Tackling the swine flue pandemic
SWINE flu, technically known as H1N1, started earlier this year in Mexico, migrated northwards into the USA and Canada and then crossed both the Atlantic and the Pacific Oceans. It has since touched the shores of Australia, Africa and China and wrought havoc among their respective populations. WHO has reported that at least 2,185 persons have already died. Hundreds of thousands of others are still suffering from this virus.
As anticipated, H1N1 has also found its way into South Asia. It first appeared in India and has then surfaced over the past few weeks in densely populated Bangladesh. By last count, the number of Bangladeshis identified as having this form of deadly viral flu has crossed 270 and two of those infected have died.
As expected, public anxiety has slowly surfaced. The print and electronic media have not resorted to sensationalism but have been responsible in their reporting of the exacerbating situation. Till now, fortunately, there has not been any politicization of this issue.
Nevertheless, there have also been factual stories of mothers running around with young ailing children from clinic to hospital, looking for doctors, medical attention and suitable medicines -- all to no avail. Such reported incidents have not inspired confidence in what government authorities, responsible for controlling and managing this pandemic, have been claiming.
One thing is clear. The pandemic is spreading in Bangladesh -- slowly but definitely. It is also true that our government and those responsible in the Ministry of Health are trying to instill some degree of order in the arrangement for tackling this emerging crisis. The point is whether the plans and the strategy being put in place are suffering due to lack of coordination. There also appears to be some degree of confusion among the physicians with regard to the diagnostic procedure and the application of prescribed drugs. This has to stop.
Various institutions including the Institute of Epidemiology, Disease Control and Research (IEDCR), the ICCDDR,B and the local chapter of WHO have extended their assistance to our effort. At the same time we have the Bangabandhu Sheikh Mujib Medical College Hospital, Dhaka Medical University Hospital, Suhrawardy Hospital, Dhaka Shishu (Children) Hospital and the National Chest Diseases Hospital preparing themselves and making all necessary arrangements to handle a full-blown epidemic. Such pre-emptive planning for the urban areas in and around Dhaka is laudable. However what about the smaller towns and other divisional headquarters? One hopes that similar pre-emptive planning is also being put together in our vast rural hinterland. I am mentioning this because some of the Bangla newspapers have reported insufficient medical logistical support in the border areas with land entry points from India.
In Dhaka and also in other major cities, quite naturally, a lot of pressure has been generated on public hospitals and on their emergency facilities. The electronic media has telecast reports of overcrowded chambers and frustrated relatives of patients complaining about lack of attention and prescribed medicines. Some, suffering from other ailments (like dengu) and requiring urgent assistance have also questioned the wisdom of not having separate waiting areas for patients who have swine flu symptoms. The hospitals administrations have to streamline the application of necessary measures. Otherwise, even the best efforts will fail.
The other option will be for patients to seek medical care in the unregulated private medical clinics which are expensive and not always reliable. This should not happen.
The existing scenario has been made further complex because of questions related to sufficient availability of swine flu vaccine and also post-infection medicines. Bangladesh, according to experts, is understood to have already crossed danger level 2 on this pandemic scale. Some have suggested that though it has not turned into an epidemic, the situation is not very different.
I agree with the view that the situation could turn serious. However, there is no reason to panic. Our Ministry of Health will have to play an important role in this regard. In this context, it was good of the authorities to announce that the government has a stock of 2.9 million doses of the anti-viral drug 'Oseltamivir'- in both capsule and syrup forms. It is expected that this stock can meet escalating requirement till November of this year. It is also significant that the government has asked local pharmaceutical producers to manufacture another 10 million dosages of this medicine. One hopes that one will eventually not need to use this medicine in such large quantities. However, it is better to be prepared than to be sorry.
The Health Ministry has said that this anti-viral drug will be available on prescription in all public medical colleges, hospitals, civil surgeon's offices in districts and upazila hospitals for free. This is a laudable decision by the government and should also include in its purview those patients who have for any reason also sought medical care from private clinics. It may be noted here that different drug stores are seeking to profit from this unusual condition and are overcharging for this drug. Some are even asking the exorbitant price of Taka 1,800 for a strip/file of 10 pieces. This might partially be due to panic buying, but the price needs to be strictly controlled and monitored.
It is true that Bangladesh is now facing a new respiratory disease. It would also be correct to say that we have faced the outbreak of dengue hemorrhagic with some success. We can similarly contain the spread of this aberrant viral flu through preventive measures.
As expected, the government will have to enforce strict observance of health rules at points of entry into the country -- airports, sea ports and land ports. Similarly, we must also through individual initiative, take necessary action to create a safety zone for ourselves. Doctors have underlined the need to limit body contact with people as much as possible, to wear masks (facemasks, surgical masks or N95 masks) to avoid the spread of the virus through coughing or sneezing and to avoid crowded places. Following these measures might be difficult within our tradition bound society but they need to be undertaken. Such steps should not be interpreted by others as signs of being rude within our socio-cultural mores.
A bit more of personal care and observance of hygienic standards will greatly reduce the risk. It would also be prudent not to readily resort to drugs without any clinical judgment or without prescription of a physician particularly in the case of persons suffering other serious/chronic medical conditions.
Throughout the world, people, because of globalization, are learning to adapt. We have to do the same.
Muhammad Zamir is a former Secretary and Ambassador and can be reached at mzamir@dhaka.net
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