M. P. Ravindra Nathan

Suddenly, there is a new twist for all South Asian doctors in England.

The British government has recently passed a law that restricts jobs for trainee doctors outside the European Community (EU). If a suitable applicant from EU is not available, the job will go to an International Medical Graduate (IMG) which includes any South Asian doctor. Worse still, the many thousands of South Asian doctors (mostly Indians) currently employed by the National Health Services (NHS) in various training capacities are faced with the possibility of having to leave the country, without completing their residencies and obtaining the pos-graduate degrees. I wasn�t truly aware of the gravity of the situation till one of my junior colleagues here asked me to visit the Web site www.bbc.com, to get the latest scoop.

Now, there is a serious ongoing campaign by Indian immigrant physicians in U.K. to change this ruling. Even the Indian high commissioner in U.K. has registered his protest to represent the matters at the government level. �Thousands of trainee doctors from abroad have been �betrayed� by a sudden rule change,� say the campaigners. Hundreds of doctors have protested outside the Department of Health over the past several months to vent their concerns and doubts. These changes can potentially leave thousands jobless.

The following just about sums up what was posted at the BBC Web site:

�New immigration rules mean most non-EU doctors can no longer complete NHS training without work permits. But the government says it is protecting posts for U.K. graduates as supply of doctors outstrips demand.� Who is telling the truth? Is it another way of discrimination? The British Association of Physicians of Indian Origin (BAPIO) says at least 15,000 doctors may have to leave the county, heavily in debt and without having completed their qualifications, despite having been encouraged to come to the U.K. in the first place.

�A lot of new, budding doctors enthusiastically seek to complete their training in Britain because of the opportunity to support the NHS - and the knowledge they can then take to their practices in their home countries," said Ramesh Mehta of BAPIO. "They sell their homes, take out loans and leave their families behind to work in Britain. The change in rules is an absolute betrayal. Many will now return home with debt but no diploma, no qualifications.� �

The sad part is that a poorly trained East European doctor who speaks little English can get a job in the NHS but not a well-trained Indian doctor who almost always has good command of the language. However, a new scheme just established called �Medical Training Initiatives� (MITs) that allows the IMGs to train in the U.K. for a maximum of 24 months before returning home is a ray of sunshine amid the dark clouds. Fortunately the current problems do not affect second-generation South Asians, UK citizens.

Compared to all these, I should say, we definitely enjoy working in our current health system in USA, whether you are a trainee or a consultant. To start with, the pos-graduate training format here � residencies and fellowships � is structured and one doesn�t need to apply for a house officer�s job every six months as I did during my three years stay in England. So, the trainees have little to complain about except perhaps the long hours.

However, U.S. Health Services also face many challenges. There is constant debate about whether or not socialized medicine might solve our problems since we have a whopping 48 million uninsured people. That includes many South Asians too. Yes, we need to make a few changes, especially revising medical liability reform strategy and ensuring access to medical care for every single American citizen. But, before we adopt �socialized medicine,� a lot of thinking and research need to be done.

For now, private practice model may still be the more efficient system. But �cost, quality and access� are the three problems to be resolved. As Andy Stern, president of the Service Employees International Union, said in Wall Street Journal recently, �There seems to be broad consensus that we need a universal system that provides affordable coverage, choice of doctors and insurance plans, core benefits, and shared financing among employers, employees and government.�

Every country has its own set of problems and it behooves us to come up with solutions. And I have no doubt during the next decade radical changes will occur in U.S. health systems as well and it is important for all of us � physicians, nurses, administrators, politicians and the public to work together and come up with a �magic formula.�

Part of this article was published in St. Petersburg Times (Hernando) recently.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.

	Payal Patel

As we approach springtime in Florida, most people may have already noticed symptoms related to seasonal allergies. In this article, I would like to explain what seasonal allergies are along with information on managing them.

Allergies in general are your body�s reaction to foreign things in the environment. This is the body�s way of getting rid of the allergen by making the person have allergic symptoms. Approximately 20 percent of the general population is considered allergy prone. The most common types of seasonal allergens include pollens, weeds and outdoor molds. Allergies can usually appear as young as 2 yrs of age. But the most common age of allergy presentation is from age 4-6 yrs. If a child has one parent with allergies, there is a 30 percent chance of having allergies in general, compared to an increased risk of 70 percent if both parents have allergies. Children with eczema or asthma also have an increased risk of having allergies.

The usual symptoms include runny nose that is clear in color, sneezing, nasal congestion, postnasal drip, itchy eyes, nose and throat. Associated symptoms can be headaches because of constant congestion, and coughing and clearing of the throat due to post-nasal drip. There is no associated fever with allergies.

The usual determination of allergies are based on time of year, as well as reports of repeated incidence such as only in spring or only in fall. Also, important is the duration of these symptoms. If they occur only for 10-14 days it may be a cold-a viral infection, but if it has been greater than two weeks, then allergies can be strongly suspected. Allergy testing is helpful to identify moderate to severe allergies to dust mites, pet dander, pollens and molds but are not usually indicated for mild seasonal allergies.

Treatment for allergies includes elimination or avoidance of the allergen by remaining indoors during high-pollen count. Seasonal allergens usually peak late morning to afternoon, windy days when pollen is flying around, and when the lawn is being mowed. During these times, it is helpful to stay inside along with the closing of windows in homes and cars to lessen the exposure to the allergens.

Medications such as antihistamines namely Benadryl, Dimetapp for allergies, and Claritin are available over the counter. Prescription medicines include Zyrtec, Clarinex, Allegra and Singulair. Nasal sprays such as Nasonex, Flonase, Nasacort, Rhinocort, Astelin are underused in the pediatric population but are helpful to lessen local symptoms of congestion, runny, itchy nose, as well as reducing the post-nasal drip. For itchy watery eyes, allergy eye drops can relieve symptoms.

It is recommended to try over the counter management of allergies for 1-2 weeks, but if allergies still persist or are getting worse, your pediatrician will be able to help with prescription medication along with general guidance. Prolonged uncontrolled allergies can lead to sinusitis due to the inflammation in nasal passages and increased nasal secretions and also can block the auditory tubes leading to ear infections. It also is important to control allergies for asthma-prone children since allergies can trigger an acute asthma attack.

Dr. Payal Patel, a board-certified pediatrician with practice location (Lutz Pediatrics 18928 N. Dale Mabry Highway, Lutz, FL 33548) can be reached at the office at (813) 909-2199 or by e-mail at [email protected]