It is through some conspiracy of nature and destiny that I found myself again in an intensive care unit (ICU) after my one-month stay in Candos in February. This time I was hospitalized in Central Flacq which prides itself of a new ICU complex. When minister Faugoo inaugurated the Central Flacq ICU, a few detractors mockingly thought it was the inauguration of a graveyard with only two ventilators and a lack of sophisticated equipment. My article is the humblest tribute I could pay to the specialists, consultants and medical officers who work anonymously, saving lives at great risk. I want to reiterate my thanks to the more anonymous nursing officers who stand by the side of men and women struggling in the penumbra between life and death.

I have spent more than 30 years in the civil service and I feel elated on such occasions when my counterparts in the health service rise to the level of my deeply high expectations. If I am humbled by the undaunted courage and assiduity of these officers, it is because I feel proud of the effectiveness of the health service here, especially in emergency situations. The efficiency rest of a system lies in its ability to face crisis successfully. No doubt I may be suspected of being overzealous because of my obstinate subjectivity. But then every personal opinion is subjective though I want to substantiate my stand on certain grounds.

I have admired the way officers are drilled into the discipline an ICU should radiate. Very often officers are cajoled into bending the rules by kith and kin visiting the sick. These are the critical moments when discipline must be embedded in the behaviour of the public and of workers. By creating too many exceptions to the rule, we have perverted the rule itself. Discipline hurts, but it is better to take the wound of bruised ego than to risk spoiling the organizational efficiency of a situation. Should discipline be enforced only if it is a matter of life and death? No. The laxity characteristic of many institutions in Mauritius demonstrates the accumulation of permissiveness for no rhyme or reason. The Director of the ICU, Central Flacq, is no nonsense man and ward managers reveal the same inflexibility at times, which is most welcome for the success of the unit. At what time should visitors be allowed? What if one person uses his power and authority to negotiate an unauthorized visit? Very often civil servants, the top brass yields under the weight of the pervertor?s status. A strong officer who does not fear punitive transfers or a politician?s or another potentate?s insults is infact laying the foundations of a strong institution. Let it be realized that one disciplined head surrounded by lax subordinates wrecks himself and his institution. Discipline must be enforced by all ? from the Director to the janitor. Any intermediate head who breaks the cycle mars the organizational unity of the office.

<B>Ethic carried to ridiculous extremes</B>

I have highly appreciated the task oriented service management. At times, I feel that this ethic is carried to ridiculous extremes, converting every patient into a task. I feel happy about this because I have observed how the work chain is kept alive and alert, because every worker concentrates on his task, every task being an objective. The ward manager, an administrative supervisor, ensures that there is an ergonomic framework. The charge nurse, as the technical leader, makes the machine run by allotting patients to every nursing officer. The chain runs so smoothly that specialists do not have to bother about the knitty gritty. They preserve their advisory role and this must be respected so that there is no confusion of responsibility and consequently, lowering of standards. We must at all costs maintain high standards among the top brass in any institution. If you ask the Regional Medical Officer to do a nurse?s job, you are destroying genius, sabotaging an intellectual?s ambition to contribute to the level of his excellence.

<I>?Discipline hurts, but it is better to take the wound of bruised ego than to risk spoiling the organizational efficiency of a situation. Should discipline be enforced only if it is a matter of life and death? No. The laxity characteristic of many institutions in Mauritius demonstrates the accumulation of permissiveness for no rhyme or reason.?</I>

I feel grieved that the task oriented attitude touches extremes when the nursing officer, for the chain to work, must complete his medical protocol as from 5 a.m. to pave the way for the next shift to take over. The patient is reduced to a cog. It is also unfortunate that the ICU is poorly designed. It is both a work place for workers and a resting place for patients. Glaring lights, TV noise, guffaws of laughter cause unnecessary disruption.

This analytical description should not dissimulate my reiterated gratitude to the formidable staff of ICU, Central Flacq and my pride of belonging to a gradually improving civil service.

<B>Santosh Kumar MAHADEO</B>