What was even more mystifying was the fact that he had tested negative for Hepatitis C when he had donated blood four months ago. It was easy for the health-conscious 22-year-old to put two and two together.
Hepatitis C: The deadly drill
The use of unsterilised dental instrument is the second largest cause of the spread of hepatitis in Pakistan.
The
use of
unsterilised
dental
instrument
is the
second
largest
cause of
the
spread
of
hepatitis
in
Pakistan.
LAHORE:
Imran
Ali
got
the
shock
of
his
life
when
his
blood
samples
tested
positive
for
Hepatitis
C.
He
had
gone
to a
private
clinic
to
donate
blood
to
one
of
his
friends,
but
instead
found
out
that
has
own
blood
was
tainted
with
the
deadly
virus.
What
was
even
more
mystifying
was
the
fact
that
he
had
tested
negative
for
Hepatitis
C
when
he
had
donated
blood
four
months
ago.
It
was
easy
for
the
health-conscious
22-year-old
to
put
two
and
two
together.
“The
only
thing
that I
could
figure
out
which
could
have
caused
hepatitis
was a
dental
examination
I
underwent,”
pinpoints
Ali.
“I
had gone
to a
small
clinic
near my
home in
Iqbal
Town and
I was
told the
equipment
was
clinically
sterilised
but
later I
found
out that
using an
autoclave
[a
steam-heated
vessel
where
dental
instruments
are kept
and
boiled
at
certain
heat and
pressure
levels
to kill
all
viruses]
is the
proper
way to
get
sterilisation
done and
the
clinic
didn’t
have
that
procedure.”
Ali
subsequently
filed an
application
with the
Health
Department
to take
action
against
the
private
clinic,
but his
plea did
not bear
any
fruit.
His
friends
and
lawyers
then
advised
him to
file a
complaint
with the
Ombudsman’s
office
or file
a case
against
the
clinic
in
court.
“But
I didn’t
have any
proof to
substantiate
my case
so I
didn’t
consider
it a
viable
option.
Had the
Health
Department
taken
the
matter
seriously
and
seized
the
equipment
of the
clinic,
it could
easily
have
established
that the
equipment
wasn’t
sterilized
properly,”
he says
in
dismay.
Unfortunately
Ali’s
case is
not an
isolated
one.
According
to the
statistics
available
with the
Hepatitis
Prevention
and
Control
Programme
(HPCP),
which
gives
guidelines
and
drafts
policy
for
controlling
hepatitis,
every
ninth
person
in
Pakistan
is a
hepatitis
patient.
There
are no
proper
figures
available,
but
health
officials
say that
the
second
largest
transmission
source
for
hepatitis
in
Pakistan
is non-sterilised
dental
equipment.
The
number
one
cause is
reused
blades
and
razors
at
barber
shops.
What
puts
those
undergoing
dental
work
particularly
at risk
is that
in many
dental
procedures,
blood
will
necessarily
contaminate
instruments.
“In
orthodontics
(the
alignment
of
teeth),
maxillofacial
surgery
or
root-canal
treatments,
instruments
will
definitely
come in
contact
with
blood,”
explains
dental
surgeon
Dr Anwar.
“There
is a
small
pin
called
the
reamer
which is
inserted
into the
gums
and, in
many
cases,
it isn’t
sterilised
properly
if it’s
not put
in
autoclaves.”
Thus,
the
proper
sterilisation
of
dental
equipment
is of
utmost
importance
for
preventing
the
spread
of
blood-related
infection.
Yet,
this
basic
safety
precaution
is
neglected
at
several
dental
clinics.
“There
are
above
30,000
unregistered
so-called
dental
surgeons
and
quacks
in
Punjab
alone,
and they
are the
second
largest
source
of
spreading
hepatitis
in
country,”
says
Pakistan
Medical
Association
(PMA)
Joint
Secretary
Dr
Salman
Kazmi.
“Other
than
some
teaching
public
hospitals
there
isn’t
any
Central
Sterilisation
Services
Department
(CSSD)
where
all
surgical
instruments,
especially
dental
instruments
could be
properly
sterilised.”
One
of the
reasons
that
autoclaves,
while
being of
utmost
importance,
are
severely
underused,
is
simply
because
of the
cost. A
good
autoclave
costs
around
Rs
250,000
and runs
on gas
or
electricity.
