IN our previous article on this topic, we looked at some of the economic issues that serve as a barrier to health care access. Beyond economic issues, there are, however, many issues that limit access and this week we shall look at manpower and geographic issues.

Manpower

Health care delivery depends on human capital to a significant degree despite the increasing use of technology. If there are no doctors, nurses, or ancillary health-care personnel, then there is effectively no health care to access. Jamaica has 0.5 physicians per 1,000 population and 1.8 nurses per 1,000 population (2016 World Bank data). Our Caribbean neighbour Barbados has 2.5 physicians per 1,000 population and 3.1 nurses per 1,000 population. The United States has 2.6 physicians per 1,000 population and 15.7 nurses per 1,000 population. High-income countries on average have 3.7 physicians per 1,000 population compared with 0.3 physicians per population in low-income countries. When we look at specialty care, the gap is much wider and shows why many citizens will unfortunately not have access to speciality care. In the USA, for example, there are 22.3 neurologists per 100,000 population but in Jamaica, we have about 0.0000023 neurologists per 100,000 or 2.3 neurologists per one million. There are 33,701 cardiologists in active practice in the USA resulting in a ratio of about 102 cardiologists per one million population. In Jamaica, we have less than 30 cardiologists in active practice for a population of three million resulting in a ratio of less than 10 cardiologists per million. Many subspecialty areas in neurology, cardiology and other specialities have no representation in the physician pool. Likewise, many of the smaller Caribbean islands have no specialists in many medical fields.

In terms of nurses, high-income countries average 11.4 nurses per 1,000 population when compared with 0.9 nurses per 1,000 population in low-income countries.

While it is sometimes difficult to accurately estimate how many physicians are needed for any one country as this may vary significantly depending on the health, age, and disease burden of a population, the World Health Organization (WHO) recommends one physician per 1,000 population.

It is not difficult to see how manpower shortages affect health care delivery. In our public hospitals and clinics (particularly specialist clinics at our tertiary hospitals) there are long waits both for an appointment to be seen and also long waits during the clinical encounter. Many of our specialists' units which require nurses with advanced qualifications. Intensive-care units (ICUs), labour and delivery wards and operating rooms have critical nursing shortages. In an ICU setting it may very well be that a bed is available for an ill patient but there is no nurse available to deliver care. Operating rooms can sit empty despite physicians who are able to operate because there are no nurses to assist in the operating room or recover the patient after surgery.

These issues are not only noted in the public sector. There are several areas of medicine in the private care arena for which specialists are in relatively short supply or non-existent leading to long waits to see a physician or in some scenarios result in the need to seek care abroad. Interestingly issues of manpower availability are not confined to low-and middle-income countries. The crisis in the National Health Service (NHS) of the United Kingdom is frequently in the news. One of the causes of the failure of health care delivery is a shortage of personnel. The British Medical Association estimates that in their secondary care system there are physician vacancies of 9,053 posts and nursing vacancies of 47,496 posts. Nursing shortages are a problem in most high income countries leading to aggressive recruitment from low and middle income countries which in most cases are unable to compete with the remuneration that is offered.

A manpower issue that is particularly affects low and middle countries is the use of allied health-care practitioners. More developed health care systems have long recognised that much of medical and nursing care is relatively routine and does not require the relatively high cost of physician and nursing labour to deliver. The use of technicians, nursing aides and physician extenders can allow the delivery of health care in a more efficient fashion and to a wider range of individuals. A good example of this is the use of technicians to acquire images for cardiac ultrasound (echocardiography). Echocardiographic images are obtained in a certain sequence, from defined areas for each study. This is standard for every patient. A technician can be trained to do this competently within a few months allowing the cardiologist to spend minutes reviewing the images and reporting vs spending 30 minutes acquiring the images. In the United States the use of technicians for cardiac ultrasound has been routine for more than 30 to 40 years. A technician doing cardiac ultrasound frees the cardiologist to do work for which he is uniquely qualified and which cannot be performed by those with lesser levels of training. The use of midwives for routine delivery is another example. Obstetricians can focus on the delivery of infants that are at high risk for complication or who have problems during labour and delivery. There are, however, many other roles for which allied health-care providers can be useful and generally these are often ignored in health-care systems of low- and middle-income countries.

Geographic distribution of health-care resources

In our previous article we discussed the disparities between countries in terms of access to care but in almost all countries there are significant disparities within countries. These can be seen most easily when comparing the urban rural divide. Globally and within countries, there is significant inequity in the distribution of health-care resources with 80 per cent of resources often accessible to the top 20 per cent of the population in terms of economic position while the bottom 80 per cent have access to 20 per cent of the resources. If we were to think of the distribution of cardiologists in Jamaica. Most of these physicians practice in Kingston, St Andrew, and St Catherine. Mandeville and Montego Bay have probably four cardiologists between them. Aside from outreach clinics, seeing a cardiologist does require travel to one of these areas. Imagine if you live in Portland; then seeking care likely means a day devoted to health care alone. On that day you will not be able to go to work, you may have to think about how do you arrange childcare? If you do not have a car, how will you travel to the hospital or cardiologist's office and at what cost? For many low- and middle-income countries economic opportunities, amenities and quality of life are greater in urban settings, leading both physicians and nurses to gravitate towards those areas leaving rural populations relatively underserved. Globally it is estimated that half of the population lives in rural areas compared with 38 per cent of nurses and 25 per cent of physicians.

