A TYPICAL day in the emergency department consists of a perpetual stream of patients coming in and out. Our senses have gotten accustomed to human suffering — perhaps it is our survival mechanism. In rolls a young man on a stretcher, in his mid-20s, barely breathing. His accompanying cousin provides a history of gastroenteritis and treatment is started on the lines of diarrhoea gone horribly wrong. The search for intravenous access proves futile. His veins have simply collapsed.
“Doctor, I cannot find IV access!”
Multiple attempts and ultrasound guidance allows us to finally establish an IV line. Resuscitation is underway. Team work at its best: glorified dramatically in television shows and movies, but far more mundane in real life.
“He is crashing, there is no pulse. We are starting chest compressions!”
CPR is started and out pours blood — from his mouth, his nose, from all the sites where intravenous access was attempted. Can this be haemorrhagic fever? We weren’t given a history of fever, were we? A quick retreat into the new crop of attendants that have come reveals that the patient was indeed running fever for a few days, and does have a positive history of animal exposure.
“Maintain strict contact precaution, I want infection control and infectious diseases departments on board. I want O negative blood stat!” Trying to sound calm under these circumstances, with not only the patient’s life at stake but also that of your team members, is not easy.
“Doctor, I have blood on my hands, there is blood on the floor. The more compressions we do, the more profuse is the bleeding!”
Amidst all these statements, his heart starts beating. A collective sigh of relief; he is intubated and artificial breaths are started. All laboratory investigations are sent to ensure continuity of care, to try and find the answer to all the whys.
“He is coding again, start CPR!” and the exercise begins one more time. One, two, three, four five, six…
Out pours blood, almost equal, perhaps more than what we are transfusing. Infection control and infectious diseases departments are standing by, witnessing our losing battle. Holding his cold hands, at times you wish that some life from you might find its way into his empty, lifeless torso.
Wailing and crying outside — his mother has arrived. But we have lost him and the code is called off. There is sanity amidst chaos: explaining precautionary measures to family members, tracing any persons who have had contact with the deceased, and assessing for preventive treatment. Informing the ambulance taking the dead body about the probable diagnosis is a task in itself.
Our job is not over yet. Now comes the debrief and panic. Did we miss anything? Is there anything more that we could have done? All the healthcare workers who may have been exposed must be listed. What about the nurse who is six-months pregnant? Or the resident who has just been through a traumatic, life-changing personal experience and already experiences anxiety? Do I carry it back home to my kids, my parents? Do I need to be put on prophylactic therapy with its multiple side effects? I am deeply unsettled waiting for the lab results to come back. What if they are positive? What if they are negative?
Similar scenes are being played out in emergency rooms across Karachi. The recent mass exposure to animals over Eidul Azha in combination with the heavy rains have led to a serious quagmire, both metaphorical and literal.
Crimean-Congo haemorrhagic fever is a viral haemorrhagic fever, spread through Ixodid (hard) ticks, found in wild and domestic animals such as cattle, goat and sheep. The virus is transmitted to humans through contact with infected ticks and animal blood. Human-to-human transmission can occur through exposure to infected blood or bodily fluids.
In spite of warnings issued from various forums, unsafe slaughter practices, infected animals and deplorable sanitary conditions have resulted in multiple cases being diagnosed across Karachi, with some resulting in mortality. This year, the outbreak is lasting longer and behaving unusually.
Healthcare subject specialists are doing their best, but is it enough? The general public needs to understand their role in contributing to such outbreaks, and how they can therefore prevent them. Dealing with such diseases is resource intensive, especially when precaution is better than cure.
It is therefore incumbent on us to be more responsible and proactive in ensuring better and safer slaughter practices. Karachi needs to have specific designated areas for slaughter outside the city limits and not in our galis and mohallas. Offal and other waste needs to be disposed off hygienically. It is essential that such an avoidable crisis is prevented from ever occurring again.
The writer is a consultant at The Indus Hospital, Karachi.
(This article was also published in Dawn on September 04, 2019)