Vaccines - how much to trust the doctors?

Read a disturbing story in today's Times about how doctors are prescribing expensive vaccines without informing the mothers/fathers that there are cheaper alternative available which do the job just as well. The Government has prescribed a range of diseases for children to be vaccinated against, and there are a series of drugs available - But doctors often provide the much more expensive option since they pocket the difference which is shockingly high in many cases (refer below article). My doctor is a case in example- initially she used to tell me that she is using the more expensive injection since chance of fever for the baby is less, and i was fine with that.. Later she began using the more expensive injections without even informing that there is a choice, And while this is ok for me since the company reimburses the medical bills, it is certainly not ok for many other who cannot afford such expensive vaccines, or would probably need to forego something in order to pay for the imported vaccine without being aware that there is an alternative available.
Then there is the whole issue of additional vaccines which are not on the mandatory list but which the doctor will puch onto you saying it is good for the child-and i for one find it very difficult to say no when someone qualified as a doctor says that something is good for the child. Again the margins for the additional vaccines are very high as most of these are imported.

The main worrying thing about the vaccines though is their age/quality. Around the time S was 2 months old and many of her vaccinations were due, there were a series of reports in the newspaper about how small babies had been given old vaccines/spoilt vaccines and had died. Extremely scary. There are frequent power cuts in India and many of the vaccines need to be refrigerated, so the older they are the higher the chance of them being spoilt. So best to go to a dcotor who has lots of patients so that the drugs are rotated often and lesser chances of the drugs being old in my view

Lastly the whole question of whether to vaccinate or not? there is the problem of the child getting high fever after the vaccine (not in all cases though). Then many people believe that the child should build their own immunity for the milder diseases (pneumonia for instance) and also the vaccine does not provide protection against all strands of that particular virus (again pneumonia- the PCV only provides protection against one strain of pnemonia). My thought on this is that -should vaccinate against all major diseases, I would also try to vaccinate against the minor ones such as pneumonia where the child has a higher chance of contracting the disease ( I get chest congestion very often and very easily so would protect against this) but other minor diseases where likelihood is less and can be avoided with care I would chose not to vaccinate.


The referred article.....
Docs pocket hefty money for shots
Give Vaccines Not Recommended For Universal Immunization
Vaccines are meant to help prevent diseases. But they could also have another vital use as an alternative and significant source of income for doctors. Many vaccine manufacturers are offering vaccines at hugely reduced prices to doctors, many of whom charge the full price from patients, pocketing the difference. The greater the discount, the bigger the profit margin for the doctor. So when a doctor pushes a vaccine that is not part of the universal immunization programme, it would be difficult to decide whether he is thinking of your child’s health or his pocket. A study by Dr Rakesh Lodha of the Department of Paediatrics, AIIMS, and Dr Anurag Bhargav of Jan Swasthya Sahyog in Chhattisgarh, published in a recent issue of the Indian Journal of Medical Ethics, reveals the huge difference in the price of vaccines offered to doctors. “The percentage margin between the price to doctors and the MRP ranges from 30% to 69%, while in rupee terms, the discount over the MRP per vaccine dose ranges from Rs 85 to Rs 620,” the study says. Many vaccines require giving three or more doses and hence the profit margin could be as high as Rs 1,800 per child vaccinated. Interestingly, the vaccines being offered at hugely discounted prices to doctors are not those that are recommended for universal immunization. Such aggressive promotion is for new and expensive vaccines and combination vaccines whose use in the Indian context is “not well established in terms of epidemiological rationale or cost-benefit analysis”, says Dr Lodha. In yet another study, consultant paediatrician Dr Yash Paul from Jaipur found that the difference between the MRP and the price for doctors or chemists is very small for vaccines which are part of the National Immunisation Programme. The huge discount of Rs 500-Rs 600 is only for the newer vaccines. Dr Paul points out that doctors would be tempted to administer newer discounted vaccines which give them a huge profit margin. “If the difference between the MRP and cost to the doctors is equal or nominal, doctors may consider the comparative merits of the vaccines instead,” states Dr Paul. He cites the example of the DPT vaccine, recommended for universal immunization, which has an MRP of Rs 15.50, and given to doctors at the discounted price of Rs 12.50, a minimal difference, whereas the MRP of DaPT, a modified newer version of DPT is Rs 699 and the cost for doctors is Rs 595.