This disparity between urban and rural areas is not only a problem of low and middle income countries. In the United States the ratio of primary care physicians to 10,000 population is 39.8/10,000 in rural areas compared to 53.3/10,000 in urban areas. Studies have documented that treatment for heart attack which is time dependent has worse outcomes in the rural United States. Patients in rural areas often have to travel further for care. For example, one study found that patients in need of radiation therapy in rural America needed to travel an average of 40.8 miles when compared with a patient in an urban setting who travelled an average of 15.4 miles. In Europe living in a rural area has been associated with a lack of access to qualified health-care workers, greater distance to major hospitals, less effective emergency care services and greater demands on health-care workers.

In future articles we will address other issues related to health care access.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call 876-906-2107

Santo Domingo, DR.
The Dominican Republic continues with low records of coronavirus cases, a disease that has caused 4,384 deaths and 660,814 affected in three years.

The General Directorate of Epidemiology of the Ministry of Public Health notified 14 new cases of covid-19 after processing 935 samples, of which 249 were PCR and 686 were antigenic.

Bulletin #1079 indicates that the daily positivity stands at 2.29 % and that there are now only 53 active cases.

Regarding hospitalizations, no persons are in Covid beds or Intensive Care Units.

Lessons from Covid

On March 1, 2020, the first case of Covid-19 was diagnosed in the country, and for three years, it has been fighting against the disease.

To know the experience, Listín Diario will gather four speakers and 12 panelists who have played essential roles in the fight against Covid-19 to expose the experiences and actions adopted by the country in front of the pandemic during the National Forum Covid-19, which will take place next Friday, March 10.

The activity, organized by Listín Diario together with the Pontificia Universidad Católica Madre y Maestra (PUCMM) and the Ministry of Public Health, is aimed at presenting the experiences of the work carried out in the management of the Covid-19 pandemic to see the lessons learned and the strengths left to the health system, three years after the diagnosis of the first imported case in the Dominican Republic.

The forum, which will have three large panels, will include the participation of the Minister of Public Health, Daniel Rivera, who will speak on the Management of the Public, Private, and Citizen Alliance, and Mr. Chanel Rosa Chupany, who headed the SNS, among others.

It should be noted that the latest variant of covid’s severity has lessened substantially, with mild symptoms and no hospitalizations. Also, the natural immunity produced by an infection prevents further contraction or spread of the virus.

AUTHORITIES RAMP UP EFFORTS TO KEEP AFRICAN SWINE FLU, BIRD FLU OUT

By Anesta Henry

Cabinet has approved the resources to bolster efforts to prevent African swine fever or bird flu outbreaks on the island.
Although not saying exactly how much had been provided, Chief Veterinary Officer Dr Mark Trotman said that in addition to monitoring outbreaks in other countries, the Ministry of Agriculture has been working closely with farmers to ensure they are implementing preventative measures to protect their pigs and birds.
There have been outbreaks of African swine fever across Europe and bird flu in parts of Asia.
Speaking from the well of Parliament as the Estimates Debate continued on Friday, Dr Trotman said the ministry has also been producing public service announcements to inform Barbadians about the two “serious” diseases, including the damage they had the potential to cause.
“At the end of the day, it is up to the farmers to put measures in place to prevent the entry of the viruses, whether it be bird flu or African swine fever. From an entry standpoint, we are doing some monitoring of landing sites because the bird flu is a highly pathogenic avian influenza, to use the correct term.
“This particular outbreak seems to be transmitted through migratory birds which is a little different from the previous episodes, which makes it a totally different beast to deal with,” Dr Trotman said.
He added: “So we are monitoring sites where wild birds come into the country. Barbados, as you know, is right in the middle of the Atlantic flyway; birds travelling south in the winter do rest in landing sites in Barbados and that poses a risk of entry of the disease into the country. So monitoring those landing sites becomes important, so if we do get birds that are potentially coming in we can pick that up.”
The Chief Veterinary Officer said officials have also been creating a database on the poultry and pork industry to identify where farms are situated and what risk factors exist, particularly if they are close to landing sites for birds.
He said that while there is an ongoing community outreach programme to register farms, there is evidence of a significant number of unregistered farmers.
Dr Trotman pointed out that these farmers do not access the services of the Ministry of Agriculture for technical support or veterinary assistance because they do not consider themselves farmers.
“We are putting GPS points on each of these farms so we have a good overview of where they are, not only so that we can identify them, but in the event of an outbreak we can map it and identify how the disease can possibly spread from there outwards.
“We have found that we have well over 1 500 pig holding areas, which were a lot more than we thought there were. The poultry industry, they are such a diverse group of farmers – you have your commercial entities, you have your small holders, you have your backyard farmers – and each of them has to have a tailored approach in terms of what they can do to protect their farms,” he explained.
With respect to the importation of pork and poultry products, Dr Trotman said as the need arises and outbreaks widen within certain countries, restrictions are being implemented to prevent the entry of the viruses.
“We put restrictions to prevent it from entering through passenger baggage, through commercial entries, while trying our best to safeguard a certain level of trade. We have had to take a more surgical approach to this rather than an outright ban on all poultry and pork products.
“We have done that quite successfully with countries such as the United States and Canada, and so we are looking to try to do it with the United Kingdom as well,” the Chief Veterinary Officer said.
anestahenry@barbadostoday.bb

The post ON GUARD appeared first on Barbados Today.

