Re: Doctor Slaps HIV Positive Patient at Hospital -Patient died

[Guest guest]

Dear Forum readers,

Dr Yatin & Deepak Dobhal answer each other really and what falls out is that the

health system is so bad in India that neither perspective can be accommodated.

It only requires disposable gloves to ensure safety for all medical personnel.

If India can't afford soap and disposable gloves for all relevant health service

providers then what hope has anyone got. That is all that is required to prevent

tranmission and in a developed country like India it is amazing that we hear the

comment that " frequently we re-use gloves which had grown fragile from multiple

uses " . What else might they be " growing " I wonder.

Universal precautions post HIV/AIDS says that all patients should be viewed as

being HIV+ve and dealt with accordingly. It is as simple as that.

If a surgeon is anxious about his health and safety he should see all patients

as potentially +ve and behave accordingly. After all we only know about half of

those who are. Some are identified by compulsory illegal testing and flawed post

test counseling that sounds like this - " Sorry your test came back positive to

HIV we cannot admit you to this treatment facility " Not only is the patient

devastated but he is also panicked by not being able to have a normal surgical

procedure undertaken.

This even happened for a lady who was booking in for normal obstetric services

in a Maharashtra Nursing home. Any surgeon who is concerned about the risk of

sero conversion needs to be very well aware of what those risks are.

For instance an accidental scalpel wound to an operating surgeon is not a risk

to the doctor provided he deals with the wound appropriately. If the doctor of

course was +ve, and there are many in India who are, they should not conduct

procedures where surgery is necessary, for the sake of their patients.

I also have a problem with the notion that a patient wilfuly hides their status.

In my opinion the only time a patient's HIV status needs to be known is if here

is a desire to donate organs or receive an organ transplant or of course for

major surgery where blood work is very necessary.

There may be a need to know their status if investigations of unexplained

illness lead to a conclusion that a test is warranted and in that instance the

Doctor and the patient are the only ones who need to know so that proper

medication and treatment can be provided.

When asked by patients about who they need to tell after a positive test my

response is always. Who needs to know? Not so many people really.

I am fascinated by the comment " admin personnel in BMC hospitals guard HIV

Blood safety kits zealously " . What on earth are these? Surely not the kits that

emergency service personnel use to clean up a chemical spill?

What exactly are the risks that resident doctors and interns are exposed to if

they have a positive patient whose status is not known? I have an idea that the

perceived risks are magnified out of proportion to the real risks.

Lets start identifying the supposed risks for ordinary ward rounds. The only

person who needs to be extra careful is the hematology nurse who collects blood

samples.

I am not a clinician but all the HIV clinicians in melbourne would not be

wearing gloves when they routinely examine HIV+ve patients. I am not a nurse

either but the Melbourne nurses in the AIDS wards would not be dressed or

equipped any differently than nurses operating anywhere else in the

hospital. I am not a lab tech either but they would be used to taking

precautions because often they are the first people to know what disease the

patient has and they need to be prepared for anything.

HIV is only transmissable not infectious and I am continually amazed at how many

people still refuse to believe that fact. It is not like SARS or the EBOLA

virus.

I am in fact writing from the position of a care, support and treatment

advocate and often parts of all the above duties can impact on the day to

day care of the patients that people like me, and the affected people at the

level of the community, provide.

How can ordinary people relax and be sensible about this problem when those

who should now more and be less hysterical create incidents even after so

many decades of information and knowledge about the virus?

It is also amazing how little fear there is of the various HEP diseases in

indian health care settings. Much more resilient viruses but very little

concern about them. Even the incidence of doctors who don't wash their hands

between patients on ward rounds is alarming.

It is clear that more information and continued updating of all health care

staff is essential.

AIDS watch organisations need to be continually vigilant. No way can this

vigilance be seen as being a witch hunt by whistleblowers. I move around

infected and infected communities in India and often I become aware of

people whose behaviours can give rise to risks. When I ask about whether

they would or had considered testing their reaction is why would I want to

know?

There are so many reasons why people ought to know their status not the

least of which is the fact that the earlier they find out the longer they

can live but unless clinicians are having unprotected anal or vaginal

intercourse or sharing needles used by patients there is little or no risk

of sero conversion.

Of course we need to be constantly vigilant around the use of unsterile needles

or instruments between patients. It is definately not acceptable to hear nurses

saying that the steriliser wasn't working and the doctor told me to just wash

the instruments under hot water because we can't afford single use or disposable

apparatus. In India you just can't afford not to.

Geoffrey

E-mail: <gheaviside@...>