Dr Niyaf's Online Clinic
http://blog.niyaf.com
Dr Niyaf's Online Clinic
House fly invasion 2008: is a diarrhoeal epidemic imminent? Again?
Last year, around June, I issued a public health warning on a house fly invasion in Male' via this blog. That time, as was expected, a surge in diarrhoeal disease incidence was noted. Several children were affected by the illness with many requiring hospital care for severe disease. Food and drinking water contamination was thought to be the mechanism of spread. Thanks to a visiting Thai research team, the organism responsible for the illness was identified as Rota virus following tests on several patients.
This year, we are again experiencing a house fly invasion. We are perhaps experiencing the early days of the invasion. Unless steps are taken to control this vector, we may have to face another diarrhoeal disease epidemic in Male'.
Food hygiene and clean drinking water are of paramount importance in preventing diarrhoeal diseases from spreading. The many open air restaurants around Male' would need to work hard to control the fly population in and around their premises. Food handling safety must be ensured at all times but particularly during these times.
I recently sat with a couple of doctors in the Executive section of the canteen at IGMH to discuss a few clinical issues. I do not eat food from the canteen for health concerns and the sight in and around the canteen convinced me that I was right to be concerned. The place was full of house flies. They were everywhere. I assume, not necessarily from having witnessed any evidence of it, that the operators of the canteen must be doing something to control the vector; but clearly they were on the losing side. So would the many hundreds of people eating at the canteen. Just imagine what impact the newly opened "open air " section would have on food contamination by the flies!
General cleanliness at the household level and at the community level would be required to control the fly population before it causes an inevitable public health crisis. The public on their own and the government authorities too must take necessary steps as soon as possible.
In particular, I would like to urge the general public to take extra precautions in ensuring that drinking water is clean, safe and non-contaminated. Boiling drinking water could be something that could be done at the household level to ensure the safety of drinking water. Perhaps the public water supply company could take public steps to alleviate our concerns too.
Food handling both at home and at public food outlets must be made safer and cleaner. Keeping food protected from flies and other vectors would be of particular benefit during the fly season.
Last, but definitely not the least, improved personal hygiene with particular attention to hand hygiene before handling food or drinks would go a long way in preventing diarrhoeal diseases.
Take care.
This year, we are again experiencing a house fly invasion. We are perhaps experiencing the early days of the invasion. Unless steps are taken to control this vector, we may have to face another diarrhoeal disease epidemic in Male'.
Food hygiene and clean drinking water are of paramount importance in preventing diarrhoeal diseases from spreading. The many open air restaurants around Male' would need to work hard to control the fly population in and around their premises. Food handling safety must be ensured at all times but particularly during these times.
I recently sat with a couple of doctors in the Executive section of the canteen at IGMH to discuss a few clinical issues. I do not eat food from the canteen for health concerns and the sight in and around the canteen convinced me that I was right to be concerned. The place was full of house flies. They were everywhere. I assume, not necessarily from having witnessed any evidence of it, that the operators of the canteen must be doing something to control the vector; but clearly they were on the losing side. So would the many hundreds of people eating at the canteen. Just imagine what impact the newly opened "open air " section would have on food contamination by the flies!
General cleanliness at the household level and at the community level would be required to control the fly population before it causes an inevitable public health crisis. The public on their own and the government authorities too must take necessary steps as soon as possible.
In particular, I would like to urge the general public to take extra precautions in ensuring that drinking water is clean, safe and non-contaminated. Boiling drinking water could be something that could be done at the household level to ensure the safety of drinking water. Perhaps the public water supply company could take public steps to alleviate our concerns too.
Food handling both at home and at public food outlets must be made safer and cleaner. Keeping food protected from flies and other vectors would be of particular benefit during the fly season.
Last, but definitely not the least, improved personal hygiene with particular attention to hand hygiene before handling food or drinks would go a long way in preventing diarrhoeal diseases.
Take care.
Growth Charts for children
I am writing this post on the request of some friends and colleagues who wished to get links to the CDC (USA) growth charts. One might have to get used to using these charts and interpreting the information obtained from plotting a child's growth measurements on them.
