Bollywood has a great influence in India. As an example, actor Salman Khan is in news steering the nation to debate on road safe-ty issues. As a bizarre exception, Yash Chopra, a great director, died of dengue and yet it did not have lasting impact on the way this major public health issue is addressed in this country.
Most people thought it was very unfortunate and even policy makers did not see it as an opportunity to initiate public health reforms in the country. So, does bad luck or being unfortunate causes dengue?
No, clearly not. Dengue is caused by dengue viruses and is transmitted by mosquito named Aedesaegypti and Aedesalbopictus. Hence, the real misfortune is that we use the asylum of “bad luck” whenever there is a real public health crisis.
The number of dengue infections in India amounts to 24–44 million contributing to 34 per cent million infections of the global total. To prevent dengue outbreaks, the initial set of solutions is to get rid of mosquito breeding areas. Is this possible? Yes, it would definitely be possible when Prime Minister’s Swatch Bharat Abhiyan (SBA) is implemented in full spirit in every area. Given this ambitious programme may take some time to provide results, some immediate mosquito control measures are immediately needed.
They include minimal engineering approaches such as filling, levelling and drainage of mosquito breeding areas. Generally known as “source reduction”, the principle is to drain off any artificial pools of water such as water containers, empty pots, discarded tins, broken bottles and coconut shells. There are also chemical methods available such as sprays but the effect is only temporary.
Most importantly, personal protection measures will have to be followed such as using mosquito net, screening the buildings with copper or bronze meshes and using repellents. Despite of all these, mosquitoes can breed and we might still be exposed. Hence, we need stronger surveillance for dengue to prevent outbreaks.
Surveillance involves controlling outbreaks, preventing their spread and thereby creating a healthy community. A stronger surveillance network is essential not only to maintain health of communities but also to counter threat of biological weapons.
Dengue deaths would be minimised if the engineering department functions well, awareness is spread so that individuals own up responsibility of personal protection and communities strive for mosquito free areas.
The greatest responsibility is, therefore, with the urban/rural local bodies to keep the sanitation tidy and healthy. Yet, every year, during dengue outbreak, one would read in the media that the minister suspended the doctor or the government announces a new hospital or a new health scheme.
Knee-jerk reactions
Tactlessly, the blame is put often on the health department, comprising of the only professionals who might be doing something to mitigate the suffering. These tranquil knee-jerk reactions readily available to policy makers are akin to blaming the firemen for doing their best to defuse the fire.
In addition, public health training and application of skills needs to be integrated into practice of routine practitioners throughout the country to prevent and mitigate outbreaks such as Dengue. Public health cadre comprising of trained and professionally skilled manpower should be functional in all the states.
It is a fallacy of terming dengue deaths as unfortunate and system continues the eternal neglect of public health. The public too would remember for some time and then there is lull till next outbreak. Dengue as an infectious disease is only an index of many dreaded diseases and poor public health system in India. Like every year, dengue fever will be on the rise this year too. The month of May marks the precursor season for the rise of dengue cases.
This is the perfect month to analyse whether deaths due to dengue are unfortunate and therefore, nothing can be done about them or could the government do anything to prevent them.
This year too, we have choices: One is to call the deaths as unfortunate, second is to place the injudicious blame on the health department or finally, is to address the real public health issues. Let us hope that only the wise choice is made ahead of the dreaded dengue season in India.
(The writer is Additional Professor, Public Health Foundation of India, Bengaluru)