Mr. Hasan, a 35 year old businessman comes to Dhaka from Barishal to purchase goods for his shop every two weeks. The last week was totally different for him that was marked with a horrible experience.
When he was heading to Dhaka by bus, he got introduced with a stranger who sat beside him. The stranger seemed to be a gentleman who talked to him a lot and offered tea at a bus stoppage.
After taking tea Mr. Hasan went into deep sleep before stepping into the bus again. He could barely memorise anything. When he woke up, he found himself lying on a floor and wrapped with a dirty bed sheet in Mitford Hospital. His money, mobile phone, wallet, debit card, watch, wedding ring and even his spectacles were vanished. He lost almost everything and blamed himself for his stupidity. When he looked into the surroundings, interestingly he found himself not the only patient with poisoning in that hospital ward .
Everyday, a significant number of patients with poisoning with unknown etiology during travel get admitted to different hospitals in the country. The victims are usually sedated, robbed and abandoned almost exclusively in public places. They are usually found unconscious on public transport, brought to hospital by police and are admitted as police case. In the absence of accompanying relatives and identifying documents and without adequate toxicological facilities at the hospitals, the available healthcare resources and professionals can not give proper supportive care and monitoring they actually required.
In a study by Bangladeshi doctors entitled “Criminal poisoning of commuters in Bangladesh: Prospective and retrospective study” which was published in Forensic Science International; (2008) 180:10–16 revealed that the number of travel related poisoning cases are on the rise. In 2004–2006, travel-related poisoning increased from 6.1 to 9.5 percent of all admissions (210–309 of 3266–3843 per year), representing 46.6–55.7 percent of all admitted poisoning cases. In 2006 alone, 309 patients (9.5 percent of all 3266 admissions; 55.7 percent of all poisoning cases) were treated for travel-related poisoning.
Travel-related poisoning in Bangladesh is the result of drug-facilitated organised crime. Benzodiazepines are commonly used drugs in Bangladesh. Muggers choose these drugs because they act rapidly, produce deep sedation and cause victims to have transient amnesia for events that occur under the influence of the drug.
In the study, the reported occupations of 139 victims were diverse, ranging from farmer or day labourer or rickshaw puller (34.5 percent), three-wheeler or taxicab driver (7.9 percent), retiree, public service employee (21.6percent) and teacher (7.2percent) to businessman/manager (13.7percent) and individuals working or residing abroad.
Among 145 patients, 98 percent remembered buying or accepting food or drinks before losing consciousness. Among the 145 victims, 24 percent had consumed green coconut juice, 21 percent cold drinks, 21 percent tea and 4 percent other fruit juice. Three patients had bought and consumed locally produced pickle from hawkers and one had bought and eaten lychees when changing buses.
With the invention of new drugs, the trends of poisoning have been changed over the recent years. Few years ago, it was observed to be induced with Datura and allied compounds, now benzodiazepines are commonly used. Very recently some people have been reported to be poisoned by inhalational poisoning. It has posed a serious threat and emerged as a most dangerous drug-facilitated organised crime.
Doctors usually termed it as unknown poisoning as they are not sure and as we do not have any toxicology center that can analyse and interpret. Lack of information is a major problem for the management of these patients. Due to unclear etiology, stomach wash is given invariably as a part of supportive management with the hope of removing an unknown poison from the stomach. But the research suggests that Benzodiazepines have been the substances of choice in these drug-facilitated crimes, the fact that most patients could be managed without intensive care, and that all fully recovered in 1–3 days, strongly suggest modifications to their emergency management because the risk of complications of stomach wash (e.g., aspiration pneumonitis) seems to greatly outweigh its highly unlikely benefit in these victims of poisoning who are usually unconscious upon admission.
The lack of appropriate diagnostic facilities in forensic and clinical toxicology have so far barred local physicians from unveiling the epidemiological proportion of this massive assault on Bangladeshi commuters. An effective approach for prevention and treatment of poisoning would be establishment of Poison Control Centers, with access to computerised database and staff that has a high level of expertise dedicated to early diagnosis and clinical management of poisoning.
Source: The Daily Star, July 25, 2009