Contaminated cough and paracetamol syrups imported into Gambia almost certainly caused the deaths of 66 children due to acute kidney injury, according to an investigation led by the United States Center for Disease Control and Prevention and Gambian scientists.

The links between the children's deaths and contaminated medicines first came to light in October, when the World Health Organization sent out an alert saying four cough syrups made by India's Maiden Pharmaceuticals Ltd contained toxic levels of diethylene and ethylene glycol and should be withdrawn.

The new investigation "strongly suggests" that medicines contaminated with the toxins, imported into Gambia, led to the cluster of acute kidney injury among 78 children. Most were aged under 2, and 66 died between June and September 2022. Four more children have since died, bringing the official toll up to 70.

WHO DEMANDS ACTION FOLLOWING COUGH SYRUP DEATHS

Maiden has denied its drugs were at fault for the deaths in Gambia, and the Indian government has said the syrups showed no contamination when it tested them. Production at the factory was stopped in October, but the company is now seeking to restart work.

The report, published in the New England Journal of Medicine on Thursday, reached its conclusions by looking at medical records of patients where available, as well as interviews with their parents and caregivers. It also says other evidence, such as the tests of the medicines, the wide geographic spread of the cases, and the fact that the illness did not spread to adults, pointed towards a toxin rather than an infectious agent.

There have been a number of poisonings linked to diethylene and ethylene glycol in the past in countries including Haiti and Nigeria, but the report says this is the first known incident when imported medicines were at fault rather than domestically developed drugs.

"This likely poisoning event highlights the potential public health risks posed by the inadequate quality management of pharmaceutical exports," the report said.

Since the deaths in Gambia, 201 children have also died in Indonesia, and 19 in Uzbekistan, linked to different manufacturers' contaminated cough syrups.

Although the behavior of these diseases cannot be viewed on the Epidemiology Directorate website, because it is outdated, one death from leptospirosis and six reports have already been observed in just one week, the first in 2023. Although the numbers are not available to make comparisons of the behavior of dengue, as of the first week of this year, 70 cases of dengue had been reported, a viral disease that requires epidemiological surveillance and that greatly affects children under 15 years of age.

For the same period last year, 68 cases had been reported. No deaths had been reported as of this date. Hospitals such as Robert Reid Cabral and Hugo Mendoza report a low amount of patients. However, the disease is a latent threat and community collaboration is required to prevent it.

 

MCh Surgical Oncology or Master of Chirurgiae in Surgical
Oncology also known as MCh in Surgical Oncology is a super speciality level course for doctors in India that they do after completion of their postgraduate medical degree course. The duration of
this super speciality course is 3 years, and it focuses
on the diagnosis and surgical management of all types of cancer, in order to
improve the procedure outcome and chances of survival.

The course is a full-time
course pursued at various recognized medical colleges across the country. Some
of the top medical colleges offering this course include All India Institute Of
Medical Sciences, New Delhi, All India Institute Of Medical Sciences,
Rishikesh, Uttrakhand, All India Institute Of Medical Sciences, Bhubaneshwar,
Orissa.

Admission to this course is
done through the NEET-SS Entrance exam conducted by the National Board of
Examinations, followed by counselling based on the scores of the exam that is
conducted by DGHS/MCC/State
Authorities.

The fee for
pursuing MCh (Surgical Oncology) varies from college to college and may range from Rs.7 thousand to Rs. 94 lakhs.

After completion of their
respective course, doctors can either join the job market or can pursue certificate courses and Fellowship programmes recognized by
NMC and NBE. Candidates can take
reputed jobs at positions as Senior residents, Consultants, etc. with an
approximate salary range of Rs 26 lakhs to Rs. 87 lakhs per annum.

What is
MCh in Surgical Oncology?

Master of Chirurgiae in Surgical Oncology, also known
as MCh (Surgical Oncology) or MCh in (Surgical Oncology) is a three-year super
speciality programme that candidates can pursue after completing a postgraduate
degree.

MCh Surgical Oncology focuses on the
diagnosis and surgical management of all types of cancer, in order to improve the
procedure outcome and chances of survival. It aims to enable candidates to develop their knowledge and
extend and advance their practice to achieve competence in Surgical Oncology,
providing candidates with breadth and depth of experience. Specialty areas
include Endoscopic Laser Surgery for Head and Neck Cancer Surgery,
Reconstructive Surgery, Skull Base Surgery, Thyroid Surgery, etc.

The Competency-Based
Postgraduate Training Programme governs the education and training
of MCh in Surgical Oncology.

The
postgraduate students must gain ample knowledge and experience in the
diagnosis, and treatment of patients with acute, serious, and life-threatening
medical and surgical diseases.

PG
education intends to create specialists who can contribute to high-quality
health care and advances in science through research and training.

The required
training done by a postgraduate specialist in the field of Surgical
oncology would help the
specialist recognize the community’s health needs. The student should be
competent to handle medical problems effectively and should be aware of the
recent advances in their speciality.

