Health Minister asserts:

Swine flu, dengue, IDPs’ health my top priorities

by Panchamee HEWAVISSENTI

In an exclusive interview with the Sunday Observer, Healthcare and Nutrition Minister Nimal Siripala De Silva highlighted his priorities on dengue and the swine flu control with emphasis on health of IDPs and the development activities in the Uva.

Q: The first person diagnosed with the swine flu has already been found. The public is panicked as the virus is likely to spread all over and create a dangerous situation in the country. How does the swine flu spread from one person to another?

A: Influenza is quite common in pigs. Yet the 2009 flu outbreak is due to a new strain of subtype H1N1 which was not previously found in pigs. Although the strain can be transmitted from human to human, direct transmission of swine flu from pigs to humans is occasionally possible.

Therefore, it is our responsibility to inform people to maintain their personal health habits, such as washing hands, using a handkerchief when sneezing or coughing, to be careful not to touch things with bare hands so that they could avoid infection as far as possible.

When the virus enters a human body, high fever resulting in coughing continues. When a person coughs the virus comes out with mucus and saliva and thus it enters another person.

Another important point is that when a patient is diagnosed with swine flu such a person should be separated. It is not at all advisable to let him or her mingle with ordinary people because of the high probability of the disease spreading to another.

It has infected 36,000 people in 76 countries and claimed 163 lives according to latest WHO figures. Naturally the fatality rate of infants and old people are high due to the intensity of the sickness.

People put their lives at risk when they neglect symptoms of the disease. People should be cautious if they detect any changes in them such as high fever. It is imperative to obtain treatment before it would be too late because unlike dengue, swine flu can be cured with medicine. If the patient receives treatment at the right time there is nothing to fear about swine flu.

Q: Is the Health Ministry prepared for any eventuality? Is the Government ready with its plans to contain the spread of swine flu?

A: The Government has already made necessary arrangements to treat all the people afflicted with swine flu. We have made special arrangements in the structure of the hospitals to treat those patients. I have obtained sufficient amounts of medicine for swine flu from the WHO and distributed them among 20 main hospitals in the country. So, there is hardly any reason to fear over swine flu. Swine flu is not as fatal as dengue.

When the swine flu was first detected in Mexico in late April, the Government initiated action to prevent Sri Lankans becoming victims to the flu. When the WHO signalled the outbreak of the swine flu, the Government being conscious that it would come from abroad, immediately implemented special `flu detective systems’ at the Katunayaka Airport.

If a passenger with high fever arrives at the airport, the scanning machines indicate that with red colour. Then special arrangements are made to keep the patient away from others till he or she fully recovers.

It doesn’t mean that each and every passenger infected with swine flu can be detected. The machines only detect the persons with high fever. There is a high possibility of missing those who are diagnosed with swine flu but without any symptoms of a high fever.

So such people might develop high fever later as in the case of the boy who has arrived from Australia. He contacted the swine flu while he was in Australia and has developed high fever and cough after several days of arriving in Sri Lanka.

Q: For a government which crushed the world’s most ruthless terror outfit, keeping dengue at bay is simple but over 10,000 patients and 125 deaths are recorded so far. How confident are you to claim that dengue can be overcome as you got rid of terrorism?

A: As terrorism was not eliminated over-night, we cannot get rid of dengue in one or two days. It took three decades to fully get rid of terrorism. Likewise it may require three or four months since there is no brisk way of getting rid of dengue fully. It should be done systematically on step by step basis. It takes time to change people’s attitudes and lifestyles.

That cannot be achieved over-night. So we have a huge responsibility to organise and educate the public on the ways and means which can be made use of to destroy dengue breeding places. With the support of the public in full measure, I strongly believe that we would be able to fight the battle against dengue successfully.

Q: How long will it take to eliminate dengue fully?

A: That is to say if we receive the cooperation of the public in full, elimination of dengue could be achieved within a short period as of a month. It all lies in the hands of the public.

Q: How can the public contribute to the elimination of dengue? The major part of the elimination of dengue is the responsibility of the public. It is beyond the achievement of the Government to go from house to house of a population of 18 million people and destroy the places where dengue mosquitoes breed.

A: It is the collective responsibility of the people to destroy dengue. It should be done at various levels. The disposal of garbage should be done in the most suitable way.

