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Thailand: patient's rights and A/H1N1 public info

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  • Thailand: patient's rights and A/H1N1 public info

    Source: http://www.nationmultimedia.com/2009...n_30102841.php

    With lives in the balance
    By PONGPHON SARNSAMAK
    THE NATION ON SUNDAY
    Published on May 17, 2009

    Dr Kamnuan Ungchusak had a dilemma. As spokesperson for the government's Disease Control Department, it's his job to keep the public informed about new flu outbreaks.

    But when two Thais were confirmed as having the A (H1N1) virus - the inadequately named "swine flu" - he had to decide whether revealing personal details like age and gender conflicted with their right to privacy.

    "It was one of the toughest moments of my career," says Kamnuan, a 20-year veteran of the medical profession.

    "The patients' relatives asked us to not reveal any details, and as a doctor, I had to respect that."

    He was in the midst of a press conference at the Public Health Ministry, with confirmation that tests carried out in the US showed the two Thais who'd recently returned from Mexico had the influenza virus.

    People were expecting to hear every angle of the situation.

    Withholding the details might suggest the ministry was trying to hide something, even as people were racing to protect themselves from infection.

    And yet there was another consideration every bit as serious.

    "Releasing any details that could help identify the infected citizens would mean they'd be publicly stigmatised," Kamnuan says.

    He recalls that when Severe Acute Respiratory Syndrome (Sars) and bird flu reached Thailand in the last decade, the Health Ministry revealed all details of those who had contracted the afflictions, even their names.

    The result was a severe negative impact on the lives of the victims and their families.

    "We learned that we'd totally violated the patients' rights - and that we shouldn't do that again," he says.

    Protect the individuals, or protect the masses? The numbers don't always carry their seeming weight.

    Kamnuan knew that if the people infected in the latest outbreak were shunned by society, they might well stop going to hospital for treatment out of fear of further humiliation.

    "They'd buy antiviral drugs from a drugstore and treat themselves, without a doctor's supervision," he says.

    "This would be dangerous to them and the general public, so we decided we couldn't identify either infected person."

    Kamnuan says the patients' personal information would be released if they were found to be outside the control of a doctor.

    If the doctor ordered them to stay home for seven days and they refused to comply, they could be jeopardising the public at large, particularly if they were going around without a surgical mask.

    Kamnuan insists that details such as age, gender and occupation would be released only when they had clear significance in helping control the flu's spread.

    If studies established that a certain age group was the primary group at risk of infection, for example, the age of those already infected would become acutely relevant.

    "We have to tell the truth to the public," Kamnuan says, noting that a great deal of information still hasn't got out adequately.

    "A lot of people still believe this virus is capable of killing 50 million people around the world, as the Spanish flu did in 1918."

    In fact, he says, studies have confirmed that the A (H1N1) virus has a low mortality rate and infected people can be cured by the antiviral drug oseltamivir.

    Also, scientists and health experts around the world are developing a new vaccine to stop the influenza's spread.

    The important factor in keeping the public informed, Kamnuan says, is keeping the focus coolly on the facts, and avoiding exacerbating the situation and triggering an overreaction and panic.
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