Screw-ups and Systems

In Chattisgharh, innocent women die. A waste of young life. A carnage.

An outcry that happens only when something goes wrong- ensues. Doctors are blamed. Government officials are crucified. Autopsies reveal no technical problems with the procedures. But tests reveal rat poison in some of the dispensed drugs. It may still be only contributory. Was the sterilization process adequate? How was the asepsis? Did the doctors oversee it properly? More importantly, did the government let them?

Ambriose Parre was an amazing Surgeon. It is possible that he was better skilled and more innovative than any Surgeon alive today. But he did drainage of abcesses, setting of some broken bones, removal of some body-surface tumours that were small, and amputations. Things a first year surgery Resident could do today. The only difference was that he lived a few centuries ago. Nobody knew what an infection was. Semmel weiss, the gyeneclogist who suspected that some “cadaverous particles” that were transmitted by doctors were responsible for increased infections among newly delivered mothers and insisted that they wash their hands was born centuries in the future. Though Simmelweiss saved thousands of lives he was ridiculed to death by contemporary doctors. Joseph Lister and Louise Pasteur had to come before many were convinced.

Just a few decades ago, during the first world war, the treatment for a compound fracture was amputation of the part. An arm bone fracture with an open wound- chop the hand off. Fracture Femur with an open wound- off with the entire lower limb. Trying to treat it without that, usually led to infection, septicaemia and death.

Now I can re-attach a severed hand. I walk into the theatre. I change my clothes. I wash my hands with disinfectant. I wear caps and gloves. I gown, put on sterile glove. I don’t have to think about these things. That is the drill.

The theatre is kept sterile. There are UV light sterilisers that are put on every night. The instruments are sterilized by many sophisticated techniques that are different for each classes of them. I have only a vague idea of all that. Actually, I am quite ignorant. None of these superb instruments, just right for the various steps involved, are designed by me. Ambriose Parre made most of his instruments himself.

The patient doesn’t scream when the knife is put on him. There is the Anaesthesiologist, and an entire speciality of anaesthesia, to take care of that. The drugs including gases that will be administered to him in the process of an eight hour surgery will number to over a fifty. I am not even aware of all that.

There was a system to train me. Here, I took some effort to train myself, but if I was in a western country, I would not have been in this position without being adequately trained.

The patients expect me to do the best. There are superiors and administrators looking over my shoulder. There are audits. And these are all fair. They are necessary.

Because I am no hero. I am just a component in the system. I may be responsible for certain parts of it. I may even be important. But I am answerable to the system that made everything possible.

Systems have brains. Not one, but millions. It is an answer to people that says that there is no thing as collective intelligence. There is. It is a contribution of the ideas and efforts of countless men and women. Not all of them are alive. It is an amalgamation of the work of generations. It is a synthesis of an idea. The idea, that systems can be improved incrementally over generations. It is what made humans beat all other animals hollow.

Systems are only as good as the people that use it. They depend on honesty, reliability and responsibility. They depend on the public’s right to demand, question and ensure. They depend on all of us.

And we have a long way to go.

Dr Jimmy

I am a Doctor, Writer and Science Communicator. I am a member of Info- Clinic, and have written a few books. This site features my blog posts and stories. Thank you for visiting. ഞാൻ എഴുതാൻ ഇഷ്ടമുള്ള ഉള്ള ഒരു ഡോക്ടർ ആണ് . നിങ്ങളുടെ താത്പര്യത്തിന് നന്ദി .