01 June 2015

A home-grown solution to the home-based problem called Dengue*

*An earlier version of this article was published in the 'Daily Mirror' on June 1, 2010.  I have made a few changes in view of changes in the political scene.  The mosquito has survived these changes.  

Keheliya Rambukwella, the then Media Minister and Cabinet Spokesperson stated five years ago that the Government was committed to finding ‘home-grown’ solutions to ‘home-based’ problems.  Given that all problems find articulation ‘at home’ and some indeed are home-made this ‘home-grown’ approach does make sense.  The so-called ‘ethnic’ problem was home-grown and home-based, although it was fed by foreign fertilizer and spawned headaches in other countries which in their ignorance, innocence and arrogance made worse.  Many solutions were formulated and some thrust down our throats.  Nothing happened. It was the home-grown that finally delivered us from the menace of terrorism.  ‘Home-grown’ then is a tested approach.  

Rambukwella called for a ‘complete change in the people’s mindset to safeguard a hard-won peace and to move forward’.  These are great words, and most importantly, applicable to other situations as well.  I am thinking of Dengue. 

For years the war was a veritable hingannage thuwaalaya (a mendicant’s wound).  It yielded a lot of talk, some action, many promises, some braggadocio and yet when it came to delivery, there was dead silence (‘dead’ being the key word here).  The same with Dengue or any other such problem; a lot of noise about things being planned and done following public outcry but at the end of the day the problem has persisted. 

It is time to do a cost-benefit analysis of all measures implemented to control Dengue.  The costs will include officials in the Ministry who have gone to other countries to attend workshops on Dengue Control, on study tours and chit-chats with ‘experts’.  It might even be true that some officials have visited other countries more frequently than they have visited areas where a higher incidence of Dengue has been reported.  

Some officials take refuge in relativity: ‘our numbers are more encouraging than those of our neighbours’.  Or, ‘the number of Dengue-deaths was lower in April 2010 compared to April 2009’.  Of course this is not to say that nothing is being done.  The awareness campaign has been effective in getting the support of the public to identify and do away with Dengue-breeding conditions.  The problem persists, still.

There is a sense in which some people think Sri Lanka is part of Cuba or vice versa.  That’s got to do with nostalgia more than anything else.  Not taking anything away from the Cuban Revolution and Fidel Castro of course and not taking anything from the fact that ‘nationalism’ should not make us automatically reject solutions that have a high success rate, especially in combating disease; but the Cuban situation is very different to ours when it comes to the phenomenon called Dengue.  

In Cuba, the cause of vector breeding is the uncovered collection tank.  In Sri Lanka
the vector breeds mainly in free standing containers open to the rain. This is why we hear ‘experts’ telling us to be mindful of coconut shells, tins, broken glass, tyres, certain kinds of plants with large leaves. The problem in the main remains non biodegradable domestic waste lying freely in the peri-domestic environment. So far the various collection systems implemented have failed because the entire system is made for buck-passing (between local government authorities, Environment Ministry and the Health Department), lack of political will (beyond rhetoric and grand launchings) and lukewarm response from the public. 

Source reduction is the accepted principle of Dengue Vector Control. It means eliminating breeding places.  The ‘ground battle’ against Dengue therefore begins at home.  Non-biodegradable items should be first collected away from the rain.  The Public Health Inspector should ensure that there is waste segregation at the household level.  The local council has to coordinate with the PHI to transport these sorted, non-biodegradable items.  BTI, the ‘magic solution’ bacteria, works for permanent containers and is not a suitable vector control method for a situation where there can be any number of temporary water-holding containers.  That’s Rs. 250 we are talking about, by the way.  The elimination of peri-domestic breeding places of the vector is obtainable by responsible, methodical and dedicated action by the PHI, the local government body and the citizen.  

Think about the number of non-biodegradable containers that you handle on an average day.  Add to these the ‘natural’ containers such as coconut shells.  Calculate the number of minutes you spend around your garden.  Count the number of mosquitoes you swat or at least the number of times you get irritated by their insufferable buzz.  Do this and I grant you will have a better sense of how responsible you have been as a citizen and a parent or member of a household. 

