Tuesday 26 August 2008

The cat in gloves catches no mice

Since the first cases of AIDS in Indonesia (and elsewhere, I'm sure), hospitals have got their knickers in a twist about universal precautions. These require health care providers to assume that all patients are potentially infected with a nasty, which they could catch themselves or pass on to other patients. So they should take appropriate action to reduce that risk.

The most basic precaution is to wash hands before and after handling any patient - in theory the simplest and cheapest precaution, but in practice often the most difficult. Even if you can persuade the doctors to spend 15 seconds washing their hands, there is the problem that it is not unusual for hospitals here to be short of water.

For more risky activities, like taking blood samples, they should wear latex gloves. But the budget for these is usually red-penciled so there's always a shortage. Visiting a hospital can be like the condom advert, with lines of recycled gloves hanging out on lines.

But although it's rarely necessary, somehow universal precautions here are always equated with 'pakaian astronaut' (you can work that out). A doctor on one mail list here recently noted that patients would become offended if their doctor wears such clothing to set up a drip. Probably rightly! So unnecessary! Although there are of course times when such clothing is needed, for example for midwives assisting birth. But of course, they never get it.

Many hospitals charge patients for the latex gloves used on them, again causing offence for those who do not understand. So many hospitals institute what we call 'Odha precautions' (Odha = PLHIV): they only take preventive measures for patients known to be HIV-positive. Some require testing on arrival to determine status.

Couple of years back we discussed this with the director of one of the more prestigious (and expensive) hospitals in Jakarta. We noted that universal precautions are also needed to prevent transmission of hepatitis B and C viruses, which are much more infectious than HIV. We also noted that these infections were much more common than HIV among the 'general population' in Indonesia. His response? "We don't treat the 'general population."

Little wonder that more than 10% of patients in Indonesia catch something nasty while in hospital.

Babé

No comments: