Bonthu Rammohan, the Mayor of Hyderabad, has arrived four months late. What he and his team of Greater Hyderabad Municipal Corporation (GHMC) officials should have done before the onset of monsoon or atleast at the time of the first showers in June, is being done now in September. A classic case of the administration reacting late and inefficiently to a crisis.
“Do not let water accumulate in flower pots, coconut shells,” says Rammohan as he removes them from the parapet in a locality in Hyderabad. Standing by the side, a man with a fogging machine strapped to his back, sprays apologetically. Pep talk given, Rammohan moves on, having stuck some vague sticker to the wall.
A photo-op, best avoided. Since newly appointed Municipal Administration minister KT Rama Rao has asked everyone to get on to the field and spread the word about sanitation, it would help if the officials spread themselves out in order to reach as many localities as possible.
But just because the monsoon season is almost over in Hyderabad, the challenge is not over yet. Having seen our daughter battle dengue all of last week, necessitating hospitalisation and interacted with medical practitioners, I offer these ten suggestions to the GHMC. The organisation would do well to examine and implement them to ensure Hyderabad does not face a similar dengue scare next year.
1. Local hospitals and nursing homes always know where the cases are coming from. The Entomology wing of the GHMC needs to be in contact with them, take that data and target those specific areas in every zone. A paediatrician told me close to 30 people were diagnosed with dengue just in one locality of Kompally on the outskirts of Hyderabad. It is such clusters that need to be focused on.
2. In the cases where the entomology wing takes the data, it does not believe it unless patients get a test done by the Institute of Preventive Medicine (IPM). Only then the government will recognise them as dengue cases. This is reflective of a stubborn attitude and refusal to acknowledge the problem at hand.
At this point in time, most poor patients go for the Rapid Diagnostic Test (RDT) to check if they are suffering from dengue. It is not the most reliable test but then the Elisa test is more expensive and not everyone can afford it. The government should treat those diagnosed by RDT as dengue suspect case and treat them accordingly. This red tape attitude of the government this year made them claim there are no dengue cases this year. Health minister E Rajender even blamed it on the media, not the mosquitoes.
3. It is in the run-up to the monsoon that public awareness campaigns should have been undertaken, involving residential welfare localities. After we are done with this year’s crisis, target May 2020. The government is doing so now after public and media outrage and intervention by the High court after a PIL was filed. Construction sites where work is taking place need special focus as both workers and their children are exposed to mosquito bites there.
4. The dengue crisis in Hyderabad that officially, has claimed four lives in the last ten days may be at the last stage for this year but doctors say those who were affected by a mild form of dengue this year run the risk of acquiring a severe form next year if exposed to a mosquito bite. This is serious.
5. The next big immediate risk is that of swine flu which is already rearing its head. Awareness about public hygiene is very low and with Ganesh Chaturthi festival on, to be followed by Dussehra, exposure to public places will be high. Hand washing, wearing of masks, avoiding sending a sick child to school are measures that need to be enforced strictly. Public health education is of paramount importance. Even a throat infection acquired by one member of a family after travel outside is a potential risk to others at home and in his workplace. Mass gatherings are a definite health risk.
6. A lot is being made of fogging at this point in time. Doctors say fogging is not as effective when the epidemic is active. Anti-larval measures are far more effective and should have been done early. This is an important lesson for 2020.
7. The present dengue, malaria, chikungunya and viral fever crisis has exposed the shortage of beds even in private hospitals in Hyderabad. Public health policy-making need to take care of that and think of how to plan better next year. The other problem for hospital managements is less turnaround time for a bed. This has meant an inferior quality of washing of bedsheets leading to other forms of infections for patients and attendants like skin rashes.
8. The GHMC needs to invest in its entomology wing which has a staff of 2090 right now. This is the first line of defence that has to be active on the field and not only when a VIP comes visiting or when a VIP makes a phone call asking for a visit to a specific area.
9. Hospitals should be told not to turn away patients just because they do not want to have a tragedy on their hands. Each smaller hospital when confronted with a serious case, should have the wherewithal to refer the patient to a bigger hospital where again he should not have to wait endlessly for medical attention. A 13-year-old patient from Secunderabad died due to dengue because he had to wait for three hours for a bed in a premier corporate hospital.
10. Ban entry of politicians into hospitals for photo-ops. It is completely unacceptable that a crowd of politicians, hangers-on and the media should enter wards that should ideally be sanitised. What they end up doing is they carry germs at a time when patients have lower immunity levels and are very vulnerable.