Tuesday, March 27, 2007

Dr. Lister I Presume?

A recent newspaper article originating in the Canadian west tells of a regional health centre shut down due to problems in sterilization procedures. This is, sadly, not an isolated case.

One of the greatest breakthroughs in medical science was the dicovery that disease was caused my microorganisms rather than foul air, or an imbalance in natural humours. The consequent notion of disinfection, along with anaesthetics, made modern medicine.

The subsequent discovery of antibiotics and the Vietnam experience, where the overreliance on antibiotic qualities entered the mainstream, changed medicine again, for the worse. After the 1970 common wisdom held that infection was a secondary concern, that disease or trauma repair came first, antibiotics would handle the other. Common wisdom flowing from this also changed the physical structure of hospitals. Where, at one time hospitals were striking for their antiseptic utility, they became, with remarkable celerity, quite homey with furnishings of a less spartan nature. These furnishings were also far less sanitary. Virtually all Canadian hospitals built in the 1970s and 1980s were carpeted. This in spite of what everyone knew of how clean home carpets were. Room furnishings too became dirt bombs as householding services were less medically supervised and allowed to decline.

The rise of superbugs, antibiotic resistant disease organisms - first evident during the Vietnam experience, spread world-wide to become the number 1 problem for medicine to-day. New antibiotics have not equalled the efficacy of penicillin, and have to be carefully applied to maintain what effect they have. The rise, and threatened rise of newly- evolved disease forms threatens the return on pandemic style disease. What is remarkable is that a subject - antisepticity - formerly an aspect of basic medecine has had to be rediscovered by medical personnel to-day. Some, apparently, still see it as a subject belonging to the age of medical dinosaurs. The unfortunate part, for the public, is that the learning experiences might prove disastrous.

Another tangential problem is the rise of the hospital bureaucracy - non-medically trained personnel who manage and operate hospitals. Ideally they are subservient to the medical staff, in practice, however, like in all such situations they develop a knowledge base, a unique position and a power of their own. Whether things get done, or not, depends, often, on powerful organization people with no medical training. The lapses in sterilization at the hospital out west can be laid at the door of an administration that failed to supervise a vital medical process. The medical staff who assume somebody is doing their job are equally at fault. In such cases there are usually other indicators besides growing numbers of sick people. Tragically, such failures happen all too often.

Hospitals, the folklore went, were places to avoid - places were a lot of dying took place. Sadly that is a truism. However, statistics tell us the hospitals really arent safe. They are places where accidents happen with all too much regularity, where people get sicker instead of well. For all our technological advances we are restoring a level of 19th century danger to modern medecine. And it could be avoided, or greatly minimized, by rereading and following Lister.

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