When H1N1 strikes

During this stressful pandemic times, it is understandable that people are getting alarmed and confused. There is also a sense of helplessness as we see the death toll continues to rise (71 dead in Malaysia as of today). And of course, it is human nature to apportion blame to certain quarters especially the Health Ministry and healthcare workers.

I, myself have not been spared the misfortune of blame, even by my regular patients. Not only that, 2 nights ago, a lady who claimed to be the wife of a 60 year old man, stormed into my consultation room demanding to know why I had given her husband, who is a known hypertensive and had high fever and URTI sypmtoms antiviral treatment without doing any test to confirm H1N1. I told her since we are now in pandemic, all influenza like illnesses will be presumed to be H1N1, and this is also the directive from the Health Ministry. Not happy with my explanation and not giving me a chance to clarify further, she continued to reprimand me and to my surprise, snatched the patient record card right in front of me. I was injured in my effort to prevent her from running away with the card (with the help of another accomplice) and this matter has now come under investigation by the police.

The clinic does stock up antiviral for H1N1 as with other clinics around the nation who had partipitated in the program. The cost of treatment has now come down to RM80 (previously it was RM180) for clinics which is in the list Just key in the area code in the box, and you will find the list of clinics in your locality.

The article below is another example of blame apportioned to a private doctor before further investigation.

Tuesday August 25, 2009
Results show teacher died from A(H1N1)
By MAZWIN NIK ANIS, IAN YEE, TheStar

PUTRAJAYA: The primary cause of death for the SMK USJ 12 teacher who died on Aug 19 was Influenza A(H1N1), said Health Minister Datuk Seri Liow Tiong Lai.

The 38-year-old only received the right treatment when she came to Kuala Lumpur Hospital six days after a private clinic tested her positive for the disease.

Liow said the teacher, who was in the high-risk group as she was obese, had sought treatment from a clinic on Aug 13 after suffering from fever and cough for two days.

Although she tested positive for Influenza A, the doctor only gave her symptomatic treatment and not anti-viral medication.

On Aug 18, she sought treatment at a private hospital after experiencing breathing difficulties and cyanosis and was referred to Kuala Lumpur Hospital where she was given anti-viral treatment immediately.

However, the woman died on Aug 19 due to pneumonia. The next day, results from the victim’s throat swab confirmed she had Influenza A(H1N1). The teacher’s death bring the total number of A(H1N1) fatalities to 69.

The following article quoting Dr Steven Chow, confirms my treatment stand that we should presume all influenza-like illnesses as H1N1, and the rapid test kit is not sensitive enough to detect the virus in many cases.


Sunday August 23, 2009
Doctors confused by many ministry guidelines
By LESTER KONG, TheStar

PETALING JAYA: Some private medical practitioners are confused by the Health Ministry’s guidelines on how to treat patients with influenza-like illnesses (ILI).

Federation of Private Medical Practitioners Associations Malaysia president Dr Steven Chow said the many guidelines that were issued were often conflicting.

For example, Dr Chow said general physicians (GPs) had been asked at one point to send all cases to the nearest hospital for testing; and when the hospitals could not cope, they were asked to send only selected cases.

He added when deaths were first reported, private doctors were blamed for late diagnosis and referrals to government hospitals.

“When dengue was not controlled, they were blamed and then the A(H1N1) came.

“This does not help the doctors on the ground. It is a nightmare for our GPs,” he said in an e-mail interview.

He added that private sector GPs also faced a shortage of anti-viral drugs to treat the virus.

“The main stockpile is with the Government and we are not aware of the type prescribed by the Minis-try.”

However, Dr Chow reminded that the A(H1N1) strain was resistant to existing antiviral drugs.

“Antiviral drugs are not the magic bullet for stopping or controlling this pandemic. There has been too much hype on the usefulness of these medications,” he said.

Dr Chow also pointed that rapid test kits, which increased the cost of care were not specific or sensitive enough for diagnostic use.

On Health Minister Datuk Seri Liow Tiong Lai’s directive to private healthcare providers to raise the level of suspicion on the virus, Dr Chow said the Federation had advised members to treat all ILI as A(H1N1).

He said the federation was ready to work with the Ministry to fight the virus and take pre-emptive measures to decrease future fatalities.