By Harendra de Silva –

Vidyajyothi Prof. Harendra de Silva

An internal memo GRM/B/14/2022 sent to doctors in Castle Street hospital for Women dated 14/11/22 informs of temporary stoppage of Full Blood Count (FBC) investigation. Depriving medical professionals access to basic medical investigations which would lead to what could be ‘perceived’ as negligence of healthcare, leading to death or further deterioration of health of patients would be an extremely dangerous situation! 

Medical professionals would be helpless although the legislators and policy makers would be aware of the outcome, i.e., of death. ‘Manslaughter’ is an appropriate word to use in this situation (the crime of killing a human being without malice aforethought, or in circumstances not amounting to murder). In other words; doctors are now being forced not to order tests what could be perceived as negligence which in turn could possibly lead to death of patients followed by possible litigation. If the decision makers are aware of possible death by their decision, then it amounts to more than manslaughter. If doctors are unaware and helpless then it could be interpreted as being used by proxy! However, in this situation they would be aware and if they continue without protesting, there would be some degree of culpability of being passive perpetrators!

For the public it is important to explain the value of the Full Blood Count (FBC) which is a basic first line blood test that would screen the type of infection/disease as viral or bacterial/inflammatory and indicate the type of treatment as well as determine further investigation. It would also indicate the extent of bacterial infections. The haemoglobin level and some other indices will point to the presence of anaemia and the type of anaemia. It could also point to allergy or parasitic infection with elevated eosinophil counts. There are other innumerable indices and interpretations of data. It is particularly crucial in suspecting and diagnosing dengue fever especially identifying the critical stage and monitoring, and is indispensable in detecting evidence of leaking and possible bleeding with low platelets. In other words, 10% of dengue patients who would leak are likely to die without facilities to do FBC testing. 

When we cannot identify bacterial infections by doing the FBC we are more likely to use antibiotics blindly and unnecessarily wasting precious foreign exchange and add unwanted side effects. Have the decision makers not heard about being penny wise and pound foolish?

When we cannot do FBC in hospital we will be forced to send the tests to the private sector although illegal. We cannot allow patients to die! The act of directing investigations to the private sector, questions rules and regulations as well as ethics. It also opens doors to corruption! It is possible to write volumes against this foolish decision by the government. I also blame ministry officials who bowed down to political pressure without protesting! Who is accountable for losing track of stocks of reagents? The health trade unions of course represent themselves and not patients? Isn’t it time to prick everyone’s conscience??