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PubMedDate not supplied

Estimates of the years-of-life-lost due to the top nine causes of death in rural areas of major states in India in 1995.

BACKGROUND: Years-of-life-lost (YLL) contribute nearly two-thirds of the disability-adjusted life-years (DALYs) worldwide and are especially Important for India where infant and child mortality is still high. These were estimated for India under the Global Burden of Disease study for the year 1990. No estimates are available for the different states of India. We aimed to prepare state-wise estimates of YLL for different causes of death in rural areas and to determine the causes responsible for a higher burden in different states. METHOD: Percentage deaths of the top 9 causes reported in the Registrar-General's Survey of Causes of Deaths (Rural)--1995 in 13 major states of India and different age groups was applied to the expected number of total deaths. The life lost according to the standard life-table was age-weighted and discounted using the methodology of the Global Burden of Disease 1990 study. The causes of death were based on lay reporting which otherwise seem reliable. RESULTS: The all-cause YLL in rural India in 1995 were 207 per 1,000 population. The minimum was 74 in Kerala and maximum 276 in Madhya Pradesh. Pneumonia was the top cause responsible for 15 YLL. The inter-state variation was high as Tamil Nadu had only 1.6 and Uttar Pradesh 30.5 YLL from this cause. Cancers were a uniform burden across the states. Heart attack, and bronchitis and asthma cut across the more and less developed states. Suicides were a heavy burden in Andhra Pradesh and vehicular accidents in Haryana and Rajasthan. Bihar, Gujarat, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh had communicable and nutritional conditions as predominant causes while Kerala and Punjab had non-communicable diseases as the predominant cause of YLL due to premature mortality. CONCLUSION: These results provide a new perspective about the causes of death that need more attention in rural areas of different states of India. These will also help prioritize areas which require more inputs at the state-level and hence will be useful for health policymakers.

Adolescent↗
PubMed2000

Grant awarded to support AIDS projects in India.

The Francois-Xavier Bagnoud Foundation (FXB), New York, New York, will develop community-based programs in rural Rajasthan, India, to stem the spread of HIV/AIDS and other sexually transmitted diseases (STDs), with the support of a US$300,000 grant from the Bill and Melinda Gates Foundation. According to the WHO and Joint UN Programme for HIV/AIDS, an estimated 3.7 million people are living with HIV/AIDS in India, more than any single country in the world except South Africa. HIV/AIDS and other STDs are spreading rapidly in Rajasthan, a rural state in northwestern India with a population of 44 million. The FXB Rajasthan Society will administer the grant. Building on the strong tradition of community health care workers in India, the society will develop a model for AIDS/STD education employing village counselors, migrant workers, and peer educators, with the goal of increasing awareness of STDs and promoting voluntary testing and treatment. The community-based model will then be adapted for use across India as well as in other developing nations. "We are thrilled to receive help from and to work with the Bill and Melinda Gates Foundation," said Countess Albina du Boisrouvray, FXB. "Stopping the spread of AIDS needs a serious financial commitment as well as a bottom-up, community-based approach. The Foundation understands this, as do our partners in India".

Acquired Immunodeficiency Syndrome↗
PubMed1992

The facilities and challenges for cancer control in India.

India is a vast subcontinent with 845 million peoples occupying 2.5% of land mass of the earth, but carrying 15% of the world population. It is a multiracial society with widely varying cultures, habits, languages and many different ethnic groups. The pattern of cancer, therefore, mainly depends on their habits and life styles apart from other variations. Head, Neck & Esophagus cancers in the male and cervix and breast cancers in the females are the main cancers. All together they form nearly 60% of all cancers. The incidence rates are around 90/100,000 though this is an underestimate as cancer is not a notifiable disease in India. It is estimated that by the year 2,000 there will be six million cancer patients in India at any given time with nearly 2 million new patients annually. The over-all facilities for cancer treatment vary widely from metropolitan cities to rural areas where 70% of the Indian population lives. In major cities, good to excellent treatment facilities exist in comprehensive cancer centres--yet in the rural setting the facilities are sketchy at best or non-existent at worst. The Government of India in its national cancer policy has recognized regional cancer centres and consolidated other existing centres. There are 10 regional cancer centres thus identified, each one at a different level of development. For optimal requirements at least 600 teletherapy units, (existing 150--not always functional) 100 departments of surgical oncology and an equal number of medical oncology divisions are needed (existing 20). The demand for cancer treatment facilities are, therefore, very high with poor available facility. Nearly 50% of patients present late for treatment and therefore appropriate education in prevention and early diagnosis are important factors. The Government of India through Ministry of Health has identified cancer as a major health problem by the year 2,000 and hence planning by the National Cancer Plan is operative in many States. Major cancer institutions (like the Tata Memorial Centre) have taken a lead to intensify the public and professional educational activities and have developed rural modules for primary and secondary prevention. The author exemplifies this by actual on the spot activities of the rural centre and stresses that in a country like India, the need is to develop small community cancer centres with the rural cancer effort as the base so as to reach out to the community for early diagnosis of treatment.