The
candidate is also expected to know the principles of research methodology and
modes of the consulting library. The candidate should regularly attend
conferences, workshops and CMEs to upgrade her/ his knowledge.

Course
Highlights

Here are some of the course highlights of MCh in Surgical Oncology

Name of Course

MCh in Surgical Oncology

Level

Doctorate

Duration of Course

Three years

Course Mode

Full Time

Minimum Academic Requirement

Candidates must have a
postgraduate medical Degree in MS/DNB
(General Surgery) obtained from any college/university recognized by the
Medical Council of India (Now NMC)/NBE, this feeder qualification mentioned
here is as of 2022. For any further changes to the prerequisite requirement
please refer to the NBE website.

Admission Process / Entrance Process / Entrance
Modalities

Entrance Exam (NEET-SS)

INI CET for various AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS
Bengaluru

Counselling
by DGHS/MCC/State Authorities

Course Fees

Rs.7 thousand to Rs. 94 lakhs

Average Salary

Rs 26 lakhs to Rs.87 lakhs per annum

Eligibility
Criteria

The eligibility criteria for MCh in Surgical Oncology are defined as the
set of rules or minimum prerequisites that aspirants must meet to be eligible
for admission, which includes:

Name of Super Specialty course

Course Type

Prior Eligibility Requirement

Surgical Oncology

MCh

MS/DNB (General Surgery)

Note:

· The feeder qualification for MCh Surgical Oncology is defined by the
NBE and is subject to changes by the NBE.

· The feeder qualification mentioned here is as of 2022.

· For any changes,
please refer to the NBE website.

• The prior entry qualifications shall be
  strictly by Post Graduate Medical Education Regulations, 2000, and its
  amendments notified by the NMC and any clarification issued from NMC in
  this regard.
• The candidate must have obtained permanent
  registration with any State Medical Council to be eligible for admission.
• The medical college's recognition cut-off
  dates for the Postgraduate Degree courses shall be as prescribed by the
  Medical Council of India (now NMC).

Admission Process

The admission process contains a few steps to be followed
in order for the candidates for admission to MCh in Surgical Oncology. Candidates can view the complete admission process for MCh in Surgical Oncology mentioned below:

• The NEET-SS or National
  Eligibility Entrance Test for Super speciality courses is a national-level
  master’s level examination conducted by the NBE for admission to DM/MCh/DrNB Courses.
• Qualifying
  Criteria-Candidates placed at the 50th percentile or above shall be declared as
  qualified in the NEET-SS in their respective speciality.
• The
  following Medical institutions are not covered under centralized admissions for
  DM/MCh courses through NEET-SS:

1. AIIMS, New Delhi and
other AIIMS

2. PGIMER, Chandigarh

3. JIPMER, Puducherry

4. NIMHANS, Bengaluru

• Candidates
  from all eligible feeder speciality subjects shall be required to appear in the
  question paper of the respective group if they are willing to opt for a
  super-speciality course in any of the super-speciality courses covered in that
  group.
• A
  candidate can opt for appearing in the question papers of as many groups for
  which his/her Postgraduate speciality qualification is an eligible feeder
  qualification.
• By
  appearing in the question paper of a group and on qualifying for the examination, a
  candidate shall be eligible to exercise his/her choices in the counselling only
  for those super-speciality subjects covered in the said group for which his/ her
  broad speciality is an eligible feeder qualification.

Fee Structure

The fee
structure for MCh in Surgical Oncology
varies from college to college. The fee is generally less for Government
Institutes and more for private institutes.
The average fee structure for MCh in Surgical Oncology is from Rs.7 thousand to Rs. 94 lakhs per year.

Colleges offering MCh in Surgical
Oncology

There are various medical colleges across India that offer courses for
pursuing MCh in (Surgical Oncology).

As per National Medical Commission (NMC) website, the following medical
colleges are offering MCh in (Surgical
Oncology) courses for the academic year 2022-23.

Sl.No.

Course Name

State

Name and Address of
Medical College / Medical Institution

Annual Intake (Seats)

