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A raging fever in the blood

By Tony Deyal

It just happened in Jamaica, but with a vengeance and some missiles.  According to the Jamaica Gleaner (January 13, 2020), Vector-control personnel carrying out fogging exercises are facing hostility from residents across Jamaica, with the latest reported incident in St Catherine. Having worked as a Dengue Communications expert for many years, I believe the response, though extreme, is not unexpected and some people might believe it is long overdue.

The reason is that in the midst of raging dengue epidemics, the cry goes out throughout the lands of the Caribbean, “Let us spray.” And there goes forth the word from ministries of health that the whole world should be sprayed. Then they drag forth vehicles that make noises and send out fumes and vapours so that the faithful would know that the ministries of health are interested in their well-being and are supposedly saving their lives. The birds of the air, the bees in the bush and the fishes of the lake die but the mosquitoes continue to thrive.

This is because the faithful, despite keeping their windows closed against the toxic substances, praise those on high for heeding their pleas for help. Meanwhile, the Aedes Aegypti mosquitoes, safe inside the houses, especially the larvae and little ones in vases and flower-pots, with no Herods in sight, live happily ever after.

What makes it worse is that year-after-year the ministries of health are continuing to use the same response even though the situation has changed drastically. It used to be that in the rainy season the mosquito problem reached a point where communities put pressure on their parliamentary representatives and the ministers of health. Out came the ubiquitous spray machines. Citizens praised the government. The government patted itself on the back. The health sector knew that after the collateral damage of a few deaths and some illnesses, especially among children, the dry season would soon come and give them a well-earned break.

That was then. The problem now is that climate change has removed the very distinct wet and dry seasons and replaced them with long periods of severe drought interspersed with episodes of sharp, short, very heavy showers. There is no respite, no period like long ago when the distinct dry season reduced the deaths for a while and gave everyone a breather. Aedes Aegypti and other mosquitoes, including the feared Asian Tiger, now go forth and multiply in ever-increasing droves right in and around your home 24/7, 365.25 days a year. To believe that fogging would deal with the problem, the health sector has to be more stoned than the vector control workers in St Catherine.

Yet, the spraying continues despite the change in climate and the fact that all ministries of health, and all medical officers of health, know that the best means of dealing with dengue is source reduction of mosquitoes. This means not providing them with breeding places and spaces as well as dealing with the larvae before they are hatched. The health sector officials know that the dengue-spreading mosquitoes love clean water. The Aedes Agypti live where they can get a quick snack, especially at dawn or dusk. They don’t live in dirty drains or “lime” on street-corners.

Dengue has four “serotypes” or variations of the disease. Working in the Caribbean on Dengue projects, I got all four, each worse than the previous one. It was ironic than when I got the last one (I won’t say “contracted” because it was a one-sided agreement), I was a resource person in a Dengue workshop in Barbados. When I saw that the vase in my expensive hotel room had mosquito larvae in it, I knew two things.  The mosquitoes had already planted their spies to find out what we were planning and that there was nothing I could do but pray since I was already prey. When I told a friend how ironic it was that I got dengue at a regional gathering of dengue experts, his response was, “Is a good thing it wasn’t an AIDS workshop.”

Dengue makes it very difficult to eat anything. It attacks your salivary glands and taste buds, mugging them into submission. It is a virus that wages a relentless attack on your system. There is constant pain behind the eyes and in the joints. Some muscles, even the large frontal thigh muscles, become cramped and virtually useless.  The tablets buy a little time and space in the ongoing drama of pain but as the hours’ pass, the pain returns with the violence of tsunamis and the fever once more tops the charts. Dengue is appropriately called “break-bone” fever.  It leaves you “mash-up” for periods up to three weeks. In fact, some people take much longer to recover from its effects. What is even more frightening is the relapse period when you come out of the hospital, feel better, work hard and then collapse.

There are two things to avoid.  One is any drug or tablet that is aspirin-based. This makes you bleed internally and can cause Dengue Hemorrhagic Fever (DHF). The second is to keep your spirits up and not succumb to depression induced by the combination of the disease, the medication, and the health sector’s callous insistence on spraying on the road outside the house when Dengue lives close to its food – meaning you, me and everybody else. In legal terminology, they are the in-house lawyers and not the outhouse ones.

During my last and very serious Dengue attack, I made a joke about my situation and wrote that after three days, my wife Indranie was finally forced to concede that I was very good in bed. However, she thought that I could have done a little less moaning, groaning and heavy breathing. Things got so bad that I ended up in the hospital with a raging fever in the blood which forced me to exchange Indranie’s ministrations for IV with whom I spent a few bedridden days and nights.

Perhaps it is that same fever in the blood which is now causing “misguided individuals” in Jamaica to throw stones at the vector workers. While it is definitely not the answer to their problems, I believe it should be taken as a relevant question about the politics of health in the Caribbean. If we don’t intend to deal with dengue at source, then it would be better, and perhaps more effective, to pray than to spray.

*Tony Deyal was last seen saying that if you don’t intend to deal with Aedes Aegypti in the homes of the people, then don’t live within a stone’s throw of them.





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