Cancer Care Facilities↗
PubMed2004

Epidemiology of tuberculosis: current status in India.

India is classified along with the sub-Saharan African countries to be among those with a high burden and the least prospects of a favourable time trend of the disease as of now (Group IV countries). The average prevalence of all forms of tuberculosis in India is estimated to be 5.05 per thousand, prevalence of smear-positive cases 2.27 per thousand and average annual incidence of smear-positive cases at 84 per 1,00,000 annually. The credibility and use of the estimates are discussed in detail. Reports on recent studies on the time trend of the disease from some areas in India, e.g., Chingleput in Tamil Nadu are discussed. They confirm the slow downward trend over a fairly long period of observation, as in the rural areas around Bangalore. It also outlines the serious escalation of disease burden in a tribal population group in Car Nicobar over a period 1986-2002, and highlights the nature and extent of the emerging threats. Some epidemiologists forecast a rise of 20 per cent in incidence in the next 20 yr, for India, with a cumulative rise of 46 million cases of tuberculosis during that period, largely as a consequence of HIV epidemic. The Governmental efforts at intervention through Revised National Tuberculosis Control Programme (RNTCP) and at monitoring the epidemiology of intervention through organising routine reporting are highlighted, and data are presented and evaluated on these. RNTCP needs to be used as an effective instrument to bring a change in epidemiological situation, through fast expansion and achievement of global target. The present review describes the global tuberculosis situation, and views it in the context of the goal of the antituberculosis intervention activities. It presents the epidemiological situation in India, comments on the current trend and discusses the efforts taken towards making projections on the likely burden of disease in India over time.

AIDS-Related Opportunistic Infections↗
PubMed2005

Dental education in India and Japan: implications for U.S. dental programs for foreign-trained dentists.

An understanding of international dental education systems is critical for the education of foreign-trained dentists in U.S. dental programs. However, there is little information on this topic. This article provides information regarding 1) dental history, 2) dental school system, 3) curriculum/examination at dental school, and 4) dental licensure in India and Japan. There are 185 dental schools in India and twenty-nine in Japan. The number of first-year dental students is 12,872 and 2,647 in India and Japan, respectively. A five-year dental education, which includes 4,035 curriculum hours, leads to the B.D.S. degree in India, whereas a six-year dental education program, which includes 5,060 curriculum hours, leads to the D.D.S. degree in Japan. No undergraduate predental study is needed prior to entry into dental school in both countries. In India, the entrance examination is extremely competitive; however, there is no nationwide licensure examination. In Japan, dental schools use more sophisticated dental materials and equipment in the clinical phases of the curriculum than in India, but there is no clinical examination at the time of graduation. Several implications for U.S. dental programs for foreign-trained dentists with respect to screening applicants and curriculum development are discussed.

Curriculum↗
PubMed2005

Polio eradication in India: current status.

India has reached the final stage of polio eradication. The polio partnership in India, under the leadership of the Government of India, mounted tremendous response to the outbreak. The progress since 2003 is the most significant in the history of polio eradication in India. Surveillance sensitivity was increased to reach the goal for polio eradication. Since nearly all polio cases now occurring in India are caused by type 1 poliovirus in children, monovalent oral polio vaccine type 1 (mOPV1) was introduced in select high-risk districts of UP, Bihar and Mumbai-Thane during the April and May 2005 National Immunisation Days and the June and August 2005 in 6 sub-national immunisation rounds. Strategies were also being implemented to improve the impact of supplementary immunisation activities in the high-risk areas. As a result of supplementary immunisation activities targeted using surveillance data, India has made striking progress towards polio eradication.