1

M.Ch - Surgical Oncology

Uttar Pradesh

Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow

2

2

M.Ch - Surgical Oncology

Uttar Pradesh

King George Medical University, Lucknow

6

3

M.Ch - Surgical Oncology

Uttar Pradesh

Institute of Medical Sciences, BHU, Varanasi

5

4

M.Ch - Surgical Oncology

Uttarakhand

All India Institute of Medical Sciences, Rishikesh

26

5

M.Ch - Surgical Oncology

Telangana

Osmania Medical College, Hyderabad

5

6

M.Ch - Surgical Oncology

Tamil Nadu

Madras Medical College, Chennai

2

7

M.Ch - Surgical Oncology

Tamil Nadu

Kilpauk Medical College, Chennai

6

8

M.Ch - Surgical Oncology

Tamil Nadu

Regional centre for Cancer Research and treatment, Adyar, Chennai

9

9

M.Ch - Surgical Oncology

Rajasthan

All India Institute of Medical Sciences, Jodhpur

4

10

M.Ch - Surgical Oncology

Pondicherry

Jawaharlal Institute of Postgraduate Medical Education &
Research, Puducherry

3

11

M.Ch - Surgical Oncology

Orissa

Acharya Harihar Regional Cancer Centre, Cuttack

2

12

M.Ch - Surgical Oncology

Orissa

All India Institute of Medical Sciences, Bhubaneswar

4

13

M.Ch - Surgical Oncology

Maharashtra

Bhabha Atomic Research Centre,Mumbai

14

M.Ch - Surgical Oncology

Maharashtra

Tata Memorial centre, Mumbai

24

15

M.Ch - Surgical Oncology

Madhya Pradesh

Sri Aurobindo Medical College and Post Graduate Institute ,
Indore

4

16

M.Ch - Surgical Oncology

Kerala

Regional Cancer Centre, Thiruvanthapuram

6

17

M.Ch - Surgical Oncology

Karnataka

Vydehi Institute Of Medical Sciences & Research Centre,
Bangalore

5

18

M.Ch - Surgical Oncology

Karnataka

Kidwai Memorial Institute of Oncology, Bangalore

11

19

M.Ch - Surgical Oncology

Karnataka

St. Johns Medical College, Bangalore

1

20

M.Ch - Surgical Oncology

Gujarat

B J Medical College, Ahmedabad

10

21

M.Ch - Surgical Oncology

Delhi

All India Institute of Medical Sciences, New Delhi

15

22

M.Ch - Surgical Oncology

Bihar

All India Institute of Medical Sciences, Patna

2

23

M.Ch - Surgical Oncology

Assam

Dr. B. Borooah Cancer Institute (Regional Cancer Centre),
Guwahati

3

24

M.Ch - Surgical Oncology

Andhra Pradesh

Sri Venkateswara Institute of Medical Sciences (SVIMS) ,
Tirupati

2

Syllabus

An MCh in Surgical
Oncology is a three years specialization course that provides training
in the stream of Surgical Oncology.

As of 02/03/2023 the competency-based curriculum for
MCh in Surgical Oncology course is not available on NMC's official Website.
However, the course content of the Jawaharlal Nehru Medical
College, Belgaum represented here can be used for
reference and an idea of what the Syllabus of the MCh in Surgical Oncology course will
contain:

PART ONE:

MOLECULAR BIOLOGY OF CANCER

1. The Cancer Genome

2. Mechanisms of Genomic Instability

3. Epigenetics of Cancer

4. Telomeres, Telomerase, and Cancer

5. Cell Signaling Growth Factors and Their Receptors

6. Cell Cycle

7. Mechanisms of Cell Death

8. Cancer Metabolism

9. Angiogenesis

10. Invasion and Metastasis

11. Cancer Stem Cells

12. Biology of Personalized Cancer Medicine

PART TWO:

ETIOLOGY AND EPIDEMIOLOGY OF CANCER

Section 1: Etiology of Cancer

13. Tobacco

14. Cancer Susceptibility Syndromes

15. DNA Viruses

16. RNA Viruses

17. Inflammation

18. Chemical Factors

19. Physical Factors

20. Dietary Factors

21. Obesity and Physical Activity

Section 2:
Epidemiology of Cancer

22. Epidemiologic Methods

23. Global Cancer Incidence and Mortality

24. Trends in cancer Mortality

PART THREE:

PRINCIPLES OF CANCER TREATMENT

25. Surgical Oncology: General Issues

26. Surgical Oncology Laparoscopic

27. Radiation Oncology

28. Medical Oncology

29. Assessment of Clinical Response

30. Cancer Immunotherapy

31. Health Services Research and Economics of Cancer
Care

PART FOUR:

PHARMACOLOGY OF CANCER THERAPEUTICS

Section 1: Chemotherapy Agents

32. Pharmacokinetics and Pharmacodynamics

33. Pharmacogenomics

34. Alkylating Agents

35. Platinum Analogs

36. Antimetabolites

37. Topoisomerase Interacting Agents

38. Ant microtubule Agents

39. Targeted Therapy with Small Molecule Kinase
Inhibitors

40. Histone Deacetylase Inhibitors and Demethylating
Agents

41. Proteasome Inhibitors

42. Poly (ADP-Ribose) Polymerase Inhibitors

43. Miscellaneous Chemotherapeutic Agents

Section 2: Bio therapeutics

44. Interferons

45. Interleukin Therapy

46. Antisense Agents

47. Ant angiogenesis Agents

48. Monoclonal Antibodies

49. Endocrine Manipulation

PART FIVE:

CANCER
PREVENTION

50. Preventive Cancer Vaccine

51. Tobacco Dependence and its Treatment

52. Role of Surgery in Cancer Prevention

53. Principles of Cancer Risk Reduction Intervention

54. Retinoids, Carotenoids, and Other Micronutrients
in Cancer Prevention

55. Drugs and Nutritional Extracts for Cancer Risk Reduction
(Chemoprevention)

PART SIX:

CANCER SCREENING

56. Principles of Cancer Screening

57. Early Detection Using Proteomics

58. Screening for Gastrointestinal Cancer

59. Screening for Gynecologic Cancer

60. Screening for Breast Cancer

61. Screening for Prostate Cancer

62. Screening for Lung Cancer

63. Genetic Counseling

PART SEVEN:

SPECIALIZED
TECHNIQUES IN CANCER MANAGEMENT

64. Vascular Access and Specialized

65. Interventional Radiology

66. Functional Imaging

67. Molecular Imaging

68. Photodynamic Therapy

69. Biomarkers

PART EIGHT:

