Dengue Dilemma and the Escape Route

This was something I wanted to write for some time but kept delaying it for many reasons including political.

When some issue is taken out of context and used as a political gimmick, even with much discomfort, I tend to refrain from taking the center stage.

Train to think logically and constructively, I sometime find it difficult to find an audience (group of intellectuals in a forum) to discuss a topic at length.

This was something we used to do even when we were just interns.

For an example we were faced with a dilemma of the treatment protocol as interns.

On many occasions we were sure we had made the correct diagnosis but the standard treatment did not ensue improvement or recovery.

In one of these occasions we decided to double the dose of an oral antibiotic which was only 12 cents a capsule.

We could not double the other agent given I.M and very painful too since with the wrong dose of that I have seen few children dieing (not any one who was under me) as misadventures.

Most of the misadventures were hushed up even then since the treatment was free and innocent patients were prepared to take some of the gullible lies from the administrators.

This has become a common occurrence nowadays let me not digress.

When we did increase the dose the patient started responding.

That was good news.

Unlike today we did not rest with that we asked the question why half the capsules were not working?

Obvious conclusion was that somebody was introducing dud capsules in the supply chain.

We reported this and the Ministry then had the way to investigate the supply procedure and then caught pilfering from the Medical Supply Division and the substitution of dud ones to replace the same.

This was big news then.

This is a common practice in India even now before they reach our shores.

That was Professor Senaka Bible's time and we were very happy.

Years later I came to Colombo General Hospital and this practice was rampant as nothing constructive to abort this practice was in situ and Professor Bible had died under mysterious circumstances.

The modus operandum was for the guys to come as patients and take month's supply of drugs and unload them at the nearest private pharmacy.

There were many other offenses (rice and eggs were meant to for patients were stolen during the Pang Polling days) I discovered as a D.M.O but these things are happening in much bigger scale now and I am still digressing from the major objective.

The point I want to bring out is that there is very poor accountability and the procedure for investigations is hampered both within and outside the health sector.

This is true for correct diagnosis too.

If one looks at a record of a patient who returns home comparatively well or who succumb in both private and public institutions the error rate of diagnosis is around 60% to 80% .

This figure has never been estimated for PMs (postmortems and not prime minister) after the introduction of private practice. 

Many a times not done in a proper scientific way.

Postmortems are avoided at very convenience of the doctors.

The other issue is that there is no proper consultation among individuals with expertise in other fields and different skills.

This is the salient feature in the practice of medicine in Sri-Lanka.

When something goes wrong the the diagnosis that come to the forefront is dengue. 

The gullible media also report them without serious investigation.

All what one needs is a platelet count and a slide test that detect antibodies (no distinction from old or new antibodies).

The test to show rise in titre is not evident in many cases.

There are multitude of other that can lower platelets.

Concrete proof is lacking and impartial objective scrutiny is never done before or after the event.

Once it is labeled as Dengue many doctors can have a sigh a relief that they have covered up their inefficiencies and tracks.

Unfortunately it covers up the administrative failures too.

When a society is corrupt to the core and in effect the legal and medical systems are not strengthened to investigate and find viable remedies this filters to all the other segments of life including schools and universities and proper conduct of examinations and elections to are left to the undesirable elements.

That is when non-medical people too get involved in detecting virginity when the pertinent question that should be asked is; Is it consensual (does not matter one is married or not-even in marriage it should be consensual not by force due the fact one is legally married; marriage gives a license) or not?

Every other case of death is buried under the mountain of dengue (we have to formulate strict guide lines).

1. The correct procedure is to have strict guide lines for diagnosis of dengue.

2. Then the next step should be and when the death is contentious (not dengue) there should be a procedure to arrive at an alternative diagnosis.

3. The third step should be to have independent clinical audit that is not practiced in this country.

I can give you an incident when medical people failed to come to consensus regarding the increase of kidney disease in North Central Province.
They did not have a protocol to deal with the scenario.
The dengue scenario is no different to me.
We are barking at the wrong tree
Only taking political mileage.
Poor mosquito should not be an escape goat and escape route for our indifference since medicine like books are given free by the government.
All governments are also culpable whether they are democratic or otherwise.
We need a system in place when the system fails everything else fails.

Nobody ask the question why almost 50% did not vote.

Simple answer to that is when the system in place has failed the very system that generate credibility is lost for ever and the apathy sets in.

These are not only philosophical points but these are social issues too.

Everybody in power, not in power, able, disable, in private practice, in government institutions and in all spheres of activity should have a fare share of responsibility.

We are all culpable either direct or indirect or not in action or out of action or in the thick of actions.

We cannot leave it to the politicians alone.

What is lacking is sincerity and transparency.

As Buddhists we will have to pay our dues for these crimes of inactivity and indifference now not in next birth.