The Malaria malaise

Last local case reported in 2012:

by Carol Aloysius

The recent statement by a senior official of the Government Medical Officers Association (GMOA) has ruffled a few feathers and raised health concerns - much more than the GMOA official ever expected.The GMOA is vehement in its stand against getting employees from malaria-ridden countries to be employed here as it might cause an epidemic.

Allegations were levelled against the statement by the General Secretary, GMOA, Dr. Nalinda Herath at a press conference to discuss health implications of an Indian worker diagnosed with malaria in Nuwara Eliya early this month, smacked heavily of bigotry, racism and a hidden personal agenda of the Association.

Indigenous transmission

GMOA Spokesman Dr Naveen de Zoysa told the Sunday Observer , "What we said was the truth. After 2012, there have been no cases of indigenous transmission of malaria in Sri Lanka. But there were cases of locals being affected with the disease while returning from Africa or India," he said.

"However, this case was different. Though this patient had come on a tourist visa to Sri Lanka, he was working as a carpenter in Nuwara Eliya for several months, even though his visa had lapsed. These cases are not rare and should not be taken lightly. Merely because malaria is not prevalent today in Sri Lanka, if we permit people to come from epidemic-ridden countries and allow them to stay here freely, then again another malaria epidemic could break out in this country," he said.

Dr Zoysa said that as early as 2000, Sri Lanka had over 100,000 cases of malaria. However, in 2012 locally transmitted cases of malaria were eradicated. "Our doctors and health officials and the Anti Malaria Campaign (AMC) worked hard to achieve this remarkable result of making the country free of locally transmitted malaria cases. In fact we hear the WHO is making arrangements to visit Sri Lanka to give us Malaria Free Accreditation this year.

We should not let anyone prevent it or destroy what we have achieved in such a short time. We also said Indians have already commenced working in our country, even before the proposed ETCA Agreement has been finalised. As a result, our health status is gradually being dragged into danger. If ETCA is finalised, the situation will get worse. The authorities should do something about this in advance," he said.

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How, we wondered could signing the ETCA Agreement impact negatively on our health status. What was the connection?

Responding to our query, he said, " Signing the ETCA Agreement will open the doors to an influx of migrant workers from malaria endemic countries. Indian workers comprise the majority of those employed on tea estates, small-time businesses and construction sites. At present Sri Lanka is free from the malaria parasite not the vector that transmits the disease.

ETCA Agreement

If someone carrying the parasite comes here and visits different parts of the island and if a vector bites him or her, the disease can spread," he cautioned.

"Signing the ETCA Agreement is the responsibility of advisors, who are Sri Lankans and have been working for the Indian government since 2002. What we are saying is when ETCA is signed, it will open the doors for more foreign workers from malaria- ridden countries to come here, which could expose us to a re-emergence of malaria," he said

The only way to prevent it is to screen every single employee in their own countries before they come here for employment and to screen them here as well.

"But how can you do this to thousands of workers who believe they will get a better deal coming here than working in their own countries?," he mused.

Violated

Asked about the charge that Dr Herath's statement had violated the medical Code of Ethics, he said, "President Maithripala Sirisena recently said economists ignorant of the needs of the masses and with personal agendas, will be sent home. This statement too can be viewed on the same lines"

We asked two of the main medical professional organisations to respond to this charge.

The Sri Lanka Medical Association (SLMA) and the Sri Lanka Medical Council (SLMC) however, were strangely reluctant to discuss or comment on the matter, even though they have their own ethics committees.

SLMA sources said no official statement could be made, until the whole issue and the statement under discussion was studied in depth, and instead referred us to a book published by the College of General Practitioners on good family practice, which states that doctors should not mislead people with wrong information.

The SLMC was equally cautious in its comments. President of the SLMC, Prof. Carlo Fonseka , who is usually known for his forthright comments, refused to comment on whether or not the GMOA spokesman had infringed on the medical code of ethics and promised to take up the matter with the board later this week.

Anti Malaria Campaign (AMC) sources, however, were much more forthcoming in their response.

Director AMC, Dr Hemantha Herath told the Sunday Observer that he agreed with what the GMOA Secretary said. " No. We don't think that what he said was a violation of the medical code. After all where in the world is a person with a tourist visa allowed to work as this patient had done in Nuwara Eliya? Besides being an illegal worker, his visa had also lapsed which makes it a double 'crime'."

But that does not mean that a foreign worker detected with malaria in Sri Lanka will be left out in the cold either, he stressed.

"We make sure that an immigrant worker with symptoms of malaria is treated with the right medication - irrespective of whether he or she is working illegally or not. Our primary concern is about the person's health and ensure that they don't spread it to others by giving them proper treatment."

Asked if such workers should be sent home after they are treated, he said , "If we resort to such action it will force them to go into hiding, and infect others. This is not the first time this has happened. In general, 50 percent of our workers, especially those at construction sites are foreigners, while the rest are locals who have left the country to work and returned.

This year, of the 16 malaria-infected patients, only two were found to be foreigners with malaria.

Fourteen locals who had gone abroad were found to be carrying the disease from a malaria-infested country. Many of them are unaware of this fact."He said hundreds of workers were being employed in Sri Lanka.

"This is a huge risk, especially if they are from malaria-endemic countries. We don't want them to be bitten by mosquitoes and let the parasite to enter a new victim."

Malaria vector

"We have plenty of malaria vectors here. If a person with the malaria virus is bitten by one of these mosquitoes, it can get infected. All mosquitoes are fresh blood feeders.

When they suck the blood of an infected person , they spend a part of their life cycle in the body of the infected person. A mosquito that bites such a person and bites someone else can transmit the disease easily," he said.

When asked what the solution is, he said, "What we need to do is to create awareness among employees and employers to act responsibly and screen themselves for malaria, prior to coming here. But that is left to the employers and employees of those countries. If we interfere there could be complications,' he said.

The goal of the AMC was to eliminate the malaria parasite so that the disease would never recur in Sri Lanka. " We have already set up a national strategic plan for this.

We have blood tests, blood films and also a Rapid Diagnostic Test (RDT) which gives the results of a blood test immediately.

All it takes is a tiny prick of the finger, and our very sensitive equipment will do the rest".

"If anyone doubts as to whether he or she has contracted the disease, then we have the PCRO DNA tests in our own laboratories," he said.

The GMOA had the last word and said "As doctors, we want to save lives. Another malaria epidemic would wipe out everything we have achieved, besides thousands of lives would be wiped out, as it did in the 1930's. Let's not go back to that dreaded past again".