Sunday 14 May 2017

Chikungunya, Dengue - Are we prepared?


  
Chikungunya is an emerging, mosquito-borne disease caused by an alphavirus, Chikungunya virus. The disease is transmitted predominantly by Aedes aegypti and Ae. Albopictus mosquitoes, the same species involved in the transmission of dengue.

We have seen that Chikungunya results in high fever accompanied with severe debilitating pain, especially in joints.  Rashes can also be seen in severe cases. Weakness, dizziness, continuous vomiting leading to dehydration, very poor oral intake and bleeding are dangerous signs.

The monsoon season is round the corner. Governments are talking about cleaning the drains, as if this is a one-time annual process. Chief Ministers and Health Ministers have started calling meetings to “take stock of preparedness”. Closer to the rains, messages will be published to “educate” the common person on the problems of breeding mosquitoes in stagnant water.

However, are we really prepared for the onset of such viral infections? Why do we have a knee jerk reaction every year with same unfortunate consequences? Why don’t we, the common people, hold the Government accountable and why do we succumb to their hollow promises that “this will not be repeated next year.”

In 2016, politicians blamed bureaucrats who blamed Municipal Corporations who in turn, have politicians. Some Health ministers stated that Chikungunya does not lead to death ignoring the health challenges that the masses face, while patients grieved about the passing of their loved ones. TV anchors screamed at the top of their voices about accountability and newspapers gave these stories headlines, gradually relegating them to inside pages. Have we really learned a lesson from last year?

The monsoons will come and then retreat, water logging will reduce and dry up, and hospitals will make excuses and then will reporting lesser patients. News channels will gain TRP’s for a few weeks and gradually the news will become old and disappear only to reappear the following year. Everyone will then heave a sigh of relief and as always happens in our country after every epidemic or emergency, the problem of the year would have been “managed” and given the short public memory, this year’s challenges will soon be forgotten.

Have we learned from 2016 or will this blame game chorus continue in 2017 as well?

Knee jerk reactions to a health scare seems to be the norm rather than the exception with us. We know that this problem recurs every year and will continue to recur in the years ahead till we are able to eradicate the disease. So why is it that we are not able to plan earlier and reduce the severity of the impact of these mosquito borne disease? Why don’t our Governments have a task force that will focus on planning for the coming year?

Identify and map the areas - Hopefully, after last years’ experience, the authorities would have mapped all the areas in our cities, which they have identified as prone to collection of water. With proper planning, we can ensure that steps are taken to rectify all such areas well before the onset of the monsoons.

Epidemiological evidence – Based on the records for the current year our health researchers would be aware of the strain of the virus and medication needed to handle this. There should be no surprises.

Quick reporting of the outbreak is essential – this would mean setting up situation rooms / monitoring and evaluation centres in areas where we have seen the problem. These need to be manned and monitored with clear accountability and responsibility documents and communicated.

Laboratories – Testing of samples became a huge bottleneck in 2016. We should ensure that laboratories are identified and communication sent to the citizens. And of course, we need the tariffs for tests agreed and announced in advance.

Feedback – Data from laboratories needs to be collected on an hourly basis and analysed for course correction. Delays can prove to be fatal for some patients. Teams set up in advance will help to analyse data and course correct fast.

Funding – It is hoped that funding for the epidemic has already been set aside for all the action that need to be taken now. Blaming the centre for not providing funds at the last minute is not the answer to managing the problem.

Hospitals, clinics, nursing homes and doctors should be identified and listed. Contact phone numbers and pre-set prices for tests and treatment need to be widely advertised well before the outbreak.

Education of the citizens is an ongoing matter and should become a part of the curriculum of schools rather than delay action till the problem strikes. Education should be in the areas of

1.     What to watch out for and where to report the disease.
2.     Making homes mosquito free
3.     Spraying all rooms with safe aerosols
4.     Using mosquito nets
5.     Covering water containers
6.     Drying water tanks, pets’ bowls and potted plant plates
7.     Not letting water stagnate and other such preventive steps.

Once a clearly documented plan is agreed and in place, getting it activated should be relatively easy and quick.

Finally, no mass health programme can work unless there is clear accountability established. No politician, bureaucrat or health worker can be permitted throw up their hands and shrug their shoulders while the hapless common man waits for treatment.

The blame game needs to stop immediately. To say that there will not be an outbreak in future is wishful thinking and a pipe dream. To plan for the outbreak and contain its spread is more realistic.

If Sri Lanka, one of the worst victims of malaria, can become malaria free, as certified by the World Health Organisation in September 2016, is it too difficult to hope that India too can reach levels of cleanliness where malaria and other mosquito borne diseases will no longer plague our citizens?


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The author is the founder Chairman of Guardian Pharmacies and the author of the best-selling books, Reboot. Reinvent. Rewire: Managing Retirement in the 21st Century; The Corner Office; An Eye for an Eye and The Buck Stops Here - Learnings of a #Startup Entrepreneur. 

Twitter: @gargashutosh
Instagram: ashutoshgarg56
Blog: ashutoshgargin.wordpress.com


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