Then there is the PHI.  Is anyone supervising the PHI?  Does the Health Department have the necessary resources to make sure that the PHIs are competent and efficient?  Is the local government authority delivering promises made in election campaigns? Are citizens button-holing politicians, boxing their ears and saying ‘you are not doing your job, chum!’?  In other words the important thing is to recognize the necessarily collective nature of the process. 

Public health is a devolved subject.  Hence the greater responsibility lies with the provincial health and local government ministers.  Technically, it is not Sirisena’s or Kotalawala’s problem. Neither is it the problem of the Health Ministry.  Unfortunately those who have the least responsibility have the loudest shout, the most power and access to resources.  They get the joy-rides. They waster money and time. Nothing gets done on the ground. The home-based problem remains a problem.  ‘Home-people’ die. 

We will not get a home-grown solution until the ‘home’ starts to think and act. We still don’t have a formal and comprehensive system to collect non-biodegradable items in segregated form. We don’t have bothal-paththara kaarayaas (bottle and paper collector) anymore.  The local government authorities have to initiate a comprehensive collection system.  Until this happens, the impact of the conscientious householder will be limited and insufficient.  There should be a storage facility for every local authority and a system for recycling the waste. 

Who will bear the cost, some might ask. Those who ask these questions are ignorant perhaps of the fact that there’s gold in ‘waste’.  There are SANASA (Sinhala acronym of Thrift and Credit Cooperative Societies) societies that run solid waste management programmes that generate huge profits, for example.  Polythene and plastic is now being recycled into petroleum products.  Glass can be recycled. So too, paper.  That’s money.  Forget all that.  It is still less expensive than a solution-seeking process that involves joy-rides and leaves the problem intact. In your backyard, I should add.

Mahinda Rajapaksa once reflected on the public service thus: මම හැම වෙලාවෙම කියනවා වගේ කඳුළින් එන ජනතාවගේ කඳුළු පිසදාන්න පුළුවන් රාජ් සේවයක්අපට අවශ්‍යයි. මෙය හිතේ තබාගෙන කටයුතු කළ යුතුයි. තමන්ට ලැබෙන වරප්‍රසාද වලට වඩා ජනතාවට අමාත්‍යාංශයෙන් ලබාදිය යුතු වරප්‍රසාද මොනවද කියන එක පිළිබඳව හැම ඇමැතිවරයෙක් සොයා බලා කටයුතු කළ යුතුයි. රටේ ජනතාවගේ අවශ්‍යතා ඉටුකිරීමට නව ඇමැතිවරු මෙන්ම නිලධාරී මණ්ඩලය උපරිමයෙන් කැපවිය යුතුයි. ජනතාවගේ අවශ්‍යතා හඳුනාගෙන ඒවා ඉටු කිරීමට සෑම අමාත්‍යාංශයක් තුළින්ම කටයුතු කළ යුතුයි. මේ රට සමෘද්ධිමත් කරන්න, මේ රට වෙනුවෙන් අලුත් දෙයක්කරන්න අපි සෑම විටම කටයුතු කළ යුතුයි.

He was essentially calling on politicians and officials to attend to their duties and responsibilities. He was calling for a public service that can wipe away the tears of the public, not one that adds an additional reason to weep.  The approach necessary for Dengue control is contained in the above words.  Talk shops should be shut down.  All white collar pundits should be told to visit the backyards of their houses.  Before mobilizing ‘paid’ volunteers, steps should be taken to get the doctors, the PHIs and local authorities to do justice to the salaries they get.  First stop, the premises of these offices.  Next their houses. 

We defeated the world’s most ruthless terrorist outfit.  This required the brave soldier  walk the length and breadth of the Eastern Province and them scour the Vanni for three years.  There is absolutely no excuse for the combined force of health and local councils not to cover all the premises under their jurisdiction in a single year to clear this fitly mess. Placing a routine collation system in collaboration with the community is for the future.  Hire and fire if that needs to be done, but get the job done. 

Here’s another terrorist.  It’s devouring our people, especially our children.  This home-grown solution can be implemented.  Get it done.