Thu | Aug 17, 2017

Dr Alfred Dawes | Sowing the seeds of our own diseases

Published:Wednesday | June 1, 2016 | 6:00 AM
Dr Alfred Dawes, immediate past president, Jamaica Medical Doctors Association
Acting Chief Medical Officer in the Ministry of Health, Dr Winston De La Haye, (left) and Pan-American Health Organisation technical advisor, Dr Taraleen Malcolm, examine a bottle for possible mosquito larvae.
The attempts at vector control is hindered by the continued practices of littering and failure of households to properly clear mosquito breeding sites.
Breeding sites for the aedes aegypti mosquito
The Aedes aegypti mosquito
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In one of my first meetings with then Minister of Health Dr Fenton Ferguson, I asked him how the Jamaica Medical Doctors Association could help him. His one request was that we assist in spreading the word about the need for personal responsibility in combating the spread of chik-V.

We gladly obliged, taking to the media to encourage persons not to litter and to destroy mosquito-breeding sites. So much so that one colleague joked that I had become famous as the chik-V surgeon.

The seriousness of Dr Ferguson's request was not apparent until the attempts at fogging and other forms of vector control by the Ministry of Health were hindered by the continued practices of littering and failure of households to properly clear mosquito-breeding sites.

His successor, Horace Dalley, and the present health minister, Dr Christopher Tufton, have also preached this message of taking personal responsibility for vector control in and around our homes. Yet, still we continue to sow the seeds of our own diseases.

Our present level of apathy for joining in the fight against infectious diseases is a far cry from the resilience of ordinary Jamaicans who beat malaria and yellow fever to become one of the first countries in the world to be declared free from those mosquito-borne diseases.

 

Worse off than our grandparents

 

One Cyprian Dawes, my grandfather, who led the malaria eradication programme, would travel throughout Jamaica ensuring that the message of personal responsibility was spread and every Jamaican played their part, no matter what class or creed. The army of public health inspectors did an amazing job of reaching the farthest corners of Jamaica, at a time when media access by Jamaicans was limited and road travel was a task for which you had to psychologically prepare yourself.

Yet, in today's information age where the message is blasted at us from various traditional and social media platforms, we are worse off than our grandparents when it comes to assimilating knowledge and changing our behaviours accordingly.

Campaigns such as 'Nuh Dutty Up Jamaica' have tried to effect change. Yet, driving behind a car, you can tell what they were eating and drinking by identifying the garbage thrown from the windows. Our beaches and gullies are filled with plastic bottles and styrofoam containers that act as perfect incubators for mosquitoes.

Nearly 700 million people contract a mosquito-borne disease each year, resulting in more than one million deaths. Our local pest, the Aedes aegypti, is responsible for spreading dengue, chik-V, ZIKV and, importantly, yellow fever.

Yellow fever is deadly and in spite of there being a vaccine, yellow fever causes 200,000 infections and 30,000 deaths every year. It is active in our South American neighbours and we now have an entire generation of Jamaicans who have no exposure, hence immunity to this disease.

Decreasing the size of the population of the Aedes aegypti will significantly cut our chances of having a widespread outbreak in Jamaica. We, however, remain at risk because we are dependent on the Government to fog the place.

Fogging is not the answer. Fogging kills adult mosquitoes. The larvae in your garbage and stagnant water hatch within a few hours and start spreading diseases and laying more eggs. Even worse, Jamaicans don't like the smell of the fog and will quickly lock all windows and doors so as to keep the fog out. This serves to protect the mosquitoes living inside our homes. These are destructive behaviours that we refuse to change.

 

Weary of being afraid

 

One of the main factors that will continue to negatively impact our attempts at behavioural change is that Jamaicans have gone through a lot. During the Battle of Britain, Londoners went about their daily business with no fear of German bombers. When an alarm was sounded, they would head for the shelters, but then when the all-clear was given, they would continue with their work if there were not victims. This shocked the Germans, who thought they would crush the moral of the Brits and have them deserting London out of fear of the blitz. While lauded as bravery, this has a simple psychological explanation. The Londoners were weary of being afraid. After the first near-miss and the constant threats that failed to kill them, they shut down the part of their minds that feared the threat and were able to continue with the work of building their army.

Similarly, Jamaicans were overloaded with messages about the threats of chik-V and ZIKV. They got hit, probably 80 per cent of the population by some estimates, but they survived: a near-miss. And now, with continued warnings about the need to destroy breeding sites and properly dispose of garbage, we have shut down that part of our brains. The message is just not getting through and nobody understands why, after we suffered from chik-V, we should continue to ignore it. The answer is simply because we suffered so greatly from chik-V.

There has to be another way to effect behavioural change, as three ministers of health have found out.

Brazil has resorted to the deployment of the army to go house to house and supervise the destruction of breeding sites. This would probably not work in Jamaica. A start would be strict enforcement of littering laws. Jamaicans respond to fines, as the seat belt law was able to demonstrate, with a remarkable jump in the percentage of drivers buckling up after the law was enforced and big fines paid by motorists.

The public announcements should continue, but the PR geniuses who come out election time should try and make the message one that is more easily absorbed. This complex problem needs to be addressed, as the country cannot afford to lose any more lives or productivity as a result of mosquitoes.

- Dr Alfred Dawes is a general laparoscopic and weight loss surgeon at the Island Laparoscopy and Medical Care. Email: info@islandlaparoscopy.com; yourhealth@gleanerjm.com