Dengue Diagnosis or "Inaccurate Diagnosis"
Why I encourage mosquito breeding
I managed to fine a huge book on mosquitoes and won't dish out remedies to exterminate mosquitoes.
My fish thrive on their eggs and are very healthy and I do not need to buy fish food.
Mosquito larva is our cesspit cleaner.
Cockroach is our gully cleaner.
The gecko is our pantry cleaner.
Please do not kill them with potent insecticides and they kill our bees,too.
Bees who pollinate are almost gone extinct.
A Gram of fish food is more expensive than Thriposa or Samapoa.
Reproduction
This was something I wanted to write for some time but kept delaying it for many reasons including political.
When an 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.
One who is trained to think logically and constructively, I sometime find it difficult to
find an audience (group of intellectuals in a forum) to discuss any topic
at length.
This was something we used to do even when we were just interns.
For an example we were faced with a particular dilemma of a treatment protocol as interns, we would pause and reflect.
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, I have seen a few children dying (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 originals.
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 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 investigation 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 Ceylon.
When
something goes wrong 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 illustrate rise in titre is not evident in many cases.
There are multitude of other conditions that can lower platelets.
Thrombocytopaenia is a serious condition in both children and adults.
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, too 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
only 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 an 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
fair 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.
