Ignorance is not bliss when it comes to neurological disorders. Indians, however, need to worry more as they face a double whammy. Not only are they miserably unaware of such ailments, but also the country is woefully short of neurologists who come in a highly uneven ratio of 1: 8, 50, 000 of the general population. Add to that the rural-urban divide and the disparity becomes even more glaring, with even fewer neurologists catering to the non-urban population that continues to throw up more and more cases with each passing day.
According to an article Neurology: The Scenario in India published in the Journal of Association of Physicians of India (JAPI) in January 2012, there are approximately 1,100 qualified clinical neurologists working in India which are too few to meet the needs of its 1.2 billion population.
While cases like a four-year-old boy from West Bengal suffering from Congenital Insensitivity to Pain with Anhidrosis (an inherited disease of the nervous system that prevents the sensation of pain, heat, cold, or any real nerve-related sensations called as CIPA) are rare, ordinary Indians are not even aware of common neurological disorders. And the dire shortage of qualified neurology workforce is destined to make matters worse.
Medical experts reckon the gap especially pertaining to rural-urban divide. Dr Sanjay Kumar Saxena, head of neurology department at Fortis hospital at Noida, laments, “There are not sufficient neurologists to take care of the nervous disorders, whatever few which are available are mostly restricted to the metros so the needs of the rural and other cities are not met.”
Of the 1100 neurologists, over 400 work in four large metros of India, leaving many districts and towns across the country to be covered by a single neurologist each. As a result of this disparity, only a small proportion of neurological cases can find their way to the neurologists and it is believed that over 90% of the neurology is handled by the internal medicine specialists. Compared to this, in developed countries the ratio of one neurologist for population varies from 20,000 to 50,000. Further, approximately only 80 students are registered for neurology courses every year throughout the country.
Some of the common neurological disorders in India are epilepsy, Parkinson’s disease, dementia, brain damage due to birth trauma, nerve weakness, neurological disorders consequent to nutritional deficiency and exposure to neurotoxic chemicals. Epidemiological indices of epilepsy in India are comparable to those from developed countries, with a prevalence rate of approximately five per 1,000 and incidence rate of approximately 50 per 100,000.
The age adjusted prevalence of Parkinson’s disease is 71.6 per 100, 000. For the country’s greying population, dementia is a problem which has become a serious concern.3.7 million people in India are affected with dementia and the figure is expected to double by 2030.
The recently reported congenital insensitivity to pain with anhidrosis (CIPA) is one of the rarest of its kind, with the first case being reported in 1983. Till date, 84 documented living cases have been reported in the United States and more than 300 in Japan. In India, one such case had come up approximately 20 years ago in Bangalore while the case of the four-year-old from West Bengal is the second.
Pointing out the steps needed to address the common neurological disorders in India, Dr Manish Sinha, consultant neurology, Moolchand Medcity, New Delhi emphasises, “We should spread awareness about detection and prevention of neurological diseases. There is an urgent need to improve neurology care at all levels of the hierarchy of the health care pyramid. Health budget should be enhanced to increase manpower and meet the growing technology requirements. There is also a need to increase the number of neurology training institutes without compromising on the standards of training.”
Concurring with Sinha, Dr Rajesh Kumar, consultant neurology at Rockland Hospital, reiterates, “Neurological disorders are most often neglected due to the lack of awareness, which in turn acts as a hurdle in further treatment of the disorders. Also, it is important that people are aware of the common neurological disorders so that they are able to address the issue on time to prevent complications.”