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by Fathima Razik Cader

In May this year, the Public Health Department of the Colombo Municipal Council, put into action, an effective Dengue Control Programme and today, Dr. Pradeep Kariyawasam, Chief Medical Officer of Health and his team of Doctors and Officers, the Rotarians, the Scouts and volunteers who were part of that exercise, can sit back and look smug in the face of a successful campaign. But let me hasten to assure you that is not the case. Whilst feeling good about the outcome of that campaign, Dr. Kariyawasam and the Officers of the PHD are constantly addressing the threat and that means being committed towards preventing another outbreak of dengue via the aedes mosquito - the deadly carrier.

According to reports, the districts of Colombo and Matara were the most affected last time round - around April and May this year. However, there was a marked drop in the number of clinically diagnosed cases.

The figurers released by the PHD reads thus: June 2003, recorded 19 cases and July 2003, recorded 25 cases as against 102 cases and 69 cases respectively, during the corresponding period last year. These figures show that the awareness campaigns and other steps taken to educate and inform the public on the dangers of this virus and how one can prevent it from spreading have proved fruitful. Says Dr. Kariyawasam, "In view of the erratic weather pattern, cases of dengue are reported periodically and constant vigilance in respect of keeping homes, gardens and surrounding areas clean and free from breeding sites is a must".

With the North East monsoon expected during October and November, people should be alert, as the aedes mosquito will naturally start breeding wherever clean water collects or stagnates. It is therefore up to each citizen to be civic-minded and alert to the dangers in order to protect him and others.

The district of Colombo is the most vulnerable on account of the number of government and private hospitals that house thousands of patients.

Most government hospitals are congested and a patient admitted with the virus can pass it on to another patient. To add to the problem, sanitation around the hospitals is also poor resulting in other diseases too emerging from time to time. Pockets in and around the city of Colombo are more prone to such diseases and one cannot help but drive home the point that being vigilant to breeding sites will help in no small measure to contain and control the proliferation of mosquitoes, and by extension, mosquito borne diseases.

The "Green Star Sticker" campaign has proved successful. Officials and volunteers have found more houses qualifying for the sticker and it is their fervent hope that homes that have been presented with the sticker will continue to maintain their premises. Launched in the year 2000, the sticker campaign has motivated many residents to strive to obtain one - so much so that volunteers have reported a decrease in the number of homes and buildings without stickers. In addition, shramadana campaigns periodically conducted to clean up identified areas have also borne fruit. Juxtaposed to this, CMC Officers continue to take action against owners of homes and buildings found wanting in as far as this issue is concerned under the Mosquito Borne Diseases Regulation. Clean up or pay-up seems to be the motto that the CMC adopts!

Some of the steps taken by the PHD of the CMC have been regular spraying of appropriate chemicals into canals and in other instances, introducing guppies into canals - both methods that effectively eliminate the mosquito larvae. However, in some areas, residents living in the vicinity dump garbage into canals - a practice that is counter-productive. Apart from the outlets getting clogged with the dirt that has been dumped, an unhealthy stench emanates leaving those unfortunate to be around with no choice but to inhale the noxious air. In addition, the garbage kills the guppies and the result - mosquito larvae begin to breed freely. Another method adopted to contain mosquito breeding is by fogging underground drains, but here too, municipality workers have found garbage dumped or stagnating in stretches of the drains.

This then negates the effectiveness of fogging and the time, effort and (financial) resources spent in such an exercise, literally, goes down the drain - all because some citizens show callous disregard towards their health and that of others.

A novel method of preventing mosquito stings is by the 'bed-net impregnation' programme. Bed-nets are sprayed with non-toxic insecticides and this is effective for approximately six months. Some of Colombo's leading girls' and boys' schools have had bed-nets in the hostels so treated.

Pest control officers of the PHD carry out the exercise and schools interested in getting their assistance should make a written request to the Chief Medical Officer of Health of the CMC in this regard. The chemical - Permathrin, is non-toxic and the cost of spraying a net is around Rs. One hundred. It is therefore cost effective as well.

What is of grave concern to the PHD is the lack of sanitation and cleanliness in government departments. "Government institutions are of the view that such places are above the law" said Dr. Kariyawasam. "We have warned many institutions and in fact, have taken some of them to Court", he added.

Those occupying government quarters are also law-breakers in this regard. What makes it difficult for the PHD to act on a complaint is that no one actually takes the responsibility of maintaining these building and 'passing the buck' seems to be the modus operandi when confronted with allegations of violating the law. Sadly, even the higher echelons of learning - the universities, also face similar problems.

"Our future leaders are studying in these institutions and they are being allowed to go with the idea that lack of hygiene and sanitation within the universities is part and parcel of life", laments Dr. Kariyawasam.

In reply to a question on the high rate of incidence of dengue in certain parts of the city, Dr. Kariyawasam said that, those areas are constantly monitored and the issues addressed. If such areas (considered endemic) are controlled, the virus can be effectively controlled all over the country, he asserts. The PHD appeals to all hospitals and medical practitioners to inform the department if a confirmed case of dengue is detected. This will help the Medical Officer of Health who covers that area, to take appropriate steps to control the virus from spreading further.

The PHD has also received several complaints from patients and visitors that the ground floor areas of most private hospitals are full of mosquitoes - a complaint they say is justifiable. This is in view of the price a patient pays to receive the best of medical care, treatment and service - but sans mosquitoes!

With the North East monsoon in the offing, it is of paramount importance that each person makes his or her own contribution towards controlling the breeding of the aedes mosquito - for in the process, one also makes a positive and tangible contribution towards the eliminating of other mosquitoes too. This will naturally contain other mosquito borne diseases as well and make the task of the PHD of the CMC (and perhaps that of other local authorities too), that much easier in eliminating diseases in areas under their control.

At the end of the day, it might be you or I who will be affected by the virus. The PHD, as part of its responsibilities, will continue to use every possible means of eliminating the larvae. But it is definitely not a part of an officer's job description to clean our homes, gardens, gutters or surrounding areas. The onus of doing so is solely ours.

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