It’s how govt handles it

Published: 00:05, Jul 17,2017 | Updated: 00:51, Jul 17,2017


The most unsettling information perhaps is that regional public health officials were expecting such an outbreak this year based on the viral epidemic patterns of the region. The responsibility of monitoring the possible epidemic was again with the IEDCR, but nothing was done, writes Afsan Chowdhury

THE politically sensitive Mohammad Nasim was at his most insensitive when he said on the parliament floor that chikungunya is nothing to worry about and a few paracetamol tablets will take care of it. Few of those who have got it will agree. It is a mind-crushing, bone-crushing, body-mangling attack that leaves one disabled for even several months. To say it is nothing was the last thing he should have said. If he wanted to say that it was not fatal, then there are better ways to convey the information. As the minister of health and veteran politician, he could also mention what the government was doing. Unfortunately, he came across as a person who thought the media were making a big deal of a small matter and the people were acting like a ninny.
The two mayors of Dhaka, the city’s urban superstars, were even more casual and even blamed the victims. One insulted them by saying that he was not expected to go and put up mosquito nets at homes to protect the people. Although he later apologised, his words made it clear how they looked upon the citizens. The ruling party seems so confident of its popularity and its consequent victory in the next elections that it does not seem to bother about the residents and the voters. It is a scary thought. If this is how it behaves two years before the polls, what will it do once the elections are over and it is in power again?

Overreacting to a mild pain
MANY have said that people are over reacting as chikungunya is not a killer; so, it is not a serious problem. But the idea that a crippling, disabling ailment that has already cost millions in lost work time, income, medication, mosquito repellant, etc is not a serious matter indicates an attitude problem that shows up in many other sectors as well.
Recent disasters have also exposed the feeling that floods do not kill, are an act of nature and, hence, not a big deal. That almost no one died in the haor area floods means it is not that serious. The ho-hum manner with which corruption allegations are being pursued in haor area shows the sense of urgency. As the ordeal showed, the floods have led to rice supply difficulties and negatively impacted all the major indicators of the people’s life there and elsewhere.
The CHT landslide disasters show how a variety of factors, including settling people on vulnerable zones, have long-term impact. The cutting up of hills was not considered serious since it was perceived as creation of homesteads but the lack of understanding of local ecology and pressure of home-making led to a crisis and loss of lives. Living in conflict with nature goes on all the time and it does not matter if it is the rich such as the BGMEA or the poor living in slums. The difference is: one was a violation of nature by choice and the other is a violation because there is no choice.

The chikungunya choice
THE mayoral opera of cruelty was best displayed by a mayor who celebrated his success wildly including with media leaders. The current regime will be remembered more for murder of many livelihoods of the poor who had shops on the pavement than anything else. The arrogance of this man was best represented by his disdain for the sufferers of the ailment and blaming them for not using nets at night. He could have remembered that the chikungunya mosquito bites mostly during the day not nights and cleaning and collecting garbage including water containers are part of the DMC task list.
But the main concern that we have is that a plan does exist that could have been put into effect but was not. This was completed in 2016 with WHO support in view of the dengue crisis but not implemented. The reason behind that is the lack of coordination between the various sections of the health ministry. Although the director general of health services has a project to prevent such outbreaks, it did not work.
A confirmed source says, ‘Bangladesh has a dengue prevention strategy which covers chikunguniya. It was developed by a Sri Lankan consultant back in 2016. It has adopted the regional dengue prevention strategy of WHO for SEA Region. The problem is that national dengue prevention programme never coordinates with city corporations or city corporations never coordinate with the national programme. We have good strategies but zero implementation.’
This means that there is a problem of health governance and it is not due to the negligence of the people as the health minister and the mayors have been saying. When elected officials are not ready to take responsibility but shove the blame to the people themselves, the issue is one of bad governance not bad diseases.

What could have been done?
SUCH mosquito-borne outbreaks have been happening all over the world and WHO has developed a standard plan which can be readily adjusted and adopted based on six major components.
The six components of the regional strategy are: (1) strengthening surveillance system for prediction, preparedness, early detection and response to chikungunya outbreaks; (2) improvement in early case detection and case management of chikungunya fever; (3) integrated vector management (IVM); (4) social mobilisation and communication; (5) partnerships; and (6) operational research.
But perhaps the most unsettling information is that regional public health officials were expecting such an outbreak this year based on the viral epidemic patterns of the region. The responsibility of monitoring the possible epidemic was again with the IEDCR, but nothing was done. The first outbreak was at least three months back but no attention has been paid since that time and no steps taken. It was allowed to happen.
This kind of neglect is possible when one does not care or have to care about people and their votes. The party in power can afford to behave like that with no opposition around and voices stifled including by indiscriminate use of laws, court cases, etc. But any government with a weak governance mechanism is actually its own strongest threat. Bangladesh’s politically powerless people cannot do anything but the political power on which it rests now perhaps be crushed by its own lack of efficiency and indifference to public suffering.

Afsan Chowdhury is a journalist and researcher.

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