Book review

This thriller portraying an outbreak of a mysterious disease is too close to reality for comfort

Public health services are troublingly unequipped to handle the situation described in Sidin Vadukut’s ‘Bombay Fever’.

The “medical thriller” Bombay Fever begins with a Mumbai-based journalist travelling to Geneva to cover a watch exhibition, where he has an unexpected encounter with an infected Sri Lankan woman. The woman collapses and dies in his arms. The journalist returns to Mumbai with a bad cough and sparks a full blown outbreak of a disease that the world has never seen.

The novel is named after the fictitious infection (which will, one hopes, remain in the realm of fiction) whose moniker comes from the character of the journalist. Sidin Vadukut’s novel encapsulates what an outbreak really looks like – panic among the public, politicians playing down the seriousness of the situation, scientists and epidemiologists completely out of their depth. And journalists hunting for a lead.

Vadukut said that he wanted to write a medical thriller after he did some research on the global Spanish flu outbreak of 1918, which killed millions at the time. The central character of the book is Aayush Vajpayee, who is posted as a social medical officer at the time of the outbreak. His job is to combat antimicrobial resistance by interacting with all stakeholders including doctors, pharmacists, nurses, and the community at large.

The evidence given by Vajpayee to a commission formed to inquire into the government’s response to the outbreak forms the backbone of the book. While on his trips to various houses, Vajpayee stumbles on the patient zero of the outbreak in India - the journalist who is found dead in his house. The victim is found literally “melted” down, a peculiar symptom of the disease.

Vadukut brings several twists to the plot, dropping a few hints on what could have caused the outbreak to keep the reader on the edge. Is this a bug that has been identified in the past? Or is it just a drug-resistant form of an already known virus?

What goes wrong during a disease outbreak

Predictably, it takes a few weeks for authorities to get a handle on what is causing the outbreak. As the novel portrays realistically, bringing in representatives of government bodies that are supposed to swoop in during an outbreak – scientists from the National Centre of Disease Control, for instance – takes a long time. In the end, a clue to containing the outbreak comes from unexpected quarters.

The reader gets a glimpse of the worst that can happen when there is a communication breakdown. Especially when social media, such as WhatsApp, explodes with forwarded messages carrying blatantly wrong or misleading information. The impact of fake news on public health has already been witnessed. During vaccination drives for measles rubella this year, WhatsApp messages claiming it makes children impotent did the rounds.

This book presents a scenario where the harm done by seemingly helpful forwards is much worse. Just like in the novel, the government is often unable to stem the explosion of false information. Here, the chief minister herself inadvertently gives out information which is misinterpreted and leads to more deaths. Vadukut makes the valid point that hiding information from the public, or underplaying information about an outbreak, can only lead to more confusion and panic.

Sidin Vadukut
Sidin Vadukut

Unpredictability of medicine

In India, outbreaks of disease are frequent. Just this May, in a tribal hamlet of Andhra Pradesh, sixteen people died in three weeks of causes that are still unclear. Government officials blamed the deaths on habits such as drinking unsafe water, eating “rotten” meat and social conditions like malnutrition. The people brought this outbreak upon themselves, the officials seemed to say. While it is understandable that the real cause of deaths is sometimes very difficult to understand, there was no real attempt made to find it either. Uncomfortable possibilities, like a malaria outbreak, are dismissed.

In the book, the deadly Bombay Fever affects not just the invisible poor, but even the richer sections of the population. It is perhaps for this reason that the elected leaders are forced to take notice.

Bombay Fever effectively portrays what is already known about medicine – that it has severe limitations. A fever, cold and cough can be the symptoms of many different kinds of infections. Even if a bug is identified, often doctors may not know how it works. Medicine is sometimes guesswork, often hoping that existing drugs will cure patients. Even after bringing outbreaks under control, sometimes scientists do not know why certain measures worked. This book pays tribute to those who work in these extremely limiting conditions.

After writing his dedications, the author cautiously addresses “everyone else” and says: “This is a work of fiction, outrage accordingly.” The warning is unnecessary. The country’s public health system is in such bad shape that the sort of outbreak described in the book doesn’t seem very far fetched. Will it take a horrible outbreak of the sort described in the book for the government to take note of public health? Let us hope not.

Bombay Fever, Sidin Vadukut, Simon & Schuster.

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There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.