Defining Priorities

The long foreseen breakdown of public services in  the old metropolises and the yawning gap between demand and provision in the newer, fast-growing cities are contributing to a telling redrawing of the trajectory of public health emergencies. Such a development, if ignored and left unremedied, may well contribute to a distortion of the factors that define public health priorities. A case in point is the leptospirosis scare in Mumbai, labelled an epidemic in some quarters, and the way it emerged.

Leptospirosis is not unknown and has been reported in the city off and on. Earlier this month, however, private doctors in some of the northern and western suburbs began to see cases of a ‘mysterious’ fever, whose symptomatology resembled malaria, though patients did not respond to anti-malarials. Many cases proved to be fatal. That is when some private doctors approached the local civic authorities seeking help in identifying the diseases. Blood samples of the dead, then numbering 10, were rushed to the National Institute of Virology at Pune. Meanwhile several private doctors, some specialists in nephrology, opined that this may be leptospirosis which is spread through the urine of rodents and may have been a consequence of the flooding in the area when the population had to wade through flood waters contaminated with sewage. The cases however had begun to show up in June before the floods, though their number increased after the July 12 floods. The hospitals had conducted confirmatory tests on blood samples for leptospirosis. However, civic officials insisted that it could be any of the three causes: dengue fever, falciparum malaria or leptospirosis. Specialists pointed out that after all only about one in 10 cases of smear negative falciparum could be diagnosed through the routine blood tests for malaria and that there had been an increasing trend in these undetectable cases in the city of patients who presented a clinical picture of the diseases. Civic hospitals and private doctors were advised to rely on and record a good clinical picture and to treat the patients with both broad spectrum antibiotics and anti-malarials.