Chikungunya: we were warned
Michael Abrahams, Online Columnist
I had not planned to write about chikungunya again, but recently I came across some information that is cause for concern.
In May 28-30, 2012, a chikungunya Caribbean subregional meeting was held at The Jamaica Pegasus in Kingston. The meeting was supported by the Pan American Health Organization (PAHO), in addition to the Division of Vector-Borne Diseases of the United States Centers for Disease Control and Prevention (DVBD, CDC). The participants from 22 countries included clinicians, vector-control teams, and laboratory technicians. Representatives from our own Ministry of Health were also present.
The objective of the workshop was stated to be "to raise the capacity of Caribbean countries' health systems for the timely identification of chikungunya outbreaks in the context of other epidemic-prone diseases, such as dengue".
At the meeting, it was established that the Caribbean was one of the most vulnerable subregions in the Americas and that aggressive vector control, among other measures, was an important component of management. Epidemiological surveillance and quarantine were also discussed, as well as the mobilisation of funding from national and international sources. As a matter of fact, international experts and health professionals present at the meeting prepared a 34-page document outlining steps to be taken to deal with chikungunya.
So, what the hell went wrong?
Many Jamaicans are unaware that such a meeting took place, in our own country at that, almost two and a half years ago. Our authorities had ample time to prepare us for the entry of this disease into our country, but their efforts were puny at best, and we are now dealing with a full-blown devastating epidemic.
My own experience with the infection not only brought home the potential severity of the symptoms, but also how widespread the problem has become. My entire household has been infected with the virus. I rarely miss work because of illness, but because of persistent joint and muscle pain, I had to stay home for a few days. On my first day off work, I called my office to speak with the pharmacist, only to be told that the pharmacy was closed because she was down with the virus. I then asked to speak with the general practitioner who runs the medical centre, but was informed that he, too, was ill with the virus.
I later called a patient I had scheduled for surgery the following day to cancel the case, only to realise that she, too, was down with the virus and would not have been able to make it anyway. The last patient that I performed major surgery on also had to be rescheduled because she, too, was afflicted. Yes, the situation is that bad.
And people are dying. One school lost two teachers and a student in a single week. One day last week, I spoke to two doctors, who work in two different parishes, who told me that each of them knows three persons who died from complications from the disease. The following day I spoke to a friend of mine who lives overseas and came to Jamaica to bury her father, who died from complications after contracting the virus.
Yet, despite the overwhelming morbidity and economic cost (13 million man-hours and $6 billion lost, according to the Private Sector Organization of Jamaica), as well as mortality, resulting from inadequate preparation and poor execution of recommended measures, the minister of health says he did nothing wrong and the prime minister agrees, saying that he is doing a good job. To say that I disagree would be a gross understatement.
The ministry has not been honest with us, at one point saying that there were only 35 confirmed cases when some of my colleagues were seeing as many as that in one day. Yes, the Government may have had knowledge of only 35 confirmed cases, but they must have been aware that the infection was exploding, with hundreds, or possibly thousands of clinically diagnosed cases.
Communication with, and education of, the public was also dismal. We were not informed about the potential severity of the disease, exacerbation of pre-existing conditions, likelihood of chronicity, and vulnerability of the very young and the elderly. Recently, at a public forum, the minister admitted that, regarding measures taken to combat the epidemic, "the reach and extent were inadequate".
And there was definitely no attempt at aggressive vector control. Some apologists claim that we are to blame for the epidemic because we are too nasty. They are partially right. We are an undisciplined lot who frequently discard rubbish through car and bus windows and into gullies and canals and somehow have an aversion to using garbage bins, and are now paying the price.
But what is the use in having a Ministry of Heath, and using taxpayers' money to pay employees there who shirk their responsibilities and place people's lives at risk?
So, the 'no-accountability' ship sails on, with no apologies, no resignations and no firings - while Jamaicans die and continue to suffer.
Michael Abrahams is a gynaecologist and obstetrician, comedian and poet. Email feedback to firstname.lastname@example.org and email@example.com, or tweet @mikeyabrahams.