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Day 51 – Coming out of Lockdown Better – Specific Changes for Health

10.05.2020

As we come out of lockdown, there are changes we want in society. We don’t want to just “go back to how it was” because “how it was” was a very unequal, unjust “class society”. Getting that changed falls into the heading of “general changes” that must be on our agenda.


But today I’m thinking about the “specific changes” that are necessary for the health sector. 


In particular we need changes in two aspects of the health system: preventive health and universal, free health care. 


Today let’s look at the first of these, the much-neglected preventive health aspect. 


In Mauritius, if we have been able, today, to reach 14 days with zero new cases of Covid-19, it is in large part due to the fact that we already had a trace-and-test tradition, as well as other measures that date from the eradication of malaria here some 70 years ago. They are invisible services, and often the kind of thing everyone from editorialists to economists to the bosses all refer to as “government wasting money”. The epidemic is a lesson to us that this is the best investment imaginable for any society.


And it is not just now that LALIT says this. 


To give an idea, I invite you to read an excerpt from one of many letters LALIT has written over the decades. This one was written nearly 20 years ago on 21 May 2001 to the then Health Minister, Ashok Jugnauth (Week-End took our letter up on 27 May). The letter gives an idea of the detail in LALIT we always go into on preventive health measures against epidemics:


“Dear Sir,


“It is with great concern that we have learnt of cases of malaria being contracted in Mauritius and of the death toll having risen to two people (who contracted malaria abroad) and died here.


“We are shocked that the new government has not yet re-opened the counters at the Airport for the customary health checks.


“In particular we accuse the Ministry of Health of gross negligence. We explain.


“a) If there is one genuine accomplishment of the Mauritian state in all its history, it is the fact that ours is perhaps the only country in the world to have eradicated malaria after it had been the MAJOR cause of death in the country.


“b) This total eradication, and the subsequent maintenance of a state of zero local infections, has been due to an initial popular mobilization to destroy all breeding grounds, and then to ongoing policies of the Health Ministry, in particular: cleaning and spraying work done by government labourers (in Kreol called “malarya”); door-to-door checks by officers (in Kreol called “marsan lafyev”), who also do follow-up calls on all incoming visitors from endemic areas after they have filled in a form at the “Health check” counter at the airport, which is the key to the success of the program.


“c) ... We are also shocked that you have been in charge of the Health Ministry since the formation of the new government, and you have not re-instated these same health counters.


“d) If two desks, for checking if people had travelled to any country where malaria is endemic, were allegedly “slowing down” disembarking passengers, then two more should be added when you re-instate the tables.


“e) It is a fact known to all who collect data, that people respond with more accuracy if they know WHY a question is being asked, and BY WHOM  it is being asked. In particular, when public health is concerned, the questions as to where one has travelled and what one’s address in Mauritius is, are questions which citizens will answer with extreme accuracy, if they know that it is the Health Authorities that will be using them. By sharp contrast, if people know that it is the police and immigration authorities, there can be expected to be the usual resentment. There are even, we hasten to point out, questions about the fundamental right to freedom of movement that are posed. (In a road block for example, the police can ask name and address and questions about insurance and road tax, but not “where you are going to be this week” or “where you have come from” or “who are your friends” or “where do you work”. This kind of question is only asked by police in a police state.)  ...


“f) We believe that perhaps the SINGLE MOST PRODUCTIVE WORK SECTOR in the country is the malaria control workers - whether at the airport, or home visits, or canal clearing, or spraying. These are workers who produce inestimable wealth, by preventing illness and premature death.


“g) We have been informed by workers in the sector that there are today LESS officers doing door-to-door [trace-and-test] checks than there used to be. ...


 “We also call on you at once to recruit government labourers to clean up canals and spray against mosquitoes. We call on you at once to recruit government officers to do door-to-door checks, on a massive scale. ...


 “You are in a position where history will judge you. Will you be the Health Minister in office when the country starts to be invaded, once again, by the killer-disease?”


Lindsey Collen


for LALIT, a personal view.


PS Thank you to Kisna for the research work.