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Year : 2002  |  Volume : 50  |  Issue : 4  |  Page : 359-360

In reply

Correspondence Address:
P Roy

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Source of Support: None, Conflict of Interest: None

PMID: 12532512

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How to cite this article:
Roy P. In reply. Indian J Ophthalmol 2002;50:359-60

How to cite this URL:
Roy P. In reply. Indian J Ophthalmol [serial online] 2002 [cited 2020 Jun 2];50:359-60. Available from: http://www.ijo.in/text.asp?2002/50/4/359/14745

  Dear Editor, Top

Thanks for an opportunity to reply to Dr. Roy's queries.

Why people dare is an interesting question and has been asked umpteen times of adventurers and explorers over the centuries. I can speak of my own evolution from a surgeon who once sent away a positive HIV patient (and one with HBsAg antigen positivity too) to a person who now operates on scores of such patients without fear. My fears disappeared gradually once I was armed with sound scientific knowledge and certain psychosocial support and philosophical attitude.

The scientific facts first. HIV can be transmitted only by contact of body fluids through open surfaces. So we use double gloves and make sure there are no pre-existing areas of broken skin on the hands during surgery. Secondly, every surgery on such patients is carried out after proper instructions to the assistants and reminders to ourselves, regarding the dos and don'ts. The article by Biswas et al provides excellent information about how to make changes in our ophthalmic practice so that the risk of cross-transmission of HIV is minimised. But what about patients that we see day in and day out where we do not know the HIV/ CD4 count status? I operated a patient for diabetic vitreous haemorrhage and found CMV retinitis half way through the surgery. What if somebody was operating a cataract or an emergency leg fracture or ceasarean on this patient? This is where the concept of universal precautions comes in. All medical personnel, from laboratory technicians, to anaesthesiologists and their technicians, nurses in wards and operating room, surgeons and their assistants -everybody who comes in contact with body fluids of any patient - needs to be educated about universal precautions. Exposure can occur unawares from patients whose HIV status we would not know. Once we know about HIV, we are better prepared to avoid mishaps like needle pokes, but avoiding such pokes has to become universal. Similarly proper disposal of all contaminated material and use of disposable materials has to become universal. This will certainly increase the economic burden of medical care but such systems are essential when we are in the midst of an epidemic of HIV. The hospital administration plays a major role in setting up such systems and ensuring that the risk to the personnel and to other patients is brought to a very low level.

As regards the non-medical motivation of accepting to operate in high risk-situations as CMV retinitis, what motivates the solders to fight war and what reassurance do their families have of their safety? What motivates people to go up Mount Everest/ reach the South Pole, treat patients of leprosy/ tuberculosis/ Ebola virus, etc? After all, why do they do it? Once these questions come up, individuals have to answer to themselves. People with HIV have to face a lot from society and the medical community.[1] What if our child had CMV retinitis and everybody refused to even examine the eye? Are we immortal and will we not die from causes other than HIV-how long will we avoid death and disease? Attitudes about moral superiority, sense of duty, fear of death, readiness to take high risks, expectations from life and thoughts on purpose of our life on earth all come into play when one decides to do or not do surgery in high-risk cases. And remember that Hepatitis-B infection is much more rampant and a substantial threat to medical personnel than HIV. Should we send all Hepatitis-B and CMV patients to live and die unattended on the outskirts of the city (including our children if they get the disease), or should we close our eyes and say let someone else do it, why should I? When confronted with more and more patients of CMV retinitis and other HIV-related infections, my own attitude has changed and the support from the institute/hospital has increased. The fear is gone because now we have multiple systems in place to ensure that the high risk has come down to a very low-risk situation as far as the technical aspects are concerned. If others can do something, why shouldn't I do it too, and do it better? Treating CMV retinitis is no exception.

  References Top

Reference>Jain K. Positive Lives. The story of Ashok and others with HIV. New Delhi; Penguin Books India; 2002.  Back to cited text no. 1


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