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17th May 1998

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After thought
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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