Charise Simpson | I spy an outbreak

Whitehouse, Westmoreland. Westgreen, St. James. Content, Manchester. Nearly one month after Hurricane Melissa, these and other communities across western Jamaica are still drying out. Parents now warn their children to avoid the “rat water”, as reporters repeat two words that carry a new kind of fear: leptospirosis outbreak.

Melissa may have torn roofs from houses in October. But for the remainder of the year, she will be testing the strength and limits of our public health system.

The Ministry of Health and Wellness has confirmed a leptospirosis outbreak, with suspected or confirmed cases in at least eight parishes, including St. Ann, St. Mary, St. James, Hanover, Westmoreland, St. Elizabeth, St. Catherine and Trelawny.

As of November 22, there were ten confirmed and 91 suspected or probable cases, with 11 deaths. Leptospirosis spreads through water or soil contaminated with animal urine, often from rats. It thrives where flooding, damaged infrastructure and poor sanitation collide, precisely the conditions Melissa left behind.

To the credit of the state, the response moved early. Within days, the Pan American Health Organization trained staff at the National Public Health Laboratory to test for leptospirosis and supplied thousands of diagnostic reagents. The ministry activated its outbreak protocols, ensured antibiotics are available in public facilities and formally declared the outbreak to unlock coordination, resources and surge capacity.

But these actions overlook a deeper truth about how Jamaicans actually seek care. Many of us wait until symptoms become unbearable or rely first on bush medicine or avoid clinics because of cost, stigma or fear of neighbours' judgement. Trust is the real currency of public health, and without it, outbreaks move faster than our systems can.

TRAIN ORDINARY PEOPLE AS FIRST LINE OF DEFENCE

Around the world, the countries that spot outbreaks quickly share one trait. They do not rely solely on doctors, laboratories or health ministries. They train ordinary people to act as the first line of defence.

In Zambia, more than 11,000 community health volunteers now conduct disease surveillance in their own districts. In some areas, these volunteers identified more than 40 per cent of suspected cholera cases while distributing chlorine and supporting rehydration points. Their early warnings triggered rapid responses to measles and anthrax before those illnesses could spread widely.

Ghana has built a community-based early warning system where volunteers report unusual fevers, rashes or deaths directly to district surveillance teams. It was this system that identified a meningitis cluster in Sekondi-Takoradi, outside the usual meningitis belt, preventing a major outbreak.

And in Malawi, simple digital tools now send real-time community signals into national systems. Using a seven-one-seven benchmark (seven days to detect, one day to notify, seven to respond), health authorities contained a measles outbreak in Mangochi to cases 126 and one death.

These are not high-tech miracles. They rest on a simple truth: the people who first notice danger are the people who live closest to it.

Teachers, church leaders, youth organisers and Justices of the Peace interact daily with households that may never walk into a clinic unless they are severely ill. And after Melissa, the Government's national volunteer registry was oversubscribed within days, clear proof that Jamaicans are willing to step forward. Yet many who registered have heard nothing since.

The willingness exists, but what is missing is a system that integrates these residents, along with community health aides, vector control workers and environmental health officers, into a coordinated early warning network for disease.

A MELISSA-READY MODEL

Countries that detect outbreaks early do so by training community members to recognise danger signs and linking them to straightforward reporting channels that feed directly into surveillance teams. Jamaica can do the same, and must.

A Melissa-ready model would build on what already exists: a trained core of local health sentinels, a predictable route for reporting concerns to parish teams and basic tools that matter in the first 72 hours, such as chlorine tablets, safe water guidance, rodent control information and clear referral pathways.

Melissa may have triggered leptospirosis, but it will not be the last disease to follow a major storm. Flooding, damaged pipes and poor sanitation heighten the risk of water and vector borne illnesses including diarrhoeal diseases, cholera and mosquito borne infections such as dengue. As climate change intensifies, disasters of Melissa's scale will become more frequent, giving these pathogens more opportunities to spread.

International medical teams have strengthened Jamaica's immediate response, but their presence is temporary. The diseases are not. Leptospirosis will linger long after the storm drains. So will dengue, gastroenteritis and the next microbe that thrives in stagnant water and broken infrastructure.

This is why the knowledge and vigilance that remain in communities long after the last foreign medical mission departs may be Jamaica's most valuable form of health preparedness. Building back better cannot only refer to roads, bridges and roofs. Melissa has made it clear that we must also build back better health defences, starting in the same lanes and districts where danger first appears.