Times of India
05 August 2010

Dr Hemant P Thacker is a consultant physician with south Mumbai hospitals)
This film has been playing at all hospitals to full houses in Mumbai for the past five weeks. In fact if you were to be admitted to a hospital for anything else, it would be strange, for more than 50% of most hospitals are full of malaria patients and space is at a premium.

It is not as if the population of the city has increased overnight but the sharp rise in the mosquito menace has given rise to this unprecedented surge in cases. Stagnant pools of water decorate every nook and corner of the city. From the posh to the poor, the localities are dug up, the payments are excavated, the builders have erected tanks (legally or illegally) and these have filled up with bountiful rains. The monsoon is cursed – damned if I do and damned if I dont ! The breeding of the female anopheles carrying its lethal plasmodia (malaria bug) bombs is ubiquitous in the city.

The poor Mumbaikar, irrespective of the strata of society, is a bloody target to this swarm of insects and that’s where it all starts!

Mumbai is a predominantly vivax dominated region. While falciparum is the lethal killer, vivax is the chronic bug. Difficult to eradicate, for it requires a tedious followup with drugs for 15 days, most patients feel well when the acute malarial phase is treated and often abandon the remaining course. This breeds chronicity. The parasite multiplies and then attacks with renewed vigor. Often it overwhelms the body systems resulting in kidney, liver and even cardio–respiratory failure. Since the parasite resides in the red blood cell (RBC), it results in a breakdown of blood giving rise to increased indirect bilirubin (wrongly interpreted as jaundice) which can thicken the blood and block the arteries of essential organs.

Malaria also causes a drop in platelets. Though the normal count is between 1.5 to 4 lakh, physicians do not worry with counts even as low as 15,000. Infact in the last two months, in the more than 300 patients I treated, I have given platelet transfusions only twice.

My motive of saying this is that just low platelets should not make you run to a hospital. Subtle signs of bleeding that your doctor can decipher, should be sought.

If the municipal authorities are to blame for poor hygiene, (lending a deaf ear and blind eye to irregularities) then the doctors and patients need to be pulled up for the phenomenon of inadequate, incomplete and intermittent medication.

Educating primary physicians about the correct drugs and doses and enlightening patients about the necessity to complete treatment is important. There is no need for the whole city to take any preventive drug.

Where does the buck stop?
My fear is that rampant and often unwarranted but incomplete use of potent drugs will soon render the bugs resistant in the near future and what will happen in the next monsoon?

A disease of yesteryears has arisen like a phoenix. Let us wake up and ask for our fundamental right to health for the poor citizen is paying with his time and life for a preventable disease. The might of man is humbled by the sting of a mere ‘macchar’. Truly nature is the equalizer.