Since dengue mosquitoes breeds in clean water, those areas where the water collects such as tins, plastic containers etc should be destroyed. It is not a difficult task to keep one’s surrounding clean. The mosquito which carries dengue virus can only fly a distance of 500m. Therefore the person who does not care to clean his surroundings and destroying places where mosquitoes breed has to face the repercussions himself.

Q: How much has the Government allocated for the dengue elimination program?

A: It is hard to give the exact figures. Nevertheless the Government spends a huge sum of money for various activities connected with eliminating dengue, such as distribution of leaflets, PHIs and, other public health officers to treat those who voluntarily attend `Shramadhanas’ etc. and also for other related things. The financial aspect of this is negligible. What is most important is the public support.

Q: What punishments are imposed on those who help breeding dengue?

A: According to `Dengue Elimination Act’, a 6 months imprisonment and a fine of Rs. 25,000 can be imposed. Considering our cultural norms, it is not advisable to go to the extent of imposing above punishments.

We should first warn them and if they do not respond favourably, we have no option but to take action against them. Already over 300 persons have been found guilty. By imposing punishment it is hoped the people could be motivated towards elimination of dengue.

Q: How successful is the `dengue eliminating project’ launched at schools and work places?

A: The success of those projects cannot be measured immediately. It may take a few months to assess the outcome because those who become dengue patients at present are those who were stung by mosquitos couple of weeks ago.

If the density of mosquitoes was reduced by those projects as expected, the result would appear in another couple of week’s time. Thus we would be able to analyse how many schoolchildren or employees became victims to dengue before these projects and after that. We could conclude that those projects are highly successful if the rate of the schoolchildren or employees infected with dengue is found to be comparatively lower over time.

Q: The huge piles of garbage has its unpleasant effect on the public. Some hold a strong view that the dengue cannot be eliminated merely by keeping one’s surroundings clean unless otherwise providing a workable solution to get rid of garbage.

Moreover, it causes various other health problems too. Of the Panadura, Navinna and Bloemendhal “garbage mountains”, the last alone has a volume of 3 million metric tons of garbage. When small tins and plastic containers are filled with water, they provide the ground for breeding dengue. Has the Health Ministry found solutions to the ever increasing garbage problem?

A: We have identified that the failure to ensure proper disposal of garbage results in spreading dengue. Health Ministry held awareness programmes with the Local Government Commissioners and Members and requested their assistance for the proper disposal of garbage to ensure healthy surroundings. We organised several `Shramadana’ programs in collaboration with civil defence committees.

It is imperative to dispose the garbage on a regular basis. Here too the ministry requires the public support to a great extent. If I were to cite an example, when the Ministry found a bare land to dump garbage, at Kolonnawa the dwellers rose against the `Colombo garbage’ being brought to their areas.

So, people should not entertain such narrow views on public issues. We have to dispose garbage in a least harmful manner to the environment. It is high time for people to treat the disposal of garbage as a matter of national importance and be flexible and broad minded to assist the Government in solving the problem.

Q: Poorly maintained public lavatories, drainage systems, and damaged roads are highly susceptible to breeding of dengue. If you carefully observe, you could still find such places. What action has the health ministry taken for the proper maintenance of those places?

A: I must mention that it is beyond the scope of the Health Ministry to repair the damaged roads, clean public toilets, or household surroundings. Many mistake it to be a responsibility of the health ministry. What the Health Ministry can do is to guide and direct the public on what should be done.

There are responsible bodies who should take action against those things and it depends highly on public cooperation. Due to lack of commitment in cleaning surroundings and public areas dengue has spread at rate more than we could imagine. I should reiterate that eliminating dengue is a collective responsibility which a single body alone cannot cope with.

Q: Have you come across any persons with dengue at IDP centres?

A: No patients or deaths due to dengue are reported at IDP centres.

Q: How has the health ministry executed its role in uplifting the health sector in Northern and Eastern areas including IDP centres?

A: The Health Ministry has launched a huge project to uplift the health of those areas which were formally struck by terrorism. We have employed a large number of health officials in those areas who work under not so comfortable conditions. A special unit has been in operation temporally to fulfil health needs of IDPs. AT the moment we bring doctors and nurses daily from Anuradhapura to IDP centres. We have developed Chettikulam and Vavuniya Hospitals. We also admit patients to other hospitals as well.

