Eve Clinic for Women & Children, located near Nalahiya Hotel, will be opening its doors in January 2010. I hope to be able to start work from the first day of operations.

I have had a long chat with a Minivan News journalist a short while ago. She is planning to write an article about the concerns that I have raised. Finally, some responsible journalism; or did I speak too soon.

Anyway, I hope the messages that need to get through does. We have had some very sick Dengue Fever cases in last few weeks. We have had some very close calls in that time. The number of cases we are getting are not small. They may not have reached a peak yet; meaning it could get worse before it gets better unless we act now. 

The rainy season IS here. We would be foolish to ignore the lessons from natural history of mosquito breeding. We must expect a boom in mosquito population just after the rain. The clear water "pools" that Aedes mosquito likes to use for breeding would be plenty. That could mean an increase in the mosquito responsible for spreading Dengue Viruses.

I hope the hospitals across the country would help Center for Community Health and Disease Control (CCHDC) in assessing the national and regional case incidence by reporting ALL cases that get diagnosed as Dengue Fever or are suspected as Dengue Fever. I suspect the present case reporting to be very weak - especially within Male'. I suspect that many cases that get screened at clinics and probably more at main hospitals don't necessarily get reported to CCHDC. They must ALL be reported for CCHDC epidemiology unit to be aware of the actual scenario. Otherwise we face a discrepancy between what we as clinicians see and what the CCHDC analyzes our epidemiological status to be.

We should NOT wait till we actually reach the peak incidence before we take steps to stop disease spread. Why would we want to do that when we could act earlier and help prevent that peak from appearing in the first place?

Mosquito control need not be an expensive intervention. We have had some extremely positive responses from some of the island communities in past years. I have witnessed, first-hand, community action at Gaaf Alif Thinadhoo the year before last, when the public cleared all mosquito breeding areas from one end of the island to the other during the office weekend! I know many other communities did the same during that period. 

The public need to be informed and energized into action. As a clinician I too have a duty to my community. The least I could do in this situation would be to voice my concerns and get people to act to avert possible morbidity. I call on all communities to take steps to control mosquito population in their locality. Prevention is possible. All communities can prepare their own interventions. It does not have to be fogging the island with insecticide spray. That could help in the short term. It is not something that I would recommend. Removing mosquito breeding places is more effective in the long run. It is more cost-effective as well.

I also hope that some parents of kids who have had severe forms of Dengue Fever share their experiences; positive and negative with the public. Some of them have had very traumatic experiences with a few of them having to bear the sorrow of losing a loved one. Their words and they themselves could help pressure the authorities, get NGOs active and energize the public to work together.

I also got a message from the newly established Maldivian Red Crescent society that they too are planning activities in the islands to help educate the public about Dengue and also plan community action to control mosquito population. I welcome the news. I hope to contribute in any way that I can.

I just hope, like everything else these days, this public health issue does not get hijacked by anyone for political gain. I hope journalists would be aware of this dimension to our current socio political climate and take great care to deliver their end of the social responsibility to the community in a clear and responsible way.

There is hope. All is not lost. It never is.

The exact data is held elsewhere and not readily available to the public. Perhaps the numbers this year have not reached that critical level for the monitoring system to ring out alarms. What I am stating is a clear observation that my colleagues and I have been noting for the past many years. I was going to say that this year is no different. It is similar in that the peaks is here. But it is worryingly different too; the severity of the cases are significantly higher than usual. We have had more than a few cases already this year when we (and the families) literally held our breaths. We have largely done very well and we have been a bit lucky as well; we have escaped without a mortality. May Allah keep it that way, Ameen.

I am nonetheless very concerned. I fail to see an appropriate response from public health authorities, the media and even concerned public to this almost predictable public health emergency. I have talked to media personnel many times over the past few weeks. They are mostly interested in other, apparently news-worthy, topics and not so interested in information and concerns related to service-crisis at public healthcare institutes or emerging medical public health concerns such as this. I hope at least some of the reporters I have spoken to would write about these issues and increase public awareness and call them and the authorities to action. 