This
means
that
even
those
small
clinics
that
actually
consider
sterilisation
important
may not
be able
to
afford
an
autoclave.
In
the
absence
of
proper
equipment,
they use
other
methods
which
are not
as
effective.
“What
happens
here
that in
many
small
clinics
dental
surgeons
use
ovens to
sterilise
the
instrument
which
isn’t at
all
effective
in
killing
bacteria.
Only an
autoclave
can do
it
properly
and
safely,”
says
Abid.
And
even
where
autoclaves
are
available,
there’s
the
usual
problem
of poor
maintenance
and
apathy.
“There
are
autoclaves
in all
government
hospitals
at
district
headquarters,
however
in
several
cases
they are
not
working
properly,”
reveals
Kazmi.
Another
way to
disinfect
instruments
is by
chemical
sterilisation
which is
conducted
by
dipping
instruments
in a
solution
which
has
chemicals
like
gludraldehyde.
While
Dr Anwar
and Dr
Kazmi
lay the
blame on
the
quacks,
others
allege
that
even
reputed
hospitals
don’t
have
proper
means of
cleaning
dental
gear.
“There
are some
departments
at the
Punjab
Dental
Hospital,
where
there
isn’t
any
proper
mechanism
of
sterilisation.
In the
scaling
department,
there
isn’t
any
proper
procedure
for
sterilization
and even
autoclaves
are out
of
order,”
claims a
dental
surgeon
at the
PDH.
“The
surgery
department
system
is very
nice,
but
inside
every
department,
instruments
and
mouth
mirrors
are
dipped
in the
same
solution
for the
whole
day for
sterilisation.
The same
instruments
go in
every
patient’s
mouth
and are
likely
to
spread
hepatitis
from one
person
to the
other.”
Given
that
over 550
patients
frequent
the PDH
every
day, the
chances
for
transmission
are thus
extremely
high.
However,
the
Medical
Superintendent
(MS) of
the
Punjab
Dental
Hospital
refuted
the
claims
that
dental
equipment
is not
properly
disinfected
at
public
hospitals.
“We
properly
sterilise
equipment
at
public
hospitals,
however
the
problem
lies
with
quacks
and some
small
clinics,”
she
says.
A
dentist
surgeon
at Mayo
Hospital,
however,
claims
that
it’s not
as
simple
as that.
“Most of
the time
the
sterilization
of
dental
equipment
in
public
hospitals
depends
on lower
level
employees,
who do
it
during
the
evening
or
night.
If they
don’t do
their
job
honestly
the risk
factor
goes
above
manifold,”
he
explains.
“There
should
be some
training
sessions
to
create
awareness
and
responsibility
among
lower
staffers
who
sterilisedental
equipment
in order
to
prevent
hepatitis
from
spreading.”
However,
any
oversights
or
ommissions
in this
regard
often go
unpunished.
Dr Altaf
Hussain,
the head
of
health
department’s
Hepatitis
Preventive
Control
Programme
(HPCP)
says,
“We give
a policy
line to
control
hepatitis,
but we
don’t
have any
mechanism
to check
or
punish
those
who use
non-sterilized
instruments.
The EDOs
(Health)
in their
districts
are
responsible
for
this.”
The
Punjab
Government
had in
fact
launched
an
anti-quackery
campaign
to
prevent
the
spread
of
hepatitis,
but it
failed
to show
results.
An
official
in the
health
department
claims
the
problem
persists
because
government
officials
have no
proper
mechanism
to
inspect
instruments
at
private
clinics
and drug
inspectors
are only
sent out
to check
on these
clinics
once in
a blue
moon.
According
to Dr
Altaf
Hussain,
applications
regarding
unsterilised
instruments
can be
filed
with the
area’s
EDO
Health,
after
which
the
health
department
has to
take
appropriate
action.
Sadly,
this
procedure
is not
really
followed.
“The
drug
inspectors
mostly
settle
issue
with
quacks
or small
clinics
on their
own and
the show
goes on
and
these
people
keep
playing
with
lives of
innocent
people,”
reveals
another
official.
In
this
situation,
victims
like
Imran
really
have
nowhere
to turn
to have
their
complaints
heard.
And
every
day that
this
situation
persists,
more and
more
people
fall
victim
to this
criminal
neglect.
Published
in The
Express
Tribune,
March
21st,
2012.
