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June - July 2005


Outstanding Young Person of the World 2004-5: Dr Koshy P. Eapen

It is difficult to comprehend the sense of joy I got when I read about the award of ‘Outstanding Young Person of the World' given to a very young, handsome Indian doctor working at the University of London Hospital. I had never met the young man;but the desire of interviewing him for our readers became intense.

I wrote to him for an interview. We met in a café near Oxford Street. Humble in manners but proud of his achievement, Dr. Koshy Eapen has an infectious optimism about him. A man with a mission, idealistic in his ambitions yet practical in his approach, the young doctor loves to talk about his work with, hold your breath, old people. Geriatric Care, as they call it in medical world. He is a medical researcher on the epidemiology of geriatric care at the University of London. He has won sever awards including this year’s University of London’s Excellence and Achievement Award, and the 2002 outstanding Young Indian of the Year Award for his services to geriatric care. At the apex sits, till now, the ‘Outstanding Young Person of the World –2004-05 bestowed by the Junior Chamber International of the United States.

Born in Kottayam, Kerala, the young Koshy has had a bright educational career. At every step of the educational ladder he was given scholarship which perhaps made him work harder and receive another scholarship.

Koshy was the first Indian doctor to be awarded the full Cambridge Commonwealth Scholarship for his studies on the health care of the elderly. A Cambridge-Nehru scholar, he won the prestigious Harrison Watson and the Cambridge Commonwealth/JNMT scholarships.

He also won awards that enabled him to visit and research at the National Institute of Health at John Hopkins University , Maryland, and the University of North Carolina in the US, and Erasmus University, Holland. After a fellowship in clinical training in Oxford, Dr Eapen joined the University of London where he is now on a Mountbatten Scholarship.

Dr. Eapen loves his work with a passion. He also holds a degree in Management. Passing through such rigorous discipline, he takes an overall view of health care systems and is endeavouring to find an ideal health system for the elderly in India who constitute over 12 per cent of the population in India.

“Why is the study of geriatrics so important, particularly in India where the resources in medical care are so scarce even for the young people”? I asked.
“Most problems in India deal with numbers. Geriatrics is no exception. It is currently estimated that adults over 60 years make up 8% of India’s population and by 2021 that number will be 137 million. India now has the second largest aged population in the world. The small-family norm means that fewer working, younger individuals are called upon to care for an increasing number of economically unproductive, elderly persons.

If you consider work participation among the elderly as an index of poverty (if you work when you are old, you only do so because you need to), then in India approximately 60 per cent continue to work beyond 60 whereas in some developed nations only 2% over 65 are part of the labour force. In India, even in the above-80 group, about 20% are forced to work.

It is not that the elders who do not participate in the workforce do not contribute to the economy – only it is not taken into account. They contribute by bringing up grandchildren, doing voluntary service, caring for the sick, and often counsel and resolve conflict by virtue of their position. In many cases they are also repositories of knowledge, experience, culture and religious heritage.”

“What are the common geriatric problems? What infrastructure is needed to handle these problems? Is India in a position to handle them?”
Dr Koshy: “The need of the elderly are unique and distinctive as they are vulnerable. Health, economic and psychological needs are most important. Among the medical problems, vision (cataract) and degenerative join disease top the list, followed by neurological, cardiovascular and urinary diseases. Malignant diseases account for a sizeable extent of morbidity. Other problems of concern are malnutrition, frequent falls and cognitive dysfunction. To compound this, the aged often have more than one illness.”

“Are there any priorities in treating the elderly?”
There are no clear guidelines for hospice care in India. Life and death decisions cannot be left to doctors along; the wishes of patients and their relatives have to be sought. None of this happens inIndia in the absence of clear guidelines. For an elderly person belonging to the lower strata of society, an illness can be a calamity. Visit to hospital is almost impossible. Thus, treatment rarely happens in such cases, as the family has not only to forego its income but also pay for the treatment. Even if they do go to a government hospital there is often no doctor there. So, most elderly people, especially in the rural areas, remain untreated.”

“How can geriatrics be managed in a country like India with limited resources. How have the developed countries coped? Can the system in developed countries be replicated in India?”
Dr Koshy: “It is often argued that care provided to the aged in India is inadequate as a result of meagre resources. We do not have to replicate costly western system. If Kerala could have a life expectancy and a health-care system on a par with the best in the world at a fraction of the cost incurred there, it is certainly possible to replicate this success for the elderly too. Elderly people value small improvements in health care more highly than young people and so it is often not difficult to satisfy these needs but only the government must have the will to do so.”

“What kind of research are you doing on geriatric management and care?”
Dr Koshy: First, it is necessary to dispel the belief that old age is synonymous with ill health and disability. Many of the chronic disabling conditions can certainly be prevented or postponed. This is adequately proved by the experiences in different countries. For example, the Japanese show that with ageing there is much less increase in chronic problems such as cancer, heart diseases, cataract and glaucoma than in the case of Europeans. However, the Japanese migrants to the United States who have adapted to Western lifestyles have much higher cholesterol levels and heart disease rates than the Americans. This shows that is lifestyle and not genetic factors that lead to these diseases and, hence, are eminently modifiable.

Current research also shows that the age of onset of ill health rises faster than increases in the life
Span, resulting in a “compression of morbidity” (only a short period of ill health before death). This, then, is the aim of geriatric care: to reduce or postpone the onset of age-related illness so that an elderly person suffers ill health only for a short period before death and is able to lead a healthy life.
Experience from other countries shows that elderly patients need a more broadbased, inter-disciplinary approach to managing their health as problems are often multi-dimensional – biological, social, emotional, psychological and financial. If tackled by the medical fraternity alone, it touches only the tip of the iceberg. Geriatric care requires integration of medicine and community management.

It is also essential to keep the elderly in the confines of their homes for as long as possible and admission to hospitals for long-term care only after a careful medical/psycho-social assessment and trial of rehabilitation. This is because the morbid elderly living with their families at home recover faster than those in hospital.

The health care system in India relies on the patient approaching the health provider, but this is precisely what the aged do not do. What is needed is a more active health team that goes into the rural areas and slums providing free medical care and counselling for the elderly at their doorsteps. A proactive approach is eminently possible in India, even with its limited resources. That means the tem can also undertake general screening of the elderly for medical problems, psychological problems such as dementia and depression, strength of arms and legs, and living conditions. Promoting daily exercise, quality of the home etc.

It is also imperative to train doctors, especially those working in the rural areas, to handle specific illnesses associated with ageing. A laudable effort in this context is the Kaliandiri experiment in Tamil Nadu, which demonstrates that total health care for the rural aged is possible within the existing infrastructure.”

Dr Koshy Eapen outlined his future projects which will go a long way in establishing a geriatric-care system for each state in India. He only needs a positive nod from any state government in India. He also would like to support charities that are enthusiastically working for the health and welfare of people of India. “We should give back something to the country where we were born and educated”, he said with some emotion.

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