Last week, Ajay Bhowmik of Bagbazar Lane faced a peculiar problem when he went to the crematorium to carry out his father’s last rites. The doctor at the crematorium read the medical certificate of cause of death (MCCD) and stopped the cremation. The reason: he could not make sense of the certificate. He is not the only one. Doctors at crematoriums are frequently complaining that the new-format certificates handed out to them by the bereaved families are leaving them flummoxed. “Give us back the old fashioned ‘death’ certificates with which we are comfortable. Get one from your general practitioner,” Bhowmik was told.
The government, the initiator of the MCCD to create a base for one of the most ambitious projects on disease mapping and research, plans to make the doctors aware of the need to write death certificates in a different way. Although four months have passed from the time the government launched the disease-mapping project — mainly with the help of new MCCD — most doctors in and around the city are writing out death certificates in the original style. The new format requires a doctor to mention the disease that claimed the life in question.
Health policy-planners have been trying to create a durable database relating to most common causes in terms of diseases and deaths in Calcutta and elsewhere in Bengal, which will enable them to formulate strategies. The international code of disease control requires the certificate to state the exact cause of death, which will throw light on the person’s illness pattern and the prognosis of the disease from which he died. A perturbed government has now sought the help of the Indian Medical Association (IMA) to sensitise over 12,000 doctor-members of the association in and around Calcutta to the utility of the new MCCD.
“The news is, indeed, disturbing. It seems the private practitioner needs to be explained the reasons behind the concept of the new MCCD and the procedures. We are getting complaints that many doctors are refusing to write out certificates in the format we have prescribed,” said Prabhakar Chatterjee, director of health services. “We have, therefore, asked the IMA to help us by conducting workshops to explain to the doctors the logic behind the disease-mapping project,” he said.
The new form specifies that a doctor write out the patient’s age, sex and disease profile, along with his occupation and habits. “If followed properly for a few years, we will have a clear idea about the exact number of people dying from malaria, gastro-enteritis, jaundice or typhoid. It will also give the government a clear picture about the budgetary requirement,” feels Medical College and Hospital superintendent K.K. Adhikari.
In Bengal, nearly 40,000 children and adults die of what doctors believe is gastro-enteritis. According to estimates, nearly 400 die from malaria and jaundice in and around the city fringes alone. But, there is no official data available. The government has discovered that most doctors — barring a few in certain state run-hospitals — are ignorant of the ways to fill out the death certificate. “Doctors are continuing to write death certificates on their own letter-pads. Some say they do not have access to the new certificates, while there are cases where the new forms have been hastily filled up with several points missing,” said Subir Ganguly, president of the Bengal branch of the IMA.