I was shocked on hearing about the
‘sterilization tragedy’ in Chhattisgarh. Yes, it is in fact a sterilization
tragedy. Sterilization - Sterilization (also spelled sterilisation) is
defined as “any of a number of medical techniques that intentionally leave a
person unable to reproduce”. A government-organised family planning camp in
Bilaspur district of Chhattisgarh, took a wrong turn on that fateful day.
Sterilization also means
making a surface, article etc. free from any kind of organism. This is
essential for any health care practice, especially in a setting where any kind
of surgical operation is taking place, even as simple as sterilization for population
control. Such a setting should not exist with without strict sterilization and
aseptic practice.
However, we all know
that India is a land of “Jugad”,
and ethically and scientifically recommended practices are things that are
beyond our comprehension.
But, what led to the
tragedy? I don’t have any detail about ‘what happened in Chhattisgarh’ but I
have an insight into what usually happens in India in the name of infection
control practice through my professional experience.
We are at a pre-historic
stage in terms of awareness, and burdened by lack of resources. The situation
is even worse in government hospitals situated in the periphery.
I was more surprised
when I heard that the doctor in question has been suspended with immediate
effect!
Blaming the doctor,
making him the scapegoat for everything that went wrong in a medical set up is
an inherent problem of Indian society. But no one wants to see beyond that.
Root cause analysis of any problem is not in finding a scapegoat and burning
him like we do in Dussehra.
It is a clear fact that
all those hospitals run on poor supply of basic necessities like soap, trained
nurse, proper equipment for operation (cloths, autoclave, gloves, nurse and
proper ventilation in OT) etc., but all hospitals are given targets to achieve
within a given period.
Target of fulfilling the
dreams of different governments/ employers, like increasing the number of
operations, increasing high tech operations and achieving “x” number of total
sterilizations, free Anti-tubercular therapy or anti retroviral drugs given to
tuberculosis and HIV infected patients respectively during the year.
This is where the
problem starts:
People are over worked
and they are given exorbitant tasks to complete without any infrastructure. If
you don’t do it, you are not following the instructions you are given, so you
are in danger of losing your job. And if you make some compromise and continue
to work with whatever resource you have, then you are doing your duty.
At first, nothing will
happen, even if some infection occurs, people will think infection is a normal
incident. In fact, most of the practicing physicians think that we have
antibiotics to tackle the bugs. But as a clinical microbiologist, I have
observed through my practice and research that most of the hospitals in India
are full of organisms, against which there is no antibiotic at all. And the sad
thing is that there is no new molecule in the pipe line in the near future also
The reason for the
deaths can be something other than infection also, like spurious drugs
reaction, operative complication, wrong case selection etc. Root cause analysis
of all of them will lead to one answer: non adherence to the mandatory stringent
quality control norms.
Because many of us are
not aware of such things and even if we do, we turn a blind eye to them as they
are costly and time consuming and there is no chance of earning any revenue by
these quality control procedures.
The problem we are
facing today has only one answer: prevention.
But how?
Adherence to basic
quality control norms for prevention of such occurrences, which is the only
option we actually have.
Or the same story will
repeat itself:
Healthcare practices
Without soap….
Without instruments …..
Without infrastructure
for the required purpose…..
With an uphill target to
fill.
Till we have those
manage it with some “Jugad”
And if something bad
happens, identify a symbolic culprit (a doctor in this case), sack him from the
job and we are all happy till a repeat incident happens.
I was late in blogging it even though I made the draft
immediately after getting the news and I was totally upset with the incident
and after three days of the incident now the focus is changing to some spurious drugs, but point is same _ total apathy towards quality as we all do in every aspect of our life.do you know any medicine we buy from the chemist next
door may
turn out to be spurious.it can be a chemical manufactured
by some unknown unlicensed company. Even a branded medicine can also be carrying a label only but actually it might be some chalk powder packed with the companies genuine looking level by some crook, everything I mentioned doesn’t matter to us as we live in the age of apathy, compromise and Jugad.
