Welcome to Mesopota...I mean, Bangladesh.

This post is based entirely in the context of the present scenario in Bangladesh only.

They bring out all their sick into the streets, for they have no regular doctors. People that come along offer the sick man advice, either from what they personally have found to cure such a complaint, or what they have known someone else to be cured by. No one is allowed to pass by a sick person without asking him what ails him. (Nemet-Nejat, 77)
----- Greek Historian Herodotus

Have we really advanced at all, or are we still living in the Mesopotamian society?

The excerpt above, with a little bit of modification here and there would fit just perfectly to describe a lot of the people of Bangladesh, including the "educated" population. As a doctor this has been extremely frustrating, not least for the fact that someone who has probably never finished reading a child's adventure story book will find it completely within his rights to lecture me about medicine like he was an Associate Professor of Cardiology or something while he picks out a bit of stuck meat from his yellowing teeth, but more importantly - this mentality has hampered practicing medicine in a rational manner in this country. Everyone in this country is a doctor, except the doctors of course. It's fascinating.

The pharmacists, the technicians, the electricians, your next door creepy uncle with a big bulging belly, that uncle who is an insufferable Know-it-all (RIP professor snape), everyone is a doctor.

Last month one of my colleagues who was posted at a district health complex posted a Culture and Sensitivity report of a patient with Upper Respiratory Tract infection. The report was frightening - every single antibiotic we have available were either completely resistant and intermediately resistant. To put this into context - the "ideal" scenario should have been every single antibiotic on the list be sensitive and a more "realistic" scenario should have been only 1 or two antibiotics are intermediately resistant or fully resistant and everything else is fully sensitive.

And it all boils down to the "self proclaimed doctors" taking and encouraging people around them to take Antibiotics at will - with zero regards to the proper dosage and the duration for which an antibiotic needs to be prescribed - let alone making a rational choice of antibiotic.

Question 1, Who is going to answer for the above mentioned patient's death to the family?

I had another patient couple of weeks back with a Helicobacter Pylori infection - which if left untreated could potentially lead to gastric cancer. The first line H. Pylori treatment had failed twice in this patient. The updated NICE Guidelines directs us to use Metronidazole instead of Clarithromycin if the patient has never been exposed to metronidazole previously. If he has been exposed to metronidazole, we are advised to use Levofloxacilin if the patient has never been exposed to any quinolone group drug previously, most known of which is ciprofloxacin.

Guess what are the two MOST "famous" antibiotics in every friggin' household in Bangladesh? Yeah, Metro and cipro - almost more common than a common paracetamol.

Question 2, if this patient with H. Pylori goes on to develop gastric cancer, who is going to answer to him.or his family?

Answer to both questions 1 and 2 is, the actual doctors...you know, the ones who.actually went to med school.

If you are into history and would love to experience of the long lost Mesopotamian era with an infusion of dystopia, I invite you with open arms to Bangladesh - God's practical joke!