S talk

S has started chattering a lot these days. When in a good mood she chats by herself and talk ranges from nursery rhymes, to stories, to general observations on what she has been doing that day. I can't believe some of the things she says-
- I am bored of soup
- Thank you god for the tiffin, for everything
- Why did you pinch Dora, why did you pinch bottle
-Mama i want to do Babba
-Go away Suman (said to all people even if they are not named Suman)
- don't eat Ajji (my mom should not waste time eating, time which can be better used playing with S!)
- don't do meditation Ajji
-Mama, dont wear chappals in the bathroom
-wash hands now (means stop eating, wash hands and come and play with me)
-i am only putting (i want to wear my own shoes, diaper, pant, shirt etc etc)
- i am putting straightly
-Mama don't shout- i have a bad temper, and this is the only time i calm down immediately and feel quite ashamed for shouting
-Series of rhymes- Lo lo low your boat (she can't say rrr yet); little jack horner, hickory dickory dock, rock a by baby, goosie goosie gander
-some things she picked up in school- P ne khaya, R ne pakda, S ne khata, Hum sabne dekha, Bada maza aaya!!; Swallowed a peanut...
-very nice/lovely-for some food item she really likes
-put babbu in the crib
-dont feed babbu now (bit difficult to deal with this since S has started getting upset everytime i feed A)
-range of stories of how pigeon came, monkey came, lizard came and how some person picked up a broom and chased them away- courtesy Ajji's imagination during feed time
-Daddy is strong, Ajji is strong, Mummy is small (since i could not carry S during the last trimester and after the C-Sec)
Will post more as and when i recollect her little gems!

A's first trip to the park

We took A to her first trip to the park. She was bundled into her red pram and we walked to the neighbourhood park (one major advantage of Bangalore is that every nieghbourhood has a nice park for walking with a play area for kids). She did much better than i expected- she was staring at the sky and trees for the first ten minutes and then promptly went off to sleep. Unlike S who spent her first visit to the park in her pram howling so we had to rush back home. So S was playing in the playground with the hubby while i was pushing A around with her granddad!

Of 2 am soaps and late night movies

I am now the expert of what all comes on TV at 2 am in the night, courtesy A. A sleeps peacefully throughout the day and is wide eyed from 11 pm onwards when the rest of the house starts shutting down. 11 am t0 4 am is my official time to look after her since my mom sleeps at that time, so after many unsuccesful attempts to switch off the light and put A to bed in the bedroom, i give up, come to the living room, switch on the TV and mindlessly flick through channels. The preferred ones are Star World and Star Movies since those are ones with subtitles which can be watched on mute, and now i'm up to date on eposides of Prison Break (never heard of it before), Sons and Daughters and other such serials. Miss Friends though- thought there was a 12 am episode running earlier.

The hubby, who gets his daily 10 hours of sleep insists i should keep A awake more during the day. Frankly dont see how that is possible, since she is too young for us to distract her with some toys or a story. She only cries when we try to keep her awake and then we're forced to put her to bed The hubby also suggested putting water on her or giving her a cold water bath!!!! after some unsuccesful attempts to keep A in a sitting position to keep her awake - she slept through that as well!
My cousin, who had the same problem with her daugher, suggested giving a sleep medicine in the night which would break the cycle once and hopefully change it for the better. But i feel A is too young to give such medicines, so will go back to the mindless surfing of channels for now.
Btw can't beleive there are so many teleshopping channels suddenly- rather many channels only have teleshopping at 2 am in the night- do people really shop at this time?

