A 'third world' response to the dengue fever outbreak in The Bahamas

A 'third world' response to the dengue outbreak


By PACO NUNEZ
Tribune News Editor

Nassau, The Bahamas

In the poorest countries cursed with mosquito-bourne diseases, the only response available to authorities is often the cheapest and least effective. It involves driving about in trucks spewing clouds of toxic gas into the atmosphere.

Luckily, Bahamians don't have to worry about being condemned by poverty to futile efforts in the face of a serious public health concern. Rough economic times aside, this is a fairly advanced society by global standards with a high per capita income and a very respectable life expectancy.

We might not be first world, but we aren't really third world either. The life and health of every citizen matters here.

Only you couldn't tell that from the government's response to the dengue fever "outbreak" in New Providence. One look at the image that accompanies this article really says it all.

THE PROBLEM WITH FOGGING

The aim is to kill as many adult mosquitos as possible, but it turns out this is not very productive because the mature population isn't the real threat - the unhatched eggs are.

One adult female can lay hundreds in the span of a few weeks, so each new generation has the potential to become an much larger pestilential hoard than the last.

The general acceptance that on its own, fogging is inadequate has led to the development of a number of alternative methods.

In addition to "adulticiding", some have decided to use larvacide, which attacks the eggs directly. One new version, known as BTI, was used to great effect last year in Key West in response to an outbreak there.

According to the Florida Keys Mosquito Control website, BTI "is an eco-friendly, non-toxic larvicide released from a helicopter, penetrating the foliage and targeting the mosquito larvae around homes. The micron-sized larvicide droplets fall into gutters, cisterns, abandoned-swimming pools, wells, plant trivets, garbage cans, bromeliads, buckets and other problem areas."

Since the start of 2011, the website notes "the Florida Keys and Key West has not seen any new cases of dengue."

Another method is known as biocontrol: the introduction of natural mosquito predators. In some countries, fish that eat mosquito larvae like guppies and minnows have been used in fresh water lakes and ponds; others have introduced dragonflies, which eat adult mosquitos.

There is also a new device that produces carbon dioxide and emits certain chemicals that attract mosquitos, then sucks them when they get near.

AN INTEGRATED APPROACH

At the same time, fogging has its place, but only as part of an integrated approach which, according to the World Health Organisation, should have five aspects:

* A public education campaign and the creation of appropriate legislation;

* Collaboration between health officials and other public and private sectors;

* An approach to disease control that maximizes the use of resources;

* A decision making process based on evidence to make sure interventions hit the mark;

* Capacity building to ensure that an adequate response is possible in future;

So, let's see how the local response stacks up. The government has held town meetings, but even its own officials allegedly don't believe these are working, and there has been no talk of new laws.

Nor has there been talk of government working with private pest control companies, although reports have reached The Tribune of some communities taking matters into their own hands and calling an exterminator, so disillusioned were they with the government's efforts.

I suppose fogging counts as "disease control", but are we really maximizing the use of resources by sending up clouds of fog indiscriminately? I say indiscriminately, because we've heard nothing about efforts to monitor the mosquito population, even though experts believe this is an essential step in launching a targeted response.

An evidence-based approach would presumably also involve understanding how bad the outbreak is and where it has hit the worst. But that ship sailed the second health officials began telling people to treat the symptoms at home unless absolutely necessary. We will never know how many cases of dengue there were this summer.

And as far as capacity building goes, officials would first have to admit that there was something wrong with their response this time around.

OTHER PROBLEMS

First of all, it makes no sense to keep the public in the dark when it comes to a public health crisis. All it does in breed panic and mistrust.

Yet more than a month and a half into this outbreak, the public knows nothing about how bad it is or when things are going to get better.

Requests from the media for information on the first reported cases were turned down in favour of a press conference 24 hours later, causing who knows how many unsuspecting people to contract dengue in the interim.

Nor is it wise to stick stubbornly to a position if evidence to the contrary is easily available.

When asked by reporters if the government is handling the situation well, doctors not employed by the Ministry of Health react with anger. A few actually burst out laughing.

One doctor said she alone has dealt with 60 cases a day, every day since the outbreak began, and is still inundated.

But we don't really need to seek the opinion of medical experts to see the truth of the matter - the evidence is right in front of us. I have emptied all containers capable of holding water near my house, but there's a flooded construction site across the street that I can do nothing about, so the area is still teeming with mosquitos.

And while the government has tried to inform people like my neighbours about the dangers of standing water, they don't appear to be listening.

Crime is another problem for which, we are always being told, the solution ultimately lies with the public, but that doesn't mean we have no need for a police force. Why not empower Environmental Health inspectors to visit any and all properties in high risk areas to ensure all containers have been emptied?

They could also get to work cleaning up their own mess, and draining the standing water at a hundred public sites like Eastern Parade, which one Tribune reader described as "boiling with mosquitos."

And, what good will it do to upend a few flower pots if you live near a "dengue factory" like the one The Tribune identified on East Bay Street, where the stagnant swimming pool is a gravid mosquito's dream.

The Department of Environmental Health (DEH) has asked the public to bring such cases to its attention, yet a full week after The Tribune did so, nothing had changed.

And then there's the garbage. Trash attracts mosquitos and if left for too long, collects water in which they can breed. But it seems the sanitary workers of DEH must have been needed to drive the fogging trucks, because garbage has sat uncollected for weeks in some areas. Again, I need only look at the pile of trash outside my gate.

Also, how do they know how much to spray or how often when the government has failed to keep tabs on the size of the mosquito population - for which there are a number of established methods.

PERCEPTION IS EVERYTHING

Of course, it is possible I'm not doing the government's dengue fighting efforts justice - they may be larvaciding, drafting laws and ordering mosquito-eating fish as I write - but if so, it's news to me. And that really is the point: whatever the truth of the situation, the public is left with the impression that no one is taking it seriously; at least not as seriously as we would like them to.

Fogging

Even the fogging trucks, ineffectual as they are, seem to be invisible. I told a senior official recently that if it were me, I would have those fogging trucks driving around Nassau day and night, regardless of what time mosquitos are active, equipped with a siren, flashing lights and a neon sign that reads "FOGGING TRUCK".

Trust, confidence in your response, belief in your ability to handle things is what the government should be after.

In fact, I find it astonishing that the FNM hasn't grasped what kind of damage this situation could do to them politically.

One voter told me over the weekend: "I am an FNM supporter. However, for the first time I am doubting my support.

"Over the past six weeks, the way that my government and the respective ministers involved have handled - or should I say not handled - the dengue fever outbreak/epidemic has left me speechless, frustrated and extremely scared for the safety of my family.

"They need to acknowledge and admit defeat, that their current fogging/spraying is completely ineffective and we need to bring in outside help to combat this devastating epidemic.

"I have spoken with many other FNM supporters and they too are sharing the same sentiments. "This upcoming election will be theirs to lose if they don't wake up and see what's happening on this island."

Another FMN supporter said: "I don't feel safe at all. I don't feel like anyone in authority really cares. Maybe they will when it hits their family.

"But now I have to question the way I look at politics in this country. I always thought the FNM was the compassionate party, even though the PLP pretends to be. This dengue made me realise that at the end of the day, neither is really looking out for me. Maybe we have to try a new alternative."

If it were me in the hot seat, I'd be ordering helicopters, killer fish, and whatever else I could get my hands on.

* What do you think?

pnunez@tribunemedia.net

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