Fighting dengue:

Govt on right track - WHO chief in Sri Lanka

By Charnika Imbulana MUNASINGHE

In an exclusive interview with the Sunday Observer , World Health Organization (WHO) representative in Sri Lanka Dr. Firdosi Rustom Mehta, spoke on WHO’s role and mission and its assistance and support in the dengue eradication efforts of the Sri Lankan Government.

The WHO’s mission in Sri Lanka is to assist the Government and other health partners to address the changing health needs of the country during demographic and epidemiological transition, supporting the adoption of a wider approach to health and promoting equitable access to healthcare.

Fogging Machines are use in the fight against dengue

The World Health Organization, the United Nations’ specialised agency for health, was established on April 7, 1948. WHO was the first United Nations agency to commence in Sri Lanka (1952) and over 50 years on, WHO remains a steadfast intergovernmental organisation committed to supporting the people of the country to attain the highest level of health through the strengthening of the health system on the principles of equity, fairness and responsiveness with emphasis on the poor and marginalised.

Q: How has WHO been involved with the dengue epidemic controls in Sri Lanka?

A: Dengue is part and parcel of our collaborative program with the Ministry of Health under the strategic objective; dengue comes under communicable diseases and vector borne diseases. We already have an ongoing program on this, running for many years. However, from last year, the situation has taken epidemic proportions. The outbreak started again last year, around April/May. It peaked around July/August, came down after the rainy season and intensified again in November/December. From last year, almost 35,000 cases have been reported with 346 deaths so it has become an issue of concern.

Q: What has WHO been doing about this since last year:

A: WHO has been working on several areas; one of the major concerns last year was the high fatality rate. On the request of the Ministry of Health, we got a technical expert on Health named Prof. Sirikin from the Queen Sirikith hospital in Thailand to come this month to interact with and support us on the clinical management of dengue.

She held training workshops where more than 300 clinicians in Galle, Kandy and Colombo were trained on the proper clinical management of dengue. After that, several groups were formed within the Ministry of Health to work on clinical guidelines, continue medical education support and research in the latter part of the year. On the request of the Ministry of Health we sent eight consultants, medical specialists, paediatricians, and opinion leaders for two weeks in May to the Queen Sirikith Hospital in Thailand.

Cascade training

Eight consultants as master trainers have started providing cascade training to clinicians in the country. They are pushing out for better clinical management in the country.

The graph of weekly cases in 2010 shows that the cascade training may have had a bearing on the number of deaths coming down. So the program may be having an effect. This is a positive development.

One of the things they picked up in Thailand is Dextran, an intravenous fluid to be administrated to severe cases who are in shock.

This is not available in this country. After the consultants came back, we had a discussion and the Ministry decided to procure it from Thailand. The Ministry of Health procured 300 more of these vials for US$ 15,000.

The total number of vials is 1,200. They will be placed in leading hospitals to be used in severe dengue cases. This prevents a patient from going into shock. Other than this, we got a request from the Presidential Taskforce for fogging machines at a cost of US$ 1,000 per fogging machine; we have already supplied 15 machines.

Q: What are your comments and observations on the ongoing national dengue eradication program?

A: Your country is unique as all information on dengue is available on the Ministry of Health Epidemiology Unit website. For 272 medical offices of health areas, the dengue information is right there in your country.

Which other country will publish this on the public domain?

No other developing country has such a mechanism. This has to be highly commended.

Dengue is a huge problem in the region. Sri Lanka is not alone. The responsibility of controlling dengue does not lie only with the Health Ministry. The municipality, water and irrigation authorities and also the people have to emphasise on the target-that should be to eliminate dengue. Continuity of collective work is the key.

I have faith in Sri Lanka’s Health Services. I am fully satisfied with the treatment methods that are being carried out. The Health Ministry is on track on dengue controls. My daughter is also suffering from dengue and is currently admitted at the Infectious Diseases Hospital in Angoda where she is undergoing treatment. So I have first-hand experience. She is 18 years old and was admitted to hospital last Sunday.

Her platelet count fell to 145, but now it has stabilised and she has improved and is feeling much better. She may be discharged soon.

Q: What more should we do to control dengue?

A: Social marketing and advocacy are the need of the hour. It is very important.

Q: Have there been any changes in the WHO operations in Sri Lanka, vis-a-vis the pre-war period and post-war period?

A: What needs to be understood is the way the WHO works. WHO, first of all, is a member State organisation. It is a specialised technical agency within the United Nations and hence is quite different from other UN organisations.

Our Constitution is also quite different from the other UN organisations in which the 192 member states in the world constitute and provide funds through normal channels for the work of the WHO, which is called the regular budget or core funding.

All WHO country offices have a basic agreement with the sovereign government. The basic agreement in Sri Lanka dates back to 1952. WHO works in a biannual period, our planning cycle is for every two years; at the moment the biannual cycle is 2010 and 2011.

So what we do is, about a year before 2010, we started the planning process with our main counterparts that is usually the Ministry of Health, the academia, NGOs and civil society. Then we develop a work plan for the biannual period. This is called a regular budget or the funding is made available as and when donor funding comes into WHO. The donor funding is then channelled to specific projects.

This is the planning cycle and budgetary cycle and the way WHO works is a dynamic process. As and when a member country faces challenges or impediments there is flexibility to respond to it.

Q: How do you view WHO’s work in 2009? What are your observations on the humanitarian operations the same year? What happened last year due to the humanitarian operation requiring an immediate response by the UN?

A: We in the WHO, from the health side, were able to mobilise extra funding to support the activities. and the initiatives of the Health Ministry to respond in an appropriate manner last year.

I am happy to tell you that this humanitarian operation was one of the biggest that has occurred in the world where 300,000 IDPs, 300,000 people who came out of the no fire zone had to be fed, sheltered, given sanitation, given healthcare within a preparation time of only one week.

Other countries which have been in similar situations had taken about six months to a year to organise themselves. The efforts of the Ministry of Health, civil society, NGOs and other UN organisations need to be commended because there was no major catastrophe in terms of a major epidemic, communicable disease or excessive death or morbidity within the camps.

The unprecedented situation was responded to in a very efficient and organised manner.

Q: Was the WHO stationed at the time in those areas?

A: WHO had a field unit in Vavuniya. We had a few national medical officers who worked closely with the Chettikulam health cluster, supporting them constantly on a daily basis.

Q: How was the WHO involved immediately after the war?

A: WHO along with many other donor agencies worked in close collaboration with the Health Ministry and NGOs. WHO supported the resettlement and rehabilitation process of the government, with full emphasis on health through rapid assessments, providing medical equipment and supplies to hospitals for the start-up of critical emergency care, supporting mobilisation of human resources from Tamil speaking pre-interns from Jaffna and other areas to fill the gap initially of human resources in the north. This is ongoing, and is being implemented successfully. This is just before building up the system. We are just one of the players.

Q: Through whom are the funds channelled and who is the implementer on ground?

A: We have two levels-central and provincial. At central level, it is the Disaster Prevention and Response Unit within the Ministry of Health which is our focal point.

Within the provinces, it is the North West, Provincial Director and the Regional Director of Health Services through whom we channel these funding and equipment.