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RENDEZVOUS WITH FUTURE : Dr. Paul Samuel ( view bio )


The point of time now for us is that of a farewell to the very alma mater we were in, where we spent the prime of our academic life. We were together dissecting a cadaver. We were together in immersing ourselves in the pages of Chau, Bailey and Davidson. We were together in the work-up of patients and what more. But at the fag end of our house surgeoncy we are becoming free birds- a fact that makes us happy and sad at the same time. Sad in the sense, it is adieu to friends and campus life. Happy in the sense it’s time to search and conquer new green pastures. But have we ever thought about the world we are going to get scattered in as physicians or at least human beings? Perhaps this article will serve as a food for thought of the various issues and challenges we are going to face in the future.

Our world now is in an age of complexity, contradiction and challenge. All these are surely going to be reflected upon our professional life as well as personal life. So where will we get the guidelines to traverse the narrow bridge?

Let’s take a quick look at the international scenario. As we enter the 21st century, we have wealth and technology unmatched in the history of human experience. But the fortunate few in the planet enjoy it and are propelled towards a future enriched in computers, communication and life sciences. But for most of the world’s people the glittering opportunities are round the bend. Six billion of us now-a number which will reach ten billion by the year 2100 are fighting for food, water and shelter not withstanding other amenities of life. We are going to face tremendous challenges as population soars, consumption rises, conflicts arise and when solutions are beyond reach. And solutions from our part may put the fate of other species in this planet at stake.

We had a great scientist who was a key figure in the development of vaccines and adorned the title of father of Microbiology-Louis Pasteur. He suggested during 1880s that ‘humans had the power to make parasitic maladies disappear from the face of the globe’. Yet since then millions of people have died of disease like TB, malaria, AIDS, Dengue, small pox, cholera, plague, influenza and scores of others. We created Dolly but failed to control even preventable diseases- some ancient and others new, unpredicted and even more virulent. These are the fate of our expectations and new developments in life sciences.

What are the diseases we are going to deal with in future? Surely text books won’t give you any idea on it. Neither will it broaden your vision nor will it enlighten the various aspects. Recent statistics show at least 20 major maladies have re-emerged in novel, more deadly or drug resistant forms in the past. Also scientists have discovered at least 30 previously unknown human diseases for which no cure exists such as Marburg disease and AIDS. Both the numbers seem silly, but not so when it comes to the number of lives it claim. Gone will be the days when the focus of medical research is morbid diseases like diabetes, asthma and hypertension. Because the trend shows that patients will start treating themselves checking their own BP, blood glucose values and respiratory flow rates. But that will not be the case of infectious diseases. Infectious disease is capturing the field of research. Day by day, startling news awake the medical scientists. Once upon a time we thought microbes were no competition to our big human brains. We were wrong.

Let’s take a brief tour through the pages of history about microbes. Plague was present in ancient centuries. And so was small pox which was present even before Pharaohs reigned Egypt. But we brought a full stop to small pox in 1978 when the last case was reported-thanks to the global vaccination effort. The Black Death wiped about a fourth of European population in just four years-a thing unimaginable at our time. When Columbus landed in the New World the saying goes ‘he brought sugar, tobacco and syphilis to Europe’. The microbes also had a smooth journey to the New World through the African slaves brought in European vessels. The result was shocking –the native American population declined drastically. In 1918-19,great global influenza pandemic left at least 20 million dead. Comparing this statistics with World War I casualties in 1914-18, which was 8.5 million, leaves us awestruck. This may be the fact that seeded the idea of bioterrorism. Recent instances in this respect are one - the contamination of Lake Michigan with intestinal Cryptosporidium in 1993,infecting hundreds of thousands of residents in Milwaukee and two - several falling ill and few dying due to a virulent strain of E.Coli which found their way to human body through undercooked hamburgers sold by a US fast food chain. Instances are many more.

So what was happening to aid the microbes. The world was changing. People widened their habitats encroaching into inaccessible areas. Overcrowding became a common thing in the Third World urban areas. Sewage and water systems were never updated to meet the demands. Political unrest forced millions to migrate to refugee settlements where sanitation and medical care were least bothered. Changes in weather pattern favoured microbes. World shrank into a village with more and more latest developments in terms of transport, trade and communication. Moreover,information systems and high literacy favoured abuse and overuse of antibiotics. These mechanisms still work and will help to aid newer microbes and their spread.

