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This is in reference to the paper titled by ‘Resurgence of MT malaria amongst troops serving in the north east’ by Wg Cdr SK Krishnan (MJAFI 1994; 50: 5–9).
Doubts have been expressed as to the efficacy of chloroquin chemoprophylaxis. However, Krishnan has brought out that outbreaks have invariably been due to discontinued or irregular suppressive treatment. This by itself indicates that perhaps chloroquin resistance is overestimated. The control of these outbreaks on resumption of supervised chemoprophylaxis further settles the issue in favour of continuing suppressive chloroquin.
Enforcement of chemoprophylaxis is a command function and not the job of medical officers as suggested by Krishnan. In this connection Field Marshal Sir William Slim, Commander of the British Army in Burma during the Second World War, stated: “Good doctors are no use without discipline. More than half the battle against disease is fought, not by doctors, but by the regimental officers…. When mepacrine was first introduced…. often the little tablet was not swallowed. An individual medical test in almost all cases will show whether it has been taken or not…. I, therefore, had surprise checks of whole units, every man being examined. If the overall result was less than 95 per cent positive I sacked the CO. I only had to sack three; by then the rest had got my message” .
Taking lessons from history we have to concede that commanders influence health far more than medical officers. It is through the enlightened involvement of commanders that success can be ensured. Medical staff officers at formation level should carry out a ‘Medical Threat Assessment’ and communicate its results along with the remedial measures to the formation commandrs so that these get the authority of command directives.