Ready for the big one?
Surprise, surprise, Ebola has surfaced in the hemisphere, already killing one patient in Texas.
Then there's the first reported case of the disease being contracted outside of Africa as a nurse in Madrid caught it (in changing clothes, her protective suit touched her face) from a patient who travelled from West Africa. Meanwhile, we're still saying that it can't come here because West African countries screen travellers. I warned readers that was nonsense in my column 'If Ebola should come knocking' (submitted on September 29 and published on Sunday, October 5). I usually enjoy saying 'I told you so,' but not this time.
It'll be worth being a reluctant prophet if we stop playing politics with Jamaicans' health and start taking the possibility of Ebola deadly seriously. It turns out we were warned of the upcoming chik-V epidemic two years ago when PAHO held briefing meetings with regional health officials. Yet, we allowed International Monetary Fund (IMF) imperatives to prevent us from preparing even superficially for chik-V. Thank God, as I keep saying, that a chik-V epidemic is a walk in the park compared to some we've had and might yet experience. If we deal with Ebola as we've dealt with chik-V, there won't be many of us left to pass any more IMF tests.
Even now, to quell political unrest, Government is undertaking a massive clean-up. But that's another waste of time, effort and money on the altar of political expediency. What's needed isn't a massive clean-up but a continuous, systemic clean-up, environmental protection and a mosquito eradication programme that never ends. For the umpteenth time, we need to consolidate funds used on unnecessary ministries and 28 'ministers' and concentrate our spending on the health, education and security of every Jamaican.
If only we'd recognise priorities when they smack us in the face. It's depressing to record that dengue was all but eradicated in the world (by 1962, Aedes aegypti had been eliminated in 18 continental countries) until Jamaica's casual attitude to environmental urgencies resurrected that disease. Cuba had eliminated the pesky mosquito, starting with fogging and destruction of abandoned containers from as far back as 1902. The Cayman Islands has kept up its mosquito-eradication programmes, so there's no dengue there. Almost every modern outbreak of dengue can be traced to Jamaica's abysmal public-health practices (1963-64 when the first 1,500 cases were confirmed here; 1968-69 and 1977).
A sustained mosquito-eradication programme requires focus and commitment. Some of the things we should be doing consistently are:
Proper environmental management/modification procedures to prevent mosquitoes from accessing egg-laying habitats (including removing artificial man-made habitats like abandoned containers);
Disposing of solid waste properly;
Covering, emptying and cleaning domestic water-storage containers weekly;
Applying appropriate insecticides to outdoor water-storage containers;
Using personal household protection (e.g., window screens, long-sleeved clothes, insecticide treated materials, coils and vaporisers);
Improving community participation and mobilisation for sustained vector control (Jamaica used Crash Programme workers in 1977 as a one-off response during a massive outbreak);
Continuous active monitoring and surveillance of vectors to determine effectiveness of control interventions.
These proved altogether too ethereal and boring for Jamaica's political leaders, who preferred Crash Programmes; pork-barrel contracts; imported candy; perks for MPs; and kowtowing to IMF demands when those dalliances ruined our fragile economy. As mosquito-eradication programmes deteriorated, sporadic outbreaks in South America were noticed in 1971, but the mother of all outbreaks was ours in 1977 when a new strain (DENV-I; genotype III) swamped Jamaica, eventually spreading to countries that hadn't experienced dengue for decades.
By the time we got around to systematically attacking the vector using Crash Programme gangs who had been 'selected' and assigned by parish council division, it was too late. Between 1977 and 1980, more than 700,000 cases of the worst-ever strain of dengue were reported in the Americas. The symptoms were extremely debilitating. Today's chik-V symptoms are child's play to 1977's dengue.
"ong Kong flu! 'Ong Kong Flu! 'Ong
Some say it's dengue fever.
I know it's 'ong Kong flu.
You watch this dengue fever.
I know what it will do."
Now everybody must know Ebola can affect Jamaica. Will we blithely continue our horrendous environmental and sanitation practices of the past four decades? Nobody can guarantee zero exposure but Government can act as if the health of every Jamaican is more important than, for example, the production of fiscal illusions in order to pass fictional IMF tests. This must be a WHOLE GOVERNMENT effort. Neither Ebola nor chik-V can be fought during water lock-offs (encourages ad hoc collection in open containers and poor hygiene), so NWC must be mobilised to ensure regular water supplies. Waste disposal is crucial, so NSWMA must stop treating garbage-collection as a personal favour and revert to it being a solemn duty.
What have we done to protect our immigration and customs officers who are our first line of defence? Will Government immediately issue them with daily supplies of latex gloves for the handling of passports and other personal effects of passengers bringing God knows what? Can we afford not to take this simple preventative measure until the epidemic is controlled in Africa?
Will we IMMEDIATELY introduce temperature checks of all passengers from Africa, Europe and the United States at our major points of entry? Of course not. After all, we must protect the almighty tourism dollar, no matter the health risk. That's been gospel ever since we placed tourism on our fiscal altar even during the early days of the AIDS crisis.
"If it tek set
yu will mawga down.
If it tek set,
yu will mawga down.
It's a killer whoh oh ... "
We MUST create quarantine spaces at our airports NOW. Stop talking about it. Do our health-care workers have sufficient protective suits (at least 30 per day required) or are we waiting for the first deaths before begging the IMF for a 'waiver'? Are any Jamaican doctors and nurses trained to treat Ebola effectively? How? Where? When? Will we ask for special assistance in training NOW?
Do we know how to isolate suspected cases for at least three weeks to effectively contain the disease's spread? Do we understand what 'isolate' means? Can we separate suspected Ebola cases from the routine triage system our hospitals are currently forced to employ, thanks to the inane 'no user fee' policy implemented out of political desperation and retained out of political fear? That policy has already, in my opinion, caused a breakdown of hospital services and two recent tragedies at Spanish Town Hospital. Where does Ebola fit in this cesspool into which our health-care system has been allowed to descend?
What are our surveillance/contact-tracing capabilities? How'll we know how many have come into contact with a suspected case? Are treatment protocols available at all hospitals? If not, are systems for swift communication and safe transportation among health-care centres in place?
Why are health ministry officials talking to us in soothing tones with generalised content rather than speaking specifics? We want to know EXACTLY where we are. This is a deadly disease, NOT a political football. Full, frank communication and strict protective measures (not illusory platitudes) are what'll calm citizens.
"It's terrible and dreadful man.
It's terrible and dreadful man.
Yu haffe rub up rub up with
Eradication efforts quickly fell apart in the 1960s and, by 1972, small re-infestations, undetected by poor sanitation methods, especially endemic in Jamaica, appeared. In 1970, a localised outbreak of dengue coincided with the latest global threat, 'Hong Kong flu'. Because mosquito eradication had been trumpeted, many Jamaicans contracting dengue refused to believe they really had that allegedly eradicated disease. The Ethiopians put the people's fears to music in their seminal Hong Kong Flu.
Peace and love.
PS: Last Tuesday, Alzheimer's overcame my report of an ancient domino game. I played five-four, NOT five-deuce. Thanks to the ever-vigilant Mark Brooks for the correction.
Gordon Robinson is an attorney-at-law. Email feedback to firstname.lastname@example.org.