When the invisible turn invincible

Multiple drug resistance (MDR), or multidrug resistance is the resistance shown by a species of micro-organism (bacteria, viruses or fungi) against multiple antimicrobial drugs.

Antibiotic resistant bacteria are able to transfer copies of DNA that code for a mechanism of resistance to other bacteria even distantly related to them, which then are also able to pass on the resistance genes and so generations of antibiotics resistant bacteria are produced.

The prime example for MDR against antiparasitic drugs is malaria. Plasmodium vivax became chloroquine and sulfadoxine-pyrimethamine resistant a few decades ago, and as of 2012 artemisinin-resistant Plasmodium falciparum emerged in western Cambodia and western Thailand.

Multidrug-resistant Tuberculosis bacteria (MDR-TB) have also emerged. Recently, a 70-year-old woman from Nevada died from a superbug, or a carbapenem-resistant Enterobacteriaceae (CRE) called "Klebsiella pneumonia”, an infection she caught from India.

Availability of antibiotics as over the counter (OTC) drugs has led to indiscriminate use of antibiotics, contributing to MDR.

Several people also tend to cut short an antibiotics course, allowing the surviving bacteria a chance to adapt and gain resistance to the drug.

This is why doctors insist on completing a 5-day antibiotic course.

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Dr. Roshan glanced at the long line of patients who awaited him as he rushed into his cabin at Shalimand Hospital. He was late, as usual. The surgeries had kept him on his toes all through the night, and he had managed to catch just an hour of sleep before rushing back to work.

He was tired, and his back ached. Yet, he couldn’t afford to send any patients away. Many were poor, and he felt guilty to send them away. Then there was the money. He sighed. He wondered why he had become a doctor.

He had wanted to serve in the rural areas, be a savior for those who struggled without basic health services. But what had he got into instead? Corporate hospitals with posh offices and state-of-the-art equipment, operating theatres, and management-friendly policies that fleeced the poor.

With that, he also got sleepless nights, 10-12 hour long work shifts, unending lines of patients… and to top it all, his considerate father-in-law had ‘gifted’ him his own, separate clinic, so that he could work some more and earn more money.

His wife meanwhile, spent her time and his hard-earned money on the most frivolous of parties, clothes and expensive jewelry. And when he was home, all she did was nag him about not making more money, or about not accompanying her to parties.

His attendant, Parmeshwar, peeped through the door with a sly grin on his face. “This one probably knows I am a hen-pecked husband”, thought Roshan. After all, both their sons were classmates and good friends. There was no doubt that his son might tell a bit of what happened at home to his friend.

“Shall I start sending them in, Saheb?” Parmeshwar asked in an oily voice. “Yes, send them in”, said Roshan, and started treating them one by one. Many of them had stomach infections, while some had chest and lung infections. He patiently explained to them the course of antibiotics they had to take. “Take the complete course for five days”, he warned. “Or else, you will fall sick again.”

It was almost three hours, but Roshan had seen to just 35 patients. He was sleepy, and wanted to get home as quickly as possible. He had to get to his clinic too, and it was quite late.

But where was the chance? He was sure there were at least another 40-50 patients waiting outside. He was quite surprised when Parmeshwar poked his nose in to say, “All done, Saheb.”

“So quickly?” asked Roshan. “I thought there were at least a hundred people here to see me!”
“Some left, Saheb”, said Parmeshwar. “They felt it was taking too long.”

“Oh well, alright then”, said Roshan, lifting up his bag to rush home. No sooner had he gone, than another patient came in. “Has Dr. Roshan left?” asked the man. “I wanted to see him so badly. I have a sore throat.”

“He is a good doctor, but his fee is 400 rupees”, said Parmeshwar, assuming an air of importance. “Pay me Rs. 200, and I will give you the prescription for the medicines he usually gives to people with a sore throat.”

“But you’re just the attendant! Why should I give you any money?” asked the other man, annoyed.
“Look, I can make out that you are not so rich”, said Parmeshwar in a haughty voice. “How do you the others who come here manage? Dr. Roshan is a busy doctor.

He doesn’t have time to see everyone. Give me the money and I will tell you the medicines.” The poor man considered for a while. At last he gave in. Parmeshwar quickly scribbled the name of a few antibiotics on a piece of paper, and gave it to him. “Here, have these”, he said.

“If you write like this, how will I get them at the medical shop? They may ask for the Doctor’s signature or the Hospital prescription.”

“They won’t ask any such thing”, said Parmeshwar confidently. “They have been selling medicines like this for years now. How do you think the others manage? Be off with you.”

But the man wasn’t done yet. “Are six of each enough? I thought one should have medicines for 5 days.” “You ask too many questions”, Parmeshwar grumbled. “Nothing will happen if you don’t have it for 5 days. You’ll be cured in a day or two.”

The man left, and Parameshwar happily counted his earnings for the day. He had managed to make Rs. 4000. Everyday he made a good amount this way, apart from his salary.

Dr. Roshan, meanwhile reached home to find his clinic open. Who had opened his clinic before he reached home? He walked in to find another line of patients in the waiting room, while voices emerged from his consultation room. Wasn’t that his son’s voice?

“Take these medicines for three days. You will be fine”, Dr. Roshan heard his son say. “This is not a game, Vikram”, Dr. Roshan walked in, angry and upset. Inside, his 17-year old son was sitting with a stethoscope, an old, illiterate man in front of him.

“Your son treats well, Doctor”, said the old man, coughing terribly in between. “The last time I came, too, he had a look at me, and I got fine.”

“Well, he isn’t a doctor yet”, said Roshan angrily. “He still does not understand several things. Please wait for me next time.”

Roshan sent the rest of his patients away before unleashing his full fury on Vikram at home. “What do you think you’re doing?” he screamed. “You are still in your twelfth standard. Do you realize what can happen if you write prescriptions for antibiotics as you like?”

“But… but, Dad, I only wanted to help those poor people, like you”, stammered Vikram, close to tears. “I have been with you long enough to know what medicines to write for them.”

“You should know this, too” raged Roshan. “If you do not show caution while prescribing antibiotics, those poor people you just helped might get sick to such an extent that no medicine can save them! The germs causing diseases in our body are not like pencil marks that get erased when you use antibiotics like a rubber! These microbes learn to resist the power of medicines.

They learn to survive stronger and stronger doses of medicine, till one day, no antibiotic can kill them! It’s already happening! People are getting infected by this super bug and dying!”

“Stop shouting at that poor child”, came a shrill voice. It was his wife. “I told him to do it. You don’t have time to look after the clinic. Do you know how much more money you could make if you came here on time? But since you don’t, I asked Vikram to do it.”

Roshan was flabbergasted. He felt defeated.

A few months later, Vikram fell extremely sick. Roshan rushed him to the hospital. He was shocked to find Parmeshwar there, wailing and crying, his own son admitted too, with severe diarrhea, like Vikram.

All the doctors, including Roshan, tried their best to save them. But in the end, they gave up. “It’s the super bug infection”, said the senior most doctor. “We’ve tried all 26 antibiotics… but the bacterium is too strong… it’s multidrug resistant.”

That night, Dr, Roshan closed down his clinic, and resigned his job to work in the rural districts. His wife had nothing more to nag him about. As for Parmeshwar, he realized that none of the money he had made could save his only child.