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INDEX

President, IMA MS DR . BAKULESH S. MEHTA (022) 26832359 / 9820131926 [email protected]

Imm. Past President, IMA MS DR. ARUN B. PAWADE (07157) 223750 / 9373240703 [email protected]

Hon. State Secretary, IMA MS Dr. HOZIE D. KAPADIA (022) 23711051 / 9833793005 [email protected]

Hon. Treasurer, IMA MS DR. SHIVKUMAR S. UTTURE (022) 24305373 / 9820089321 [email protected]

Sr. Vice President, IMA MS DR. M. S. PATWARDHAN (0233) 2232104 / 9423036173

Vice President, IMA MS DR. T. C. RATHOD (07232) 245186 / 9422168300 [email protected]

Vice President, IMA MS DR. RAVINDRA D. JAGTAP (02166) 222998 / 9921992168 [email protected]

Vice President, IMA MS DR. ANIL SUCHAK (022) 2889148 / 9820080151 [email protected]

Hon. Jt. Secretary, IMA MS DR. ANIL LADDHAD (0712) 2765287 / 9822565225

Hon. Jt. Secretary, IMA MS Dr. SANJEEV SHARANGPANI 9422429224 [email protected]

[email protected]

Hon. Jt. Secretary, IMA MS DR. JAYESH M. LELE (022) 28823408 / 9819812996 [email protected]

Chairman, IMA MS SSS DR. ANIL J. TALATHI (02143) 252261 / 9422594236 [email protected]

Hon. Secretary, IMA MS SSS DR. SHRIKANT H. KOTHARI (022) 25171198 / 25001269 / [email protected]

9821012970

Hon. Treasurer, IMA MS SSS DR. SHAILENDRA C. MEHTALIA (022) 25132114 / 9820377174 [email protected]

Director of Studies DR. AKIL CONTRACTOR (022) 26127481 / 9892084360 [email protected]

IMA MS CGP Faculty

Hon. Secretary, DR. DILIP G. DEODHAR (020) 24334136 / 9371005036

IMA MS CGP Faculty

Hon. Jt. Secretary, DR. VIVEK BILLAMPELLY (020) 26832658 / 9822894963 [email protected]

IMA MS CGP Faculty

Chairman, IMA AMS Chapter DR. RAVI S. WANKHEDKAR (02562) 246695 /94222 96495 [email protected]

Hon. Secretary, DR. MAYA TULPULE (020) 25440530 / 9923709210

IMA AMS Chapter

IMA MAHARASHTRA STATE OFFICE BEARERS 2009-10

Editorial ................................................................................................. 2

President’s Message .............................................................................. 4

Guest Editor .......................................................................................... 4

Hon State Secretary’s Message ............................................................... 5

Date with Diabetes, Knowing the Basics .............................................. 6

Role of Family Physician in Screening & prevention of Diabetes ......... 9

Expanding the GP’s role in Management of Diabetes ....................... 11

Standard of Care in Management of Diabetis Mellitus .................... 12

Management a Young Diabetic . ......................................................... 14

Understanding the Glycemic targets and Glycemic Control .............. 16

Dietery Guidelines for Diabetes. ........................................................ 17

Carbohydrate Counting in Diabetes Management ............................. 18

Myths and Truths about Diabetic Diets ............................................. 20

Diabetes ---Exercise–Yog and… ........................................................... 21

Behavioral Aspects of Lifestyle Modifications in DM & Obesity ....... 23

Why Metformin is the first choice in Type 2 Diabetes ? ................... 25

Sulfonylureas in the Management of Type 2 DM. .............................. 27

DPP IV Inhibitors ................................................................................ 30

When and How to use Pioglitazne in Type 2 DM. .............................. 34

Initiating and Managing Insulin in General Pracitice. ......................... 36

Hypertension with Diabetes: A double burden for public health. ..... 38

Diabetic Dyslipidemia : An Update. .................................................... 41

Strategies for slowing Kidney Disease. ............................................... 44

Preventing Diabetic Foot .................................................................... 47

Eating Attitude Test, a questionnaire .................................................. 48

Diabetics and Erectile Dysfunction. ................................................... 49

You must know about Pregabalin to treat Neuropathy pain .............. 53

What GP’s must know about Type 1 Diabetes Mellitus. ................... 54

Ayurvedic Strengths for Management of Diabetes Mellitus .............. 57

Role of Vitamin D in Type 2 Diabetes Mellitus. .................................. 60

What Gp’s should know about Clinical Trials ..................................... 62

Questions & Reflections on Diabetes Management in India ........... 64

DISCLAIMER : Opinions expressed in the various articles are those of the authors and do not reflect the views of

Indian Medical Association Maharashtra State Branch. The appearance of advertisement in MAHIMA is not a

guarantee or endorsement of the product or the claims made for the product by the manufacturer.

EDITORIAL BOARD

Chairman : Dr. DEEPAK K. JUMANI

Ex.- Editor : Dr. ANIL SUCHAK

Ex.- Editor : Dr. P.N. RAO

Ex.- Editor : Dr. AJOY K. SAHA

Members

Dr. RAJESH SUBHEDAR Dr. JAYESH LELE

Dr. BALKRISHNA INAMDAR Dr. Y. S. DESHPANDE

Dr. SUBRAMANIUM JAYARAM Dr. GOPINATHAN INDUMATI

Dr. NIRANJAN VAIDYA Dr. AVINASH BHONDWE

Dr. VYANKATESH METAN Dr. RAJENDRA GANDHI

Dr. SANJAY DESHPANDE Dr. KRISHNESHKAR

Dr. RAVI PATEL Dr. GURUDATT BHAT

Dr. AJAY TILWE Dr. GOVIND DHAWALE

Published by : IMA MAHARASHTRA STATE

Contact for write-ups, articles, interviews andadvertisements : Editor : Dr. Deepak Jumani

E-mail : [email protected]

IMA Bldg, 2nd Floor, J.R.Mhatre Marg, J.V.P.D. Scheme,Juhu, Mumbai - 400 049. Office : 2623 2965 / 6521 5756

E-mail : [email protected] : www.imamaharashtrastate.org

Advertisement Cheques must be drawn

in favour of IMA MAHARASHTRA STATE

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IMA………………….. WHY ???DR. RAM ARANKAR

Past President I. M. A. M.S. &

Past Chairman, S.S.S., I. M. A. M. S.

Friends, fortunately, I had an opportunity of

visiting about 75 branches of 1.M.A. all over

Maharashtra …! Two questions were frequently

asked everywhere .... Why should 1 join I MA.? &

What I.M.A. is doing for us ? Friends, it’s time for

explanation

With 2 lac members countrywide, Indian

Medical Association, is one of the largest

organization of Allopathic doctors in the world....

recognized by Govt. of India, of which

Maharashtra has the largest strength of 23,000

members.

• It is needless to say that, being the organization

of the doctors, I.M.A. invariably works for the

welfare of the doctors and their family

members How?

1] It is the only Parent Organization, which

safeguards the interest of doctors in the

society, Government and Court of law as

well. e.g. Our approach to Supreme Court

about Profession Tax, C.P.A., Assault on

Doctors etc.

2] All types of Educational Programmes for

the doctors such as C. M . E., Lecture

Demonstrations, Seminars, Panel

Discussion,

Exhibitions, Workshops, Conference etc.

and many other Social Awareness

Programmes are organized through I.M.A.

3] In strenuous matter and in the actual

personal assaults over the doctors, strong

backing is given by I.M.A. to its members.

4] Whenever there is a case under ‘Consumer

Protection Act’ on the doctor, I.M.A. can

provide guidance, through its ‘State

Medico Legal Cell’ to the aggrieved

members.

5] In all those problems, which are

detrimental to the health of society, e.g.

quackery, superstitious beliefs, alt typed

of pollutions, addictions, Child Labour,

female faticide, harassment of women and

in many other problems, I.M.A. has taken

lead by protesting through Public

Awareness Programmes, Lectures, Rallies

and Press Conferences etc.

6] I.M.A. is always helpful in the effective

implementation of the health policies of

the Government, e.g. Triple Polio, hepatitis

B, Malaria Control, National Family

Welfare Planning, AIDS awareness etc.

7] At the HQ’s of I.M.A. substantial amount is

deposited as ‘Benevolent Fund’ which can

be useful to any of its members and

branches in Natural Calamities.

8] All over India, in almost all the big cities,

I.M.A. has got ‘Guest Houses’ which can be

used in reasonable rates by the doctors

and their family members with prior

intimation.

9] As per the Public Notice given by M.M.C.

after every five years re-registration wilt

be mandatory for every doctor, which wilt

be based on the specific ‘quota’ of credit

hours i.e. 30 hours (6 hours per year)

attended by the doctors in 5 years. The

conducting authority will be local branch

of I.M.A. which will be certified by I.M.A.

along with M.M.C.

10] I.M.A. offers many welfare schemes for the

doctors and their family members like State

and National Social Security Scheme,

Tailor made Mediclaim Insurance Scheme,

Professional Protection Scheme etc.