Child↗
PubMed1996

Genetic epidemiology of the three predominant abnormal hemoglobins in India.

Hemoglobinopathies in India are Important public health problems. Of the several abnormal of hemoglobin molecules, there are three variants, viz. Sickle cell, hemoglobin E and hemoglobin D which are predominantly prevalent in India. The cumulative gene frequencies of these hemoglobins have been found to be 5.35% in India. The average gene frequency of sickle cell and hemoglobin D in India has been observed to be 4.3% and 0.86%, respectively. In the North Eastern region of India, the gene frequency of hemoglobin E is 10.9%. Gene frequencies and spatial distribution of the predominant abnormal hemoglobins in India have been discussed in variance with the previous generalisations.

Adult↗
PubMed1996

Genetic variation in India.

In the last 25 years a number of genetic studies on the populations of the Indian subcontinent have been conducted. Unfortunately, most of the studies covered a limited number of genetic systems, and only a few provide information on the genetic differentiation and population structure of some regional caste, tribal, religious, and urban groups. Despite a recent report suggesting that in eastern India genetic affinity does not show any large degree of congruence with sociocultural hierarchy, three distinct surveys reported here indicate that geographic proximity, ethnohistory, and biosocial and cultural affiliation are important determinants of genetic affinity. Gene differentiation studies are few, but from the information of some previous papers and results presented in this special issue of Human Biology, the pattern of differentiation is becoming clear. In general, genetic differentiation in populations of India is low (0.26-1.7%), but overall genetic differentiation in 18 mixed populations of India is higher (2.23%), similar to the largest single study on 16 tribal groups from central India (2.18%). The tribal population of South India shows the highest FST value (4.1%), and this value is similar to a study of the Dhangar caste group. The reason for this high FST value is not clear. One possibility may be (semi-) isolation associated with such factors as random inbreeding and drift, which can cause high levels of genetic differentiation among the tribal groups of India and among the castes such as Dhangar. However, further studies are needed to explore the causes of such high values of genetic differentiation, especially in these populations.

Ethnicity↗
PubMed1998

Genetic variability of transferrin subtypes in the populations of India.

Five hundred fifteen samples from five populations of India (Brahmins, Marathas, Patels, and Parsees of western India and Hindus of Andhra Pradesh) were analyzed for transferrin subtypes using the isoelectric focusing technique. The allele frequencies of 8444 samples belonging to 93 populations of India have been tabulated, and data were analyzed for genetic diversity among geographic, regional, and socio-cultural groups. Three relatively common alleles, TF*C1, TF*C2, and TF*C3, showed wide variation in various populations of India. Compared with western India, a high frequency of the TF*C2 allele was observed in eastern India. This variation of the TF*C2 allele showed a geographic cline increasing from west to east, giving a significant positive correlation between the TF*C2 allele frequency and longitude. Various genetic processes that possibly maintain TF polymorphism are selection, admixture, genetic drift, and isolation by distance. The possible influence of various genetic processes is discussed.

Emigration and Immigration↗
PubMed1995

Use of EPR oximetry with India ink to measure the pO2 in the liver in vivo in mice.

The partial pressure of oxygen (pO2) of the liver in vivo in unanesthetized mice was determined using electron paramagnetic resonance (EPR) oximetry with India ink. The EPR spectra were obtained using a low-frequency (1.2 GHz) EPR spectrometer with a loop gap cavity resonator. The line width of the India ink used in this experiment was reversibly broadened by oxygen and was particularly sensitive to pO2 below 30 torr. After the administration of India ink into the tail vein, the India ink particles were taken up mainly by Kupffer cells in the liver and in part by phagocytes in the spleen. The pO2 measured in the normal liver was about 14 torr and was constant for the 2-week experimental period. The pO2 decreased when measured at 1, 2, and 6 days after treatment with hepatotoxin (carbon tetrachloride (CCl4)); within 2 weeks, it returned almost to the initial level. Measurements by EPR at sacrifice of controls and CCl4-treated mice indicated that more than 90% of the India ink went to the liver; the spleen contained 4.7% of total amount in control mice and 8.8% in CCl4-treated mice when measured 2 weeks after the treatment. These data indicate the usefulness of India ink for measuring the pO2 of the liver in vivo and that the pO2 in the Kupffer cells is decreased when the liver is damaged by CCl4.

