Two boys play in a pool of water near Jet Lines in Karachi where 20 mm of rain fell on Monday. PHOTO: EXPRESS

KARACHI: Contrary to a deeply entrenched belief, playing in the rain does not make your child sick, doctors say.

“The real issue is to convince people how diseases break out,” explains paediatrician Dr Sohail Thobani. “They happen because of an attack on the body by germs which are usually transmitted from one person to another.”

This does not mean that precautions should not be taken. the chair of paediatrics and child health at Aga Khan University Hospital (AKUH), Dr Anita Zaidi, says timing matters. “While there is no harm in children playing in the rain, they should not stay drenched for too long,” she says. “Especially children under two years of age should not play in the rain for longer than an hour, it puts them at risk for hypothermia.” Young children can lose too much body heat if they stay in the water too long.

Parents should instead be concerned if their child is playing in standing water. “There is a good chance of them contracting a number of diseases from playing in standing water,” says Zaidi. This water is not purely rain water but is mixed with sewage that has a high fecal content. Standing water also becomes a breeding ground for mosquitoes, responsible for the spread of dengue. Children will also be at risk of diarrhoea and skin infections.

But as far as simply enjoying the monsoon rain and splashing around rain water is concerned, doctors say parents need not worry. “We have certain cultural perceptions and then we have scientific fact. the two are poles apart,” Dr Thobani says. “In medicine it will always be your grandmother who knows more than the doctor.”

When it comes to contact with water, parents need to understand the difference between two types of diseases: viral and bacterial. Viral diseases, such as the common cold, will treat themselves regardless of whether medication is used or not. Medication may help ease some of the symptoms but the illness is self-treating.

It is not that simple for bacterial diseases, whose treatment with antibiotics is debated by doctors. Typhoid, for example, which is transmitted from a germ spread through stool, needs to be treated with antibiotics. “That is why using an Indian toilet is more hygienic in some aspects as your body does not come in contact with the toilet seat,” Dr Thobani says.

On the other hand, Dr Zaidi says, “Antibiotics are not necessarily required for bacterial infections; however, it must be taken with diseases such as cholera and blood diarrhoea.” Pneumonia can have both bacterial and viral properties. but again this will not happen by just playing in the rain – you would have to come in contact with someone who is already infected.

Published in the Express Tribune, September 13th,  2011.

Sitting in the doctor’s office watching my youngest boy giggle and drool, I could only think: do you have a life-threatening disease?

When I returned her call earlier that day the nurse from the Fairfax County Department of Health was polite but efficient.  my wife had taken our two boys to the pediatrician that weekend.  Another child there had the measles and our boys got exposed.

I didn’t hear much after that.  she went on about CDC protocols and symptoms.  Only when she asked if we’d vaccinated the boys did the buzzing in my head stop.  Our oldest got both rounds of the MMR (measles, mumps, rubella) vaccine so he could start kindergarten but what about our youngest?

When he went to the doctor a few weeks earlier for his “well baby” visit at 12 months, did he get the shot?  After a frantic search through the house for immunization records I stared at the doctor’s note from his last visit:  MMR scheduled for 15 months.  Unprotected.  a further search revealed my wife had only received one round of MMR; protocol back in the day.  Now both needed shots before noon the following day.  Oh, did I mention my wife was just diagnosed with breast cancer and is scheduled for surgery in September?  The buzzing in my head came back.

Someone in Fairfax County had faced an ethical dilemma and made a choice, and that choice now has us counting every cough and sneeze.

Once the buzzing subsided again I got to thinking:  when we criticize and armchair quarterback corporate and government leaders on their ethical decisions, how many of us take the time to consider ethics in our own lives?  in his book, How good People Made Tough Choices, my colleague rush Kidder identified four classic ethical dilemmas:

1).  Short-term vs. long-term: picking gains or losses now versus later.2).  One vs. many: the needs of the group against those of the few or the one.3)  Justice vs. mercy:  choosing between principles, rules, or laws and compassion.4)  Truth vs. loyalty:  Honesty or integrity vs. commitment, responsibility, or promise-keeping.

These dilemmas don’t involve right vs. wrong; rather, they involve a choice between two rights.  in this case someone picked “the one” (the child) over “the many” (the rest of us).  Not a wrong choice, just one of two rights.

Let’s take this dilemma apart.  first, I’m pretty sure this decision didn’t involve picking the heating bill over the inoculation.  Fairfax is one of the wealthiest counties in America and our pediatrician ain’t cheap.  Someone, maybe not the parent that brought this child in, but someone chose not to inoculate their kid, perhaps because they feared autism or the other purported side effects.

According to the CDC, 2008 saw more measles cases, “than in any other year since 1997. More than 90% of those infected had not been vaccinated, or their vaccination status was unknown.“  Moreover, while measles was declared “eliminated” in the US in 2000, it remains quite prevalent in other countries, and living as we do in the suburbs of Washington, DC, we have a lot of international travelers and transplants, putting us at higher risk for infection.  so this is a decision that a thinking person should have weighed quite seriously and I’m sure they did.

Leaders face these kinds of ethical dilemmas all the time.  They must sometimes choose between profits (short-term gain) and sustainability (long-term viability).  Make trade-offs between protecting a small constituent group (say, pensioners or investors) over a larger (current employees or society).  decide whether it’s more important to serve justice (adhere to laws or regulations) or to show compassion to errant employees (who may have unknowingly or unintentionally crossed the line).  Serve the interests of truth (through public disclosure) and keeping their commitments (to protect trade secrets or other data they hesitate to share).

When we face these decisions we often face them in the abstract, where the impacts aren’t clear.  Or the short-term, the individual, the embarrassment, or the case at hand loom much larger than the long-term, the needs of society, the importance of telling the truth, or adhering to the law.  Life rarely serves up black-and-white choices and when it does those are pretty easy to make.  It’s the gray, murky decisions that catch us off guard.

That’s why it’s helpful to take the abstract and make it personal.  When facing an ethical dilemma as an organization, try matching it up with one of the four ethical dilemmas.  Then make up a matching example in your personal life and see how you’d answer that dilemma.  take that answer and apply it to your original dilemma.  take the abstract and make it concrete.

Making these decisions also requires a certain degree of “ethical fitness,” which requires practice working out our ethical muscles. If we only wrestle with these issues while under fire we may panic. Practice resolving ethical dilemmas can help. so can a code. That’s why the CROA has been working on an ethics code.  It also helps to wrestle with these issues with colleagues, especially colleagues not from our own communities or organizations.  That way we get the benefit of multiple unbiased perspectives. At the CRO Summit in November we’ll go through a set of “live fire” exercises facing down the four ethical dilemmas every company or executive is likely to face.  This is a great no-risk environment to test out your own ethical muscles.

Watching and waiting to see if my son develops measles has shed a new light on the complexities of ethical decision making.  The next time I face a one vs. many choice I’ll remember the case of the parent that chose the one over the many and the impact it had on my family. I won’t pick the many over the one every time, but I will certainly have a greater appreciation for how quickly the once abstract “many” can become the very concrete “me”.