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A rejoinder to the “Kronik” of KC Ranze in L’Express on Malaria Control

02.04.2018

The weekly editorial of 1st April L’Express Dimanche (no April Fool) deplores the lack of a Mauritian identity, and suggests a kind of minimum program to avoid getting stuck with negative “identities” like the identity left after the “dega” caused by having let international financial shark Alvaro Sobrinho get a toehold in the country. The next example of what gives us a bad national image, KC Ranze argues, is the treatment visitors get coming into Mauritius by air. They are sprayed with pesticide then they are given a Health Card to fill in  - even if they flew in from Europe or the deserts of Dubai, KC Ranze adds.


 There is an invisible counter-argument, however, in the text. It is the parallel between the harm done to  “Mauritian identity” markers by Alvaro Sobrinho getting a toehold in the country and by mosquitoes getting a toehold in the country. The editorial seems oblivious to its own argumentation leading to actually letting malaria back in! Endemic malaria is quite as bad as a financial shark!


 So, the reason for this rejoinder is that nowhere in the editorial is there any attempt to avoid the words of the editorial provoking, if they were heeded by those in power, a massive error that would tarnish the very kind of “national identity” that KC Ranze is wanting to burnish. And much worse still. What if the Government cancels the Health Form and cuts the spray and, as a direct result, malaria is re-introduced and spreads rapidly?


 The pesticide and the Health Form are parts of a program that has kept Mauritius free of malaria since Independence  -- when popular mobilization, supported by the WHO, eradicated the illness that had become a central “national identity” marker.


 Malaria had previously been the cause of death of a large proportion of Mauritians. And it was a cause of much illness and suffering, too – because most people survive malaria, and are constantly getting bouts of it afterwards. People need to know the history as to why there are controls like the pesticide and the health card, and how serious a problem they were addressing. Just to give an idea of how the Mauritian identity as a “malaria death trap” was changed by this popular mobilization against malaria into the  Mauritian identity as a “paradise” – at least in being malaria-free. 


 In one two-year period in the latter part of the 19th Century 13% of the entire population were wiped out with of malaria. That is one helluva epidemic. In the 1930-40’s malaria accounted for 26% of total mortality – which sounds impossibly high. Yet, in 1947 malaria was the unbelievable figure of 71% of total mortality.


 By 1956 no malaria death was reported, and by 1968 there were no cases of the illness that were indigenous i.e. caught in the country.


 What happened?


 In 1948, the first Prevention of Malaria Act was passed, and the main vector, the Anopheles mosquito, was gradually eradicated from then on – by a mixture of  popular mobilization against breeding grounds – children in schools even went around collecting anything that could contain stagnant water, like cans or coconut shells, even cutting bamboo hedges at the node so that water could not accumulate in individual bamboo stalks – and groups of Government employees – “malarya” as they were called – went around getting stagnant water (that mosquitoes need to breed in) near rivers, streams and canals, to move downhill by digging with hoes, and then Health Ministry men did spraying with pesticide, mainly DDT. The eradication of malaria in Mauritius is one of the WHO’s success stories. Once eradicated, there needs to be on-going prevention of new “fwaye” starting up if someone with malaria comes into the country, or mosquitoes come in via aeroplanes or ships. Perhaps the story of malaria’s eradication should be recounted to visitors on the flipside of the health card, instead of jettisoning it.


 Anyway, this is the way the program works until today. Once in the late 20th Century part of the program was stopped, after a similar outcry by the media, and LALIT protested publicly. The program was fortunately re-introduced. People coming to Mauritius go through a fever-checking screen, and fill in the health form, saying what countries they have been to over the past 6 months or so. In addition, many planes from Africa, and even from the East, now go through airports in Europe or, say, Dubai on their way here. So checking the last leg of someone’s journey can miss most cases of imported malaria. People coming from malaria-infested places are then followed up by the Public Health officers (1) (2) for fever, and by a pinprick test to show up malaria. The person is isolated, and given protection against mosquitoes. And this way, imported cases of malaria are thus “sealed off” immediately by very localized pesticide spraying at the place of residence and of work of the sick person.   


 The real heroes of malaria eradication are the broad masses of the people who mobilized against the breeding grounds in the 1950’s and 60’s. The next heroes are the Government-employed workers who saved hundreds of thousands of lives by cleaning up stagnant water all over the country – far more lives than all the surgeons of the country put together! But, this kind of action by the people and by Government manual workers is based on scientific knowledge, and of the dangers of the illness to health. So, Government and editorialists should remember who the heroes are, and keep them informed and keep them in work as civil servants.