Animals↗
PubMed2000

Randomized comparative study of indocyanine green and India ink for colonic tattooing: an animal survival study.

Indocyanine green has been reported previously as a useful agent for colonic tattooing, but its durability, ease of use, cost, and safety have not been compared with India ink. Eight pigs were randomized to colonic tattooing using sterile indocyanine green or India ink injected through tandem filters. The animals were recovered and killed after 2 weeks and were examined. All animals survived the study period with no complications. We identified 17 of 29 (59%) indocyanine green tattoos and 48 of 52 (92%) India ink tattoos at autopsy (p = 0.0003). Histologic reactions were mild and were distributed similarly in each group and the intensity of the tattoos diminished similarly in both groups. Although indocyanine green was slightly more expensive, it was easier to handle compared with India ink. Both indocyanine green and India ink tattoos cause only mild histologic reaction in the swine colon when examined 2 weeks after injection. India ink is superior to indocyanine green, when used for colonic tattooing.

Animals↗
PubMed1993

An increased relative frequency of retinoblastoma at a rural regional referral hospital in Miraj, Maharashtra, India.

BACKGROUND: Retinoblastoma is a relatively uncommon childhood malignant neoplasm. It has been suggested previously that there is an increased incidence of retinoblastoma in India, but this has been reported primarily from urban cancer centers and may have been confounded by a referral bias. METHODS: The authors have evaluated the relative frequency of tumors in children younger than 15 years of age from 1987 to 1990 at Wanless Hospital, a rural regional referral hospital in India. RESULTS: Of 158 children with malignant neoplasms, 13% (20) had the histologically confirmed diagnosis of retinoblastoma. Assuming that these 158 children represent a nonbiased reflection of childhood cancer incidence in this region, these 20 cases of retinoblastoma blastoma represent a 3.3-fold increase over the expected number estimated with worldwide relative frequencies and a 4.4-fold increase over the relative frequency expected among a similar group of children as estimated with United States rates. The proportion of children with bilateral disease was 15%, which is less than expected (20-30%). The mean age at presentation was 41 +/- 14 months (mean +/- standard deviation) compared with 26 months in Western centers. In addition, 50% had metastases at the time of diagnosis compared with 5-10% at Western centers. The increased rate of metastases and late age at diagnosis suggest of a diagnostic delay. CONCLUSIONS: These results, in combination with previously reported increased relative frequencies from urban cancer centers in India, suggest that there may be a true increase in the incidence of retinoblastoma in India. The increase in unilateral retinoblastoma indicates that environmental factors may contribute to an increase of the nonheritable form in India.

Child↗
PubMed2004

Adaptation of the ACE for a Malayalam speaking population in southern India.

OBJECTIVE: To adapt the Addenbrooke's Cognitive Examination (ACE) as a dementia-screening tool in a community in south India. To establish that items in the adapted version are equivalent to that in the original. METHODS: The ACE was adapted into the local language, Malayalam (m-ACE), following cultural/linguistic modifications. To establish equivalence, qualitative comparisons were made (on the distribution of scores, percentage scoring at ceiling, and relative difficulty across items) between a UK sample receiving the ACE (n = 50; mean age = 67.9 +/- 7.4; education >/= 9, mean = 10.9 +/- 2.5) and a community-based educationally-stratified Indian sample receiving the m-ACE: 'India >/= 9' (n = 50; mean age = 67.8 +/- 5.2; education >/= 9, mean = 13.9 +/- 2.7) and 'India </= 8' (n = 50; mean age = 67.1 +/- 5.3; education </= 8, mean = 3.1 +/- 2.0). RESULTS: Most ACE items were retained. The score distribution (mean +/- 1SD), percentage at ceiling, and relative difficulties across items is comparable between the UK and the educationally equivalent India >/= 9 groups. Language, Naming, Attention and Orientation are relatively easy (>/= 80% at ceiling) and Recall and Verbal fluency are relatively difficult (</= 22% at ceiling). Although the percentage at ceiling were lower for the India </= 8 group, the order of relative difficulty was similar and the percentage scoring at floor was </= 10% on all except visuospatial item. CONCLUSIONS: The m-ACE provides a culture-fair Malayalam adaptation of the ACE with component items of equivalent difficulty.

Aged↗
PubMed2002

Cancer patterns in eastern India: the first report of the Kolkata cancer registry.

