Tertiary care Hospitals in Kashmir Lack Infrastructure: Doctor Bashir Gaash

Doctor Bashir Gaash is one of the pioneering, efficient epidemiologists of Kashmir valley. He holds an expert vision, excellence, experience on flu related diseases . In an Exclusive interview with The News Kashmir Magazine, DR. Bashir Gaash talks to Rameez Makhdoomi. DR.Bashir Gaash especially threw light on the Swine Flu scare that had hit entire India sometime back .
How do we describe swine flu?
Flu (medically called influenza) is a short term infection of respiratory tract caused by any type of influenza virus which primarily affects the throat, sound box, windpipe and lungs, but also enters the blood stream and reaches all parts of the body. A person can get it in 1-2 days of contact with some infected person. The vast majority of cases have very mild symptoms like running nose, cough, mild fever, and body aches and pains which last for a week and go as in common cold. Some, however, can get serious features as high fever, severe headache, breathlessness or vomiting and need hospitalization.
Difference between swine flu and bird fly?
All the flu viruses that are currently spreading in the world arise from any place with big farms of swine and birds being reared together. In such places the flu viruses living in the throats of the three (pigs, birds & men catering to them) interchange and can give rise to a new virus. People don’t have resistance to such newly produced viruses and get infected immediately. That is the reason behind global epidemics at periodic intervals (3-5 years cycle). Most of the global epidemics (called pandemics) have risen from China or other countries of the East Asia, but this new pandemic, which started in 2009 is from Mexico.
The new virus selects a carrier and method of spread: The Avian Flu (bird flu) can be transmitted by birds to birds as well as to human beings. The rate and intensity of spread is low in bird flu but once human beings get it there are chances that 50% of the patients cmay die. That means in bird flu less people become infected but once infected half of them can die. On the contrary, the main route of spread of ‘swine flu’ virus is man to man, so any person can get infected easily, but only a few will get serious disease. It is easier to curb bird flu (culling of birds and ban on import/export of birds) but difficult to control ‘swine’ flu since we can’t ban travel of human beings from one region to another.
What about vaccinations. How effective are they?
The real bad habit of the flu virus is that it goes on changing its nature. When the changes are mild the vaccine available in the market can be given and provides protection. When the genetic change in the virus is big as occurred in 2009, the vaccine available in the market is ineffective for protection. The World Health Organization routinely gives recommendation each year for the vaccine to be produced for the flu virus that year. It takes almost 2-4 months for the entire process till the vaccine comes in the market and by that time the infection has spread and people got their own resistance from mild infections.
For the vaccine to be effective it should be given 10-20 days before anticipated infection. In the Northern hemisphere, October is the best season for giving vaccines to at least health professionals and those who are at an increased risk of death from influenza (like children under five, adults above 65, pregnant women, and those with longstanding diseases or receiving drugs that lower body’s resistance to infections).
The protection afforded will be till some new virus emerges and attacks human beings. It is a killed vaccine and therefore side effects are less.
Your take on our health infrastructure to tackle swine flu?
Our state has Disease Surveillance & Epidemic Section at the respective Directorates of Health at Jammu as well as Srinagar. The section at Jammu is not as developed as in Srinagar. However that in Srinagar is well-staffed and well-equipped. There are highly qualified epidemiologists. And, in Barzullah, a State-level Public Health Laboratory has been established as early as 2007. A separate virology section was demarcated, and a qualified microbiologist posted for epidemiological and disease surveillance work. One of the epidemiologists has been trained in the Tropical Karolinska Institute of Amsterdam, and the microbiologist got trained in no less an institute than Johns Hopkins, Baltimore. In addition, we have a videoconferencing hall with automatic cameras for immediate videoconferencing with the World Health Collaborating Centre for Southeast Asia (the National Centre for Disease Control, Sham Nath Marg, Delhi) so that daily conferencing could be held between the State and district health officers and the experts at the National Centre.
The public health laboratory and the emergency video-conferencing centre were established in my period as State Surveillance Officer. Both the epidemiologists have worked as my deputies and have proved their worth. However both the centres were rendered functionless after my retirement in 2010. The grave error the previous government committed was to transfer the microbiologist to NRHM which deprived the Public Health Lab of an experienced public health microbiologist which overtime got denigrated to just another district level laboratory.
The primary responsibility of predicting, preventing and controlling outbreaks lies with the Directorate of Health Services and not with SKIMS or the GMC. The tertiary care hospitals are for managing serious patients, but lack the necessary infrastructure as well as doctors qualified in tackling epidemic prone diseases. There are no isolation wards, no dedicated ventilators for infective patients, and no coordination between the institutes.
I can say without fear of being contraindicated that the Directorate of Health services, particularly in Kashmir, has failed in its preventive endeavours.
In Kashmir do we have sufficient number of doctors to tackle epidemic like scenarios?
We have enough doctors to undertake preventive and controlling activities. Most of them are highly qualified but, for their own convenience, have been given senior positions which should have been filled on seniority basis and not out of favouritism by some congress leaders. Most of our doctors in the field want to work but they suffer because of favouritism, nepotism, inefficiency of their superiors and arrogance of politicians. Most of the time you will see doctors who should have done public health work busy pleasing bureaucrats or their political bosses. The specially trained Community Health Officers are mostly trade-union leaders and do no health work at all.
Precautions to be taken against swine flu?
Precautions are same as for any acute type of respiratory infection including flu, measles, and whooping cough etc. The virus first infects the throat and reproduces in millions there, and thence can be transferred to others or to our own body parts while talking loudly, sneezing and coughing. Hands become infected and should be washed with soap and warm water. Eyes, nose and mouth should not be touched with hands unnecessarily. If we sneeze or cough it should be done away from others, preferably in the open and definitely not into our own hands. The mouth as well as nose should be covered with a suitable mask. The specialized N95 masks are not needed except by those who cater to the suspected or affected patients.
What can be likely side effects of taking a drug like tamiflu without prescription?
Tamiflu (oseltamivir) is an antivirus drug that kills the virus in the body and cures the patient. There is no justification for self use, since side effects are common and some of them could be serious. Therefore the drug should be given only when advised by health professionals for prevention of infection in the family members or work mates etc or for treating patients.
Are the traditional prescriptions like camphor or smelling elachi effective against swine flu?
H1N1 Type A flu (wrongly called swine flu) is a serious disease and if a person gets it he should follow the protocol recommended by the World Health Organization. If the disease is mild it is self-limited and goes of within a week without leaving any residue. If severe the patient is to be admitted in a well-equipped hospital. WHO sees no role for local remedies and the allopathic medicine has no knowledge of the benefits of any local remedies for this type of infection.
Why is this time death count so high in India on account of swine flu?
I said that the flu virus is very fond of minor or major genetic changes for its own survival. These changes are aimed at speeding up the spread from man to man or increasing its invasiveness. We expect a yearly change, and since the virus loves cold and moves to the southern hemisphere when the North of the world gets warmth weather starting from April, we anticipate some change on its next visit. For the last 5 years since 2009, when it first appeared it has not undergone any notable small or big change. This limited its spread as well as its invasiveness, but last year, as was found by an Indian scientist working on a collaborative project of MIT/Harvard, Saisekharan, found the first single mutation in the virus which could have increased its pace of spread as well as disease producing capability. May be it was so aggressive this time. We should expect more changes in the future.

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