PRACTICE OF ONCOLOGY

70. Design and Analysis of Clinical Trails

Section 1: Cancer of the Head and Neck

71. Molecular Biology of Head and neck Cancers

72. Treatment of Head and Neck Cancer

73. Rehabilitation after Treatment of Head and Neck
Cancer

Section 2: Cancer of the Thoracic Cancer

74. Molecular Biology of Lungs Cancer

75. Non – Small Cell Lung Cancer

76. Small Cell and Neuroendocrine Tumors of the Lungs

77. Neoplasms of the Mediastinum

Section 3: Cancer of the Gastrointestinal Tract

78. Molecular Biology of the Esophagus and Stomach

79. Cancer of the Esophagus

80. Cancer of the Stomach

81. Molecular Biology of Pancreas Cancer

82. Cancer of the Pancreas

83. Molecular Biology of Liver Cancer

84. Cancer of the Liver

85. Cancer of the Biliary Tree

86. Cancer of the Small Intestine

87.Gastrointestinal Stromal Tumor

88. Molecular Biology of Colorectal Cancer

89. Cancer of the colon

90. Cancer of the Rectum

91. Cancer of the Anal Region

Section 4:
Cancer of the Genitourinary System

92. Molecular Biology of Kidney Cancer

93. Cancer of the Kidney

94. Molecular Biology of Bladder Cancer

95. Cancer of the Bladder, Ureter, and Renal pelvis

96. Molecular Biology of Prostate Cancer

97. Cancer of the Prostate

98. Cancer of the Urethra and Penis

99. Cancer of the Testis

Section 5:
Gynecology Cancers

100. Molecular Biology of Gynecologic Cancers

101. Cancer of the Cervix, Vagina, and Vulva

102. Cancer of the Uterine Body

103. Gestational Trophoblastic Neoplasms

104. Ovarian Cancer, Fallopian Tube Carcinoma, and
peritoneal Carcinoma

Section 6: Cancer of the Breast

105 Molecular Biology of Breast Cancer

106 Malignant Tumors of the Breast

Section 7:
Cancer of the Endocrine System

107. Molecular
Biology of Endocrine Tumors

108. Thyroid
Tumors

109.
Parathyroid Tumors

110. Adrenal
Tumors

111. Pancreatic
Neuroendocrine Tumors

112.
Neuroendocrine (Carcinoid) Tumors and the Carcinoid Syndrome

113 Multiple
Endocrine Neoplasias

Section 8:
Sarcomas of Soft Tissue and Bone

114. Molecular
Biology of Soft Tissue Sarcoma

115. Soft
Tissue Sarcoma

116. Sarcomas
of Bone

Section 9:
Cancer of the skin

117. Cancer of
the skin

118. Molecular
Biology of Cutaneous Melanoma

119. Cutaneous
Melanoma.

Section10: Neoplasms of the Central Nervous System

120. Molecular
Biology of Central Nervous System Tumors

121. Neoplasms
of the Central Nervous System.

Section 11: Cancers of Childhood

122. Molecular
Biology of Childhood Cancers

123. Solid
Tumors of Childhood

124. Leukemia
and Lymphomas of Childhood

Section 12: Lymphomas in Adults

125. Molecular Biology of Lymphomas

126. Hodgkin Lymphoma

127. Non –Hodgkin Lymphomas

128. Cutaneous Lymphomas

129. Primary Central Nervous System Lymphoma

Section 13: Leukemias and plasma cell Tumors

130. Molecular Biology of Acute Leukemias

131. Management of Acute Leukemias

132. Molecular Biology of Chronic

133. Chronic Myelogenous Leukemia

134. Chronic Lymphocytic Leukemias

135. Myelodysplastic Syndromes

136. Plasma Cell Neoplasms

137. Cancer of Unknown Primary Site

138. Benign and Malignant Mesothelioma

139. Peritoneal Surface Malignancy

140. Intraocular Melanoma

Section 15: Immunosuppression- Related Malignancies

141. AIDS-Related
Malignancies

142.
Transplantation –Related Malignancies

Section 16:
Oncologic Emergencies

143. Superior
Vena Cava Syndrome

144. Increased
Intracranial Pressure

145. Spinal
Cord Compression

146. Metabolic
Emergencies

Section 17: Treatment of Metastatic Cancer

147. Metastatic
Cancer to the Brain

148. Metastatic
Cancer to the Lung

149. Metastatic
Cancer to the Liver

150. Metastatic
Cancer to the Bone

151. Malignant
Effusions of the Pleura and the Pericardium

152. Malignant
Ascites

153. Para
neoplastic Syndromes

Section 18: Stem Cell Transplantation

154. Autologous
Stem Cell Transplantation

155. Allogeneic
Stem Cell Transplantation

Section 19: Management of Adverse Effects of Treatment

156. Infections
in the Cancer Patient

157. Leukopenia
and Thrombocytopenia

158.
Cancer-Associated Thrombosis

159. Diarrhoea
and Constipation

160. Diarrhoea
and Constipation

161. Oral
Complication

162. Pulmonary
Toxicity

163. Cardiac
Toxicity

164. Hair Loss

165. Gonadal
Dysfunction

166. Fatigue

167. Second
Primary Cancer

168.
Neurocognitive Effects

169. Cancer
Survivorship

Section 20: Supportive Care and Quality of Life

170. Management
of Cancer Pain

171.
Nutritional Support

172. Sexual
Problems

173.
Psychological Issues in Cancer

174.
Communicating News to the Cancer

175.
Specialized Care of the Terminally III

176. Community Resources

177.
Rehabilitation of the Cancer Patient

Section 21: Societal Issues in Oncology

178. Regulatory
Issues

179. Health
Disparities Cancer

180. Cancer
Information on the Internet

Section 22:
Complementary, Alternative, and Integrative Therapies

181. Complementary, Alternative, and Integrative
Therapies in Cancer care

The postgraduates will be sensitized to regulations
under different

statutory Councils, such as the Medical Council of the