 LALIT, 2 April 2018.


 (1) In 2009, a maintenance strategy was in place, according to Authorities. Its main components are: -


“1. Surveillance of incoming passengers – this consists of the screening of all passengers


arriving from malaria-infested countries at the port and airport and their follow up for taking blood slide to be tested for malaria.


2. Early diagnosis treatment and follow up of cases – this consists of free of charge blood examination in government laboratory for specimen collected by Health Surveillance Officers, public and private sector. A 24-hour laboratory service for malaria diagnosis. Free treatment for patients in both public and private sectors. All cases of falciparum malaria are monitored for drug resistance. Drug policy and guideline for treatment of cases. Follow up at regular intervals of all malaria cases.


3. Entomological surveillance and vector control – this consists of: survey of all mosquito breeding places. Night catches for adult mosquitoes. Susceptibility test for insecticide. Vector control consists of regular measures against mosquito larvae using insecticide Temephos. Encouraging community participation in elimination of mosquito breeding grounds in the immediate surroundings. Spraying of Port and Airport compounds every six months.


4. Malaria prophylaxis – consisting of free drug prophylaxis provided to residents leaving for malarious countries.


5. Health education and training.


6. Monitoring and evaluation.”


 Source:  http://health.govmu.org/English/Documents/Bulletins/mal-history.pdf


 (2) In 2018, the Health Minister gave an update on his site.


Prevention and control of Chikungunya, Dengue, Malaria and Zika are critical, says Minister Husnoo


 08 February, 2018: The prevention and control of chikungunya, dengue, malaria and zika are critical for Mauritius because our island is vulnerable to outbreaks of the above mentioned diseases. This statement was made this morning by the Minister of Health and Quality of Life, Dr Anwar Husnoo, in Port Louis during an intersectoral meeting on vector-borne diseases which brought together several stakeholders from the public and private sectors.


The meeting, chaired by the Health Minister, discussed about the current situation, measures taken and the way forward. All stakeholders, namely the Ministry of Local Government, Ministry of Environment and Sustainable Development, Ministry of Education and Human Resources, Tertiary Education and Scientific Research, Ministry of Tourism and Leisure, l’Association des Hoteliers et Restaurateurs de l’île Maurice, Business Mauritius, World Health Organisation, the police, private clinics and private sector operators, have been called upon to reinforce the surveillance system put in place as regards vector control activities.


Emphasis was laid on cleaning of drains; disposal of wastes; cleaning of bare lands, canals and river banks; cleaning of school yards; fogging and larviciding; community participation and assistance of local NGOs to sensitise the population; and sensitisation campaigns through the media.


Minister Husnoo pointed out that these vector-borne diseases are not endemic in Mauritius but that necessary actions and preventive measures need to be taken so as to prevent the proliferation of these diseases which are transmitted by mosquitoes.


He listed out some of the reasons why Mauritius is vulnerable to these diseases. These are: extensive travel and trade links of Mauritius to dengue, chikungunya, malaria and zika endemic zones; high number of high risk environmental pockets favouring breeding of mosquitoes; and lack of immunity in the population which increases the risks of outbreaks.


Minister Husnoo pointed out that last year there were 28 cases of imported cases of malaria, three cases of chikungunya, 13 cases of dengue and no cases of zika. He called for extreme vigilance since summer months are associated with an increase in mosquito population. “Recently the country has witnessed localized heavy downpours thus resulting in accumulation of water which will lead to increase in breeding places, while overgrown vegetation can serve as mosquito harboring places”, said the Minister.


Several measures have been put in place by the Ministry for the control and prevention of the diseases. As regards disease surveillance, case detection starts at the port of entry. Passengers coming from endemic regions are screened by health inspectors and the thermal scanner at the airport. These passengers are thereafter followed up at their place of residence.


Vector control activities include survey of mosquito breeding sites such as peri-domestic areas and flood prone areas, as well as larviciding which is carried out all over the island throughout the year. Fogging and spraying activities are also undertaken whenever required. Ongoing sensitisation and awareness campaigns through media and at community level are


Source: http://www.govmu.org/English/News/Pages/Prevention-and-control-of-Chikungunya,-Dengue,-Malaria-and-Zika-are-critical,-says-Minister-Husnoo.aspxSource:


Date: February 08, 2018