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After thought
When that deadly flu struck
By Kumudini Hettiarachchi
It was the irony of ironies. President Chandrika Bandaranaike Kumaratunga
was in Geneva to speak on “Health in developing Asia: Seizing the opportunities”
at the invitation of the Asian Development Bank and the World Health Organisation,
while “model” Sri Lanka was in the vice-like grip of a flu epidemic.
Deadly it was for the very young and very old, while stories spread
like wild fire that even youths were not spared. There were claims that
people attended the funeral of an 18-year-old who had died of the flu in
Moratuwa, while others said they heard of a 24-year-old in Galle who had
succumbed to it. It had started off in early April and ravaged Colombo
and some of the major towns by the New Year. And what did the authorities
do_..absolutely nothing, until it reached epidemic proportions.
At the beginning, the Health Ministry kept quiet, may be the officials
were hiding their heads in the sand like the proverbial ostrich and hoping
the flu would just go away. Oh, so reminiscent of the cholera epidemic.
The Medical Research Institute (MRI) did not carry out immediate research
until the media took up the cause of the suffering masses, especially the
thousands of very ill children who were being brought to the Lady Ridgeway
Hospital. Even then there was speculation - was it the virulent chicken
flu that had hit Hong Kong? Was the flu aggravated by El Nino or the heat
wave which was gripping the country? Why did the symptoms differ from victim
to victim?
Finally the MRI did come up with a likely identification. It was Influenza
“A”, the MRI said, but there was a catch - final confirmation was needed
from the World Health Organisation laboratory in Mill Hill, London. So
the findings and specimens have been sent there. Have we got the result?
Haven’t noticed it being publicised. I may not have spotted it in the media,
what with having to nurse a very sick baby with continuous 103F fever for
10 days and living in tension as to when he would have to be admitted to
hospital. Or may be the MRI “mailed” the findings and the specimens and
they are lying at the Central Mail Exchange caught up in the postal dispute.
Seeing that the flu was afflicting mostly children, with about 1,000
seeking treatment daily at the Lady Ridgeway alone, what did the Education
Department do? Kept mum, and at the last minute came out with a firm decision.
“We cannot close schools,” the department laid down, “because syllabuses
have to be covered”. So the schools went on, with absenteeism hitting a
high never seen before. Students, teachers and even principals took to
their beds with the flu. But the department “decree” was final. What benefit
would there be of a syllabus fully covered, if the students are dead? For
that matter even if they survive, they are bound to be weak and prone to
other diseases, so absenteeism will be high throughout the year. But what
does the department care? The only thing which matters is that the syllabus
has to be covered. It would have been laughable if not for the fact that
it was tragic.
However, several schools were closed in Colombo to accommodate the policemen
who had been brought to provide security to the city on May Day. What priorities
Sri Lanka seems to have. Of course, the Education Department will argue
that these schools were being closed just for a day and classes would be
held on a Saturday to cover the missed sections of the syllabus. Why couldn’t
the same thing be done, by closing schools for a week or 10 days to curb
the influenza epidemic? I am sure, parents would have been more than willing
to send their children to school on other public holidays.
Some sections of the media showed their partisanship even during this
national crisis. While independent newspapers carried the toll of child
deaths, the state-controlled press quibbled over the cause of death, coming
out with a lengthy explanation that they hadn’t succumbed to the flu, but
to Reyes syndrome, which was a result of ingestion of medicine containing
aspirin.
How do you bring down the fever of a baby? Doctors prescribe Panadol
or Calpol every six hours (stressing that it should be only four times
a day), or advise using a suppository once a day if the temperature is
over 102F and sponging the baby. For this flu, after doing all this, the
temperature still does not come down. The other remedy — give Brufen between
the Panadol or Calpol doses. And the paediatrician apologetically tells
you it comes in tablet form. There’s no syrup. In desperation, to bring
the burning fever down, I tried forcing half a crushed Brufen tablet with
honey, down the throat of my kicking and screaming 18-month-old son and
I tell you it doesn’t work. He spits it out and gets so agitated that the
temperature rises further. Do those who import medicines, (I presume the
main importer is the State Pharmaceuticals Corporation), know that in neighbouring
India, they have a syrup called Ibugesic Plus, with I think the same composition
as Brufen? It works wonders and at least is palatable for babies.
The other agony parents have to undergo is take the temperature, by
placing the thermometer in the armpit of a struggling baby for “just” two
minutes. Only those who have tried it know that two minutes seem an eternity
with a baby. In this case too, there are cheap thermometer strips which
can be pasted on a baby’s forehead, in India. But the common man, woman
and child should not have access to such “luxuries”.
Don’t we, this “role model” in Asia have a contingency plan in crises
like this? Shouldn’t the different sections of bureaucracy, such as health
and education have met and decided on an action plan? This would have been
an ideal “opportunity” for Sri Lanka to “seize” and prove our “role model”
status. Or wasn’t this influenza epidemic big enough for the movers and
shakers to shake off their lethargy and do something about it? Maybe it
was a disease which struck down only plebeians like you and me, so the
bureaucrats on their pedestals had nothing to do with it.
The need of the hour
During this influenza epidemic the only thing that was crystal clear
was that different sections of the government and bureaucracy were working
independently leaving the people who needed urgent information in the blues.
There was a need for a coordinated effort among those departments whose
services were required in such a health emergency. The contradictory reports
in the media, with one section claiming that the epidemic was on the wane
and another giving high casualty figures added to the confusion.
The need of the hour is a Crisis Control Centre — that can handle crisis
health situations like the recent epidemic for example — with the involvement
of the relevant authorities such as the Health Ministry, the Sri Lanka
Medical Association, the General Medical Officers’ Association and any
other department whose services are required. Such a centre would not be
a permanent one but will be co-opted at short notice as a health crisis
develops in the country and go into action so that the public including
doctors, patients and distraught parents could contact the experts themselves
directly for information and advice.
A hotline manned round-the-clock, during the emergency period, would
help prevent mass panic and make the people aware that the situation was
under control. Mustering the support of the electronic and print media,
particularly the vernacular press, to disseminate correct information on
such an epidemic is also essential.
When a health crisis threatens to develop into an epidemic, the priority
of the government and health authorities is to ensure there is no panic
or mass hysteria and more importantly to make people aware that the situation
is under control. That was sadly lacking during the recent flu epidemic
and in similar situations in the past.
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