Friday, 7 August 2020

Committees in PSM

The Many Committees in PSM tell a story- lets read it.
(Questions asked have been marked with *) 

The story begins in 1943.
Government of India (still under the British) appointed BHORE (SIR JOSEPH BHORE) to assess
the health situation in India and make recommendations. He took 2 years roaming around and made his recommendations in 4 volumes! Keywords we need to remember-
• Integration of preventive and curative services at all administrative levels
• Development of PHC in 2 stages- short term and longterm (called the 3 million plan) (*)
• Concept of “social physicians” (3 months training) Then we got independence and apparently got smarter. 

We decided to see if what the Goron ka Bhore had recommended is working or not! 

So came the MUDALIAR COMMITTEE in 1962 to provide afresh look. It said strengthen
what we have, don’t build more. 

Next year (1963) came the CHADAH COMMITTEE. It was
made to study arrangements for the NMEP’s maintenance
phase. It said one basic health worker should work for 10,00 population. And they should be
multipurpose health workers-malaria + family planning +
vital statistics (*) 

Then 2 years later (1965) came the MUKERJI COMMITTEE. They very smartly realized that what
Chadah ji said is not working.
Neither Malaria nor Family planning work is being done properly. So let’s separate them.
Let’s make basic health worker work for all other random stuff.
And family planning assistant to do only family planning jobs.
They also said separate malaria from family planning!
Then in 1966, same committee found that it got too much for
the states to do because of lack
of funds. So they worked out a system called “Basic Health Service” being provided at the
block-level to figure out the
administration jargon. 

JUNGALWALLA COMMITTEE came the year after that (1967).
Srinagar mein baithke they
talked about how to eliminate private practice for government
doctors and just how to integrate health services. So they came up with the idea of
“Integrated Health Services” (*) 

met in 1973 (6 years later) and this committee was called the
“Committee on Multipurpose
workers under Health and
Family planning” (because we like revisiting the past!). They said
• Convert the current Auxilary Nurse-Midwives into Female Health Workers
• Convert the Basic Health Workers/Malaria Surveillance Workers/Vaccinators/Health Education Assistants/Family planning health assistants into
Male Health Workers
• Introduce MPWs first into Malaria maintenance phase and Smallpox controlled areas, then spread them out
• One PHC for 50,000 people
• Every PHC should have 16 subcentres 

• Every subcentre should have 1 male and 1 female health worker Then two years later came

They wanted to make a plan to train all these new position people. They said we need more people (these positions aren’t enough!). So their recommendations were
• Train para and semi-professional workers- like school teachers etc to help out in the community 

• Establish 2 more cadres of health workers- Multipurpose
Health Workers and Health Assistants between the community level and doctors at PHCs 

• Develop a Referral Services Complex

• Something about medical education also

• Most importantly it said that
Primary health care should be provided within the community
itself through specially trained
people – place the health of the
people in the hands of the
people themselves! (*) Its long I know..but I hope it

Acoustic neuroma

Most common intracranial schwannoma.

80% of all cp angle tumours.

it's benign. B/l acoustic neuroma is diagnostic of NF2. 

Most common age group is 40 to 60 yrs of age. 

Tumour is radioresistant.90 % of cases are u/l. 

Most schwannomas are sporadic.

Earliest symptom: Deafness, tinnitus .retrocochlear hearing loss, true vertigo not seen due to central adaptation. Marked difficulty in speech understanding.earliest nerve involved is 5th cranial nerve.2nd nerve is facial.

Earliest sign: corneal reflex is impaired.
Histelberger sign and teal's sign +ve .
recruitment is negative.
BERA: delay in 5th wave.
MRI is gold standard investigation.
Vertebral angiography is done for differentiation from other CP tumours.
Surgery is TOC.
For hearing rehabilitation in b/l acoustic neuroma: Auditory brain stem implant.