A joins us

A, our darling baby daughter joined us on the 10th of February. She turns one month tomorrow, and how the days have flown by. The birth story is a long episode and will take another post but suffice it to say it was not I how had expected it to be!
Handling two kids is really a handful, but i luckily have the support of my mom and a full time baby maid. End of this month i will be leaving for Bangalore with my mom and the two kids and am there for two months, by which time i should have learnt to manage two kids on my own a bit better hopefully.
S seems quite happy with the new arrival and keeps kissing her, pulling her 'chubby cheeks' and patting her. She helps out with bringing the nappy and soap and shampoo for bath and keeps asking to comb the baby's hair. But her other behaviour has become quite terrible and i feel she is showing her unhappiness with the new kid getting the attention in other places. She starts crying and wailing loudly for the smallest of things- if we ask her to get off the swing (we have a swing now at home- Daddy's gift for S on her second birthday, she loves it and spends at least an hour on it everyday), or dont show her Nemo for the 100th time in a week, or if her Ajji has lunch instead of watching Nemo with her- really small things which she would have been ok with earlier. She has also started wailing to go and come back from school(but luckily over the last few days that has got better). So far we have been able to manage my mom (her Ajji) looking after S during all the feeds - in fact my mom only looks after her most of the time since i need to give so much time to A. But today my mom had to go out for sometime and that also coincided with A's feed time. When i got up from the living room where i was sitting with S to feed A, she started crying and stamping her feet, insiting that i should carry her, I carried her for 5 minutes and then A started crying louder and louder and I tried to explain to S that see A is crying , i need to feed her , why dont you sit next to mama and read this book, but she insisted that i carry her, andcontinued to sit ony my lap. Finally i put S down and she howled for some time before the maid took her to the swing to distract her. Hope S grows out of this soon, or i'm going to be a very tired and upset mother soon!

A is quite different from S. Firstly she looks more like the hubby whereas S looks like me. She is also a night baby- most nights she is awake from 2:30-4:30 feeding and playing and sleeps through large parts of the day. S had got the day-night routine right from day one and used to play quite a bit during the day and wake in the nights only for the feeds. Also A is quite aggressive in her demands from day one and insists on being carried on the lap most of the day even when she’s awake, while S used to play quite happily in the Moses basket by herself. Anyway I now know most of the late night shows on tv and have caught two three movies with subtitles running at 3 in the morning! Wonder when this cycle will reverse- its manageable now since my mom looks after both the kids in the morning and I get sleep till 8:30-9 am.

Other updates in brief
We celebrated S second birthday on the 6th with a Jerry cake, a swing and motorbike from her dad, earrings from me (ears not pierced yet though!), earrings from Ajji and flowers and new dress from her Bua. Decided not to have a party and call other kids since I was not sure whether I would be in the nursing home or at home, and anyway S doesn’t really play games at birthday parties, or interact that much with the other kids- maybe for her third birthday she will herself be excited about a party, and cake and friends
We played Holi this year after a long time. It was S first Holi experience and she really enjoyed playing with the pichkari (its got lights and she still plays with it), and the water gun. WE played within the building and there was another kid (muchy older) who kept throwing water on S and the hubby helped S in spraying him back with water. S was not very thrilled with the colours being put on her face so we put only a bit on her face and more on her arms!
We moved house, sold our old place and rented a new one. Two main goals- one to move into a better apartment (achieved) and two to reduce the ties to Bombay ( I don’t like this city). The packing and unpacking was quite hectic but my mom and dad were there to help, otherwise it would have been very tiring in the ninth month. The new apartment is quite nice- the security is good, the neighbours are friendly (one of them came over with a packet of brownies to welcome us) and best of all, there is a girl of S age in the flat below us- so far the interaction has not been the best given S mood swings and temper tantrums, but am hoping it would improve over time
For New Years this year we went to Kashid, a beach resort about 3 hours from Bombay to a friends place. It was with old college friends and well worth the effort (driving there and back over two days) and S enjoyed all the attention being the only kid there! My friend has a dog- and S kept feeding him biscuits, running after him etc. My friends kept her well entertained pointing out flowers, birds, giving her various creams to play with (she loves that) and she played in the beach and water with the hubby. New years night we went to my friend's parents friend place where there was another girl of S age, so some time went in playing with her toys, running around with her etc.
Back to the two kids now!