I am proud to claim that we were able to provide all facilities to IDPs without depriving them of even the most elementary health requirements. Among the IDPs there were approximately 300 expectant mothers who were about to deliver. We identified that these special patients should not be kept at common IDP centres so that we arranged separate wards for them at Chettikulam hospital.

We also built an operation theatre to cater to their needs. I am glad to be present at the time the first baby was born at a specially arranged ward, after we rescued them from the clutches of LTTE. We have provided all facilities for IDPs on par with Colombo hospitals. We launch program at various levels such as on nutrition, Oral health and preliminary health etc. We have also launched a program to uplift the psychological health of the IDP’s as well.

At the initial stage we received assistance from health staff who came from abroad. There were Indian and French hospitals in the area and the majority of them have now gone back to their countries.

There was a huge rush at IDP centres earlier, because thousands of people escaped from LTTE cultches were injured due to terrorist attacks. At that time the doctors who came here from various countries rendered a great service and now there is no need of such foreign staff because the ministry is strong enough to provide the necessary facilities for our brethren at IDP centres.

People who were critically injured by terrorist attacks are still receiving treatment and those with minor injuries have already recovered. Now we have to provide solutions for their day-to-day health problems.

I recently obtained financial assistance from the WHO to build quarters for 100 medical doctors in the North and East and by now we have already built 50 quarters for medical doctors and another 50 quarters for nurses.

We plan to build another 500 quarters for some more medical staff besides doctors and nurses, in future, so that they would be able to serve the people on fulltime basis. The ministry has estimated to provide 250 medical doctors, 200 nurses, 50 additional staff and other required human resources permanently in those areas.

Q: People complain that some restaurants where long distance buses stop for meals hardly maintain a healthy atmosphere and the foods sold at a higher price too are well below the standard. Many of the restaurants have observed the public health rules in the breach. How often are PHIs supposed to conduct investigations and produce unbiased reports?

A: The ministry has instructed PHIs to pay special attention to the condition of food sold at such restaurants. We have given priority to those problems which should be addressed with immediate effect such as dengue and IDP health. A large number of PHIs has been sent to IDP centres especially tasked to eliminate dengue. I admit that there may be shortcomings in handling problems you referred to due to aforementioned reasons. Yet, we will not turn a blind eye to such issues. They will be immediately addressed as soon as we provide solutions to dengue and IDP health problems. Local bodies are responsible for issuing trade licences to such restaurants. And they should take action to cancel the licence if those restaurants do not abide by the rules.

Q: How do you face the challenge of fighting rabies which has claimed 235 lives from 2005-2008?

A: There is little possibility to prevent all deaths caused by rabies because the dog population in our country exceeds 2 million. It has to be controlled in the interest of public health. We have to introduce the method of `Responsible dog ownership’ in Sri Lanka because a person interested in a puppy keeps them at home when she is young and chases her away when she grows old. This should be avoided because it is as responsible as rearing a child. The dog should be given proper vitamins, and injections on time for rabies and so on.

The number of stranded dogs is high in the country. The Government has allocated a huge sum of money for rabies treatment. There are 2,000 dog bites recorded per day in the country. The Government has to spend Rs. 36,000 for the necessary vaccines for a patient and nearly 50000 - 100000 rupees are spent on a single patient.

I do not recommend the method of killing dogs to prevent rabies. Many countries, however use that method. If you carefully examine you would never be able to get rid of dogs by killing, because if you kill 10 dogs soon another 10 will be there!I have implemented an effective method of controlling the dog population in a responsible manner, such as sterilisation of dogs, which would not involve killing of dogs.

Q: You once mentioned that Sri Lanka ranks No. 1 in `storing blood safety’. On what basis do you say that?

A: There are less than five incidents reported in the history of blood transfusion in which a patient died of HIV or other diseases.

It is a good record in comparison to the deaths connected to blood transfusion reported in other countries. So, I proudly proclaim that Sri Lanka has such systems of safe storage of blood. We obtain blood only from donors. The Government spends a huge amount of money to check for any germs in the blood obtained. The most advanced and reliable blood transfusion centre in South East Asia is in Narahenpita.

Many authoritative bodies including WHO have inspected the centre and claimed that our blood transfusion centre has high quality blood samples more than anywhere in the world. So we are extremely proud of that.