11] Members can join conferences and study

tours organized within the country or

abroad in concessional rates.

• The N.S.S.S. and State Social Security Schemes

together have a total fraternity benefit amount

of more than 8.5 lacs, with a nominal yearly

contribution as low as about Rs. 3,000/-,

without any medical examination or

complicated paperwork. No Insurance Scheme

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comes at such a low premium. Moreover, I.M.A.

gives full benefit amount even for the physical

and mental disability for which, the insurance

company does not pay.

• For Tailor made Mediclaim Insurance Scheme,

we have a coverage of 1.5 lacs fore major

diseases for 5 years, by an initial one time

payment of Rs. 5,500/- per person only ……..

which can be availed off by all our dependent

family members upto the age of 75 years !

• So, this explains how very vital for every

doctor, to become ‘Life member’ of I.M.A Why

Life member?

a] Life membership of I.M.A. is the pre-

requisite or basic condition to become

member of any one or all the welfare

schemes of I.M.A.

b) Just pay Rs. 5070/- for single member and

Rs. 7035/- for couple members, once for

all to the 1.M.A. and forget about any yearly

payment for the rest of life

c) No trouble to the members or the local

branch to keep the unwanted record of

yearly account of I-LF.C. or the suspension

of the branch due to non-payment ..

………etc.

• So, please, be a life member of LM.A. and be a

member of all the welfare schemes for the

safety of yourself and your family members at

an earliest !!!!

THE SOCIAL SECURITY SCHEME• Friends it is one of the best example of,

what l.M.A. is doing for the Doctors and their

family members.

• As you may observe, not all doctors will have

flourishing practice, but there are very few,

who with their knowledge/skill and luck are

earning plenty of money. All others are, as we

say - - - they also ran - - - type i.e. they are only

able to maintain better standard of living.

Moreover, many of the doctors are taking loan,

from all possible sources to give medical

education to their children or to send them

abroad for higher education. So much so that,

during their personal emergency, they are

handicapped!

• Now if, we look at our profession, it is totally

one man show. We expire……. and from the next

day, our income comes to zero ! Considering

the stress we are undergoing, in medical

practice, unexpected death is very much

possible!

• To give another example, when we go to a doctor

friend for any family function, we carry at least

Rs. 100/- as ‘Present’. But when the same friend

expires, though we have a strong desire to help

his family members, there is limitation to our

personal help. However if we collect Rs. 100/-

each from our fellow doctors, we can give a

sizable amount to the family members of the

deceased. So this is the main intension to

formulate this Scheme, purely on brotherhood/

sisterhood basis! In this Scheme, we not only

give, the fraternity amount after death of the

member, but we also pay full amount in

physical or mental disability of member, when

he cannot pursue his practice lifelong.

What are the pre requisites?

1. You must be below 60 years of age.

2. You must be Life Member of I.M.A.

What we need?

1. Duly filled form signed by the President/

Secretary of the Branch, with photograph of

self and nominee as well.

2. Xerox Copy of age proof i.e. (a) School/College

Leaving Certificate, (b) Municipal Birth

Certificate, (C) Front page of LIC. / Passport, (d)

Pan Card

3. Collective D.D. of the following amount:

a] Rs. 3,000/- as Fraternity Fund Contribution

(To be refunded with F.F. at the end)

+

b) Entrance fee as per age group

1) Age 20 to 30 Rs. 1,000/-

2) Age 30 to 40 Rs. 2,000/-

3) Age 40 to 50 Rs. 3,000/-

4) Age 50 to 55 Rs. 4,000/-

5) Age 55 to 60 Rs. 5,000/-

+ c) Subscription of Rs. 100 + 100 = Rs. 200/- for

first two years.

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So, i.e. if a doctor aged 28 years wants to become member of he has to get a DD. of Rs. 3000/- + Rs.

1000/- + Rs. 200/- Rs. 4200/-

D.D. must be drawn in favour of “I.M.A. M.S. S.S.S.” Payable at Mumbai. ’AT PAR’ or ‘MICR’ cheques

are also allowed.

Write your name/branch behind the D.D. and send it to the Hon. Secretary, I.M.A. M.S. S.S.S. at the

address given on the form. You will become member of the scheme from the 1st day of the following

month after realisation of your D.D. and entitled for the benefit exactly after one year, unless; your

death is accidental. In which case the scheme pays full amount before completion of one year also.

After completion of one year, you start getting letter from the Scheme every year, which informs

you, how many members death was there in that year (i.e. from 1st April to 31 March of the year

completed) and how much amount you are supposed to send. For example, if there are deaths of 10

members, then

10 deaths x Rs. 100/- = Rs. 1,000/-

Rs. 1,000/- + Rs. 100/- Subscription fee for the year = Rs. 1,100/-

• D.D. or AT PAR cheque.

• You have to send the amount for every year, continuously for 25 years. After that you are not

supposed to send the amount but, you are member of the Scheme till your death, provided you

send the subscription fee Rs. 100/- regularly every year. You are entitled for the F.F.C. from the

total No. of members at the time of your death.

• It is because, out of Rs. 100/- we take for, every death Rs. 70/- are given to the nominee of the

deceased and Rs. 30/- are kept in a corpus. From the interest of the corpus, the F.F.C. of retired

members is paid every year.

To give an example

I have personally became member of S.S.S. in the year 1992 when the total members were 600

and the benefit amount to the nominee was Rs. 40/- x 600 = Rs. 24,000/- Total amount i have paid to

the Scheme tilt today is Rs. 700/- deposit + Average Rs. 1000/- for 10 deaths, yearly for 18 years i.e.

18,000/- So it comes to about Rs. 20,000/-, but if my death is there today, my family members or

nominee will receive Rs. 70/- x 6500 present members = Rs. 4,55,000/-. So more members, more

benefit is crystal clear! No other scheme or policy gives such a vast benefit and safety today. Even if

we compare

It with L.I.C., except the similarity of tax benefit in both’ there is tremendous difference between two

• Not only that, but for convenience of members, we have given so many facilities e.g. Advance F.F.C.

of Rs. 5000/- Rs. 10,000/-, Rs. 15,000/- to avoid deletion of membership and facility of revival of

membership etc.

So friends, considering all the information regarding the scheme, be an immediate member of

the scheme. What are you waiting for?

L. I. C. S. S. S.1 Medical Exam. Must. No Medical Exam.

2 With increase age/or with disease the installment

is unjust or even the policy may be rejected. No question.

3 For Rs. 4,55,000/- i.e. today’s benefit amount, Installment will depend

the L.LC. premium will not be less than Rs. 25,000/- on death sand not more than

to 30,000/- year. Rs. 2500/- to 3000/- per year.

5


4 Payment only after death. Full payment after physical and

mental disability also.

5 Procedure to get money is time consuming. The nominee receives a cheque of full

payment within 15 days from the

information of the death without

any question or query.

MEDICAL INSURANCE SCHEME

1] It is a group health insurance scheme (Tailor made) for the doctors and their dependant family

members i.e. Wife I Kids below 18 years / Parents below the age of 75 years.

2] For Rs. 5,500/- ‘ONE TIME’ payment, ‘PER HEAD’, the individual is covered for ‘Rs. 1,50,000/- for

‘FIVE YEARS’ for 10 major diseases.

3] The diseases covered are :-

1] All cardiac diseases 6) All forms of cancer

2] Kidney failure and transplant 7] Encephalitis

3] Stroke 8] Major Neuro Surgery

4] Joint replacement 9] Liver Cirrhosis/failure

5] Major Accidents with 10] Snakebite

hospitalization of more than 7 days.

4] The existing disease is not covered.

5] Those who has not availed benefit in the previous policy, can increase their Insurance Amount to

Rs. 3,00,000/- by paying Rs. 11,000/- per head.

6] If anybody has taken insured amount partly i.e. Rs. 75,000/- within first two years, then he can

avail or claim for remaining Rs. 75,000/- also, within next 3 years for the same or any other

disease in the list. (In the span of 5 years)

7] Above the age of 45 years, following investigations will have to be attached with form.

a] Heaemogram b] Urine Report C] Blood Sugar (FIP.P) d] ECG.

e] Certificate of M.D. Physician indicating presence or absence of any disease.

8] Requirements :-

1) Duly completed form

ii) Photograph of all persons insured.

iii) Investigation reports for the age above 45 years.

iv) D.D. collective Rs. 5,500/- each x the number of dependents insured drawn on “l.M.A. M.S.

MIS” payable at ‘PUNE’.

v) To be sent on following address :-

‘I.M.A. M.S. MIS’

Dr. Nitu Mandke, I.M.A. House,

Tilak Road, Pune — 410 030.

Contact No. Dr. Bhondwe ......................... +91 9823087561

Mrs. Surabhi Joshi ............... +919860595369

9] Since it is group policy, it will be kept with I.M.A. Zerox copy will be issued within three months

to the members after scrutiny and processing.

10) Think of the big difference in the installments charged by other companies, for the same coverage,

and that too on yearly basis, get insured for you and your family members, at an earliest, with

I.M.A. M.I.S.

6


Dear Fellow Members,

Seasons Greetings to you all.