In Maldives, unfortunately, growth monitoring is very poor. Weight is the only parameter that is regularly recorded on the Vaccine and Growth record card. Monitoring weight, length and head circumference are all very useful for proper assessment of a child's over all physical growth.
Here are the links to printable PDF versions of the charts:
Girls: Birth to 36 months of age
Boys: Birth to 36 months of age
Girls: 2 years to 20 years
Boys: 2 years to 20 years
In Maldives, unfortunately, growth monitoring is very poor. Weight is the only parameter that is regularly recorded on the Vaccine and Growth record card. Monitoring weight, length and head circumference are all very useful for proper assessment of a child's over all physical growth.
Here are the links to printable PDF versions of the charts:
Girls: Birth to 36 months of age
Boys: Birth to 36 months of age
Girls: 2 years to 20 years
Boys: 2 years to 20 years
GlaxoSmithKline Pharmaceuticals to hold CME for medical practitioners in Maldives.
GlaxoSmithKline Pharmaceuticals (GSK) will hold a CME program on 23rd May 2008 at Hulhule Island Hotel for medical practitioners in Maldives. The program organised by the Colombo office of Glaxo Wellcome is one in a series of CME programs that have been organised in recent years by the international pharmaceutical company.
Topics and guest speakers:
For more information please contact Mr Muzamil on 07903801
Topics and guest speakers:
- Antibiotic Therapy in Respiratory Tract Infections
Dr Ajith Nagahawatte,
Specialist in Medical Microbiology,
University of Ruhuna, Srilanka - Vaccine- Infancy and Beyond
Dr Omala Wimalaratne,
Consultant Virologist and Vaccinologist,
Medical Research Institute,
Ministry of Health, Srilanka
- Hulhule Island Hotel
- From 7:00pm on 23rd May 2008 (Friday)
For more information please contact Mr Muzamil on 07903801
Time for Department of Public Health to act!
I am sure that those responsible for monitoring emerging epidemics in the country must have realized by now that there is a significant increase in the number of cases of Dengue and Viral Fever in the past few months. The biggest hospital in Male' is overflowing with admission, with some families making decisions to have their loved ones flown to neighboring Srilanka for admission rather than wait in the Emergency Room for days.
Yet, I fail to see, or hear of, a public health campaign to help control the spread of the illnesses. I accept that there isn't a lot that can be done to control the spread of Viral fever, but for Dengue Fever a revival of the vector control program could see much benefit.
Last year, with the general public in Male' and the different islands running the campaign themselves, clearing mosquito breeding spaces, we saw an expected Dengue epidemic averted. This year need not be different. However, we always see concerned people waiting for fatalities to make headlines before taking any action. The cost of inaction has always been greatest on the most vulnerable of our population, our kids. More than any other segment of our population, children have fallen victim to these sometimes, but unpredictably, deadly disease.
I take this opportunity to call on the concerned authorities at the Health Ministry and the Department of Public Health to revive the vector control program and other public health measures to prevent a disaster. Please, politics aside, increase the capacity of our premier health institution in managing these kinds of surges and epidemics of illnesses.
I also urge the concerned general public to pressure the authorities to take action.
Yet, I fail to see, or hear of, a public health campaign to help control the spread of the illnesses. I accept that there isn't a lot that can be done to control the spread of Viral fever, but for Dengue Fever a revival of the vector control program could see much benefit.
Last year, with the general public in Male' and the different islands running the campaign themselves, clearing mosquito breeding spaces, we saw an expected Dengue epidemic averted. This year need not be different. However, we always see concerned people waiting for fatalities to make headlines before taking any action. The cost of inaction has always been greatest on the most vulnerable of our population, our kids. More than any other segment of our population, children have fallen victim to these sometimes, but unpredictably, deadly disease.
I take this opportunity to call on the concerned authorities at the Health Ministry and the Department of Public Health to revive the vector control program and other public health measures to prevent a disaster. Please, politics aside, increase the capacity of our premier health institution in managing these kinds of surges and epidemics of illnesses.
I also urge the concerned general public to pressure the authorities to take action.
