Sri Lanka: Dengue epidemic claims scores of lives
30 June 2009
An outbreak of dengue fever in Sri Lanka has led to 151 deaths and is continuing to spread. To cover up its own responsibility for the erosion of public health care, the government has blamed ordinary people for the epidemic and imposed punitive measures on those who fail to comply with its regulations.
Since the beginning of January, 12,300 persons have contracted dengue hemorrhagic fever—a viral mosquito-borne disease for which there is no vaccine. The fatal cases have included medical staff—a doctor, a nurse, a veterinary surgeon and a medical student. Health ministry statistics show that 33 percent of dengue patients are housewives and 22 percent are children.
The outbreak has hit many districts and towns, including the main cities of Colombo, Kandy, and Galle. The number of cases in Colombo city has reached 589 since January. Colombo’s chief medical officer, Dr Pradeep Kariyawasam, recently told the media that the figure for June was 198, including 8 deaths.
Dengue fever has been on the rise over the past 20 years. In 2000, 37 dengue-related deaths occurred and in 2004 the figure was 88. The increase is a product of the deterioration of public health programs, firstly to suppress mosquito populations and secondly, to provide timely health care to those who have contracted the disease.
The government, however, has tried to shift the blame onto ordinary people. Health ministry spokesman W.M.D. Wanninayaka told the media: “The public is mainly responsible for the increasing number of dengue cases and the deaths since they are very careless about keeping their surroundings free of mosquito breeding places.”
The government enacted the Prevention of Mosquito Breeding Act in May, requiring people to remove or destroy items capable of holding water and keep gutters, down pipes and drains in good repair. Local government authorities can also be prosecuted for failing to clean canals and drains.
Individual fines range from 1,000 rupees ($US90) to 25,000 rupees. Those who violate instructions can be sentenced to six months’ jail. In an interview with the Sunday Observer on June 21, Health Minister Nimal Siripala de Silva boasted that 300 people had been punished. In some areas, the government has mobilised armed civil defence force soldiers to search house-to-house to enforce the law.
As on every other issue, the official response is punitive and militaristic. The real reasons for the rising incidence of dengue fever during the monsoon season lie in the lack of proper urban planning and widespread poverty as well as the rundown of public health services.
Dr Kariyawasam said congestion and the lack of proper sewerage and garbage disposal systems in Colombo were responsible for the spread of dengue in the city. “The garbage problem is worsening by the day with the residents dumping their garbage at places where they notice piles stacked by the roadside,” he said.
Colombo city has an inadequate drainage system, resulting in small and large canals filled with dirty water. In slum areas, there is no proper drainage or sanitation. People cannot afford to fix their shanties to prevent water collecting or to purchase mosquito nets to protect them. Outside the capital the situation is even worse.
Dr S. Gamage, the health director for the Kandy district, said most of the dengue cases in the district had been reported from the Akurana area, where water was in short supply and residents were forced to collect water in buckets.
The limited public health campaigns of the 1950s and 1960s aimed against mosquito-borne diseases, such as malaria and filaria, have been wound back. The ratio of public health inspectors has fallen from one per 10,000 people to one per 40,000. Inspectors visit door-to-door providing advice to residents.
Early detection of dengue cases is important to minimise fatalities, but most public hospitals lack the facilities to carry out full blood counts and dengue serology tests. Only wealthier patients can afford to be tested at private facilities. In critical cases, patients need to be closely monitored in intensive care units, but these are also lacking.
Like other essential services, spending on public health was slashed to fund the government’s communal war against the separatist Liberation Tigers of Tamil Eelam (LTTE). Increasingly, health services have been privatised. Most of the population, however, is forced to rely on the deteriorating public health system. A recent UNICEF report found that 34 percent of the population lives on less than $US2 a day.
The government’s new laws have provoked an angry response from working people.
Sandhya, a resident in a Colombo housing estate, told the WSWS: “Every person in this area has to breathe bad smelling polluted air all day. This canal is a massive mosquito-breeding centre. Every night we are struggling with mosquitoes and even mosquito coils cannot chase these creatures.
“The health minister says that the reason for the higher percentage of women among the dengue patients is because they were wearing skirts, allowing mosquitoes to bite them. Has he gone mad? We women have to stay at home and spend all the time in this reign of mosquitoes. That is the reason for this higher percentage of women patients.”
Local residents wrote to the Colombo Municipal Council commissioner, stating: “This estate is older than fifty years and since the beginning we have been suffering from the lack of a proper sanitary system. Even in light rain, dirty water comes into our houses... The drain that runs through our land is a terrible problem for us. Because of the dirty water of that drain, our children and adults get ill. Considering these facts, please make the necessary arrangements to make a healthy environment for us to live decently.”
The government’s response is symptomatic of its approach on every issue. Having defeated the LTTE, it is not proposing to slash the military budget and boost spending on social services. Instead, amid a deepening economic crisis, President Mahinda Rajapakse is preparing to impose fresh burdens on the working class and is boosting the security forces to suppress any opposition. Rather than improving public hospitals, sanitation, garbage collection, drainage and hiring and training health inspectors, he is sending soldiers door-to-door to arrest so-called dengue culprits.