Fri | Dec 9, 2016

Many chik-V deaths under the radar

Published:Monday | December 8, 2014 | 12:00 AMDelano Seiveright

After raising alarm about the awful impact of the chikungunya epidemic in St Thomas, battling initially strong denials from Health Minister Dr Fenton Ferguson and surrogates in influential offices, we are now faced with another disturbing dimension of the epidemic.

Over the last several weeks, I have come to realise that the affected must be grateful for at least living through the ordeal. Despite gut-wrenching reports in the media, the Ministry of Health, already bruised by its incompetent handling of the whole affair, albeit so because of poor leadership from its minister, sits silently, reflecting the culture of insensitivity, as suspected chikungunya fatalities mount.

Last week, I received yet another call about a suspected chikungunya-related fatality, the victim this time being a young and ambitious teachers' college student from St Thomas. The young lady's ordeal lasted for several weeks and included her kidneys going haywire, being in a long period of acute pain, and ultimately passing away. Her story was just another of several that I am aware of.

I recall, over a month ago, attending the nine-night of one victim, a well-known resident. I am also aware of an unemployed young woman, an elderly lady, a security guard, a handyman, and several more persons, in St Thomas alone, who died, all according to concerned parties, because of chikungunya-related complications. Of course, most of the affected had underlying medical conditions aggravated by the virus. To this day, many persons are in hospital battling the virus, which has inflamed other medical issues.

A fundamental issue here in Jamaica - where if the Ministry of Health is now to be believed, up to 60 per cent of the population, or more than 1.6 million people, may be affected by chikungunya - is that post-chik-V awareness is poor and there is no official record of related fatalities to date. This is true in other CARICOM countries, where reporting protocols seem non-existent or are unclear at best.

On the flip side, the French-ruled Caribbean islands of Martinique and Guadeloupe, with populations of around 400,000 each, reported up to mid-September 2014, 55 and 49 chikungunya-linked deaths, respectively.

Beyond that, the 2005-2006 chikungunya epidemic in Reunion, a French-ruled Indian Ocean island with a population under 800,000 with more than 250,000 affected, claimed over 230 lives.

Mortality rate

French scientists noted that the mortality rate was 1 per 1,000. Jamaica, with many times the population of each island, from logical deduction, will have higher fatalities. Unfortunately, maybe for yet again political reasons, the health ministry has not instituted any internationally accepted protocols to account for chikungunya-related fatalities, especially given the simple fact that it is an abnormal health phenomenon affecting a very significant proportion of the population.

The ministry is adopting the same insensitive and ham-fisted approach to chikungunya-related fatalities as it did with its reckless and absurd weeks-long song and dance about low-confirmed case count, despite thousands obviously affected by the virus, with many overwhelming health centres.

Incidentally, the position of the ministry isn't at variance with what has happened in other developing countries, stirring much controversy, I might add. India, in 2006, reported 1.3 million cases of chikungunya; however, the government of India reported no deaths, despite obvious evidence that deaths caused by chikungunya did occur.

This anomaly led to a 2007 research paper from India's premier Business School, the Indian Institute of Management, Ahmedabad, titled 'Chikungunya Epidemic Mortality in India: Lessons from '17th Century Bills of Mortality' Still Relevant'. The paper's analysis could be copied and pasted into the Jamaican reality with ease. The researchers noted that the key reasons for not finding any chikungunya deaths included: poor reporting of death and causes of death, lack of availability of blood-testing facilities for the virus, and no systematic efforts have been made to screen all the deaths during the epidemic to identify which of them were due to chikungunya.

The paper went on to criticise the World Health Organization, for which the Pan American Health Organization (PAHO) is its regional arm, and the Centers for Disease Control and Prevention (CDC) of the United States of America for not playing a proactive role in studying and documenting the epidemic, including mortality or warning the countries about its possible spread. This was seven to eight years ago.

In recent years, those agencies have seemingly corrected much of that problem. Lest we forget, in May 2012, a chikungunya Caribbean subregional meeting was held in our capital city with the support of PAHO and the CDC. The participants from 22 countries included clinicians, vector-control teams, laboratory technicians and, of course, Jamaica's Ministry of Health.

Two years later, Jamaica's Ministry of Health was caught flatfooted. In any self-respecting country, the responsible minister would have long resigned.

n Delano Seiveright is the caretaker for St Thomas Eastern and former president of Generation 2000 (G2K), a JLP affiliate. Send feedback to columns@gleanerjm.com and delanoseiveright@yahoo.com, or tweet @delanoseiv.