Attitudinal change of society, a must in combating dengue

By Ranil WIJAYAPALA

The rapid spread of dengue among the people rose to alarming proportions in the country with more than 180 deaths reported countrywide. The number of deaths reported from the Colombo city was more than 18 as of the second week of August. Therefore, the Colombo Municipal Council has faced with a gigantic task of preventing spread of dengue among the people. However, controlling the spread of dengue cannot be done overnight.

Dr. Pradeep Kariyawasam

According to Dr. Pradeep Kariyawasam, the Chief Medical officer of the Public Health Department of the Colombo Municipal Council, we have to have long term approach in dengue control measures if we are to overcome this menace at least within the next few years. Disciplined society, proper garbage dumping system, proper town and architectural planning and a change in the attitudes of the society is a must if we are to overcome this menace effectively Dr. Kariyawasam said.

He is also worried about the attitude of the principals and children of the leading schools in Colombo who had not extended their assistance to the dengue prevention campaign and urge the people to change their attitude as they are the ultimate victims of this problem. Following are the excerpts of the interview the Sunday Observer had with Dr. Pradeep Kariyawasam to share his opinion and the experience about the dengue control methods in the Colombo city.

Q:How do you look at the current dengue situation in the city compared to the earlier situation ?

A: There is about 80 per cent increase in dengue cases this year compared to the last year. We are almost exceeding last years total number of dengue patients by August this year. Last year we had 1551 hospitalisations with suspected dengue cases. This year already we are having 1547 suspected dengue cases. This month alone we are having 112 for the 11 days. Last year August we had 113 for the month.

This month we will have more compared to the last year. But in mid July we received reports about 20 cases per day. By the end of July it went upto about 15 cases per day. Now it is about 10 cases per day. It is going down but we don’t know whether it will go down or up.

The only positive thing is people are now joining the dengue control campaign. That also not because our effort but because of Forces are going from house to house and telling them to clean the places. Specially the Police, Air Force and the Army are doing that. But there are so many places that has to be cleaned up.

Q: How did the dengue situation got worse ?

A: I think the unwanted waste and other materials have accumulated all over the city. Specially because of the war and due to the disorderliness of the society as people think that they can live the way they want and there are no rules and regulations. I think on one side we are also to be blamed because our own officers also did not inspect these places as they should have done.

And the other thing is due to our mentality. Our people think that this is not a major problem like where the people are fighting and dying. That sort of attitude is also there. But the war is over and people can act. Now the Forces have joined the campaign and the system is getting streamlined with their involvement.

Q:The dengue outbreak is spreading so fast despite the massive awareness campaigns carried out by respective authorities and agencies. What are the reasons behind this ?

A: What has happened is last year we had a massive outbreak which was the worst outbreak for the last 45 years. But this year it is much worse.It is the continuation of the last years epidemic and it is still continuing.

I think it is due to the ground situation. Ground situation means the uncleanliness of the urban areas. Because no body went all out to clean up the city. One important issue in the Colombo suburban areas was that they did not have proper places to dump the garbage. We are shifting the problem from one area to another. Now, we have two dumping places, one at Kolonnawa and one at another place. The dumping of garbage is now happening scientifically. But, the clearance is not that good in Colombo.

Even after conducting shramadana we were not able to clear all the dump. Again you clean up some watta or one route and then take the stuff to the road. If you don’t take that stuff at the same day every minute every hour the mosquitoes in those containers or whatever could be flying out in the same area.

Q:How do you compare the dengue prevention campaign in Sri Lanka and in other countries with your overseas experience ?

A: There is a difference between the campaigns in other countries and in Sri Lanka. In other countries the society is well disciplined. If you take Singapore, they are developed and they are disciplined. But in our country when you go on the road you find that discipline is not there.

Even if they put out whatever thing that is unwanted in their houses they either recycle it or hand it over to the garbage collector. If you go to their backyard you don’t find any unwanted stuff. But, here in Sri Lanka even if you go to Colombo 7 house there is no discipline with regard to waste management.

We don’t separate waste. We don’t recycle waste. We collect all these unwanted stuff. Even rich people dump these unwanted things on the road. If you go behind mercedese benz, if they buy Rambutan the skin they throw out of the window to the road. This is the sort of society that we live in. So unless we are disciplined we cannot achieve our task.

Q:What should we do to overcome this situation ?

A: We should start from the pre-schools and from the schools to discipline the people. You cant just say you have to be disciplined, because a person who had not been disciplined for 25 years or 35 years we can’t discipline them overnight. So we have to start this from the schools itself.

I think you can combine dengue, recycling, separation of garbage and all these things into the school curriculum when children leave schools 13 or 14 years of school education they will be disciplined people. Once they become adults they will handle things in a systematic manner. That sort of long term plan should be introduced by the Government.

Q:In your opinion from where we should begin to address all these issues ?

A: This dengue problem I should say we must start with the city planning. Because we can see indisciplined way of constructing buildings.

When you go down a road, there is no straight building line or street line. Some people take one feet onto the pavement and the other people will be on their line or something jutting out of their building.

And the other thing is lamp posts. Lamp posts are placed right in the middle of the pavements.

So the pedestrians have to avoid them. So there is no discipline and you can’t see a rule of law. You have to avoid all these things. So the Government should start with the city planning and demarcate street lines and building lines and get people to adhere to the laws.

