started 1953 as part of 1st five year plan), National Filaria Control programme (N.F.C.P.), National Leprosy Control programme (N.L.C.P.), National Cholera Control (N.S.E.P. already achieved), national programmes for control of blindness/trachoma, cancer, AIDS, V.D., tuberculosis, etc.

W.H.O. (World Health Organization) also provides assistance and expertise for certain programmes.

Role of Health Centres

(1) Medical care (i) Giving first aid to all emergencies. (ii) Providing curative medical services to both outdoor and indoor patients. (iii) Refering patients requiring specialised treatment to proper hospitals.

(2) Prevention and control of Communicable Diseases. (i) Mass vaccination against various communicable disease like whooping cough, diphtheria, tetanus polio, tuberculosis, cholera, typhoid, etc. (ii) Coordinating with state and national agencies for programmes of malaria eradication, filaria, tuberculosis eradication, cholera control, leprosy control, V.D. control, trachoma control, AIDS control, etc. (iii) Taking special gatherings, exhibitions etc. (iii) Taking special precautionary measures during fairs, religious and political gatherings, exhibitions etc. (iv) Notification of the spread of epidemic diseases and measures to prevent the same, (v) Killing of mosquitoes, flies rats, strays dogs, etc, (vi) Filling or covering of mosquito breeding places (vii) Inoculation of larger water bodies with larvicidal fishes, plants bacteria and cynaobacteria. (viii) Isolation of patients with highly infectious diseases. (ix) Supervision of eating places, food and milk trades for preventing spread of communicable disease.

(3) Data Collection Vital Statistics : Community health workers collect and cross data about (i) Spread of infectious diseases. (ii) Prevalence of deficiency disorders. (iii) Progress of national / regional health schemes. (iv) Public resistance, hesitation or appathy to new programmes. (v) Sanitation. (vi) Pollution (vii) Sate drinking water and safe edibles.

(4) Maternity and Child Health (M.C.H.) : (i) Training of dais / midwives. (ii) Guiding expectant mothers about problems related to pregnancy. (iii) Routine examination of pregnant woman. (iv) Antenatal care. (v) Inoculation against tetanus. (vi) Providing facility for child birth. (vii) Post-natal care. (viii) Milk feeding programme. (ix) Prophylaxis against anaemia and vitamin deficiency. (x) Immunisation of infants against common diseases. Child survival and Sate Motherhood (CSSM) programme has been introduced since 1992. The incidence of vaccine preventable diseases has declined since then.

(5) Nutrition Education : Information is provided by health official as to the requirement of various untrients in persons of various ages, deficiency diseases, balanced diet, availability of nutrients in common foods importance of green and yellow vegetables.

(6) Sanitation : (i) Providing safe clean, germ free drinking water. (ii) Proper disposal of waste through proper latrines, compost pits, soak pit, kitchen gardens, smokeless chullah. (iii) Prevention of water pollution. (iv) Prevention of air pollution. (v) Hygienic and healthy working conditions. (vi) Hygienic and healthy housing (vii) Capture of rabid animals. (viii) Prevention of insect breeding and other vector control. (ix) Uncontaminated food.

(7) Community Health Education : Community health education is related to knowledge about transmission, prevention and mechanism of control of communicable disease, development of important noncommunicable diseases, personal hygiene and addictions. It is carried out through (i) Personal contact. (ii) Pamphlets and other printed materials. (iii) Slides, charts, pictures, cinema, radio, T.V. and other audio – visual aids.

(8) School Health Services : They provide for (i) Medical check up of the child at the time of admission and regular check up later on at intervals. (ii) Treatment and follow up action for any disorder. (iii) Immunisation. (iv) Regular screening by class teacher. (v) Guidance in personal hygiene (vi) Health education. (vii) School sanitation. (viii) School facilities including safe drinking water, prevention of infection from common glasses, proper sitting lighting and ventilation, etc. (ix) Midday meals in certain areas.

(9) Family Planning / Family Welfare : Keeping the number of children per couple to 2 is to goal of family planning so that the size of Indian population becomes stable. Health centres give free (i) Family planning advice (ii) Family planning services.

National Immunisation Programme

With the success of small pox eradication programme, an impetus has been given to eradication of six preventable disease through universal immunisation programme. The six diphtheria, pertussis (whooping cough), polio, tetanus, tuberculosis and measles. The programme was launched by W.H.O. In May, 1974 and is expected to reach every child by 2000 A.D. In India, It was launched in 1985 with reaching every child in 1992. India has fixed the year 2000 A.D. As year of health for all.