© Am Ang Zhang 2011
© Am Ang Zhang 2011
Thirty years ago, I saw
mountains as mountains, and waters as waters.
When I arrived at a more
intimate knowledge, I came to the point
where I saw that mountains
are not mountains,
and waters are not
waters.
Thirty years
on,
I see mountains once again as
mountains, and waters once again as waters.
Adapted
from Ching-yuan (1067-1120)
In 2003 the world was in the
grip of a new plague that challenged our knowledge of medicine to its
limit.
For the first time,
doctors and nurses who were normally in the forefront of the fight against
diseases were fighting for survival from SARS(Severe Acute Respiratory
Syndrome), a new and dangerously contagious disease. The alarm was first raised
by its first victim, Carlo
Urbani.
He was an Italian physician employed by the World Health Organisation (WHO) and
based in Hanoi, Vietnam and he gave the disease its current name. It was as if
this newly mutated virus knew what it was on about. Get the doctors as they
would be the first who could deal with you. Urbani died. So did some of the
medical staff that attended the first few patients.
Doctors often
thought that they would be immune, a God given right I suppose. Not so this
time! The virus obviously knew what it was doing.
Our knowledge base
was in total chaos. What we knew was obviously not good enough. Nor were the
most up to date antiviral drugs. Even then in some places they were sold out as
rumours spread. There were rumours too of vinegar and certain dietary items
giving protection to certain ethnic groups, notably Koreans. The lack of knowledge about
this new infective agent led to the great proliferation of myths that were soon
spreading like wild fire on the Internet. Anyone with cold symptoms was treated
as if he was carrying the plague. It was the plague, the new
plague.
Without any sound
knowledge authorities took draconian measures – any measure anyone could dream
up. Some worked well if only to raise public awareness. One actually caused
more harm and unfortunately deaths. That was the restriction of movement in one
of the tower blocks in Hong Kong – a true quarantine. In the absence of insight
into how the infection was spread, more people were infected. Some broke the law
and fled the buildings before the quarantine. Unfortunately 321 people were
infected and 42 died. Eventually someone was sensible enough to move them to
another quarantine site. Otherwise there would have been more
deaths.
Canada's hasty
decision to declare its virus free
status when so little was known about the virus proved costly and further eroded
the public's trust in governments and people in positions of influence.
Clinicians’ view no longer seemed to hold any sway where commercial interest was
more important.
Masks:
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Except in Canada,
one advice was almost universally adopted – the wearing of a mask. During this
time, I was in correspondence with many of my medical colleagues and relatives
in Hong Kong and Canada. One thing was clear: even the most difficult child
complied and wore a mask. To this day one still needs to wear the appropriate
mask to visit someone in hospital in Hong Kong, on top of having a dollop of
alcohol gel to sterilize one’s hands. Many clinics require patients and staff to
do the same.
Now this must be the
clearest lesson to every parent in every land. Where life and death is
concerned, there can be no compromise.
Anorexia Nervosa:
So it started me
thinking about my practice, specifically Anorexia Nervosa and other difficult
cases that I have encountered. Take Anorexia, it may have been unnecessarily
classified as a mental illness, given that it is the result of the parents
giving the individuals concerned too much right and freedom for self
determination. If a child can be made to wear an uncomfortable mask, why can
parents not make a child eat?
The answer may lie
with our view of freedom. Many parents of Anorexia Nervosa sufferers are highly
educated, and some hold high positions in big corporations and even in Health
Authorities. Many are professionals. Many have a great respect for individual
freedom and self-determination and unfortunately they get caught in a bind of
not being able to be authoritarian as far as their own children are concerned.
It is not difficult to see why many parents of Anorexia Nervosa sufferers are
not prepared to give up being a modern parent, and until they do, we
psychiatrists will have to soldier on with the difficult task of treating what
need not necessarily be an illness, let alone a mental one.
My second thought is
that when something as familiar as chest infection can turn out to be a deadly
new plague called SARS, we need to examine again the relationship between our
existing knowledge and medical practice.
We have to keep an open mind. What we
know from the past should be an aid, not a hindrance.
Otherwise we shall never see the
mountains and waters for what they really are.
From The Cockroach Catcher
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