Q:What are the other matters that has to be addressed in controlling dengue ?

A: The other important issue is the buildings. We must get the architects around and start having a design where least length of gutters. No one is checking the gutters in this country. Thailand is removing all the gutters. Singapore is not allowing any gutters in new buildings. Cuba doesn’t have gutters. So those are good examples for dengue prevention is concerned.

Q:What about the drainage and storm water system of the city ?

A: That should be properly planned and properly constructed. Otherwise if there is no flow in the drain what is the point in having those drainage. Then the canal system. Actually Colombo is a well planned city where the rain from the city first goes to the Eastern side to the paddy fields and from there through the natural paths of water it get into the canals and it goes to the sea. But this is not happening now.

Because of lots of unauthorised structures have blocked the natural paths of waterways. So we must not allow to have unauthorised constructions over the drains. Not only they construct over the drains sometimes they block the drains also. Some people put a wall across the drains. Some people I have seen get rid of drainage.Those things should be corrected.

Q:The way of life of the people also contributing to this problem very much. How can we adjust things to face the mosquito problem ?

A: Our way of life has been changed. We cant blame for this. You cant do anything about it. Due to the globalisation people don’t have time. They buy lot of stuff. But whatever tin, bottle or yoghurt cup you are using you must see that it went into the proper waste management basket or you separate it recycle it or whatever it is.

That is also not happening, everything goes with the garbage trucks. In the end, the waste you can’t put on the road. You take the problem out of your house but you give it to the common man not in the street also but in your neighbourhood. You have to be responsible for that. At the time garbage van is coming you have to put the garbage on the correct place.

That is the responsibility of the Municipal Council also. The truck goes at the appointed time. What happens is when the truck gets late people also have no patience and they dump that into the road. Sometimes the truck doesn’t come. If the truck doesn’t come you have to announce it in that area. There should be a proper way of informing the people.

Q:What is the response of the schools in the city for this programme this year ?

A: This year we wanted to use the schoolchildren to cover the whole city. But the poor children from underpreviledged schools in the Colombo North came and participated in the campaign. But some leading schools didn’t send anyone.

This is very unfortunate. Not only they did not participate in the campaign they did not clean up their schools.

If they properly inspected it they could have done that. In one school they had found 25 places where gutters were blocked and drains were blocked. How can they miss 25 places ? There was a hostel garbage collector and there was overgrown vegetation there. Why near the hostel because they don’t care for the poor students who had come from outstations to the hostels.

That is the attitude we must change.

There is no point in talking of poor slums and the shanty areas. The attitude of the rich and the educated should also be changed. Otherwise, we cant correct this situation. That leading school supposed to be producing the future leaders of the country.

I don’t know how these children are going to be future leaders if they don’t know the word ‘Shramadana’. The school principal said that their children are not accustomed to these type of things and the parents don’t want their children to engage in such activities. In other countries when people get admitted to Universities they ask about the social service that they have done. We must also have such systems here in Sri Lanka.

Q:What are the other chemicals the CMC use for mosquito controlling?

A: Third one is the use of chemicals. For open drains and stagnant drains we are using chemical called Baytex or Pantheon. We are using that for the drains. Then we are using Pestguard for fogging. That is the recommended one from the Health Ministry. We have got 35 fogging machines in the CMC. That is not really enough as there are lot of break downs.

Then we are using BTI for open areas. Then we are using Lamda Cyhalathrin. We use that specially for the poor settlements along the canal banks. The idea behind this was canals were breeding not only dengue mosquitoes they were breeding grounds for other mosquitoes also. The mosquitos come out from these canals first confront with these houses.

So those people are the ones who get the decease first. What we do is, we treat the walls of the houses with Lamda Cyhalathrin. We started that in the last year. Then we use Permethrin for treatment of inside walls plus treatment of bed nets. That we do it in schools and in housing schemes. We collect bed nets and we put them in large bucket of Permethrin.

That lasts for six months. So what ever possible but still we get these numbers mainly because city is not clean. If we have very clean city with these mosquito control programmes we can achieve our task. Otherwise we will never achieve it. But there are lot of things public can do.

Q:What are the main problems you are facing in these mosquito control programmes ?

A: I don’t have enough doctors. I don’t have enough PHIs I don’t have enough Mid Wives because I use everyone for the dengue control programme. Doctors, I should have 11 but I have only five. I have six MOH areas and three of the areas we don’t have medical officers. I need 58 PHIs but I have only 38.

Health Ministry standard is one PHI for 10,000 population. Colombo has 700,000 permanent population and have only 38 PHIs. That is for 17,500 people-one PHI. According to Health Ministry standard for every 3,000 people we should have one mid wife. For Colombo population I should have 230. But I have only 90 mid wives. In other countries they have entomological assistants. But we have a cadre called Health Supervisors.

Although I should have 55 Health Supervisors but I have only 8. Then labourers I should have 125 labourers. But until about month ago I had about 60 labourers. Actually this Council took a decision to give a contract for private firm to provide us with temporary labourers. So I got 50 more. Now I have 115.

These youths are not accustomed to this type of work but they are keen. The Jobless youth. The average age of labour force is over 50 years. They have to carry all these machines. One fogging machine weigh more than 12 kilos. Can I expect them to work for three four hours I need giant fellows like the Army. This is a war you can’t win a war with old people.