A number of viral illnesses reaching concerning levels in Male'
Several viral infectious diseases are currently causing minor epidemics
in Male' and possibly in nearby islands. The illnesses that have recently increased in number include;
At a time like this it is important to take necessary preventive measures to help control the spread of the illnesses.
- Dengue Fever and Dengue Hemorrhagic Fever
- A non-specific Viral Fever
- A non-specific Flu-like illness
- Sporadic cases of Measles
- Sporadic cases of Mumps
- Sporadic cases of Chicken pox
At a time like this it is important to take necessary preventive measures to help control the spread of the illnesses.
- Mosquito control measures and mosquito bite prevention measures are recommended to prevent the spreading of Dengue Fever.
- Vaccination against the vaccine preventable diseases like Measles Mumps and Chicken pox is recommended to reduce disease burden and prevent it from spreading.
- Case diagnosis, institution of appropriate treatment and isolation from non-affected children (and adults) is one of the most important measures to prevent the spread of most viral contagious illnesses.
- Improvement in personal hygiene; especially in the care of sick and unwell children would also help contain the illnesses.
Maldivian doctors refusing to work in the islands?
Today I heard some of my colleagues talk about the recent criticism and accusations made against Maldivian doctors that they refuse to work in the field in the islands. I believe it is only fair to put these accusations and criticism in proper perspective.
As per an agreement, signed by most Maldivian medical students at the time we receive scholarships for medical studies abroad, we are required to work an unspecified but reasonable length of time in the islands once we return after completing our training. Unfortunately in recent years, several Maldivian medical graduates were allowed exemption from this already agreed obligation while others were virtually forced to adhere to it. This had created a sense of inequality among the graduates and prompted some to refuse to carry out their obligations unless equality is restored.
There is no denying that our countrymen, women and children need our graduates to serve them in earnest. We are indeed duty bound on moral and ethical grounds to serve them. Many of the graduates have done that, in perhaps the harshest clinical settings they themselves have ever had to practice under. It is therefore deeply concerning and highly unfortunate that Maldivian doctors as a whole have been accused of being insensitive to the peoples needs.
I do understand and share the feelings of those who have served in the islands when they hear of their colleagues' refusal to do the same. It is even more disgusting when rules are bent and broken in favour of allowing certain members of the medical fraternity to be made exempt from such rules. If rules are to be applied, they have to be applied across the board. No exceptions and no exemptions. We must create such a situation of equality.
Indeed, if one would be so diligent to look into the matter, one would find instances where a number of the graduates were never asked to serve in the islands. Surprisingly some were held back from doing so even upon request. In this kind of situation, the accusations are misleading and demeaning.
The current practice of sending graduates fresh from medical colleges to work unsupervised, on their own, in a poor resource setting is also questionable. Most of these doctors, although full and complete graduates from medical schools, have little or no experience in handling cases entirely on their own, especially in high pressure and resource constrained settings as those found at most health centers in the country. It is perhaps better to allow them to be nurtured and groomed under proper supervision for a reasonable length of time at a tertiary hospital or regional hospital before being posted to practice medicine on their own.
It is, in my personal opinion, paramount that we revise and review the current practices of posting Maldivian doctors to the Health Centers and Regional Hospital, if we are to realistically tackle the medical staff shortage situation in the islands. The current system is flawed and outdated. The exceptions and exemptions of days gone by have made it an inequitable system that is frowned upon by Maldivian medical graduates.
I support and am in favour of posting Maldivian doctors to the islands to serve our people. For this to work, we must make the system fair for everyone. For the doctors posted in the islands to deliver reasonable quality of services they must be nurtured and groomed well prior to their postings. The places they are posted to must also be resourced-sufficiently to allow for the doctor to serve to his abilities.
As per an agreement, signed by most Maldivian medical students at the time we receive scholarships for medical studies abroad, we are required to work an unspecified but reasonable length of time in the islands once we return after completing our training. Unfortunately in recent years, several Maldivian medical graduates were allowed exemption from this already agreed obligation while others were virtually forced to adhere to it. This had created a sense of inequality among the graduates and prompted some to refuse to carry out their obligations unless equality is restored.