Friends as you all know the IMA MS PPS ( IMA Maharashtra State Professional Protection

Scheme) was started on 1st July 2008 that is Doctor’s day. We are very glad to inform you that the

response from the members has been very encouraging we have enrolled around 270 members till

date and the membership is increasing by the day.

I would like to bring to your notice some of the highlights of the PPS.

Why at all there arose a need for the IMA to start its own PPS?

1. As we all know that most of us are insured with some or the other insurance companies

or some other private agencies like Apex for our indemnity cover.

2. These companies only take care of your financial part of the litigation.

3. They are not bothered about what will happens to the reputation of the doctor who is

undergoing litigation.

4. These companies are very eager to do an out of the court settlement with the complainant

hence giving the impression that the doctor is at fault.

5. The lawyers provided by these companies are not expert in dealing with the medical

negligence cases. In all the cases the onus of providing expert opinion is on the doctor.

6. Most of the doctors who had an experience with insurance company would agree that

their services were far from satisfactory.

Looking at all these things and to make matters easy for the IMA members this novel scheme was

started in the State of Kerala and to tell you the success story. Kerala state had a litigation rate of 30

to 40% against the doctors. As the scheme became popular and more and more members enrolled in

the scheme the State PPS started fighting the cases on behalf of the doctors. Now the present story is

that the litigation rate has come down to around 10% because the scheme is not ready to make an out

of court settlement and fights the case till supreme court. The effect of this was that all the Doctors

in Kerala are members of IMA and also members of PPS.

Similarly Gujarat State PPS is also very successful. There are 8000 members of the Gujarat state.

Due to the overwhelming popularity of the scheme the first 6000 members in Gujarat state don’t have

to pay any premium for their cover with the scheme.

There is a National PPS scheme also which operates from Kerala the advantage of this scheme

is that one can buy multiple units of cover in this scheme. At the time of award of compensation more

and the cover with the state scheme is not sufficient the both the schemes can work together and

settle the claim.

What is the PPS Scheme?

1. This is a Professional Protection Scheme Started by IMA Maharashtra State Branch for the

benefit of its members.

2. All the members of IMA Maharashtra can enroll in this scheme. Before the first renewal the

Member must become a life Member of IMA.

3. A member can enroll in the scheme by paying a requisite amount of admission fee(One time)

and an annual fee which will be payable every year. The fee depends upon the specialty of

the member and number of beds in the hospital. The fee is to be payable by a D.D. in favor of

IMA MS PPS payable at Nagpur.

4. The cover of the member Starts from the 1st of the next month and the renewal will be on 1st

of April every year.

7


What will the scheme do for its Members?

1. Provide legal defense in civil/criminal cases before the medical councils, consumer

redressal fora and courts.

2. Provide reasonable expenses for bail.

3. Pay fine with in prescribed limits.

4. Pay the settlement arising out of civil or consumer protection act within prescribed

limits.

Has the scheme had any cases against any of its members?

Yes the scheme did have four cases against its members and in all the cases a proper legal

course was advised to the member and all the members were satisfied.

Till now the response to the scheme has been very good. Looking at the benefit this scheme

provides, we appeal to all the members to enroll in this scheme.

Finally we appeal to all to help IMA movement grow by enrolling yourself as members of PPS

Dr. Krishna Parate 9823050572 Chairman IMA MS PP

Dr. Anand Kate‘ 9822278590 Co-Chairman IMA MS PPS.

8


BIO-MEDICAL WASTE—LEGAL STATUS

MPCB Authorization/Registration

• All of us now know that the said 1998 Act as

enacted by Parliament pertains to the Bio-

Medical Waste (Handling & Disposal). In

accordance to the said Law all Medical

Practitioners (General Practitioners,

Consultants, Hospitals, Nursing Homes etc.)

must fill up the form with MPCB(Maharashtra

Pollution Control Board) and get an

‘Authorization’/Registration.

• Failing to fill up the forms and get this

‘Authorization’/Registration from MPCB is a

gross contravention of the Law and nobody

can save the Medical Practitioner from the

penalties that would be levied by MPCB in

such instance.

• With this communication we urge those IMA

Members/Hospitals, who have as yet not

registered and received ‘Authorization’/

Registration from the MPCB, to approach

MPCB offices STAT and complete the necessary

legal formalities.

• If any member has a problem in getting

registered with MPCB he/she may contact IMA

MS office.

2) Incineration v/s Deep Burial

• All IMA members are herewith advised that

as the Law has clearly stated that “Category

1: Anatomical Body Waste type of BMW can

be disposed by way of INCINERATION / DEEP

BURIAL METHOD”.

• In towns with population less than 5 lakhs

and in rural areas the ‘Deep Burial Method’

of disposal of Category 1 BMW is legally

permissible. It is observed that the MPCB

officials and the Incinerator Service Providers

have been illegally pressurizing our medical

fraternity to join the Incinerator Service

Provider.

• All of us need to stand as one to oppose this

unholy nexus of the MPCB officials and Service

Providers forcing us to join the Incineration

Service Provider at the rates finalized

unilaterally by the Service Provider.

• The MPCB notices are willfully

misrepresenting the facts in the case of PIL

(Nos: 32/2006 & 41/2006) in Bombay High

Court and the Hon. Court directive of March

2006. In fact these Public Interest Litigations

in the Bombay High Court were pertaining to

Large Corporation, Municipal and other Govt.

Hospitals in Metro Cities who had been

disposing Category 1 BMW by Deep Burial

Mode. After hearing the plea the court then

directed the Public Health Dept. of Govt. of

Maharashtra to file an affidavit conveying

their ‘Action Taken Report’ in adherence to the

1998 Law.

• In another instance, a Star Question (LAQ) was

raised in the Maharashtra State Legislative

Assembly (Winter Session 2008) by Hon MLA

Dr. Vinay Natu et al regarding the newspaper

item of action notice by MPCB against the

Ratnagiri Jilha Shasakiya Rugnalaya (Civil

Hospital) for illegal disposal of BMW.

• In the answer given on the floor of the esteemed

House the Public Health Minister stated that

the BMW disposal of the Civil Hospital,

Ratnagiri was done by ‘Deep Burial Method’

in accordance with the Law.(a copy of this

communication is attached).

• Hence it should now become amply clear that

the stance of the MPCB Officials that everybody

MUST join the Incinerator Facility because

there is a Court directive (and ‘Deep Burial

Method’ is not permitted) is a big HOAX being

perpetrated on the Medical fraternity. (Now,

Wake Up!)

• So, at every town and rural areas we can (and

MUST) use the Deep Burial Method of disposal

for Category 1 Anatomical Body parts Bio-

Medical waste. We should not fall prey to the

‘Dadagiri’ of MPCB and Service Provider.

3) Standards for Rates of (CBTSD)Service Provider

In various Metro Cities there are many

authorized Common Bio Medical Waste Treatment

Storage and Disposal Facility (CBTSD) Service

Providers. It is now very clear that :

9


1) These Service Providers have been fixing their

Service Charges, Registration Charges etc. at

their own sweet will.

2) There is, at present, no standardization of

rates for CBTSD Service Providers

3) The MPCB is not accepting the responsibility

in the matter of standardization of these

rates

4) The Medical Fraternity is left at the mercy of

the CBTSD Service Provider and MPCB always

favors the Service Provider.

It is essential that we, as IMA MS, convey our

demands to the State Government that:

1) The Govt. of Maharashtra should constitute

an Advisory Committee to supervise the BMW

issue. In fact, in the said notification of the

Law of 20th July, 1998 this has been clearly

stated on Page 3, Item No:9.

2) IMA MS must have proper representation on

this Advisory Committee as stated in the Law.

3) The fixation of Service Providers’ Rates, Deep

Burial Method Applicability etc. issues

should come under the purview of this

committee. These issues can not be left at

the mercy and free will of the MPCB officials

as it would be a gross contravention of the

Law as enacted by the Govt. of India.

10


Dear Friends

In this article I am going to highlightimportant and silent features of some of theprojects launched by IMA Head Quarters.These projects have all the ingredients showingIMA’s concern towards the society. If sincerelyimplemented by any IMA Branch it willincrease their reputation in their own area.

1. Aao Gaon Chalen

Mahatma Gandhi said “India live in itsvillages” President Shri. A.P.J. Abdul Kalamdares us to dream, and to dream big. Politicianswrongly blame medical fraternity for not goingto villages. Considering many such thingsNational IMA launched its dream project “AaoGaon Chalen”

“Aao Gaon Chalen” was a multidisciplinary nationwide rural health project. Itwas expected that this will sensitize themedical fraternity to village health problems andwill serve the poor and built a positive image ofmedical profession in the minds of people.

The projects aims at holistic improvementin village health using existing infrastructureand promoting inter-sectoral co-ordination andnetworking through active involvement of theIMA task force, the Government health caredelivery system and the community.

Proposed Health Activities during theproject.Planning and organization of activities.(a) Each branch of IMA will plan its health

activities based upon the prioritization ofneeds as per the prevalent health problemsin the area.