The control of Dengue fever requires mosquito control measures such as clearing their breeding micro-environments and use of personal mosquito repellents and barriers. I would urge all readers to share this information with their contacts and get everyone working towards prevention of mosquito breeding in their home environment. We can all do our bit. Prevent water-logging in our household; in empty cans, rooftops, drains, gardens, wells, construction sites, etc. Similar water-logging in public places such as state buildings, parks, construction and work sites must be addressed by the concerned authorities. Such water-logged micro-environments are used by mosquitoes to breed their progeny.

With Dengue peaks being so predictable we could come up with "pre-season" activities to create awareness and conduct activities to prevent the peaks rather than, year after year, just respond to a crisis.

The rainy season will soon be upon us. Perhaps it is not too late already.

Most regions of the world have controlled Measles to pre-elimination levels already. SEAR remains the only region which is far, far behind in achieving that goal. One country in particular, India, for various geopolitical reasons is the stumbling block in this endeavor. The larger majority of measles cases and deaths from Measles at present occur in a few states of India. Much effort is being put in to tackle the problem. However, we came to the realization that much more needs to be done. 

According to available knowledge, Measles elimination is biologically possible and feasible. Many of the experts believed that provided a concerted effort is put in and sustained for a few years across the world; in particular in the hots spots of UP and Bihar of India, we would be able to eliminate measles from the region and then eradicate it from the world. An estimated 130,000 kids continue to die in India from Measles every year; a number that could well be prevented by use of currently available measles vaccines.

Well, the meeting decided to advice the regional high level meeting - which will be underway in Nepal in a few days time - to set the goal of 2020 for elimination.

Maldives with our high coverage of measles vaccines should be ready to push for elimination should the target be set. Much would need to be done to ensure that vaccine uptake is sustained at the currently high levels to make the effort fruitful. Our biggest challenge would be to address the emerging issue of vaccine refusal in the Maldives.

I hope to be involved in a meeting to address this very issue in the very near future. 

I will be traveling to Delhi on an official visit from 24th to 28th August to participate in a WHO conference on Measles eradication campaign. During this period I may take more than the usual time to respond to questions you post on this blog. I am sure you will understand.

Will write about the meeting when I return.

Take care,

Niyaf

Those who now hold the responsibility of running IGMH seem to be all too happy to let someone else shoulder the burden. Attempting to revive the ailing institution, one could deduce from their eagerness to sell, would, to them, amount to political suicide. To sell the idea of selling IGMH, they are showing the truly terrible condition it is in and by allowing the decay to rot the institution to its core they'd like people to smell the stench till everyone gives in to the idea. It does reek even now.

On the other side of the political divide are those who would love to see the institution crumble to dust so that they may lay all blame on their opponents; again for political gain. So it would seem that IGMH has it's fate sealed. After all, it is a win-win situation for both parties.

The dotted line has apparently been prepared already. It only needs that fateful stroke of a pen. That is where we are at now. At least that's what we are being told. It is either Corporatization or Public-Private Partnership.

Corporatization is a nice way of saying that it would be sold to a private company to run as a business. Privatization is apparently too easy to digest so we go by a word that many can't even chew. We are resigned to the statement that if we are unable to manage it by ourselves; we may as well get someone else to manage it and make it viable. Now, wouldn't that be nice and easy!

I have to admit. I am pretty disappointed that it has come to this. But we all saw it coming. Years of neglect, not just since last November, has got all of us in this situation for which many of us can't see another option. There are other options but there is hardly any trust left.

Then there is this remote possibility that "we" would not lose control altogether. The Public-Private Partnership where the ownership is with the state but managed by a private party as a business venture. A bit like what has been happening all along, but now with the legal blessing. I wonder if the money skimmed to private accounts would be legal in that situation! Just a thought.

I am yet to be convinced that either of the plans have been studied well enough from a public service point-of-view to throw all fears away and take the plunge. The water looks scary and dark from where I stand.

Then again; I could change where I stand. Listening to one of the chief architects of Operation: Bin the Junk say "our way or the highway" was probably a divine a sign for us. Perhaps the highway would be a good place to stand. Another thought. And in one day. I must be on a roll today!