India Act, The Code of

Medical Ethics, Transplantation of Human Organs Act,
etc. They will also be

familiarized with other legislation /Acts, that affect
the practice of Clinical

Medicine (like the Consumer Protection Act, The Drugs
and Cosmetics Act,

The Medical Termination of Pregnancy Act, The
Narcotics and Psychotropic

Substances Control Act, etc.)

Career Options

After completing an MCh in Surgical Oncology, candidates will get employment
opportunities in Government as well as in the Private sector.

In the Government
sector, candidates have various options to choose from which include Registrar,
Senior Resident, Demonstrator, Tutor, etc.

While
in the Private sector, the options include Resident Doctor, Consultant (Surgical Oncology),
Visiting Consultant (Surgical Oncology), Junior Consultant (Surgical Oncology), Senior Consultant (Surgical Oncology), Assistant Professor (Surgical Oncology),
Associate Professor (Surgical Oncology).

Courses
After MCh in Surgical Oncology Course

MCh in Surgical
Oncology is a specialization course
that can be pursued after finishing a Postgraduate medical course. After
pursuing a specialization MCh in Surgical Oncology, a candidate could also pursue certificate courses
and Fellowship programs recognized by NMC and NBE, where MCh in Surgical Oncology is a feeder qualification.

These include fellowships in:

· Fellowship in
Onco-Surgery

· Fellowship
in Surgical Oncology

· Complex
General Surgical Oncology (CGSO) Fellowship

Frequently
Asked Questions (FAQs) –MCh in Surgical OncologyCourse

• Question: What is the
  full form of an MCh?

Answer: The full form of an MCh is Master of Chirurgiae.

• Question: What is an MCh in Surgical Oncology?

Answer: MCh Surgical Oncology or Master of
Chirurgiae in Surgical Oncology also known as MCh in Surgical Oncology is a super
speciality level course for doctors in India that they do after
completion of their postgraduate medical degree course.

• Question: What is the
  duration of an MCh in Surgical Oncology?

Answer: MCh in Surgical Oncology is a super speciality
programme of three years.

• Question: What is the
  eligibility of an MCh in Surgical
  Oncology?

Answer: The candidates must have a postgraduate medical Degree in MS/DNB (General Surgery) obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE, this feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.

• Question: What is the
  scope of an MCh in Surgical Oncology?

Answer: MCh in Surgical Oncology offers
candidates various employment opportunities and career prospects.

• Question: What is the
  average salary for an MCh in Surgical
  oncology candidate?

Answer: The MCh in Surgical Oncology candidate’s average salary is between Rs. 26 lakhs to Rs. 87 lakhs per annum depending on the
experience.

• Question: Can you teach
  after completing an MCh Course?

Answer: Yes, the candidate
can teach in a medical college/hospital after completing an MCh course.

On Thursday March 2, 2023 the Healthy Caribbean Coalition hosted, “Childhood Obesity in the Caribbean – How do we care for the 1 in 3?” – a webinar aimed to create a space for persons with lived experience, advocates and practitioners to discuss childhood obesity treatment and management in the Caribbean.

The conversation centered around the need to embrace and protect a child’s right to health which should be extended to quality healthcare services and support.

The panelists provided their unique perspectives on how we can actualize caring for the 1 in 3 Caribbean children who are living with overweight or obesity.

Professor Alafia Samuels
Chair of NCD Child and member of the Board of Trustees of the World Obesity Federation

Professor Anne St. John
Pediatrician and Medical Director for Youth Health Heart with the Heart and Stroke Foundation of Barbados

Ms. Michelle Sutton
Health and Wellness Coordinator, Ministry of Education, SKN

 

• Mr. Komo Phillips, Parent
• Mr. Kareem Smith, person with lived experience

Moderated by:

Alaina Gomes
HCY and Counselling Psychologist, Antigua

Pierre Cooke Jr.
HCC Technical Youth Advisor

Danielle Walwyn
HCC Advocacy Officer and Coordinator of Healthy Caribbean Youth

The conversation started with centering on the lived experience with perspectives by Jomo Phillips and Kareem Smith – both of them sharing their thoughts on how obesity is viewed in the Caribbean. Kareem shared,

How is obesity viewed in the Caribbean? – a simple answer is “not very good” and from my perspective from a young age, that is because there are a multiplicity of very politically incorrect – sometimes insulting words – and ways that are used to describe children who are overweight and in some circumstances where there are very few real pathways for parents and children to actually address that problem

He also shared that children are exposed to a “tremendous amount of dialogue about their weight” which is not constructive or helpful from friends, family and even physicians. Danielle echoed this sentiment from her own personal experiences with being overweight as a child.