(b) The IMA branch will survey the village tobe adopted to know the demographicprofile and identify the health care needs.

(c) Active collaboration with the state / districthealth care delivery system will be sought.

(d) The schedule of activities will be preparedin advance under information to HQs.

The proposed activities are :Creation of health awareness

General health and hygiene, adolescenthealth, FP, MCH care esp. ANC and anaemia,gender sensitization, quackery, sexdetermination, female infanticide, etc.(a) Katputli shows; nukkad nataks(b) School health talks; essay and painting

competitions(c) Debates in schools and colleges.(d) Social meetings involving pradhans, gram

sabha members, community leaders andreligious leaders.

Diagnosis and treatment

(a) Health camps comprising ANC care, FPguidance and counseling OPD services forminor ailments.

(b) Special clinics / camps – detection ofanaemia, DM HT, CAD, TB leprosy,gynecological problems, filariasis, etc.

(c) Immunization clinics.(d) Cataract operation camps(e) Sterilization camps

Other activities.(a) Formation of support groups (Kishori

groups, geriatric groups, diabetic groups,etc.)

(b) Blood donation camps(c) Important health days’ celebrations(d) Adolescent health activities.(e) Paediatric health care(f) Geriatric health care(g) Participating and strengthening national

health campaigns / programmes.

Expected outcome

(a) Orientation of doctors to village healthproblems.

(b) Fulfillment of iMA’s dream of providinghealth to the most vulnerable.

(c) Better image building for the medicalprofession.

(d) Demystification and socialization of themedical profession

(e) Better co-ordination among health servicesthrough public and private partnership.

(f) Effective and efficient rural health caredelivery system.

11


(g) Promotion of inter-sectoral co-ordinationto better the village health scenario.

(h) Promotion of community participation andinvolvement in health

(i) Control of epidemics and endemics.

The project will be a catalyst forreplication and furthering future healthdevelopment activities.

Initially it was decided that “Aao GaonChalen” Committee will be formed at local,state and national level with a good coordinationbetween them. Each local branch will adoptone village and start doing activities there.According to the size and interest of themembers, IMA local branch will adopt morevillages in future.

2. Anaemia Free India

Anemia Free India campaign waslaunched by IMA HQ on 1st July 2005 (Doctors’Day). This project was based on followingimportant observations.

(a) India leads in iron deficiency anaemia inworld.

(b) Over 90% Indian Women,. adolescent girlsand children are anaemic.

(c) Anaemia results in physical weaknessand increased vulnerability to innumerablediseases.

(d) Anaemia can cause adverse pregnancyoutcomes and even mother’s death.

(e) Anaemic mothers bear anaemic children.(f) Anaemia not only effects children’s

academic performance but hampers theirlinear growth and development.

As all members are qualified doctors Ishould not detail out the causes of anaemiaand how it affects the patient. In short, it effectson concentration, memory, tired feeling,irritability, decrease in intelligence, decreasesin physical fitness, ultimately decreasing theefficiency in all the people effected by anaemia.IMA has taken a serious note of its negativeimpact on the health scenario of the countryand decided to decrease the prevalence and

incidence of anaemia and launched “AnaemiaFree India” Campaign.

IMA decided a way out

(a) Public awareness programme throughrallies and walks.

(b) Anaemia detection & treatment camps bylocal branches in their area & in villagesadopted under AGC.

(c) Awareness programme in schools /Colleges / Community.

(d) TV/Radio Talks/Press Conferences.(e) Joint meetings of Doctors/Nurses/

Teachers/ICDs staff/NGOs at each IMAbranch.

It is IMA’s dream to make India Anaemia Free.We appeal all our members to help IMA toachieve this goal. Arrange Diagnostic andtreatment Camps in nearby schools, villages,slums etc. Carryout public awareness ralliesin your areas. Write articles in News Papersfor public awareness.

Dr. Adhao

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• The Central Government of India has notified the new Ethics regulations in the Gazette of

India on April 16, 2002, provides that “ A Physician should participate in professional

meetings as part of Continuing Medical Education Programmes, for at least 30 hours every

five years, organized by reputed professional academic bodies or any other authorized

organisations. Since the above provisions have become mandatory, it has become necessary

for the Maharashtra Medical Council to consider the whole matter and issue necessary

guidelines in regard to its implementation. It has become necessary to accredit identified

organisations so that the certificates of attendance at CME issued by them can be taken as

valid

• ORGANISATIONS/ ACADEMIC ACTIVITIES TO BE ACCREDITED

FOR C.M.E. CREDITATION

The Maharashtra Medical Councils shall consider the applications for accreditation of

following organisation for holding CME programmes and convey their approval if the organisation

fulfils all requirements.

1. All recognized Medical Colleges

2. Indian Medical Association or the State Chapters of the Indian Medical Association.

3. National Academy of Medical Sciences.

4. Specialists Associations (only National level Associations or their State Chapters).

5. All recognized Postgraduate Medical Institutions.

6. Central Govt. and State Govts. Hospitals (including Districts Hospitals) and training centres in

health field including Ministry of Health and FW, Defence, Railways.

7. International conference of professional bodies.

8. National conference of professional bodies.

9. State Level Conference of National Organizations.

10. Professional bodies of repute functional at District, City, State Level eg. Physician Forum/

Surgeons Forum/ Doctors Forum etc. in their areas/ specialties and super specialties.

Notice Dated 29/01/2010

Increase of Registration Fees

As per the notification dated 25 Jan 2010 issued by the Government of Maharashtra in

respect of registration of Provisional certificate fee increased from Rs. 120/ to Rs. 500/ (Rupees Five

Hundred Only) and for permanent registration fee is from Rs. 540/ to Rs. 2000/ (Rupees Two thousand

Only) with effect from 1st Feb. 2010 .

• Sd/

• (Registrar)

• Maharashtra Medical Council

• Fees Structure

• Sr. No. Details Fees in Rupees.

1 Provisional Certificate 500/- 2 Registration Certificate 2000/- 3 Additional Qualification

120/- per qualification 4 Good Standing Certificate (MMC) 120/- 5 Duplicate Certificate 120/

- 6 Change of Name 70/- 7 Letter Certificate 70/-8 N. O. C. 70/- 9 Renewal Fee 500/- up to

01.03.2007. The registered practitioner who fails to apply for the renewal of his registration

within the specified period may apply in the prescribed form along-with late fee of rupees

one hundred per month or part thereof, for renewal of the registration as per Sec. 23(b) MMC,

Act 1965. 10 Good Standing Certificate (MCI)

• 2000/-(MCI) by Demand Draft, drawn on any Nationalised bank in favour of Secretary, Medical

Council of India, New Delhi payable at New Delhi.

13


• And 120/-(MMC) by Demand Draft, drawn on any Nationalised / Schedule bank in favour of

Registrar, Maharashtra Medical Council, Mumbai payable at Mumbai.

• Fees Structure

• Sr. No. Details Fees in Rupees.

1 Provisional Certificate 500/- 2 Registration Certificate 2000/- 3 Additional Qualification

120/- per qualification 4 Good Standing Certificate (MMC) 120/- 5 Duplicate Certificate 120/

- 6 Change of Name 70/- 7 Letter Certificate 70/-8 N. O. C. 70/- 9 Renewal Fee 500/- up to

01.03.2007. The registered practitioner who fails to apply for the renewal of his registration

within the specified period may apply in the prescribed form along-with late fee of rupees

one hundred per month or part thereof, for renewal of the registration as per Sec. 23(b) MMC,

Act 1965. 10 Good Standing Certificate (MCI)

• 2000/-(MCI) by Demand Draft, drawn on any Nationalised bank in favour of Secretary, Medical

Council of India, New Delhi payable at New Delhi.

• And 120/-(MMC) by Demand Draft, drawn on any Nationalised / Schedule bank in favour of

Registrar, Maharashtra Medical Council, Mumbai payable at Mumbai.

APPLICATION FOR THE RENEWAL OF REGISTRATION

To,

THE REGISTRAR,

Maharashtra Medical Council

Anand Complex, 2nd Floor,

Sane Guruji Marg, Arthur Road Naka,

Mumbai 400 011

Sub. : Dr. (Smt. / Shri _________________________________________________________

Regitration No. Regn. Date :

Sir,

I the undersigned applicant, request you that my name may be continued on the Register of

Medical Practitioners maintained by the

Maharashtra Medical Council as per 23(a) of MMC Act 1965 and amendment 2003 My particulars

are as under :-

Name of the Applicant ______________________________________________________________________________

( Begining with surname in capital Letters ) (Surname) (First Name) (Middle Name)

Father / Husband’s Name___________________________________________________________________________

Mother’s Name_____________________________________________________________________________________

Maiden Name______________________________________________________________________________________

( In case of married women) (Surname) (First Name) (Middle Name)

Date of Birth of the Applicant______________________________________________________________________

RESIDENTAL ADDRESS :______________________________________________________________________________

Taluka / City : Disrtict :_____________________________________________________________________________

Postsal Index No.(PIN) : ______________________________ State & Country : ______________________________

14


Tel. No.( Res.)______________________ (Clinic)_________________ (Mobile ) ________________________________

Details of Qualifiaction Name of College University Year of Passing MBBS Regi.No.& Date

M.B.B.S./ Other

P.G..Qualification Addl. Qul. Regi.Cert.No & Date

Demand Draft / Pay Order No. &

Date____________________________________________Rs.________________________________________

Rupees in words____________________________________________Drawn on_______________________

Place. _________________________________________________________

I enclosed herewith attested photocopies of following documents :

1. Photocopy of the Certificate of Registration of Maharashtra Medical Council.

2. Demand Draft / Pay Order favouring Registrar, Maharashtra Medical Council Payble at Mumbai.

3. Zerox copy of MMC I-Card

4. One copy of Latest passport size Photograph.

Date :

Place : Signature of the Applicant

Note :-

1. All particulars be correctly filled in neat legible hand writing, in BLOCk LETTERS i.e. no. running

hand.

