Semmelweis' legacy in present day India #SwachhIndia

by - December 08, 2014

Ignaz Semmelweis.

You have never heard his name. And yet, you and I are probably alive today because of him and his perseverance.

Born of Hungarian ancestry, Semmelweis initially joined a law college back in 1837 before switching over to the medical field. While working in the Vienna General Hospital, this young man in his twenties doing his surgical training noticed a very curious fact. The hospital ran two maternity clinics, one run largely by medical students while the other was largely attended to by midwives. He found that the death rate in the hospital run by medical students was significantly higher (13% as against 2% in the second maternity clinic run by midwives.) The deaths included both pregnant mothers and newborn infants, secondary to puerperal fever, a form of septicemia. It reached such a level that women begged not to be sent to the first clinic for their delivery, even preferring to deliver on the streets in some sad cases.

The findings stumped this young man initially. How could trained doctors be killing more women and children than midwives? The doctors offered many reasons in their defence but none really sat right with Semmelweis.

Streptococcus pyogenes,
the cause of puerperal fever
still exists today.
It was when a friend of his died following an accidental ‘minor’ prick while performing an autopsy that the mystery started to unravel before Ignaz’s eyes. As he watched his friend die, he noted that his friend had the same symptoms as those pregnant women and newborns who suffered a premature end. He realized that most of the doctors were coming straight from the autopsies they had conducted and into the labour room to deliver newborn. Though they were washing their hands with soap and water, it was not enough to clean the doctors hands entirely. That was the difference – the midwives never participated in autopsies and hence never carried the ‘infectious particles’ from the dead back to the living.

Semmelweis' endeavours resulted in him challenging the iron-clad system and demanding that his peers use stronger chlorinated lime solutions to wash their hands before conducting any procedure on a living patient. As it always has and sadly still continues to be, the words of a young man trying to change what is the norm were not well received by his seniors and peers. His implications that the doctors were themselves responsible for the deaths of the women and newborn was met with barely concealed anger and stiff resistance. And yet, statistics were in Semmelweis favour.

Source: Here
The numbers don't lie.

Once his method was implemented, the death rate fell from 13% to 2.38%, with no fatalities reported at all in some months, something unheard of back then in the obstetric set up. Even as the statistics supported him, the mind-sets resisted. They mocked his theory of these ‘invisible infectious particles’ whenever he spoke of it. The proof of the presence of the invisible killers – what you and I know as bacteria – would arrive only decades later, demonstrated successfully by Louis Pasteur. Semmelweis passed away a year later at the age of 47, still trying to convince the medical field to wash their hands before and after every procedure.

Today, we in the medical field call him the ‘saviour of mothers’. Semmelweis' Germ theory is taught to every medical student, making us aware of the invisible particles than can make us doctors killers even as we try to be healers.

Semmelweis' ‘Recognize-Explain-Act’ approach may not have been successful during his time but since then, it has been used in various settings to drive strategies to fruition. Today, before and after any surgery and procedure, I and my fellow doctors scrub vigorously, using two separate solutions and sterile water to kill any organisms on their hands before they proceed. Even if I am in a rush, I do not neglect this step because those solutions and their actions are more important to the patient than my five minutes of time.  
Image source: here

In your homes, the antiseptics and disinfectants that you see in your house from iodine to phenol and even Chloroxylenol (what you know as Dettol) all arose from the same concept that began in the maternity clinic in Vienna: that cleanliness is a necessity for survival.

Microbes – Infection - Antiseptic/disinfectants.
Recognize – Explain – Act.
Everything we need is right there in front of us. What we lack, as Agent Coulson smugly informed Loki in the Avengers movie, is conviction.

The will to make India better does not end with showcasing our outrage IN CAPS LOCK on social media when an event of poor hygiene is highlighted. It begins with taking a step out the door and spreading the word to those who are unaware and trust me when I say this – the vast majority of the nation is still unaware. The reasons are aplenty – lack of access to healthcare, lack of information and poverty are the easily citable ones. And we need to work together to change this. The medical field cannot do it alone without aid from the administrators & government alongside active participation from the general public.

Doctors should learn to say no when forced to compromise and operate under unhygienic conditions – no threat is worth the sorrow of watching children lose their parents and vice versa as the recent health camp deaths have reminded us. 
Administrators - both private and within the government - need to re-evaluate the reasons they took up their post: is a quick penny worth selling the lives of unaware trusting fellow human beings? Are deaths due to unhygienic operative conditions still acceptable in today’s day and age? 
The public too needs to be more hands on – participating in local health programs and in turn converting from listener to speaker, carrying forward the knowledge to those still in the dark.

There is no point aiming for a healthy MG Road or JN Nagar… an infected limb will still cripple a man, even if he has maintained the best hygiene for his face. The target should be for the whole, not a few - a healthy India instead of a healthy neighbourhood. If a young doctor could stand up against his entire medical fraternity because of his beliefs, surely you can do a lot less and achieve a lot more in today’s day and age.

Stamps in honour of the 'saviour of mothers'
The end goal, even after a hundred and sixty years, remains the same: no deaths due to preventable diseases.  

Authors note:
This is my entry for Indiblogger's efforts for a #SwachhIndia in association with NDTV's SwachhIndia campaign. 

UPDATE: This post won me the runner-up prize for the NDTV SwachhIndia campaign.

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