With the currently active North East monsoon deluging the country, concern about dengue has risen again. However, 2018 recorded a reduction of about 75% dengue cases from last year, according to the National Dengue Control Unit (NDCU) data recording the number of cases at 42,658 as of Friday, November 15.
A great achievement for the country, this could be attributed to the awareness creation and many control measures by the Ministry of Health, taken in collaboration with relevant ministries and local authorities. Social responsibility plays a pivotal role in dengue control.
We look at one local council winning the battle with dengue through socially responsible garbage control.
Dengue is an acutely infectious disease with a sudden onset, transmitted by mosquitoes. A majority of the affected show stereotypical symptoms identified by medical practitioners as dengue fever (DF). However, it could also develop complications leading to dengue haemorrhagic fever (DHF) which could be life threatening. The trick is to detect and differentiate DHF at early stages to prevent complications thereby saving lives.
Health sector improvements such as enhanced health facilities, strong inter sector collaboration at the National and local levels and incorporation of Health Assistants into the system had led to the reduction of cases, according to Consultant Community Physician of NCDU, Dr. Preshila Samaraweera. Community awareness leading to early detection and treatment, as well as reducing breeding places have also been other contributory factors.
“Lessons learnt from last year’s dengue epidemic have caused communities to be more vigilant,” said Dr. Samaraweera. In 2017, the number of dengue cases rose to over 186,000 with the month of July reporting epidemic rates of over 41,000 cases. While the number of cases has reduced throughout the country, Kalutra district, to which the Horana Pradeshiya Sabha (PS) area belongs to, shows a substantial reduction in numbers, she said.
It was four years ago that the Horana PS launched its sustainable method of dengue control where community ownership played a major role in combating the spread of dengue vectors.
“It is the team work that brought results,” said Dr. Saddharma Weerakoon, one of the former Medical Officers of Health (MOH) in charge of the Horana PS area.
Quandari
‘Parisara Pola,’ where transactions happened between sellers of garbage and buyers who collected them for their livelihood, had been his brainchild. It was a‘challenge’ he had received as soon as he was appointed MOH of Horana. At that time, the dengue prevalence had surpassed 200% from that of the previous year.
This was the reason which propelled the scheme, says Dr. Weerakoon. During house inspections, his team had found out that a large number of different containers – plastic as well as glass were dotting the gardens of the areas of high dengue prevalence. However, without a proper garbage disposal scheme the community was in a quandary.
The garbage collection scheme conducted at the time by the local authority had not been very successful due to lack of equipment and facilities. A team consisting of the AGA of the area, Regional Director of Health Services and staff, the Pradeshiya Sabha, the Police and the Community Based Civil Organisations gathered together and planned ways to solve the problem.
“Meanwhile, due to the high amount of garbage I challenged a youth organisation and a school, who were in need of money to carry out the development work, to earn it through selling the garbage in home gardens and households,” said Dr. Weerakoon. The organisations, giving considerable thought to the challenge had gone ahead collecting garbage.
The school principal had called upon children to bring different kinds of garbage from time to time and the sale of this raised sufficient funds for their open-air theatre project. The youth group had visited households where they had observed 6-8 empty carbonated drink bottles lying in their gardens. The money collected from gathering empty bottled had bought electricity for the youth club premises.
Then, a team had gathered and planned a ‘day’ where those who want to get rid of their garbage and those who want to buy them could exchange their wares. “We investigated and found that there were many businesses large and medium as well as small scale / self employed people engaged in recycling,” said Dr. Weerakoon. At the invitation of the Divisional Secretary, they have assembled and had agreed to the prospect of purchasing garbage from the public.
“I had no money from the health department to carry out this initiative, as it was not a national program. I was doing it on my own. However, the Divisional Secretary, local politicians and the local authorities were quite enthusiastic and generously released necessary resources, equipment and facilities,” he stated.
Aquarium fish
The news about the event had been publicised via social media, through dengue inspection teams visiting houses and by word of mouth. “It was like a mini-fare.
We provided entertainment opportunities, promoted businesses involved in healthy lifestyles and the like.
For instance, we had organic fruit and vegetable stalls, a book stall with children’s books, a pet store or rather a store selling aquarium fish so on and so forth.” Finally the Parisara Pola had become a very popular event among children who had encouraged their parents to participate in it.
The first Parisara Pola had collected 13 tons of recyclable garbage. Though the difficulty of finding infrastructure and facilities had been there, Parisara Pola had continued for a period of time. “All in all, the project was a success,” said, Dr. Weerakoon.
The incidence of dengue had come down sharply. There had been a significant difference between the number of dengue positive containers per 100 households checked (Breteau Index levels) one week before Parisara Pola and a week after.
While the fogging and spraying had been there previously, the clean-up had been the most effective in the area.
Though Parisara Pola is not there any more, the culture of social responsibility in garbage disposal has stayed on. The Horana local council now employs Riyasara, an improved garbage collection scheme using a number of lorries, which enables householders to get rid of their solid waste at their doorstep.
Responsibility
While the MOH and public health employees inspecting the area have the responsibility of informing the public of the specific dates, the responsibility of garbage collection rests with the local authority.
The solid waste thus collected is sorted out and sold by the local authority. Though the scheme is currently carried out only within the city limits, plans are under way by the local council to expand it to cover the entire Horana PS area, from the beginning of 2019.
The scheme will be coordinated by regional Samurdhi Officers, Economic Development Officers, and Grama Niladharis in collaboration with the local council, said Dr. Prasad Liyanage, Regional Epidemiologist, Horana.
The collaboration between different sectors of the public administration, public health officials and the local community and all being focused on the single goal of preventing a dengue epidemic, had been the reason for the success in reducing dengue prevalence in the area, saidd Dr. Liyanage. Proper data management, analysis and presentation had also played a major role in the Horana PS area being able to achieve this success.