2. The application not accompanied by prescribed Fee & Photocopies of registration certificate of

M. M. C. is liable to be rejected.

3. Incomplete application form will not be considered.

GUIDELINES FOR C.M.E. ACCREDITATION

1. Accreditation/ Credit hours to be awarded will be the sole discretion of the Maharashtra Medical

Council depending upon the subject matter, Status of the speaker, Quality of the papers to be

presented in the C.M.E. / Conference.

2. Any professional organization or body or institution making to hold CME.’s should apply for

accreditation to the Maharashtra Medical Council. The council on verifying the credentials of

the organization will give certificate of accreditations to those bodies to hold CME’s.

3. The officer bearers of the Association/ Organization will apply to the Maharashtra Medical

Council on a designed application form. The application should be accompanied by the Complete

programme of the C.M.E. / Conference including the names and designation Country of the

speakers and the subject of speech.

4. Accredited bodies like IMA/ professional bodies which hold regular CME’s will have to inform

the Maharashtra Medical Council, the date of the CME, at least 15 days in advance ,so that the

Maharashtra Medical Council can send observer to the CME meeting.

5. In the application sent to the Maharashtra Medical Council, the minimum duration given to each

speaker should also be mentioned along with the topic of the lecturer while applying for the

credit hours.

6. Credit hours will be based on the composition of the faculty participation, quality of the contents

of the subject matter and feed back from the delegates (On specified performa).

15


7. Associations/ Organizations should strictly issue the certificate to the delegate who has attended

the C.M.E. no certificates should be distributed on the first day at the time of

Registration for the C.M.E. / Conference. This practice should be taken care of. The certificates be

distributed/ awarded only on the last day.

8. Associations/ Organizations will be duty bound to send the feedback of the delegates and the list

of the delegates who have attended the C.M.E./Conference. A separate list for the delegates

belonging to State of Maharashtra and delegates of the other states be submitted to the

Maharashtra Medical Council.

9. In case it is found that the certificate is false one than the issuing Association / Organization

will be debarred for future accreditation

Credit hours to the CME / State / National / International Conference /Workshop organized will

be credited on the basis of the quality of subject matter and the status of the speakers delivering the

lecturer during the C.M.E.

1. Each CME / State / National / International Conference / Workshop of two days (5-6 hours

daily) shall be eligible for a maximum of four credit hours. If it is only one day CME programme

of 5-6 hours, the credit hours shall be two hours.

2. The doctors may attend the International C.M.E.’s/ Conferences held overseas as delegates.

On the production of the certificates of attendance. CME credit hours will be given.

3. Any paper published in indexed National/ International Medical journal will entitle the

author/ co author for credit hours.

4. Doctors doing Post Graduate courses e.g. Diploma, M.D., M.S., D.N.B., M.Ch., D.M.,

Fellowships, Memberships etc. from recognized / reputed institutions in India or abroad

will get 4 credit hour per year for the duration of the courses. e.g. One year 4 credit hour. Two

Year 4 credit hour, Three year 4 credit hour as so on.

5. Any chapter published in a text book or update book published by professional bodies will

entitle the author/ co authors for credit hours.

6. Speakers at any conference/ CME/ Workshop/ training programme will be given one credit

hour per talk in addition to the credit hours allotted for that particular academic activity.

1) Author / Editor of Published Medical Text Book 16 Hours

2) Author of Chapter Published in Medical Text Book 4 Hours

Sr. No. Papers Published in International Index Journals Credit Hours

1) Original article 12 Hours

2) Case Report 6 Hours

3) Letter to Editor 3 Hours

Sr. No. Papers Published in National Index Journals Credit Hours

1) Original Article 8 Hours

2) Case Report 4 Hours

3) Letter to Editor 2 Hours

Sr. No. Participation in International Conferences Credit Hours

1) Guest Speaker / Resource Person in International 4 Hours

Conferences

2) Paper Presentation (Oral / Poster) in International 3 Hours

3) Conferences Participation in International Conference as Delegate 2 Hours

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Modalities for accreditation

All state level organisations conducting CME Programmes at present should approach the

Maharashtra Medical Council for accrediting these organisations.

On receipt of such request, Maharashtra Medical Councils shall consider the following factors

for being granted accreditation for conducting CME programmes and shall award credit hours.

1. CME programme meant for graduate doctors should have a brief session on national health

programmes on relevant subjects alongwith adequate exposure to recent advances, changing

modalities of treatment, adequate exposure of consumer protection and medical insurance

Laws, record keeping and medical audit.

2. The Organisation has all the requisites and demonstrated ability to plan and implement

CME programmes to cover the targeted group (to be specified as general practitioners,

specialists (disciplines to be specified), teachers (specialists to be specified), Vertical National

Health Programme officials etc.

3. The organisations should provide the schedule and transcripts of each CME activity.

4. Organisations should make arrangements for advance publicity to the targeted group of

participants.

5. The methodology of feed back evaluation programme should be intimated in advance.

6. The organisation should undertake to publish handouts, bring out a brief report of each

CME and also prepare a list of participants and send to Maharashtra Medical Council as

the case may be immediately after the CME programme.

Continued Medical Education (C.M.E.) which will not be accredited

1. The C.M.E.’s organized by a drug/ equipment company for promotion of the drug / equipment

will not be entertained/ considered.

2. C.M.E’s organized by the individual nursing homes/ Hospitals/ persons for marketing

purposes shall not be credited.

3. C.M.E. organized for self promotion/ advertisement will not be credited

Application for obtaining Accreditation by Maharashtra Medical Council.

To

The Registrar,

Maharashtra Medical Council,

189/A, Anand Complex, 2nd Floor,

Sane Guruji Marg, Aruther Road Naka,

Mumbai-400011

Sub : Issue of Certificate of accreditationSir,

Our organisation regularly conducts CME programmes / workshops / seminars for updating

knowledge of doctors and we have demonstrated ability to plan & implement above programs to

cover the targeted doctors. Brief details of our organisation are as below.

1) Name of organisation_____________________________________________________________________

______________________________________________________________________________________________________

2) Recognition Number of MCI (applicable for Medical colleges)_____________________________

__________________________________________________________________________________________

17


3) Name of Associations____________________________________________________________________

__________________________________________________________________________________________

4) Registration Number of Association ______________________________________________________

I request to issue certificate of accreditation to our institute / association.

Thanking you,

With warms regards,

Yours truly,

Signature

Name __________________________________________________

Official Stamp

Note : 1) Application should be made on official letter head of organisation / Association.

FORMAT OF CERTIFICATE

Name of organization organizing CME Programmes / Workshops / Seminars / Conferences

This is to certify that

Dr.___________________________________________________________________________________________

has participated as delegate in (CME Programmes / Workshops / Seminars / Conferences)

held on the Date/Month/Year.

Maharashtra Medical Council has granted_____________ Credit hours for delegates.

Signature & Name of Dr. D. N. Lanjewar Signature &

Name of Org. Secretary Administrator Organisation

7. Whether the transcript of each CME programme is considered to be relevant to the updating of

the knowledge of the medical practitioners by way of latest medical advances, National Health

Programmes, and the local needs of the area/zone/State.

8. Whether resource personnel are experienced enough in providing the CME programmes.

9. Whether arrangements are available for keeping record of participants along with their

registration no., Medical Council where registered, complete address and the no. of credit

hours of participation.

10. Whether the organisation as a programme of evaluation of CME to indicate the benefits accrued

to participants by way of updating of knowledge, upgrading their ability and benefit to the

patients.

18


11. Accreditation shall be for a period of five year at a time subject to renewal for a further period

or curtailing or canceling the accreditation for valid reasons.

12. The list of the delegates who attended the CME should be sent to The Registrar, MMC alongwith

MMC Registration Number delegates and CD of the CME Maharashtra Medical Council

Maharashtra Medical Council is a Statutory Body, established by the law of the State i.e.

Maharashtra Medical Council Act 1965. The formation of the Council is on democratic basis with

elected members, few nominated and two ex-officio members. The first and foremost function of

Maharashtra Medical Council is to give registration to Medical graduates in Modern medicine.