There are no population-based data available for the cancer patterns in Eastern India. This is the first report of cancer incidence in the region from the population-based cancer registry in Kolkata (Calcutta), the capital city of the state of West Bengal, India, for the period 1998-1999. The cancer registry collects data on all new cases of cancer diagnosed in the resident population of Kolkata. Since cancer is not a notifiable disease in India, registration is carried out by active data collection by the registry staff. The cancer registry staff visits 50 data sources comprising cancer hospitals, secondary and tertiary care hospitals, nursing homes, diagnostic laboratories and death registration offices; scrutinizes medical records and collects details on incident cancer cases. A customized version of CanReg-3 software was used for data entry and analysis. A total of 11,700 cases were registered during the 2-year period from 1 January 1998 to 31 December 1999. The overall age-adjusted (world population) incidence rates were 102.1 per 100,000 males and 114.6 per 100,000 females. The most frequently reported malignancies in males were lung cancer (16.3%), followed by cancers of the oral cavity (7.1%), pharynx (5.7%) and larynx (5.7%). In females, the most frequently reported malignancies were breast (22.7%) followed by uterine cervix (17.5%), gallbladder (6.4%) and ovary (5.8%). The data reported by the Kolkata cancer registry provide information on the cancer profile in Eastern India for the first time. The highest incidence rate of lung cancer in males in India is reported from Calcutta. A high risk of gallbladder cancer is observed in women. The observed cancer patterns indicate that tobacco-control measures and early detection of head and neck, breast and cervical cancers are of importance for cancer control in this population.

Age Factors↗
PubMed2006

Phylogenetic relatedness and genetic diversity of hepatitis B virus isolates in Eastern India.

Hepatitis B virus (HBV) has been classified into eight genotypes, and several subgenotypes, distinctly distributed geographically. The genotypes A and D were previously reported to be predominant in India. Recent studies indicated evidence of circulation of genotype C in Eastern part of India. With the aim to confirm the phylogenetic relation and molecular genetic characteristics of the HBV circulating in Kolkata, the most populous city in Eastern India, 11 strains were isolated and the complete genome sequences were analyzed. Phylogenetic analysis determined; three genotype C (adr-serotype) isolates closely related with C1 (Cs) subgenotype references from South East Asia, and three genotype A (adw2-serotype) isolates, related to Asia-variant references of subgenotype A1 (Aa). Whereas, five genotype D (ayw2, ayw3 serotype) isolates were highly divergent; one was related to subgenotype D1, two to subgenotype D3, and the remaining two clustered with a single genotype D isolate from Japan belonging to an unclassified subgenotype. Together, these two isolates differed from HBV D1-D4 subgenotypes by nucleotide differences ranging from 5.0 to 5.49%, probably indicating a new subgenotype, which we designate as D5. All serotype ayw3 of genotype D isolates had specific amino acid substitution Threonine at codon 118 and Methionine at codon 125 in antigenic determinant of surface gene that has not been reported previously in isolates from other parts of India. In conclusion; using the complete genome analyses this study has confirmed circulation of the genotype C in Eastern part of India and demonstrated considerable genotypic heterogeneity of the Indian genotype D.

Adult↗
PubMed2004

Deciphering diversity in populations of various linguistic and ethnic affiliations of different geographical regions of India: analysis based on 15 microsatellite markers.

The extent of genetic polymorphism at fifteen autosomal microsatellite markers in 54 ethnically, linguistically and geographically diverse human populations of India was studied to decipher intrapopulation diversity. The parameters used to quantify intrapopulation diversity were average allele diversity, average heterozygosity, allele range (base pairs), and number of alleles. Multilocus genotype frequencies calculated for selected populations were utilized for testing conformity with the assumption of Hardy-Weinberg equilibrium. The exact test values, after Bonferroni correction, showed significant deviation amongst Gowda (vWA, Penta E); Dhangar, Satnami and Gounder (D8S1179); Hmar (FGA); Kuki and Balti (vWA) groups. Relatively low number of alleles and allelic diversity (base-pairs size) had been observed in populations of central India as compared with southern and northern regions of the country. The communities of Indo-Caucasoid ethnic origin and Indo-European linguistic family (Kshatriya of Uttar Pradesh) showed highest allelic diversity, as well as rare alleles, not reported in any other Indian populations. Analysis based on average heterozygosity was also found to be lowest among the populations of central India (0.729) and highest among the populations from north (0.777) and west (0.784) regions of the country, having Indo-Caucasoid ethnic origin and Austro-Asiatic linguistic affiliation. The maximum power of discrimination (85%-89%) had been observed at loci FGA, Penta E, D18S51 and D21S11, suggested high intrapopulation diversity in India. Genetic diversity revealed by STR markers was consistent with the known demographic histories of populations. Thus, the present study clearly demonstrated that the intrapopulation diversity is not only present at the national level, but also within smaller geographical regions of the country. This is the first attempt to understand the extent of diversity within populations of India at such a large scale at genomic level.