Further Kareem noted that when he was growing up, he didn’t feel as if childhood obesity efforts were prioritized by policymakers which he noted is shifting but emphasized that there needs to be more monitoring and enforcement of recommended policies.

Support for children living with obesity must span sectors of society. Mr. Phillips, emphasized the tremendous support that the Heart and Stroke Foundation of Barbados’ Yute gym has provided for his family and his daughter who lived with obesity. Mr. Phillips noted that the gym provides a variety of different activities that include physical activity, healthy eating and preparing healthy meals. One of the things that he says keeps his daughter going is the ability to bond and engage with other young “people who look like her and have similar struggles but also have fun and enjoy the program as well.”

In transitioning the conversation to the management of childhood obesity, Danielle asked audience members what they thought was critical to properly manage children living with obesity. They said:

In focusing on management, Professor St John highlighted the new American Academy of Pediatrics guidelines for the evaluation and treatment of children and adolescents with obesity.

In referencing the guidelines, she noted,

Those guidelines are not too soon in coming. Over the years in pediatrics, we have really struggled to facilitate parents becoming sensitized , as Kareem mentioned in his experience. We find that doctors [and] healthcare providers are not sensitized that overweight and obesity is an issue, healthwise. A child will visit the office with a cold or cough complaint and the child is overweight. The overweight is not mentioned by the physician, just the acute illness. If you don’t identify something as an issue you don’t try to manage it. The American guidelines of about 90 pages – is quite comprehensive – in essence there is not a lot of new information there. The guidelines place emphasis on the need to examine the child, and the need to identify specific issues, risk factors, genetic factors, and other factors, which play a role in the conditions of obesity and overweight, and then there is a need to treat the obesity and overweight as soon as the diagnosis is made and not to wait until the child is a teenager

Upon reflection of the guidelines and management of obesity, panelists shared a number of sentiments:

Professor Alafia was disappointed that clinical guidelines were being released before prevention guidelines. She emphasized the need to continue with our ongoing childhood obesity prevention efforts including advocating for policies that protect food environments – like regulating the sale and marketing of unhealthy food and beverages to children. It is important to note that these prevention efforts are also critical in the management of childhood obesity.

Mr. Kareem Smith, also agreed that prevention is better than cure and “instilling good habits early in children’s lives” is important. He also noted that technical expertise is critical in guiding children who do live with obesity as the lack of guidance can lead to persons managing their weights in unsustainable or unhealthy ways.

Ms. Sutton spoke about the need to shape school environments and particularly the importance of the school curriculum. She noted that Saint Kitts and Nevis rebranded Physical and Health Education and Health and Family Life Education curricula – expanding them to focus more on the holistic health of a child. She said that these changes are in an effort to move “beyond telling people to do something – it is about empowering them and teaching them the skills sets to be healthy for life”

Mr. Phillips ended the panel by zoning in on the importance of the healthcare system in managing childhood obesity. He said that he has appreciated the passion, concern and care that his daughter’s pediatricians have provided along the journey. However, in general, there needs to be a heightened awareness and sensitivity of the challenges that these children and their families experience. Secondly there is a need for increased resources to support these persons – many more people need similar programs that the Heart and Stroke Foundation Yute Gym provides.

The webinar ended with panelists sharing their wish for childhood obesity prevention and management in the Caribbean.

Ban the marketing of unhealthy products to children because every hundred dollars they spend creates 200 dollars extra in consumption which would not have happened but for the marketing. They need to stop promoting toxic environments to our children.
Professor Alafia Samuels

My wish for the stigma associated with persons to be considered overweight and obese to be removed and for us to focus more on helping and assisting as opposed to labeling.
Ms. Alaina Gomes

My wish, in addition to supporting Prof Samuels, is to have throughout the Caribbean formulation and implementation of schools nutrition policies to encompass students from the age of 4 up to the age of 17 when they leave the school [given] that that is the environment where they spend most of their time. School nutrition policies for all schools throughout the Caribbean.
Professor Anne St. John

My wish is for the parents to understand that they are there to support their children in developing healthy habits – so stop sending the salty, sugary snacks to school and start cutting up some fresh fruits and vegetables that we can send to school for healthy snacking and healthy eating.
Ms. Michelle Sutton

That the rights of children are respected and protected in all of our obesity prevention and management efforts.
Mr. Pierre Cooke Jr.

We need to have our children treated with care and when necessary institutionalizing weight stigma and bias protocols within their spaces so that their health and wellbeing is protected. Our children deserve so much better and I think we can all agree that they deserve the best.
Danielle Walwyn

At the highest levels of Caricom – is the political prioritization of addressing obesity and not just language around it but actual action – to implement a package of policies… We need a comprehensive suite of policies recommended by PAHO, WHO, CARPHA and the HCC. So, my wish is that those policies are implemented because we know that it works and we’ve seen it in other countries and we have more to lose than many other places in the world.
Maisha Hutton

The HCC looks forward to continuing to facilitate conversations like these that center around children and their ultimate right to health.

The post World Obesity Day 2023 Webinar: Childhood Obesity in the Caribbean – How do we care for the 1 in 3? appeared first on Healthy Caribbean Coalition.