It is like the dance of disease and death that Sri Lanka engages in every year with a tiny insect. This recurring, deadly dance invariably leaves behind a trail of victims.
Although the country has been in the clutches of the dengue doom harbinger for more than 20 years, why have we not been able to out-manoeuvre this foe, was the concern in the minds of health experts as well as worried parents, as the onslaught began once again.
The rains have come and dengue figures are bound to spiral up, it is learnt.
The national need is a multi-pronged campaign to rid the country of dengue or at least to reduce the deadly impact of this disease which seems to be the scourge of Sri Lanka, was the view of many, to the question posed by the Sunday Times as to where the country has failed and failed miserably at that.
The other important thing is to have the campaign throughout the year and not only when the bites begin to show the dengue spikes during the rainy season, sources said.
Five urgent steps will deal effectively with dengue, stresses Consultant Paediatrician Dr. LakKumar Fernando attached to the Negombo General Hospital who has taken up the dengue battle head-on.
Prevention and control of dengue should not happen just today or tomorrow as the figures rise to epidemic proportions, explains this dengue specialist who first imbibed the Thai experience and then along with a team of Sri Lankan doctors assisted the Punjab Province in Pakistan to drastically reduce dengue numbers and manage patients to prevent deaths.
The five steps Dr. Fernando has been shouting from the rooftops are:
- A proactive surveillance system – The beginnings of a dengue epidemic are small. There should be a mechanism through which all General Practitioners (GPs) and all hospitals both government and private across the country should be able to inform the authorities immediately, when there are suspected cases of dengue. “Eyes and ears should be open,” says Dr. Fernando, explaining that there is a need to keep looking as to where the first cases emerge from and report immediately.
- Rapid response emergency vector control with top surveillance data – The moment reports come in that a certain area is generating dengue patients, mopping up operations should start, with vector-control groups swooping down, ambushing the mosquitoes and eliminating them as fast as possible. Dr. Fernando recalls how an annasi kotuwa (small pineapple cultivation) became the breeding ground for the mosquito, sending many dengue patients from an area of about ½ a sq.metres. With prompt action, the breeding places were eradicated. The might of the authorities should be focused on these index cases and the area sprayed and fogged to stymie the spread, in this top-down approach.
- A major awareness campaign to ensure that patients seek early hospitalization during an epidemic – When dengue cases start appearing, people need to be told what to do at the first signs, such as seeking treatment from proper hospitals with facilities for blood tests.
- Best case management aimed at reducing deaths – Health personnel should be given continuous training in the management and monitoring of dengue patients. This would ensure that no patient who walks into a hospital goes out in a coffin, points out Dr. Fernando.
- Programmes to motivate men, women and children as well as the local authorities to engage in long-term control of dengue in their areas – This bottom-up approach which should be in place throughout the year and not only during an epidemic will help to stop the spread of dengue and would involve keeping homes and the environment free of garbage, polythene and “containers” such as yoghurt cups, rigifoam boxes and also coconut shells, thambili, tyres, while ensuring that flower vases etc., are free of mosquito larvae.
Lamented a father from Negombo -- who lost his beautiful seven-year-old daughter to Dengue Haemorrhagic Fever at a private hospital in Colombo on December 31 last year that all of us are taking measures to curb dengue, but are these enough?
“Keeping our home and garden clean and mosquito-free is inadequate,” he points out, urging that each tiny lane or byroad should have a small committee to check out mosquito breeding grounds and destroy them, conducting a shramadana campaign at least once a month. We need to chip in with our effort to crush the mosquito while the authorities do their part, collecting garbage and repairing and cleaning drains for the smooth flow of water.
Dr. Fernando who speaks with experience points out that in about 90% of cases dengue has assailed the patients in their own homes, with the balance 10% from somewhere very close.
“Spraying alone is inadequate because while the larvae may be destroyed, adult mosquitoes will not be,” says the bereaved father who has organized cleaning up campaigns in his area and spraying in some schools. “So both spraying and fogging have to be done systematically and continuously,” he said.The timing of the fogging is also important. Fogging at about 10.30 in the morning does not help, according to him. “You have to catch them when they are flying around most which is between 6-8 a.m. and 4-6 p.m. with timing being of paramount importance.”
The destruction of the larvae is equally important, he says, pointing out the 10-14 day cycle during which the eggs become mosquitoes.
Meanwhile, another source said that places where children spend the most time in a day should be targeted, including schools and tuition classes and the authorities constantly reminded to seek and destroy breeding grounds.
Other sources explained the need to increase manpower in local bodies if there is a dearth while also ensuring that there is no shortage of chemicals for spraying.
Many people from different areas told the Sunday Times that no spraying and fogging had been done in their areas by the local authorities for many years. Sometimes even when they did come to spray, the workers demanded money and if refused blatantly went away without doing their job. The workers too need to be made aware that this is a national duty and not something that should bring a few rupees into their pockets, perturbed people said.
Threatening the public and fining them may also not be the answer, said a source, adding that it may be better to persuade them to keep their surroundings clean because their children may die of dengue. If they don’t listen, then a warning in writing, not a verbal one, should be handed over to the chief householder, after which more stringent action could follow.
Dengue is a national emergency and a national, multi-pronged response is needed, strengthened by political will, is the view of many. |
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