Q: It is a great achievement that a Sri Lankan Minister became the President of the World Health Assembly and the Chairman of the Executive Committee for the first time in the history of Sri Lanka. A stamp too was issued to mark the event. How will the Sri Lankans be benefited from that?

A: I could gather a vast spectrum of experience in that post. And I was also able to closely associate with other Health Ministers and Heads of States in various countries. I got an important opportunity to make the world aware of the current situation in Sri Lanka when I attended conferences.

Apart from that I received Rs.2.3 billion as a grant for the development of the Anuradhapura Hospital. That was possible because I maintained friendly terms with Japanese Health Minister for a quite long time since I met him at the WHO. Likewise I maintain close relationships with health ministers in other countries such as India and China. When I scaled the WHO ladder I was able to strengthen the bonds of friendship which helped the country a great deal. For example when the government needed to build quarters for the medical staff who work at IDP centres, I requested the WHO to assist us in building the required quarters. It was done within a couple of weeks.

Also we were able to send many doctors abroad for training and take part in conferences organised by WHO. Sri Lanka receives numerous opportunities and benefits by its Health Minister holding a responsible position .

When I hold the position at the WHO it is Sri Lankans who should be proud of it because they recognise me as the Health Minister of Sri Lanka not as a person.

It is a privilege for me as well as for the Sri Lankans. Many countries spend huge sums of money to get such position at WHO. They canvass for years for that. But in my case, I didn’t even spend a cent to get that position. It is the good faith and the image I have built in people.

Q: How do you refute the allegation thrown at you by the Opposition that your inefficient management has caused health problems such as dengue. They also argue that if you had taken action at the initial stage, deaths could have been prevented. They are of the view that you should resign?

A: If that is the case, all the Health Ministers in countries which were affected by dengue should resign. The Dengue Type 3 which is a genetically modified version of dengue is found in many tropical countries. Dengue is a problem which is created as a result of climatic changes.

The Opposition throws allegations at me with little knowledge on scientific facts. They narrate that the scientific mutation of dengue is my fault. I sympathise with those who issue such baseless statements based on their ignorance.

Moreover, countries like Mexico, Australia, USA, Switzerland too suffer from swine flu. Have the Health Ministers of those countries resigned merely because the country is infected with swine flu?

Everyone in the country should get together to overcome those diseases without capitalising on the situation to get political mileage.

I would like to ask a question from those who bring such allegations, that hadn’t they faced problems with infectious diseases like cholera and dengue during their time? And does the colour of the government matter for such diseases?

It is obvious that the Opposition have become jesters. This is a fine example for people to assess the level of intelligence of those who issue such utterly baseless allegations.

Q: What are the infrastructure developments implemented by government to uplift Uva?

A: We have implemented massive development projects in Uva Province. People in Uva have numerously benefitted by the `Pubudamu Vellassa’ concept initiated by myself.

Roads and underdeveloped villages have been developed under `Maga Neguma’, ‘Gama Neguma’ and ‘Pubudamu Vellassa’. Roads were developed to provide the easy accessibility to and from Uva. Previously it took 6 or 7 hours to reach Badulla from Colombo. Now it only takes less than five hours.

An efficient road system have been built across Uva such as Badulla, Bandarawela, Nuwaraeliya and the road extends up to Chenkaladi.

It provide easy access to areas like Colombo, Galle and Hambantota which facilitates easy dispatch of goods produced in Uva.

Health sector is highly developed in Uva. The Mahiyangana Hospital received an international award for its high standard. Clinics and community halls, water supply systems, concreted roads etc., were among the other development projects completed.

We launched special projects to uplift the economic standards of Uva. As an encouragement for those who cultivate yams, the government imposed a tax of Rs. 25 for a kilo of imported yams.

So that the local farmer would be able to earn a good profit. Providing necessary facilities, we have uplifted the standard of people in Uva.

Q: Nominations have been called already for the Uva Provincial Council elections. How is your preparation for that despite dengue crisis and allegations by the Opposition?

A: We are to give nominations on the 24 this month for the elections. We are preparing for a historical victory for which there is not the slightest doubt.

There is a different election structure in Uva Provincial Council.

There are 125,000 Tamils and 40,000 Muslims. Our aim is to strengthen bonds among other communities who support the government vision and gear up in achieving a great victory at the election.