25 Aug 2008

Battle of the medics

Here we have a doctor calling the Chief Medical Officer a liar, supporting the parents of the girl who died of dengue.

CMO’s statement amazes me

Sunday, August 24 2008

THE EDITOR: I am truly amazed and dumbfounded by the statement made by the Chief Medical Officer (CMO) of this country, who said that a postmortem examination or a confirmatory test from CAREC were needed to “confirm” a death from dengue fever!

If these are the national criteria, then I would make it my duty to also communicate this to the PAHO/WHO since our national statistical database will be completely skewed and would not at all reflect the reality on the ground.
It is a fact that in this country, dengue can be described as being “hyperendemic”. It is also a fact that wherever there exists a situation of hyperendemicity in respect of this particular disease, that the population is at a much higher than normal risk of experiencing the life-threatening complications of dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). What is also factual, is that this country also unfortunately — because of our ethnic composition — experiences high prevalence rates of hereditary haemoglobinopathies — and here I refer to both thalassaemia and sickle haemoglobinopathy. Our very own Professor Daisley has published in the research literature, findings which point to the fact that persons who possess one or other of these genotypes is at much higher risk of exhibiting the most severe expressions of this particular viral haemorrhagic fever. This finding is also reflected in the Cuban literature. This unfortunate child was thalassaemic, contracted dengue and as is suggested by existing literature, manifested features of dengue haemorrhagic fever. To suggest that unless a postmortem examination was done or a confirmatory serologic test was done by the public health lab, that a firm diagnosis of dengue cannot be made is absolutely ludicrous and has to be construed as a deliberate attempt to mislead the public.
The present administration’s historic expenditure on insect vector control has been abysmally atrocious. The last time I checked this it amounted to some TT$4 per household! Further to this, the Ministry’s Health Sector Reform programme calls for a restriction in the expansion of available hospital beds. Let me say now that in 1981, when the prevailing wisdom was as it is today, that an aggressive aedes eradication programme was less important than an aedes “education” drive, Cuba experienced a major epidemic of DHF. When there were already 24,000 cases of DHF reported, it was only by implementing a massive hospitalisation programme in which over a three-month period some 116,243 cases were hospitalised, that fatalities were controlled. Even so, 158 deaths from this disease were recorded (Gubler, G, 1989). Here we have a “two-edge” sword — few hospital beds and virtually no eradication programme.
On the basis of clinical case definition criteria, this child unquestionably had dengue fever!
DR STEVE SMITH
Consultant Physician

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