News
Epidemiology Unit buffeted by controversy
As news of five deaths due to a viral infection in the south hit the headlines, the Health Ministry’s Epidemiology Unit was in the eye of a storm, with several doctors alleging that the Chief Epidemiologist could not handle the job, but with the latter adamant that he was competent to do so.
“I am certainly not out of my depth,” asserted Chief Epidemiologist Dr. Anil Dissanayake to the Sunday Times on Thursday afternoon.
Storm clouds have been gathering over the appointment of Dr. Dissanayake as Chief Epidemiologist on December 19, 2017, with the controversy revolving around “non-technical” medical people being given “technical” positions.
There were mixed views on such appointments, with a majority of sources rejecting this measure, while a few sources said “it may be a good thing”.
Many charged that there has been a “deterioration” of epidemiological services consequent to the appointment of the ‘non-technical’ medical administrator Dr. Dissanayake as Head, for the first time in the 60-year history of the Epidemiology Unit.
Warding off such allegations, Dr. Dissanayake stressed: “I am not working alone. I have the support of all the Regional Epidemiologists and everyone here in Colombo at the Epidemiology Unit as well as all the Regional and Provincial Directors of Health Services.”
Before being selected as Chief Epidemiologist, he headed the National Blood Transfusion Service (NBTS) for six years, introducing many programmes and previously he served at the Health Ministry for 3½ years, Dr. Dissanayake pointed out.
Preceding these appointments was a long stint, another six years, as the Regional Director of Health Services (RDHS) in Kalutara, according to him “handling everything” and guiding a lot of people including Medical Officers of Health (MOHs), even during the bad period of the tsunami of 2004.
As the Kalutara RDHS he handled the curative and preventive aspects and also hospitals in that area, while during the war he had been based in Trincomalee, seeing to the treatment of internally displaced persons (IDPs) who were shipped there, after which he had been instrumental in setting up the Pulmoddai Hospital.
He stressed that senior administrators in the health sector are qualified in their field and he has an MSc in Medical Administration. His appointment as Chief Epidemiologist was part of the five-year annual transfer system. “There was an advertisement, I applied and I was selected,” he said, pointing out that the appointment was made by the Public Service Commission (PSC) in accordance with the prevailing medical minutes.
Some sources said that Dr. Dissanayake does not have the required academic qualifications of MSc and MD in Community Medicine or field experience in epidemiology-related activities, while all Consultants attached to the Epidemiology Unit have these qualifications and experience.
“As the Chief Epidemiologist, he has to provide technical advice and guidance to these Consultants and this is why we think that the current Chief Epidemiologist cannot handle the job,” a source pointed out, blaming the Health Ministry for creating this mess.
The Sunday Times learns that while the Chief Epidemiologist is responsible “for the administration of the technical and non-technical staff of the Epidemiology Unit”, he/she is also the “National Focal Point for disease surveillance excluding tuberculosis, animal rabies, filariasis, malaria, malignancies and leprosy; Manager of the National Expanded Programme on Immunization; National Focal Point (health) for avian influenza and influenza pandemic preparedness; Secretary of the Advisory Committee on Communicable Diseases; and Chairman of the Polio Expert Committee”.
Citing an example, another source said that all epidemiological-related activities — which include communicable disease control and the immunization programme – are coordinated and implemented through Regional Epidemiologists based at district-level. When the Regional Epidemiologists need any technical input, it has to be provided by the Chief Epidemiologist.
In the current setting, have routine quarterly national reviews as well as extensive annual district-level immunization reviews been conducted by the national team in the last five months, the source asked.
Referring to the crucial need of the Weekly Epidemiological Report (WER) compiled district-wise, a former Chief Epidemiologist, Dr. Nihal Abeysinghe, said that it is the bounden duty of the Chief Epidemiologist and his staff to identify the district and also the MOH areas where incidence of a communicable disease like influenza or rat fever are high and start asking some serious questions not only from the MOH but also the Regional Epidemiologist and act on it immediately until the threat subsides.
“The tasks of the Epidemiology Unit are challenging as the epidemiological scenario changes constantly,” added another source, warning that Sri Lanka may reverse all its achievements and get back into the situation of countries with fragile health systems, like some in Africa.
| Adenovirus cause of deaths in South, no epidemic | |
| Dealing specifically with the current viral disease in the south, Chief Epidemiologist Dr. Anil Dissanayake said that the cause has been identified as the adenovirus and assured that “we have not seen it causing an epidemic”. Five deaths have been reported from the Karapitiya Teaching Hospital but several others have been treated and have gone back home, he said, explaining that in this situation it is the hospital which is the main focal point and not the community. He pointed out that the Epidemiology Unit has played its role, with experts from Colombo such as a Specialist in Community Medicine, Dr. Samitha Ginige, going down there on Monday and the focal point for this subject and also a Specialist in Community Medicine, Dr. Tharanga Navodini whose subject this is, visiting Karapitiya on Thursday. “When it is not a simple respiratory disease, people get admitted to hospital and get specialist care and are treated on clinical symptoms assisted by investigations. We have virologists and microbiologists in teaching hospitals and other specialist centres who are capable of isolating organisms and finding out what is causing an outbreak. If there is anything ‘unusual’ clinicians would get more detailed tests done, sometimes getting reports from the Medical Research Institute (MRI),” said Dr. Dissanayake. When asked why he as the Chief Epidemiologist had not gone to Karapitiya himself, Dr. Dissanayake said that even if he went he would be blamed by some for doing so, as they are alleging that he is “a non-technical person”. However, on Friday, there was a meeting in Colombo of stakeholders from across the country, including the Provincial and Regional Directors of Health and hospital directors, he said. Warning that as the country faces heavy rains there could be a spate of communicable diseases, a former Chief Epidemiologist, Dr. Nihal Abeysinghe asked whether we are ready for them. Has the Epidemiology Unit taken the lead role in bracing for such disease outbreaks? He detailed the work of the Epidemiology Unit whenever there is a disease outbreak – basic investigations need to be carried out promptly to identify whether it is a regularly circulating virus or something new. This is carried out through surveillance and then testing at the MRI or at private laboratories with the Epidemiology Unit liaising heavily. Thereafter, treatment protocols would be issued to hospitals and doctors by the Epidemiology Unit which would remain in constant touch with the Regional Epidemiologists. There should be strong awareness campaigns on what precautions should be taken by the people to prevent catching an infection and also what they should do if they do catch an infection. This should be done with the help of the Health Education Bureau and the media, said Dr. Abeysinghe. Asked by the Sunday Times why there has been no concerted awareness campaign, Dr. Dissanayake said that it was to prevent the public from panicking. But all Regional Epidemiologists have been activated to distribute leaflets and posters covering all viral diseases. To a query on treatment protocols, he said that in this case, as it is linked to pneumonia, the relevant clinical college comes up with the answers. It is different for dengue and rat fever (leptospirosis) for which the Epidemiology Unit has set out Guidelines. Referring to the activities of the Epidemiology Unit, Dr. Dissanayake said that there is a monthly meeting on influenza chaired by the Director-General of Health Services attended by top officers of the Health Ministry as well as other important officials including from the MRI and those handling animal health to which the Epidemiology Unit provides its input. Asked about the Weekly Epidemiological Report (WER) put out by the unit in printed form, Dr. Dissanayake said that the last one came out in August 2017. The printing costs were borne with funding secured from the World Health Organization (WHO). However, it had not been listed in the estimates for this year, which had been drawn up before he took up duties and as such could not be printed. The WER up to the end of April 2018 is on the web, he added. |