The Lancet Student

Quackery: A social evil and a doctor's nemesis

This blog was submitted by Sagnik Sen on 29th January 2013.
Tagged with Indian public health, quackery, tubercular meningitis, Paediatrics

I have come across several different diseases in my paediatrics clinical rotation, ranging from undiagnosed and complicated cases to cases which have a very poor prognosis. Tubercular meningitis, a chronic form of meningitis, is a commonly occurring condition in India, occurring in almost 29.02% of all tuberculosis cases [1]. Prevalence of tuberculosis in children of 0-4 years of age stands at 2% of which a considerable number also contributes to meningitis [2]. Sequelae of the disease are not very good to hear — hearing loss, loss of vision, permanent paralysis of limbs, seizure disorder, etc. The associated mortality has been estimated to be 22% [3].

The child I saw a few days back, Mona, two years of age, had been having episodes of fever for about three months. Her parents reported delayed attainment of developmental goals (walking, speaking, eating on her own, etc.) till the age of one and half years age, when suddenly she started having episodes of fever. Her developmental delay might have been due to malnutrition because her family was affected by poverty. Even after recurrences of fever, they had not taken the child to any proper medical practitioner or to any Government facility. Instead they took the child to “a person in the village” who had been giving the child “puriya” filled medicines. Those who are accustomed to the local use of words (and this is for those who aren’t) would be able to understand that “puriya”-giving persons are none other than “quacks” distributing ineffective sugary or some other chemical mixtures. After two months without any improvement, and with the parents becoming increasingly concerned, this practitioner finally referred the child to the tertiary care centre associated with my medical school.

In the meantime, over these three months, Mona had gone into a state of lethargy and non-responsiveness, decreased eating and drinking, increased nausea and all other clinical features which even a mere MBBS practitioner would have been able to pick up as signs of a neurological phenomenon, which immediately would have required proper medical attention. As of now, Mona is in a comatose state, GCS 6, not responding to calls, not looking up; she is being given nasogastric feeds. Her anxious parents do not realise that she might not be able to sit up in future, or see or behave normally either; she might have permanent, significant neurodevelopmental delay.

And all this because of ignorance. Practitioners such as the one who saw Mona are everywhere in the villages: unqualified persons who can convert a poor man’s distress into a way of business and money-making. Even after 60 years of Indian independence and increase of opportunities to education and contact with mass media, events like Mona's keep on repeating. And look who has to suffer: the weak, fragile children, the treasures of the country; those little souls who are destined to take the country forward.

Thus, apart from a having a strong system for identifying unregistered practitioners, the need of the hour is partnerships and entrepreneurships from sectors like education, human resource development, communications and public health, which can endeavour to improve the quality of knowledge and awareness in the peripheries.

References
[1] Udani, P. M. et al. Tuberculosis of central nervous system; incidence and classification. Indian Paediatrics (1970) 10 : 647
[2] Rao K. N. Text book of Tuberculosis (1972), First Edition Kothari Book Depot. 339
[3] Thilothammal et al. Tuberculous meningitis in children-clinical profile, mortality and morbidity of bacteriologically confirmed cases. Indian paediatrics. volume 32-june 1995