Preserving and pursuing medical ethics at all levels is one of the most important function

of Maharashtra Medical Council. It has to see that, medical ethics are observed by the Medico’s

and the dignity, decorum and sancity of Medical Profession is maintained and preserved. The

Maharashtra Medical Council is a quasi Judicial body with a power to punish the erring medical

practitioners.

19


Indian Medical Association (IMA) is the largest NGO in the country having over 1650 branchesacross India and over 1,90,000 members and IMA Maharashtra State branch is the largest statebranch having the membership strength of about 26,000 members.

IMA HQ (Head quarters) is the parent organization situated in New Delhi. It directs thevarious State Branches to implement the policy decisions taken by the Central Council at itsannual deliberations, usually held along with the Annual Conference of IMA. It also enters in tonegotiations with Central Government, various world bodies like UNICEF, WHO, Medical Counciletc on various topics concerning medical practice and education like National Health policy andhealth programmes, Medical education, public health, epidemic control etc. It also takes upissues like Consumer law, Biomedical waste disposal rules, registrations, anti-quackery measuresand fights even at the court level.

IMA HQ is headed by the President and has a team of office bearers like Hon. Gen. Secretary,Treasurer etc. These posts are held following their elections. IMA HQ has a Central Council(CC), which is composed of members from various branches in the ratio of 1 member per 100members of the local br and from Pune, we can send up to 25 CC members. There is a CentralWorking Committee having representation from all State branches and these are elected at theState Branch’s annual Gen. Body meeting held at the State level annual conference. Maharashrtahas 21 posts, as there are 22,000 members in the state (in the ratio of 1 per 1,000 members).These bodies change each year.

On similar lines, IMA Maharashtra State (IMA MS) has its office at Mumbai and has anelected President and his team of elected office bearers. It is liaison between local br and HQ.1 state council is elected per 10 members of local br and 1 per 100 can be elected as Stateexecutive member. State executive meets at least twice per year and State Council, at least 1per annum, usually along with State annual conference. State and HQ Councils constitute theGeneral Body of State and HQ respectively and are the supreme authorities and decision andpolicy makers. On their behalf, Executive bodies act to implement Council decisions.

Both the elections to State and Central Council take place at local level at the time of localbr. Annual general body meeting, usually in Sept last week . Any valid member can get electedin them.

At the HQ level, Journal of IMA is published each month from Kolkata and is sent to allmembers of IMA. Any member can send contributions, articles etc in it. It has the highestcirculation among medical journals. It contains useful information about new rules, announcementsof conferences etc also in addition to academics. It publishes “Apka Swasthya” in Hindi andYour Health in English, for public education. Its wing, College of

General Practitioners publishes journal of Family Medicine whereas, IMA Academy of MedicalSpecialists and super specialists publishes its annuls each quarterly. Any of the members cancontribute their articles in these periodicals.

Additionally, one very important advantage of life membership is The Social Security Scheme(SSS) of the State as well as of HQ. It is really a fantastic and benevolent scheme and for ameager premium paid for 25 years, the family is assured of good Rs. 4,00,000/- plus on death.There is no medial exam. for this. The sum is paid within a few days.

Additionally, IMA functions for Nation’s crisis moments like war, disasters, famine or floods,epidemics, earthquakes, terror attacks etc. It safeguards its members’ interests against unjust

Know IMA Functioning !

20


and harassing officials, authorities and rules and regulations. It has always played a pivotal rolein Medical education and fought for rights of Interns, PG students, strikes etc. It has a largemembership from Government doctors and IMA fights for them too!

An eligible doctor (i.e. MBBS and above) can become a member of IMA by filling a simpleform and submitting his photograph and copy of his registration certificate and paying the lifemembership fees (It is currently Rs 8,800, which may be paid in installments). Out of this, Rs3,750/- is submitted to State office and HQ along with copies of the form and registration certificate.Once the HQ registers this new applicant and allots a specific number, he becomes a member.HQ issues Life Membership certificate to the new member, which is needed for Social Securitymembership. Pune br also issues separate photo id card at a nominal fee. This is an importantcard and is very useful at several places and occasions.

After becoming member, he can attend all programs/seminars/conferences/camps etc andcan take part in daily activities and functioning of IMA. He can become Managing Committeemember, office bearer etc. and develop leadership qualities too. With experience, he can go toState of HQ level working Committee too.

There are many distinct privileges of membership—attending conferences of IMA at variouslevels, conduct research, compete for awards and scholarships, study tours abroad, socialsecurity, taking part in National and State health programs, raise issues concerning medicos,remunerations etc., medico-legal help et .There is a separate women doctors’ wing and servicedoctors’ wing too. In various cities (including Delhi, Mumbai, Kolakta, Chennai, Bengalore), IMAbranches have guesthouses and they can be booked at very reasonable costs. IMA is a forum offriendship, learning, community service, family protection, fighting for a cause, health insurance,bio-medical waste disposal etc.

But apart from these, the most important advantage is that one comes to know and interactwith colleagues and help them or get help from them! Comradeship!!

If each of the article reader brings 1 new member in this family, a great goal could beachieved and still better work can be undertaken.

IMA Activities:Indian Medical Association is the premier association of qualified Allopathic doctors in India

with about 1, 90,000 members and is the largest NGO in the country.

IMA Maharashtra State Branch is the one of the largest State branches of IMA with morethan 26000 members. IMA Maharashtra State Branch is a Registered Charitable Trust havingactivities in medical education and public service programmes over last 65 years.

Some of the prominent activities are:-

1. Arranging CME (Continuous Medical Education) programmes, conferences, seminarsetc. for the updating the knowledge of the members to render better affordable andadvanced services to the society.

2. Training doctors and updating them in practice of Family Planning and control growth ofpopulation.

3. Conducting Health Check-up camps.

4. School Health check-up prgrammes.

5. AIDS diagnosis and counseling through a special cell.

6. Immunisation & family welfare programmes as a part of RCH Reproductive ChildHealthcare) activity.

21


7. Holding exhibitions for health awareness.

8. Medical books and journals library for members.

9. Public awareness programme like essays, lectures, debates etc on topic of social &cultural issues.

10. Providing healthcare services during pilgrimages like Ashadhi Yatra.

11. Health services for slum-dwellers.

12. Active participation in issues relate to medical education and practice.

13. Social Security Scheme for members.

14. Medico Legal Cell to safeguard the ethics of medical practice.

15. Standardization of Medical consulting practices and hospital services, thereby renderingquality services to people at large.

16. Active participation in Medical Waste Disposal schemes.

17. Providing Medical relief teams during disasters.

18. Physical and Psychosocial, the growth and development, fitness training, medical advicefor sports training, pre and post heart surgery, rehabilitation programmes etc for doctorsand general public.

19. “Quit Anemia” programme by 2007, especially in girls, women and children.

20. To enforce “Prevention of prenatal Sex determination rules,” prevent female feticidesetc.

And many such activities for the common people through various teaching aids like lectures,seminars, exhibition, slide shows and road plays etc.

[All the details cannot be mentioned here and can be given if desired so]

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“SAVE THE GIRL CHILD”

DASS (Doctors Against Sex Selection)

“Stop Sex Selection – Doctors can make a difference”

The State of Maharashtra located in the western part of India belongs to the category of

relatively better states of the country whether viewed from the point of view of literacy, urbanization

or various other socio-economic indicators. In spite of the prosperity of the people in the state, high

levels of education, better health indices and the fact that there have been several social reforms and

movements in Maharashtra in favor of women empowerment in past, unfortunately child sex ratio

shows declining trend in Maharashtra also.

Dr Prakash Deo, coordinator UNFPA and active life member of IMA Nagpur branch apprised us

about the stunning statistics as regards child sex ratio figured in 2001 census. This was way back in

2003 when I was senior Vice-President of IMA MS. Honestly speaking we did not realize the gravity of

the problem but he pursued us to realize the seriousness of the issue and our team of IMA Maharashtra

got sensitized. Following are the main observations and important point on which we formulated

“Save the Girl Child” project of IMA MS. We launched this project with a theme “Female Child is

Nation’s Pride” when I took over as President of IMA MS in 2004.

Whole project was based on the strong belief that the doctors are the major culprits and if we

sensitize them and if they stop sex selection and sex selective abortions (become complaint to

PCPNDT Act) an immediate effect can be seen in improving declining child sex ratio. Now National

level leadership has also realized, accepted and declared stop sex selection – doctors can make a

difference.

NATIONAL IMA’S RESOLUTION

Resolution Adopted by Central Council, IMA in Patna meeting held on 26-29th December 2006

� IMA expresses its concern over the declining female child sex ratio in the country and its adverse

consequences on the society.

� Prenatal sex determination needs to be strongly condemned. Members of the Association are

advised to desist from such illegal unethical and antisocial practice of prenatal sex determination.

� IMA is committed to work on this issue proactively, for its contribution to reversal of declining

child sex ratio and ensuring a gender balanced and healthy society.