Alleles↗
PubMed2005

Climatic controls of vegetation vigor in four contrasting forest types of India--evaluation from National Oceanic and Atmospheric Administration's Advanced Very High Resolution Radiometer datasets (1990-2000).

Ten-day advanced very high resolution radiometer images from 1990 to 2000 were used to examine spatial patterns in the normalized difference vegetation index (NDVI) and their relationships with climatic variables for four contrasting forest types in India. The NDVI signal has been extracted from homogeneous vegetation patches and has been found to be distinct for deciduous and evergreen forest types, although the mixed-deciduous signal was close to the deciduous ones. To examine the decadal response of the satellite-measured vegetation phenology to climate variability, seven different NDVI metrics were calculated using the 11-year NDVI data. Results suggested strong spatial variability in forest NDVI metrics. Among the forest types studied, wet evergreen forests of north-east India had highest mean NDVI (0.692) followed by evergreen forests of the Western Ghats (0.529), mixed deciduous forests (0.519) and finally dry deciduous forests (0.421). The sum of NDVI (SNDVI) and the time-integrated NDVI followed a similar pattern, although the values for mixed deciduous forests were closer to those for evergreen forests of the Western Ghats. Dry deciduous forests had higher values of inter-annual range (RNDVI) and low mean NDVI, also coinciding with a high SD and thus a high coefficient of variation (CV) in NDVI (CVNDVI). SNDVI has been found to be high for wet evergreen forests of north-east India, followed by evergreen forests of the Western Ghats, mixed deciduous forests and dry deciduous forests. Further, the maximum NDVI values of wet evergreen forests of north-east India (0.624) coincided with relatively high annual total precipitation (2,238.9 mm). The time lags had a strong influence in the correlation coefficients between annual total rainfall and NDVI. The correlation coefficients were found to be comparatively high (R2=0.635) for dry deciduous forests than for evergreen forests and mixed deciduous forests, when the precipitation data with a lag of 30 days was correlated against NDVI. Using multiple regression approach models were developed for individual forest types using 16 different climatic indices. A high proportion of the temporal variance (>90%) has been accounted for by three of the precipitation parameters (maximum precipitation, precipitation of the wettest quarter and driest quarter) and two of the temperature parameters (annual mean temperature and temperature of the coldest quarter) for mixed deciduous forests. Similarly, in the case of deciduous forests, four precipitation parameters and three temperature parameters explained nearly 83.6% of the variance. These results suggest differences in the relationship between NDVI and climatic variables based upon the time of growing season, time interval and climatic indices over which they were summed. These results have implications for forest cover mapping and monitoring in tropical regions of India.

Climate↗
PubMed1996

Dava, Daktar, and Dua: anthropology of practiced medicine in India.

The paper explicates "practiced medicine" as an operative cross-cultural analytic concept by locating it within previous major developments and directions of study within anthropological studies of medicine in India, and medical anthropology more generally. Practiced medicine in India, for example, allows us to see better how India manages not only multiple traditional and modern medical approaches, languages, therapeutic regimens, and materia medica, but it also leads us to a sustained moral, social and material criticism from within. The study of such diversity leads to a loosely shared, and ethnographically attestable, cultural reasoning, practice and practical ethos across the traditional and modern medical worlds. Also appearing before us are the usually hidden cultural assumptions, negotiations and compromises of diverse Indian medical practitioners, and the strengths and weaknesses of modern medicine under "normal" and "disastrous" situations in contemporary India. As India today grapples with issues of availability, affordability, equity, and distributive justice in medical care, its practiced medicine raises issues of "critical consciousness" for modern (and traditional), state supported medicine.

Culture↗