Skirmishes and confusion over distribution of oseltamivir for swine flu patients are routine these days at Pune Municipal Corporation-run Naidu hospital. On Saturday morning, Sakshi Khandeshi was seen brandishing prescriptions of three doctors in a desperate bid to move the officials at the hospital to examine her 3-and-a-half-year-old son Mihir urgently. The confusion was over the prescription not being made in the prescribed format that grades the disease in accordance with severity and enables them to identify patients needing Tamilfu and those who do not need the anti-viral drug. The mother had to wait for a good while, and was finally given four Tamiflu tablets.
“My son had fever since February 23. He did not respond to two courses of antibiotics. Doctors tell me that tablets are available only at Naidu hospital. And here the doctor refused to even examine the child asking me to get a proper prescription based on government H1N1 classification of A, B and C. If they cannot give free medicine, at least allow us to buy them,” said the mother, breaking into tears. She had travelled from Ahmednagar and was allegedly subject to rude behaviour at Naidu hospital.
Dr Umesh Vaidya, head of neonatal intensive care, a unit of KEM hospital and paediatrician examining more than 10 such cases daily in his OPD said the child had respiratory disease and fever for five days. Mihir has not responded to cefuroxine and amoxicillin. We are aware that oseltamivir has to be immediately started as it was definitely a suspected case of swine flu. “The mother had prescriptions of Dr H Mujumdar and Dr S Tarade from Ahmednagar and I wrote another for the tablet to be procured from Naidu Hospital,” Vaidya said.
Officials insisted that the prescription was not written as per government specification of classifying H1N1 symptoms — A category for extremely critical, B for fever of more than 38 degrees and flu-like symptoms (that require Tamiflu) and C category that needs symptomatic treatment of seasonal influenza (that does not require Tamiflu). Most doctors are still unaware that the prescription has to be written in such a format, says Dr Vaidya.
Dr Benedict Francis, Medical Superintendent at Naidu hospital admitted that there were daily fights over dispensing drugs. WHO has underlined the danger of drug resistance if tablets are supplied in excess of what is required. Private hospitals are indiscriminately sending prescriptions. We have to exercise caution while dispensing the tablets, he said adding that panic among parents had led to this huge rush. Dr S T Pardeshi, acting medical chief of PMC said that a meeting had been held with hospitals on February 26 and the categorization of H1N1 symptoms and the prescription format had been given to the Indian Medical Association. However, when contacted, Dr Arun Halbe, President of the IMA, Pune chapter said no written notification had been received from PMC. Authorities need to realize that there are increasing cases of swine flu and clearly the system is not prepared to tackle them. In 2009, when the swine flu pandemic had broken out we opened a helpline to clear doubts and help patients. We will now start a helpline, Halbe said.
Highly placed officials said PMC has a stock of 6,000 tablets at Naidu hospital while government hospitals and sub-centres have been given fresh stock. Despite health minister Dr Deepak Sawant assuring in Pune that there is adequate stock of oseltamivir, there seems to be a clear shortage of drugs. Dr H H Chavan, deputy director of health, Pune said some medical stores of private hospitals have been approved by FDA to sell drugs that cost Rs 500 for a strip of ten.