Saturday, March 7, 2015

Swine Flu- Lessons From The Lab


The phone rings for the nth time in the laboratory while everything and everyone are up to something, all are doing their duty to help the patients of the hospital which I can vouch is always more than their individual capacities. 

One of my technicians picks the call.

“Hello Namaste, Microbiology” she says.

While the machines run and beep continuously, a technician receives samples, another processes samples, and an another attends an another call on the other telephone, a few patients wait outside for reports, a housekeeping staff of one of the wards waits inside for reports, a clinician calls for reports, a reporting desk assistant enters some reports, and I one of the microbiologists verify some reports, in the midst of this routine she comes to me with the cordless with quite a dreary look.

“Ma’am please speak to this patient, she is asking for her H1N1 report”

I take the call.

“Hello how may I help you?” I ask the patient out of habit.

And the rest is to be swallowed, in the name of the Hippocratic Oath.

There are times such as these when we get to hear from patients the most absurd things possible to a point that they question the credibility of a doctors duties and what I understand of such difficult situation is this, if there is someone who has to show a great deal of patience it has to be the doctors. It can be nobody else.

With the ongoing H1N1 epidemic we have lessons to learn, and believe me when I say 'A LOT'. If you were to pick up a newspaper and read about ‘swine flu’ which I am sure has more than one column nowadays, you may find information on these lines:

‘Death toll rises to….’

‘’ has ‘x’ number of positive cases, and ‘y’ number of deaths

The fear is but obvious. I wish we paid attention to reverse of the coin as well. The working of Indian health care system, especially our preparedness with dealing such an epidemic, the availability of antiviral drugs and vaccination-the pros and cons; when to take them, why to take them and who should take them. The problems, more so solutions to the problems, these are the issues that need to be addressed. Even if they are, the point is that they are not very precise. As a result the pressures and forces acting upon the health care providers are more of social nature than medical due to this trepidation created. We are letting this run us as if we do not have a judgement of our own, well until the next epidemic.

Diagnostics and therapeutics are central to the working of a hospital and no doctor would risk his patient’s life by delaying a test. H1N1 testing is a molecular test, done by a method called Polymerase Chain Reaction and only a few laboratories have the setup and authorization to run this test, thus the logistical problems. Although automation and technology has reached the highest level possible in diagnostics there are areas which are new to us doctors as well. When the workload reaches a threshold, the maximum that a laboratory can do is increase its working capacity through various means, that’s exactly being done in the testing centres across the country. This scenario was quite unexpected in these places too. It is relatively easy to put the blame on the working of a system although some complaints will have the truth in them, thanks to the commercialization. 

We must not forget one thing, a diagnosis that would not have been made otherwise is now scientifically understood and medically treatable. There is no sensibility in hitting the panic button for the wrong reasons. This all the more gives us a good opportunity to confront the reality of the influenza virus. A common cold may not be a common cold after all. The antigenic shifts and drifts, the pandemics and epidemics are not for history, they are here to stay. Let us face it together!


The cordless on the table rang again.

“Namaste, Microbiology, how may I help you?” I asked.

“Doctor, I wanted to know my daughter’s H1N1 Report” came a query from a father at the other end.

I remembered his voice, the same man who had called at least five times the last evening. How could I forget the fear and anxiety in his voice, and that of the mother’s whom I could hear from behind? I searched for the status of her report as eagerly as him. Doctors are definitely humans, at the end of throughout the day.

I am doing mine, are you?