Posted by Duncan Maru, MD, PHD
We are unlikely to find the ultimate cause of death for two young male siblings who died at Bayalpata Hospital after a toxin ingestion. In our mortality review, the key point of reflection is less on our clinical operations, as they have been recently, and more on the general medical and public health infrastructure present in Achham. In the absence of autopsy and laboratory capacity to investigate this type of toxin ingestion, we are left with the tools of “shoe-leather” epidemiology—tracking down possible toxic exposures by asking family and community members. While Bayalpata Hospital does have core laboratory capacity, we do not have the more advanced toxin assays that would make it possible to identify the biochemical culprit of these tragic deaths. This is a clear example of the integral connection between public health and medical infrastructure. Effective treatment for patients, or, when cure is not possible, effective closure for the families, is not possible without the necessary laboratory facilities. Similarly, the essential public health of protecting the community from toxins cannot happen in the absence of laboratory techniques for identifying the toxins. As this case demonstrates, the oft-posed question of “should you pursue [cheap] public health interventions or medical services” misses the point.
Please click here on the formal mortality review that we conducted in investigating these deaths.
Note: this report is a part of our “Comprehensive Morbidity and Mortality Review” initiative aimed at cataloguing and reflecting on the underlying causal pathways in cases of excess morbidity or mortality. This work is supported in part by a grant from the Lovejoy Foundation at Children’s Hospital Boston, Massachussetts, USA.
