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MRI in urgent need of blood transfusion
By Apsara Kapukotuwa
The Medical Research Institute has recently come under attack -- from professional organizations such as the Government Medical Officers Association and the media -- for its lacklustre attitude towards issues of national interest.

As the national and final reference laboratory for all labs in the country, the Medical Research Institute is expected to maintain strict standards. Certain important medical tests are carried out only at the MRI -- such as rabies, electro microscopic tests, rare blood tests, VIDAL and recognition of small organisms to name a few. As the country's reference centre for epidemics, the MRI has come under flak recently specially with regard to the handling of the recent outbreak of SARS, Myocarditis and even the ongoing Dengue epidemics.

The Medical Research Institute was established in 1899 just 11 years after the Pasteur Institute. With funding from the Japanese government, which donated equipment and buildings, the MRI has 14 departments and more than 300 employees.

A national institute, the MRI is where specialists with unique expertise, many of whom the only such specialists available in the country, are based. They include a pharmacologist, (entrusted with the task of conducting the blood toxic level tests) for example, vaccinologists (the national Expanded Programme of Immunization receives its technical support from here), Virologists and a Nutritionist.

The MRI is the national centre for lab based and clinical research in the country. As such, it is the training centre for postgraduate trainees and Medical Laboratory Technicians. It is ideally also the point from which guidelines and technical input would be provided for various committees and where advice is to be given to the Government and the Health Ministry in policy planning. Co ordination with other countries is also another objective of this Institute.

Interestingly one such research, which should have already begun regarding Dengue, has still not started, according to sources. This is regarding the serotype of dengue found in Sri Lanka – whether it's D1, D2, D3 or D4.

Government Medical Officers Association secretary Dr. A. Padeniya, laments the current lack of recognition accorded to the MRI. "For the past 20 months, no research has taken place at the MRI. The present Directress who is both the technical and administrative head of the Institute has been a stumbling block as she is allegedly abusing her position, creating confusion and chaos which is adversely affecting the Institution", he said.

Facing many obstacles in coping with the work due to the lack of support and with the barest necessacities available while also having to deal with harassment has reportedly resulted in three experts leaving the MRI, one of them a highly qualified clinical immunologist.

"In the face of life threatening epidemics, MRI employees are unhappy with the Institution's contribution in finding solutions to the many problems. The preliminary inquiry that was held against the MRI Director has been stalled as the inquiry recommendations were not forwarded to the Public Services Commission by the Health Secretary.

However, due to an alleged act of insubordination to the Director General of Health, which falls under Schedule 1 of the Establishments Code, the matter has come up again", Dr. Padeniya said.

The GMOA has requested for the appointment of a committee – to develop a national policy to improve and provide laboratory facilities -- under the Chairmanship of the Health Services Director General and including MRI experts, scientists from the Science and Technology Ministry and representatives from surgical and medical colleges and the Post Graduate Institute of Medicine.

Repeated attempts, by The Sunday Times to contact MRI Director Dr. Daya Colombage, were unsuccessful.

WHO sends courier; pathology samples stay put
One serious allegation against the Directress of the Medical Research Institute is the delay in sending out pathology samples from patients in Badulla suspected to be suffering from Myocarditis during its outbreak in the area. Though the samples were collected and were available at the MRI, the samples had continued to remain at the MRI despite the World Health Organization arranging for a courier to get them to the Centre for Disease Control in Atlanta USA early in April.

At an emergency meeting held on April 18l at the Office of the Secretary Healthcare, Nutrition and Uva Wellassa Development, Dr. M.R.N. Abeysinghe, Chief epidemiologist of the Ministry of Health stated in the presence of the Acting Secretary Healthcare, Director General of Health Services and other health officials that the "WHO team which investigated the outbreak in Badulla had repeatedly inquired from him the reasons for the delay by several e mails".

Saying he could not take the responsibility for answering questions from either the Ministry or the Media regarding the progress of the investigation, Dr. Abeysinghe requested the chairperson of the meeting, the Acting Secretary of Healthcare, the Director General of Health Services and the Deputy Director and consultants at MRI to solve this problem immediately as it was a very sensitive issue of national interest and one that has received wide media publicity.

Interestingly, a request was also made for the implementation of a system where the Chief Epidemiologist could directly work with a team of microbiologists from MRI to prevent undue delays in the future.

The D/D-MRI and the consultant microbiologists of the MRI were of the opinion that the samples received at the MRI have been under the custody of the Director and that according to the information received by them, the Director has taken charge of all these samples, and that "she will personally handle those samples".

Since the meeting also revealed that she was on leave on April 18 and 19, the Chief Epidemiologist requested that immediate action be taken to dispatch the samples lying at the MRI.

MRI apathy; so patients suffer
The MRI manufacture culture plates which were used in laboratory tests such as the Antibiotic Sensitivity Test. But due to its unavailability even at the National Hospital, Lady Ridgeway Hospital or the Kalubowila Hospital etc, the hospitals were left with no choice but to use the culture plates provided by pharmaceutical companies as a way of promoting their high-end antibiotics for example. This meant the doctors are forced to recommend these very same antibiotics for fear of litigation if they were to prescribe lower priced antibiotics, which were just as efective as the high priced ones in most instances.

According to those in the medical profession, the simple function of commencing the production of culture plates would entail the saving of thousands of rupees for the poor patients of this country, especially in the case of long drawn out diseases like a Urinary Tract Infection which requires five years of treatment.

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