The new fear the world is facing at the moment is bioterrorism.To counter it, surely physicians will be called to the forefront .In the coming years wars will be fought by doctors and not soldiers carrying machine guns. The stunning fact is that while soldiers can fight war after many training and rehearsals ,what will be the modus operandi for us? Because we are going to fight new enemies whom we haven’t heard or known before and on whom our predictions and speculations never work.

Looking at the international scenario, we ought to have understood the importance of studying Community Medicine. We are surely going to deal with diseases whose pathology , epidemiology, clinical data and management are never known beforehand. We had not put necessary emphasis on Community Medicine nor did the faculty. The recent advances in epidemiology and surveillance are not known to us. We don’t know on whom we should put the blame on. It is interesting to note a new technique in surveillance. We have studied active and passive surveillance but heard of high-tech surveillance? It is a new mode used for influenza surveillance. Each season scientists take the blood sample of patients from around the world from 110 centers and conduct research on the various strains. Then they pool the data and predict which strain will dominate the next season. Then, this data is passed on to vaccine companies so that they manufacture the appropriate vaccine to be available for the next season. Interesting right! We are yet to witness more fascinating things like this.

So far we were thinking about the challenges in the international set up. What difference will it make when we think at our national level? Surely the various aspects regarding the infectious diseases are not going to change in our set up. Because the recent incident of plague in Himachal Pradesh has proved it. It clearly brought to light that the absence of proper surveillance and vigilance and a non co-operation from the authorities will surely result in such disasters .This may be one of the many challenges we will be dealing with.World is yet to learn from such mistakes done in the past.The story of Bonzali Katanga ,a health officer from Democratic Republic of Congo in 1998 is a sour reminder for us and a tragic one too.He was the sole public health officer for the town of Durba in civil war torn Congo.He noted a lethal virus infection in the workers of gold mine and suspected it to be Ebola or Marburg disease.He repeatedly sent messages to his superiors for months while assisting the patients with his limited knowledge.It took four months for the authorities to come for the aid because his place was under the control of rebels while the government was completely disorganized.Many started dying.And when help came, poor Katanga was no more.The health team found a sample of blood in his refrigerator labelled with his name.They later found out that the blood contained the Marburg disease causing virus.The story was shocking for the entire medical world, at the same time the role model of Katanga was worth appreciating and inspiring.

And when coming down to our little state-the God’s own country, new phenomena are arising .A state which boasts of its high literacy and the best health systems is facing new problems in the society like suicides.Each day morning dailies are studded with scoops of mass suicides and family suicides in their front page. And during our house surgeoncy period, I don’t think not an admission day in Medical wards have passed without attending a suicide case.The news that Kerala stands first in the statistics of suicide rate is shocking.The reasons may be many.Absence of due importance to psychology and counselling in our curriculum adds to the pathetic situation for junior doctors.Instead this trend becoming better ,surely it is going to worsen because it is said that Malayalees still think a shame to approach a psychiatrist.Can a general practitioner aid them?This should be a question we all should bear in mind in future while working in a peripheral set up.

Issues and challenges are many, no matter where our ‘green pastures’are? So, what can we do?Perhaps ,I may not be able to elicit all the ways of how to make our world a better place in terms of health.But let me invite your attention to some points.

Let us all strive to be like Bonzali Katanga, the health officer who was vigilant and sincere in his job watching out the minor but important changes that happen in public health. Let us keep all our senses open to strive for a healthier world.Let our perspective be not only treating the diseases but also preventing the disease-a fact which not realised now will put even our own lives at risk.Let us treat the patients not as cases as Sir Robert Hutchison put years ago ,but as human beings with emphasis on their mental problems there by helping them from breaking down.Let us educate the world to set aside differences to fight a common enemy –disease not aliens. Lets have a grip on the changes of time. And remember it is not possible to change the direction of the waves,but we can adjust our sails in the direction of our goals and aspirations.The challenges and problems may seem to be a huge mountain.Let’s conquer it by joining hands.Surely destiny will be ours.

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