IMA resolves that national, state and district branches: -

� Will constitute Monitoring Cell for curbing female foeticide at all levels with representatives of

ultrasonologists, gynaecologists, senior practitioners & public representatives, w

� ill continue to sensitize doctors at different forums on this issue especially on gender, legal,

ethical and right dimensions being compromised by perpetuation of this heinous crime,

� will initiate voluntary monitoring on legitimate use of sonography techniques by registered

centers, through identification volunteer monitors and further held in preventing misuse of

technology, w

� ill constitute local traveling faculty on this issue to build capacities for the members maintaining

USG machines so that their establishments are PC-PNDT Act complaint,

� will collaborate with Appropriate Authorities for effective implementation of PC-PNDT Act,

� will engage with civil society groups/members by constitution of “Doctors forum Against Sex

Selection” (DASS) to get information on erring members and garner support to curb illegal

practice.

� National IMA will provide necessary guidance to the branches to act on implementation of this

resolution.

23


Our Observations:

1. Society at large was against, is against and will remain against the Girl Child for various causes

prevalent in the society. Everybody knows the causes of gender discrimination prevalent in the

society. BUT child sex ratio was never never got affected. When thousand couples or families use

to decide that they don’t want girl child (infanticide) hardly one or two were able to achieve the

target but in the changed scenario with help of doctors (female foeticide) all one thousand

couples are able to achieve their target. (That made a huge difference).

2. Infanticide is very difficult because it generates emotions and involves cruelty. Female feticide

on the other hand generate no emotions because doctors, their assistants, paramedical workers,

nurses, even relatives of patient consider it as a medical procedure. No cruelty is experienced so

it becomes easy to eliminate the gild child in female feticide. (Difference between infanticide &

female foeticide)

3. Doctors are not perplexed by the declined child sex ratio figured in the statistics and feel that

few procedures, which they are doing per month, would not make any difference. They do not

realize the collective impact. Statistics in turn clearly indicates definite relationship between

declined child sex ratio in the areas where there are more number of USG machines.

4. Doctors have misconceptions that they are above the society and are immune to various problems

faced by other people in the society. This is indeed a myth. In reality we the doctors will also

have to bear the brunt if something bad happens in the society.

5. Our observation confirms that only 1 to 2% doctors are knowingly involved in the sex

determination and sex related abortions. All other 98 to 99% doctors are innocent but they are

busy with their own practices. Problem is that they are insensitive for statistical figures and

have apathy towards social issues. If we sensitize the 99% good doctors they will bring moral

pressure on the guilty 1% doctors.

Our team planned a mission keeping in mind these major observations.

Why our team believed that “Doctors are major Culprits”.a. We the doctors are first contact point. When couple visits us, we come to know who are

interested in knowing the sex of unborn foetus. (No Govt. Authority will come to know this).

We succumb to the desire of the couple. We are not counseling the couple against sex

selection. This is our mistake number one.

b. In India, sex determination is done only by doctors. The statistical data clearly indicates

definite relationship between declining child sex ratio and advent of USG machine. This is

our mistake number two.

c. After some extra money considerations, we the doctors are doing sex related abortions

(Female foeticide). This is our mistake number three.

“SAVE THE GIRL CHILD PROJECT OF IMA MAHARASHTRA STATE”

IMA Maharashtra State branch has always been proactive, responding to the Government for

contributing effectively through its more than 20000 members in national health programs. IMA

Maharashtra has taken a bold step to focus on this issue and to sensitize the doctors, as we strongly

believe that doctors can certainly play a major role for the reversal of declining sex ratio.

STAGE 1. (Baat) : Sensitization of doctors on declining child sex ratio.

Through the workshops, deliberations and presentations on various platforms we tired to

sensitize the doctors on declining child sex ration. The targeted audience was 99% innocent doctors.

The launching of the project was with the theme “Female child is a Nation’s Pride”.

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STAGE 2 : (Mulakat): IMA’s friendly approach.

Targeted towards individual 1% culprit doctors. To refrain them from doing sex selection and

female foeticide. This will give them last chance to correct themselves. IMA leaders will meet them

personally. This category mainly includes Sonologist and Gynecologist.

To carryout work in this stage IMA Headquarters has formed a forum named DASS (Doctors

Forum Against Sex Selection). This DASS committee formed at local, state and national level.

STAGE 3 : (Boycott): In this IMA will initiate punitive action against the culprit doctors. Suspension

of IMA membership and to boycott them will be part of that.

STAGE 4 : (Lath/Hawalat): IMA will help, Govt. Authorities and media persons in sting operations to

nab the culprits.

“Doctors ! We are here to protect the interest of our own colleagues. Taking the responsibility

of solving this problem is like “cleaning our own house” first. We are confident in our thoughts that

once our doctor colleagues realize the seriousness of declining child sex ratio and incoming man

made disaster they would certainly join the crusade to “Save the Girl Child”.

We assure that we will never forget the interest of medical fraternity.

Now we in Maharashtra are working on stage 1 and stage 2 simultaneously.

Forever yours’ in IMA.

Dr Ashok AdhaoPast National President IMA H Q (2009)

Mobile: 09423103966, 9822473651

Email: [email protected]

Main pillars of Save the Girl Child project of IMA Maharashtra State:

1) Dr Prakash Deo, Nagpur - 09425602591

2) Dr Y S Deshpande, Nagpur - 09823083841

3) Dr Devendra Shirole, Pune - 09822108183

4) Dr Vandana Gandhi, Akluj - 09422644100

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The Clinical Establishments (Registration and Regulation) Act 2010

Today our Medical Profession stands at the threshold of ‘reform’ and yet majority of the Medical

Practitioners in our nation remain largely unaware of the impending changes and challenges that we

as individuals, as well as the medical professionals’ premiere organization, are to face in near future.

It has been our national character that chaos reigns supreme just because we do not remain alert, and

same would be the case if we do not wake up to the realities of ‘The Act’ and ‘The Bill’.

It is six decades since we adopted the system of Parliamentary Democracy and it is now that we

are making first serious attempt to ‘STANDARDIZE’ Medical Practice by way of enacting the Clinical

Establishments Registration and Regulation Act. As the saying goes, ‘Der Aaye—Duroost Aaye’, we have

been quite late in putting in place a National Law on this count and nevertheless we cannot proclaim

that everything vis-à-vis Medical Practice would become automatically ‘Durust’ i.e. ‘Regulated’ &

‘Standardized’. Of course, the effort and intent of enacting this legislation needs to be appreciated.

As the legislation stands passed through both the houses of Central Legislature, albeit without

discussion or debate, it now remains to be seen as to how many states of the Indian Union seriously

work on the specifics and adapt & adopt this Act. It is, as of now, argued that our state of Maharashtra

has an Act, namely Bombay Nursing Homes Act, which takes care of the Clinical Establishment

Registration etc.. It is also our perception today that we can prevail upon our State Govt. Officials to

refuse to adopt the Central Govt. Act of 2010 & also modify the BNHA. As one reads thru’ the entire text

of the said Act it becomes obvious that the Govt. of India is practically prepared to enforce this new

Act in all the States of our Indian Union. In this New Act a broad framework has been laid down with

an intent to effect ‘Registration’ of all Clinical Establishments (except Armed Forces) and establish a

‘Registry’ thereof right from District Level, State Level up to Central Level, and also updating of

‘Registry’ every month. In the Act there is ample scope for framing of ‘Rules’ and ‘Modalities’ for the

ultimate implementation.

• There are seven Chapters and fifty-six Clauses detailing various areas of medical establishments

under consideration. Under this Act there shall be a National Council for Clinical establishments

which shall lay down specifications for Registration and standards for all types of Clinical

Establishments. This Council shall also specify the procedure for Registration and maintaining

of the Register. The Act empowers the Council authorities to levy penalties and make rules as and

when required.

• After reading the Act in detail it becomes obvious that the enacted Act provides a Basic Framework

and Fundamental Structure. In the process of adoption and implementation of the statutes as

enacted there is ample scope for the State Governments to improve and improvise. It is because of

this nuance that we as the Indian Medical association take up this matter more as an ‘OPPORTUNITY’

than as a ‘CHALLENGE’. We should put our collective intelligence to work and study the specifics in

the Act and find out where we can ‘propose’ certain modalities so as to standardize our own

profession. There is ample scope for proper ‘Classification’ of different types of Clinical

Establishments and rigorous implementation of ‘Standard Medical Practice’ as per the system of

medical education of the medical professional. We can achieve this with our (IMA) proactive

participation and responsible representation at the State and Central Government Departments.

• Hence, wisdom lies in proper ‘Proposition’ and not in obstinate ‘Opposition’.

• The Bill provides for an apex Central Committee (National Council for Human Resources in Health)

for the express purpose of enforcing and supervising the effective implementation of various

stipulations as laid down under the proposed Act. The fundamentals of constitution of this

committee as presently prescribed are severely tilted towards ‘Bureaucratic Control’ and without

any scope for proper representation of Medical Practitioners from the field.

