To dengue or not to dengue

Prevention of diseases that often affect the rich must not get preference over the diseases that cause great morbidity and mortality among the poor masses

To dengue or not to dengue

Dengue season is upon us once again. Fortunately, the Punjab government has been on ‘war footing’ against dengue for the last many years with some success in reducing the spread of this dreaded disease. Polio is another disease against which the Pakistan government has carried on a valiant fight. Important as these two might be, it is interesting that in the ‘pantheon’ of public health, all cause ‘morbidity and mortality’ from these two medical conditions is miniscule compared to other prevalent health problems confronted by the ordinary people of this country.

Polio is important for the government for two reasons. First, most of the funding for anti-polio vaccination comes from foreign sources and therefore to keep receiving these funds, the government has to show actual progress. Second, the continued prevalence of polio in Pakistan even though most countries of the world have been declared polio free has forced the government to ensure that Pakistani citizens and residents travelling abroad require proof of vaccination. If neither of these constraints existed, I wonder how aggressively active the ‘authorities’ would be to eradicate polio.

As far as dengue is concerned, I have often wondered why the Punjab CM is so concerned about this disease. The total number of people that have died from dengue for the last many years in the Punjab is probably less than the number of people that die every summer from what is known as ‘gastro’ (gastroenteritis). Something about dengue is obviously different. Unlike the mosquito that transmits malaria, the dengue mosquito breeds in ‘clean water’.

Observations then have to be made about where most of this clean water is found, and no it is nowhere near where the famous ‘masses’ live. Clean water is found mostly in the well-watered and lush lawns of our big and pricey homes or the ‘bungalows’ populated by our elite civil servants and in the equally lush parks frequented mostly by the well-off for their morning or evening ‘constitutionals’. The other types of venue that abound with such greenery are of course the exclusive private clubs with alfresco dining capabilities.

The people most often affected by dengue then are those that either live in such places or else frequent them and that also usually at ‘dusk or dawn’ thus exposing themselves to this dreaded malady. Most of them are quite well-off or at least well connected, and that explains why they are so afraid that they might contract dengue. If such people were forced to drink water that emanates from our public faucets, ‘gastro’ would become as dreaded and worthy of greater concern than dengue.

The dengue situation encapsulates the major public health problem confronted by many developing (poor) countries. The limited funds available for public health are mostly diverted towards the prevention and treatment of those medical conditions that mostly or equally afflict the rich and the well-connected. The well-connected includes our political classes and the senior bureaucracy and these are the decision makers when it comes to the allocation of limited financial resources. They will then do the best that they can for themselves.

The above observation can be extended to other diseases that are mostly or equally prevalent among the well-to-do and the poor. Of these the most important is heart disease. In developing countries, heart disease especially disease of the heart arteries leading to blockages and heart attacks is primarily a disease of the well-off and the well-fed. This clearly explains the need for ‘more’ cardiac institutes in almost all major cities.

The limited funds available for public health are mostly diverted towards the prevention and treatment of those medical conditions that mostly or equally afflict the rich and the well-connected.

Why cardiac care cannot be centralised is due to the fact that a sudden blockage of a heart artery can have serious consequences if not treated urgently. As such quick access to a ‘heart hospital’ is important. On the other hand those cardiac centres that also treat the poor are dramatically underfunded, and provide their best care to their paying patients, bureaucrats and politicians.

One of the major health problems in Pakistan is the alarmingly high rate of ‘maternal mortality’ (death during delivery of a child) and its concomitant infant mortality. Access to appropriate medical care before and during delivery is the most important prevention of such deaths. I am not aware of any ‘new’ hospitals or medical centres built that take care of this extremely at risk population. The two such hospitals in Lahore, the Lady Willingdon Hospital and the Lady Aitcheson Hospital were both built about or more than a hundred years ago. As far as child health is concerned, as far as I know, there is probably only one hospital that specialises in the care of children in all of Punjab.

It is important to emphasise that preventive medicine is in the long run much more cost effective than taking care of an epidemic when it occurs. And as is said, prevention is better than the cure. However, prevention is dependent on healthcare being provided at the basic level starting from the rural healthcare system upwards.

That brings me to my pet peeve and that is the complete disregard for the rural healthcare delivery system that was put in place in the Punjab almost 50 years ago and receives little, if any, political support. Yes, it does get some lip service every now and then, but rarely gets the financial input that is so badly needed. As they say, talk is cheap.

Here I must admit that my emphasis is egalitarian but then the rich and the powerful also need help, don’t they? And if a secretary to the government gets sick, that is of course much worse for the province than a thousand poor people that might be dying from stupid diseases like gastro or malaria or different types of liver infections that are spread because of poor hygiene and by thousands of quacks practicing ‘bad medicine’ and reusing needles to give unnecessary injections.

And yes our politicians keep promising that all the people will be provided clean drinking water. But we have now reached the point where such promises are ignored. However, when a new highway or under or overpass is promised, we know that it will be built in double fast time. In my opinion then the primary public health problem is that healthcare is not a priority for this government nor was it for the previous one.

Preventing dengue is important and it is not my intention to belittle efforts by the Punjab chief minister and his minions to prevent it from becoming an epidemic. But at the same time I must insist that prevention or treatment of any disease that often affects the rich and the well-to-do must not get preference over those diseases that cause great ‘morbidity and mortality’ among the aforementioned ‘masses’.

The ultimate test of a democracy is whether the interests of ordinary people are given as much importance as is given to the interests of the elite. Sadly in Pakistan, the wealthy and the well-connected get to benefit at the public expense while the poor are often ignored.

To dengue or not to dengue