There is no denying that our countrymen, women and children need our graduates to serve them in earnest. We are indeed duty bound on moral and ethical grounds to serve them. Many of the graduates have done that, in perhaps the harshest clinical settings they themselves have ever had to practice under. It is therefore deeply concerning and highly unfortunate that Maldivian doctors as a whole have been accused of being insensitive to the peoples needs.
I do understand and share the feelings of those who have served in the islands when they hear of their colleagues' refusal to do the same. It is even more disgusting when rules are bent and broken in favour of allowing certain members of the medical fraternity to be made exempt from such rules. If rules are to be applied, they have to be applied across the board. No exceptions and no exemptions. We must create such a situation of equality.
Indeed, if one would be so diligent to look into the matter, one would find instances where a number of the graduates were never asked to serve in the islands. Surprisingly some were held back from doing so even upon request. In this kind of situation, the accusations are misleading and demeaning.
The current practice of sending graduates fresh from medical colleges to work unsupervised, on their own, in a poor resource setting is also questionable. Most of these doctors, although full and complete graduates from medical schools, have little or no experience in handling cases entirely on their own, especially in high pressure and resource constrained settings as those found at most health centers in the country. It is perhaps better to allow them to be nurtured and groomed under proper supervision for a reasonable length of time at a tertiary hospital or regional hospital before being posted to practice medicine on their own.
It is, in my personal opinion, paramount that we revise and review the current practices of posting Maldivian doctors to the Health Centers and Regional Hospital, if we are to realistically tackle the medical staff shortage situation in the islands. The current system is flawed and outdated. The exceptions and exemptions of days gone by have made it an inequitable system that is frowned upon by Maldivian medical graduates.
I support and am in favour of posting Maldivian doctors to the islands to serve our people. For this to work, we must make the system fair for everyone. For the doctors posted in the islands to deliver reasonable quality of services they must be nurtured and groomed well prior to their postings. The places they are posted to must also be resourced-sufficiently to allow for the doctor to serve to his abilities.
Hulhumale' Hospital launches a Mothers' Group to support and promote breastfeeding
Today, Hulhumale' Hospital has officially launched a Mothers' Group to support and promote breastfeeding. This is, to my knowledge, the first of its kind in the country. As a Breastfeeding Counseling and Lactation Management Trainer I was delighted to be a part of this effort from the administration and management of Hulhumale' Hospital.
I am just returning from the inaugural information session for the mothers group where the group members were given information on various aspects of counseling and mutual support of breastfeeding practices in a community. Today we laid the ground work for future Breastfeeding Counseling Training Courses for the group members and staff of Hulhumale' Hospital. The training program is tentatively scheduled for late May to early June this year.
These first steps would definitely go a long way in making Hulhumale' Hospital and the island a Baby-friendly place.
I am just returning from the inaugural information session for the mothers group where the group members were given information on various aspects of counseling and mutual support of breastfeeding practices in a community. Today we laid the ground work for future Breastfeeding Counseling Training Courses for the group members and staff of Hulhumale' Hospital. The training program is tentatively scheduled for late May to early June this year.
These first steps would definitely go a long way in making Hulhumale' Hospital and the island a Baby-friendly place.
Interactive guide to childhood development
These are links to interactive guides to early childhood development that could be used to assess and identify developmental disabilities in children. I find this tool especially useful because of the lack of technical jargon and its easy usability by non-medical people.
Milestones
Select the age of the child and click "go". The new page gives milestones that are appropriate for the age selected and also lists warning signs for developmental disability for that age.
Check list
Select the age of the child from the drop-down box and click "go". The new page gives a check list of activities or milestones appropriate for that age. Tick the boxes that are applicable.
Milestones
Select the age of the child and click "go". The new page gives milestones that are appropriate for the age selected and also lists warning signs for developmental disability for that age.
Check list
Select the age of the child from the drop-down box and click "go". The new page gives a check list of activities or milestones appropriate for that age. Tick the boxes that are applicable.
Mosquitoes everywhere.
