Clinicians' roles in management of arsenicosis in Bangladesh: interview study
Murshed, R.; Douglas, R.M.; Ranmuthugala, G.; Caldwell, B.
BMJ 328(7438): 493-494
2004
ISSN/ISBN: 0959-8138 PMID: 14988183 DOI: 10.1136/bmj.328.7438.493Document Number: 250858
The current and the desirable participation by doctors in the national arsenic mitigation effort were explored. Twenty doctors working in three hospitals in Dhaka, Bangladesh that are well known for their interest and involvement in the arsenic problem and 22 doctors of comparable seniority from two other large hospitals in the city were interviewed in early 2002. Interviews were also conducted with 17 senior managers from government, non-governmental, and international agencies that participate in the national arsenic mitigation programme in Bangladesh. Hospital doctors working outside the specialist arsenic units reported an inadequate understanding of the diagnosis and pathophysiology, did not receive training in this field, and were not involved in the national arsenic mitigation process. These doctors do not diagnose arsenic poisoning, whether or not the affected patients present to them with multisystem complications caused by chronic exposure to arsenic. Their hospitals provide services to patients from areas that are known to be contaminated. Several representatives of the arsenic mitigation agencies confirmed that progress in the development of an effective national mitigation programme is slow and that an understanding of the public health nature of the problem is widely lacking. These representatives also expressed the view that doctors could have several important roles in dealing with the problem.