For the first time in 2010, tyre shipments to the Netherlands were found carrying the Aedes Aegypti mosquitoes, some from as far as Florida, USA. And the Dutch authorities haven’t stopped scanning warehouses receiving tyres from across the world since. “The Asian tiger mosquito is unwelcome in the Netherlands,” Bloomberg Business quoted the official website of Dutch food safety authority in 2012.
The Aedes Aegypti may have its origin in Africa, but we welcomed it in Delhi, giving it a homegrown status, quite literally. Aedes carries the dengue virus that infects hundreds in the capital. Every four years, the strain gets menacing. But our response is a routine cycle of procrastination, denial, panic, and procrastination.
Right now, we are in the panic mode.
Fighting dengue: Too many questions, very few answers
This year, officially, 2,519 people have been infected with dengue and 11 lives have already been lost. Unofficially, the death toll is 22. Non-functional hospitals have been opened up and extra beds ordered. Doctors, nurses, lab technicians have been forced to forego their weekly offs.
There is no vaccine for dengue but early detection and good medical care can lower the damage and fatalities. We need more hospitals to take the increasing patient load. But medical infrastructure alone cannot fight the disease. We lose half the battle once the mosquito breeds and flies out to get us.
Door-to-door surveillance is the weakest in Delhi. Our budgets just about cover the wages of the disease-control teams and limited operations. Fumigation, not good for asthma patients and pregnant women, is the standard practice. Even this is sporadic and limited to main roads and VIP areas. But the authorities are not the only ones to blame for keeping the dengue menace alive.
Aedes does not breed in dirty drains but needs clear water. Due to stagnant water in desert coolers, overhead tanks, Feng Shui plants and water collecting from condensers of ACs and refrigerators, half of those infected are bitten in their own homes. But most residents resist inspection and complain of harassment when they are fined.
Poorer neighbourhoods suffer the most. Firstly, they are on nobody’s radar. Secondly, in the absence of regular, piped water supply in their homes, most slum dwellers store water wherever they can. But even across socio-economic divides, most Delhi residents are not very clear about prevention, symptoms and treatment of dengue.
According to a 2012 study published in the North American Journal of Medical Sciences, 73% of the 215 individuals interviewed in OPDs in Delhi hospitals were aware that Aedes bred in clean stagnant water. But 26.5% of them believed that Aedes also bred in sewage water. Eight per cent thought dengue spreads through houseflies. Just 24% knew that Aedes bit during the day time. More than half of the respondents used mosquito repellents but only during night time.
The awareness of dengue symptoms was much lower. Only two per cent knew that it caused bleeding and 11% knew about rashes. “This is a concern because by making the community aware of the specific symptoms of dengue, we can expect early health care seeking behaviour for severe cases and provide prompt management,” the report stated.
Almost 55% of the respondents learnt about dengue from television. Only one-fourth got the relevant information from the health staff. The study prescribed active involvement of health workers and mass media in community awareness programmes. But this year, we didn’t see any media campaign till the cases started pouring in big numbers.
Brazil, which suffered a dengue outbreak worse than India’s this year, is using a software to link tweets from people about dengue to specific time and locations and not wait for official confirmation of cases that may delay action, the New Scientist reported. In Singapore, authorities have introduced a colour-coded warning system to alert residents about outbreaks in specific districts.
In Delhi, dengue wreaked havoc in 1967, 1970, 1982, 1988 and 1996. In 2006, it assumed epidemic proportions when 56 lives were lost. In 2010, the spate coincided with the Commonwealth Games.
We still haven’t made a concerted effort – a single unit that control funds, surveillance, monitoring – at dengue prevention. Multiple authorities bicker over jurisdiction, funds, hospital beds, and even the domicile status of patients. And in the absence of standard operating procedures, dengue has become big business in the unregulated healthcare market. That tells a lot about us after living over five decades with dengue menace.