This is probably the topic that I have written most often about in recent times. Yet again, I am compelled to write about mosquitoes and their potential to cause ill health in this country.
After the recent rainfall, as expected, there is a definite increase in the number of mosquitoes buzzing around and biting us to spread illnesses such as Dengue Fever. This is a huge concern for health care workers like myself. I am in no doubt that this concern is shared by many others. We all know how deadly an illness Dengue can be in its severe form.
I was at work (at IGMH) the other day when I couldn't help but complain about the number of times I was bitten by mosquitoes while seeing patients in OPD. I get terrible reactions to mosquito bites; with very rapid appearance of a severe Urticarial rash. A dozen or so mosquitoes were in a feeding frenzy within that single room. I along with the patients who had come to see me were at the mercy of these air-borne pests.
I realize that the whole of Male', and probably the rest of the country, is experiencing a resurgence of the mosquito menace. But, for the mosquitoes to be present in such large numbers in the one place where they could readily feed on people with mosquito borne illnesses (such as Dengue) is a serious concern. These hospital premises are fast becoming the prime location where Aedes mosquitoes are spreading the Dengue virus.
Where the mosquitoes are coming from, I am not so sure. But the fact that they are indeed there is as certain as these really itchy wheals on my arms. It is a very likely possibility that some of these mosquitoes are coming from outside of IGMH, probably from the several construction sites around the hospital. However, I suspect that a significant number of them are born and bred within the hospital premises!
There are so many water logged areas within the hospital premises, not least the roofing and the roof drainage system. The terraces are also water-logged for several days after the rain ceases. It probably is my ignorance, but I really don't see anyone putting in an effort to clear up the potential breeding areas within the hospital.
It is quite probable that any such effort restricted to the hospital alone would be, on its own, of no significant impact to the mosquito population. Nonetheless, I believe that such an effort is needed as soon as possible. IGMH could begin the work and urge the community and other responsible bodies to revive the mosquito control program.
I don't see any logic in waiting for the mosquito menace to cause an epidemic, as happens every year, before we launch a preventive health campaign. If we wait even a bit longer, the epidemic may soon begin. Or has it already!
After the recent rainfall, as expected, there is a definite increase in the number of mosquitoes buzzing around and biting us to spread illnesses such as Dengue Fever. This is a huge concern for health care workers like myself. I am in no doubt that this concern is shared by many others. We all know how deadly an illness Dengue can be in its severe form.
I was at work (at IGMH) the other day when I couldn't help but complain about the number of times I was bitten by mosquitoes while seeing patients in OPD. I get terrible reactions to mosquito bites; with very rapid appearance of a severe Urticarial rash. A dozen or so mosquitoes were in a feeding frenzy within that single room. I along with the patients who had come to see me were at the mercy of these air-borne pests.
I realize that the whole of Male', and probably the rest of the country, is experiencing a resurgence of the mosquito menace. But, for the mosquitoes to be present in such large numbers in the one place where they could readily feed on people with mosquito borne illnesses (such as Dengue) is a serious concern. These hospital premises are fast becoming the prime location where Aedes mosquitoes are spreading the Dengue virus.
Where the mosquitoes are coming from, I am not so sure. But the fact that they are indeed there is as certain as these really itchy wheals on my arms. It is a very likely possibility that some of these mosquitoes are coming from outside of IGMH, probably from the several construction sites around the hospital. However, I suspect that a significant number of them are born and bred within the hospital premises!
There are so many water logged areas within the hospital premises, not least the roofing and the roof drainage system. The terraces are also water-logged for several days after the rain ceases. It probably is my ignorance, but I really don't see anyone putting in an effort to clear up the potential breeding areas within the hospital.
It is quite probable that any such effort restricted to the hospital alone would be, on its own, of no significant impact to the mosquito population. Nonetheless, I believe that such an effort is needed as soon as possible. IGMH could begin the work and urge the community and other responsible bodies to revive the mosquito control program.
I don't see any logic in waiting for the mosquito menace to cause an epidemic, as happens every year, before we launch a preventive health campaign. If we wait even a bit longer, the epidemic may soon begin. Or has it already!