Kashmir valley is
witnessing another disaster in the form of Hepatitis C epidemic. In some
villages in Kokernag area the number of cases is around 40% of the total
population. In spite of media pressure and demand from local population,
authorities are still contemplating curbing the further spread of this infection.
Similar scenario exists in other districts of the valley like Shopian, Kupwara,
Srinagar and other areas of district Anantnag.
Hepatitis C is not
transmitted by routine personal contact and there needs to be an actual
transfer of the virus via blood, blood products and body fluids, from one
person to another. From the sociodemographic profile of the rural population,
one can easily exclude intravenous drug abuse or sexual contact as the cause of
the current epidemic in majority of cases. The unsafe use of syringes and
instruments by health professionals, dentists, chemists and quacks does explain
this explosive nature of the problem. The situation is made worse by the lack
of training and accountability, unsafe sterilisation procedures or no
sterilisation at all. The reuse of
disposable syringes is quite common and people are not used to questioning the
unsafe practice. Stitching of common injuries at health centers is another common
mode of infection. The practice of circumcision in our community puts children
at high risk if proper precautions are not used. Unsafe dental practices and
mushrooming of dental quacks is another worrying reason.
Use of injections is a
common practice more so in villages. Even for minor ailments, people prefer to
get medication by injection than by oral route. There is also a practice of
using intravenous fluids in villages for no apparent reason. A large number of
injections are superfluous and either due to the public, the patients, and
erroneous beliefs in the superiority of injections compared to pills, or due to
unscrupulous providers /quacks, who like to inject people because of greed for
extra money.
People should take
extra precautions when seeking help for any medical condition. When your doctor
prescribes an injection, ask if you can get along without any medicine, or if
an oral alternative is available. Many conditions, such as colds, flu, dry cough,
and diarrhoea are better treated without injected medicines. Most drugs and
other substances can be taken orally, and should be injected only in rare situations
like if someone is unconscious, or vomits so much that oral medication will not
stay down. Vitamins, glucose, paracetamol and other drugs to reduce
temperature, most pain-killers, treatments to stop diarrhoea or vomiting,
medicines to treat asthma, antibiotics (with a few exceptions, such as
penicillin) should be taken orally.
Only new and disposable
syringes and needles taken from a sealed package should be used. Syringes
should not be kept at home for reuse even on the same patient because it is
potential source of infection. If for
any reason syringe or needle has to be reused, ask if it has been autoclaved or
boiled.
Single dose vial should
be used as much as possible, which is a small bottle with medicine for one
injection only, so that there is no need to reuse the medication on same or
other patient. Multi-dose vials, with medicine for many injections, are often
used by dentists and anaesthetists when giving local anaesthesia like during
removal of a tooth. This can become a source of infection if both the needle
and syringe is not changed between the patients.
If no single dose vial
is available, see that your doctor takes medicine from a new multi-dose vial
opened in front of you. This may not always be possible and many doses are
taken out from same bottle. Some people have the bad habit to only change the
needle (and not the whole syringe) between two injections for a same patient,
(and only change the whole syringe in between patients), which contaminates the
vials because of the reflux mechanism, and you are placed at risk of getting
contaminated with the virus (HIV, Hepatitis B & C) or bacteria of the
patients before you, including drug resistant bacteria.
Recent investigations
in the USA on nosocomial epidemics of Hepatitis C showed that badly trained,
unscrupulous care givers only changed the needle and not the whole syringe to
re-inject a same patient from multiple dose drug vials. In the process of
injection, when the needle is pulled out, microscopic quantities of blood (not
visible with the naked eye), gets back up into the syringe. Thus when only the
needle is changed and syringe is reused, multi-dose vial gets contaminated with
the blood from the syringe possibly containing the infection. Then, when the
vial is used for a new patient, even if a totally new sterile syringe is used,
the new patient is at risk of getting infected with the virus/bacteria of the
patient or patients who came before him for treatment (and many microorganisms
remain viable for days in microscopic drop of blood). In 1996, even in North
America, more than half of anaesthesiologists had those bad 'dirty' practices.
Many health care givers are not conscious of the danger of this practice. So
both needle and syringe should be changed with every withdrawal of medicine
from the vial.
Another option is to
take injections from pre-filled disposable syringes– which are disposable
syringes combined with single-dose vials, or single dose cartridges. ‘Smart syringes' which include a
manufacturing system which makes them definitively non-reusable, but they are
unlikely available due to cost issues.
Many
people give injections – not only doctors and nurses, but also pharmacists,
traditional healers, family, and friends. No general statements can be made
about who gives safe injections. If a trained provider respects your requests,
uses a new syringe and needle, and takes medicine from a single-dose vial, you
are probably safer with the trained provider. But if the trained provider will
not do so, you may be safer with an untrained provider who will listen to you.
Finally
health care providers need training around infection control and sterilisation
so that this dangerous epidemic is put to a halt before it is too late. Every
new case is a potential source and the only way to break the cycle of further
transmission is to practice honestly and safely. It is your right to demand
safe health care and question where ever you are in doubt. A five rupee syringe
can save you money, can save your health and ultimately your life.
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