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• By virtue of a Presidential Order published in the Gazette various ‘Councils’( Dental Council, Medical

Council, Nursing Council, AYUSH, Para-Medical Council etc.) have become extinct entities and the

whole onus of Medical ‘Education’, Syllabus & Exams, Recognition of Institutions, award of educational

qualifications, ‘standardization’, Registration, Regulation, Accreditation etc (and what not) lies with

this ‘National Council for Human Resource in Health’. It is again a too tall an order to expect proper

functioning and delivery from the present proposed structure of the said National Council.

• This enactment has either chosen to remain silent or just failed to elaborate on certain salient

points as regards specific issues.(‘Cross-Pathy’ Practice of Medicine, Standardization of Medical

Education, Standard structure of Internship & Post-Graduate Education etc.) In the preamble it

has been clearly stated that the intent and purpose of this Act is to ‘overcome acute shortage and

uneven distribution of human resources in public health delivery system’, But from the content

and context of the present enactment it seems that the Government has relied too heavily on the

reports of it’s own bureaucratic experts and other sources with vested interest. It is painful to

note that the Central Government has not as yet considered to consult the largest Medical

Professionals Organization i.e. IMA in this regard.

• As the proposed Bill stands now, we can say that the exercise has been sincerely attempted yet it

would be essentially advisable that all the stake-holders (other than the Government Agencies)

study the Act in detail, deliberate on all the points and come out proactively with positive

suggestions for better specifications in the Act so as to enable proper implementation and delivery

in the sphere of Health all across our Nation.

• We, as Indian Medical Association Maharashtra State, have already formed a Sub-Committee of

experienced IMA MS Members to study the Bill and put forth our view-points to the Government

authorities and ask for a detailed discussion. All of us as IMA Members always have a question

‘What does IMA do for me?’ In the form of this proposed Bill here is the new horizon wherein our

collective participation can bring in a ‘Brighter Tomorrow’ for IMA Members. In case we adhere to

our usual apathy we shall ensure a ‘Bleak Future’. Hence it is our sincere request to all the members

of Indian Medical Association to peruse the details of this Act and prepare their comments and

suggestions ( Clause by Clause) and then send them to IMA Maharashtra State Office at the earliest.

Chapter I : Preliminary

This is the Preliminary Chapter addressing the ‘Short Title’, Application and Commencement,

and also explaining ‘Definitions’.

Clause 1 : After (1),(2) & (3), the last proviso provides for ‘different dates may be appointed for different

categories of clinical establishments and also for different recognized systems of medicine.

We should remain alert and aware of the situation as regards this proviso. In fact we should

proactively interact with the MoH Govt. of India on this point.

Clause 2 : After (a),(b) in the (c) (i) definition of Clinical Establishment is put forth. In this it is

categorically stated as ‘any recognized system of medicine’. We should understand the

importance of this and ask for specifications as to:

1) Which are ‘the recognized systems of medicine’” in India?

2) Of these which medical practitioners can call themselves ‘Doctors’ ?

3) Who shall be called Vaidyas, Hakims. Homeopaths etc.?

4) What about nomenclature of Para-Medical Staff?

In (c) (ii) as regards the clinical establishments there is no reference to the ‘necessary’

qualifications for running a particular type of ‘Clinical Establishment’. We need to get these

specifications as regards the necessity of ‘recognised’ qualifications incorporated in the ‘Act’.

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Chapter II: The National Council for Clinical Establishments

This pertains to

1) Establishment of National Council

2) Disqualification for appointment as member

3) Functions of National Council

4 ) Power to seek advice and assistance

5) National Council tofollow consultative process.

Clause 3:

(2) The National Council hall consist of (a)

(b) one representative each to be elected by DCI, MCI, NCI &PCI

Now that by an ordinance these four Councils have been laid defunt how shall these

representatives come on board in the National Council?

There is a provision for only one Member from Indian Medical Association and we should fight for

having at least fiveIMA Representatives in the National Council considering our Stature, Strength &

Services we provide.

(8) Here there is a provision for the National Council to constitute sub-committees for consideration

of ‘particular matters’. We, the IMA, have an opportunity here to approach the National Council and

man these sub-committees with our IMA Experts.

Clause 4 : OK

Clause 5: Most Important

(b) Classify clinical establishments into different categories

(c ) Develop minimum standards & their periodic review

It is in these spheres that we as IMA must participate proactively or else.

Clause 6:

Clause 7: By way of both the above clauses the National Council has ‘opened’ it’s doors for consultative

assistance and this is the ‘BIG’ Opportunity IMA should not miss.

Chapter III: Registration and Standards for Clinical Establishments.

Clause (8) State Council for clinical establishments

In this the structure of State Council is given. In sub-clause(2) (d) it is given that one representative

each tobe elected by the executive committee of State Unit of MCI, DCI, NCI, PCI. Now with MCI etc

being defunct bodies who shall be the representatives. We, IMA, should negotiate with the State Govt.

for our representatives on State Council.

In (f) the State IMA has been offered only one representation. We should impress upon the

State Govt. the vastness of our role in dispensing Medical Services to the Society and hence our

rightful demand for having at least five IMAMS representatives on State Council

Clause 9: OKAY

Clause 10:

• In this there is the stipulation to set-up district registering authority for each district of the state.

• It will consist of 1)District Collector 2) DHO and three members

• If such committee is not constituted all powers shall automatically lie with DHO

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We have to see to it that at all District Level Committees IMA has all three members on the District

Committee.

Clause 11: OK

Clause 12: (1) This says, as prescribed

(i) minimum standards of facilities and services

(ii) minimum requirement of personnel

(iii) provisions for maintainance of records and reporting

(iv) such other conditions

We have to wake up before this’ as may be prescribed’ happens at the Govt. level. We, the

IMA MS, must open a dialogue with the State Govt. urgently and convey that our IMA Representatives

must have participation in discussion and finalization process of these provisions.

Clause13:

• This pertains to the different ‘Classifications’ and ‘Standards’ for Clinical Establishments of different

systems of medicine as recognized by Govt. of India.

• There is ambiguity as regards ‘categorical’ Classification and ‘Standards’ as of now. Hence we as

IMA should proactively and alertly participate in the process of determining the ‘Classification’

and ‘Standards’. In this sphere local conditions shall have important bearing and we should have

our own ‘Road-Map’ in this regard.

• From Clauses 14 to 56 the Act lays down the modalities, structures and stipulations for

implementation of the Act.

• Presently we, the IMA, have chosen to ‘OPPOSE’ the ACT. Here it becomes imperative that we

realize that:

1) The ACT has already been enacted (i.e. it is the LAW now) and in due course it shall be

implemented in every State of our Indian Union.

2) Repeal of this ACT is nigh impossible as both Houses have unanimously passed this ACT.

3) When we expect regulation and standards for ‘Accountability’ in all spheres of vocation, is it

proper to ask for exemption of our medical profession from ‘Regulation’ and ‘Standardization’?

4) In spite of our opposition the Government authorities are surely going ahead with

implementing the provisions of this ACT in a short while.

5) In such instance we shall have no recourse to review or reform of the ACT.

Our present path is of ‘Blind Bravado’, instead we could chart a course of ‘Wily Wisdom’ whereby we

proactively participate in:

1) Discussing with the Government

2) Framing of the Rules, Classifications, Standards etc.

3) Become the Consultative Organization

4) Have representation in all Implementing Committees at all levels (Central, State, District etc.)

5) Insist on inclusion in all further policy decisions.

Choice is obvious and the Time is NOW.

Dr. Sanjeev Sharangpanie-mail: [email protected]

Mob:9422429224

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WORKING OF IMA LOCAL BRANCH

The local branches of Indian Medical

Association form the base of a pyramid. It is very

oblivious that working at local branches is very

important for IMA functioning.

The membership forms the basis of any

local branch. As per the constitution of IMA HQ

for formation of new branch following are the

criteria :-

(HQ Constitution point No. 4., 5, 5a. ) (IMA

MS Con. Point 7a)

1. The members of the Association shall,

whenever possible, group themselves into

separate local bodies styled as local

branches.

2. Each local branches shall have a local area

for its jurisdiction and operations to be

finally approved by the Working Committee

of the Association on the recommendation

of the concerned State/ Territorial Branch of

that area where the State/Territorial Branch

exist as per the Bye-laws.

3. No two Local ranches shall have overlapping

jurisdiction and operations in the same area.

4. A minimum of 10 members residing or

practising in a place or its neighborhood

where there is no branch shall form a branch.

Following is the compiled information about

working at IMA Local Branch as per IMA

Tamilnadu State Branch bulletin

Membership

This is the basis of existence of any local branch.

To increase the membership, please visit

www.mmcmumbai.com and find out eligible

members in your area. Propagate IMA MS welfare

schemes like Social Security Scheme,

Professional Protection Scheme etc. and also

arrange CMEs after getting the MMC

accreditation.

Fill up the membership form properly, sign it care-

fully & make 2 copies, keep Xerox at your branch

and send the original along with necessary docu-

ments like copy of MMC certificate marriage cer-

tificate for lady members

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Communication Tools : Communication is very essential for rappo with the members. Some of the

ways are as follows :

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Office Bearers are the pillars of any local branch and their respective rolls are as follows :

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SECRETARYBranch Secretary : Is the administrative hand of the branch

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