Beware of dengue fever

As many as 32 of 5,800 people suffering from dengue fever in Jakarta have died since January, while last year 5,750 cases of the same scourge occurred in Jakarta, but the number of fatalities was not made available.

This is a shocking reality that deserves the serious attention of the public, the government and the city administration. Surprisingly, however, head of the City Health Agency Choliq Masulili described this year's situation as "normal", merely because the fatalities amounted to "only" 0.05 percent of the total dengue fever cases that occurred in the capital city during the last four-and-a-half months.

Early in March this year, a health official warned of the possibility that the capital could experience the peak of the lethal disease's five-year cycle during this year. In May, another official from the same office announced that 32 people were killed by the disease.

What does all this mean?

Data recorded by the City Health Agency shows that cases of dengue fever in the Greater Jakarta area hit a high of 15,360 in 1998, 3,998 in 1999, 8,729 in 2,000, 8,820 in 2001 and 5,750 in 2002. Either the population has failed to respond to City Health Agency warnings, or the agency has done nothing significant to encourage the public to deal with the Aedes aegypti mosquitoes that carry the dengue fever virus.

The large number of victims could also indicate poor public awareness of the importance of healthy living in a healthy environment. Most residents, however, have been duly informed of the vital importance of keeping their neighborhoods clean in order to prevent the disease from spreading. They surely also know that the disease is transmitted by the Aedes aegypti mosquito, which lays its eggs on the surface of pools of water.

Nevertheless, any visitor to most of Jakarta's kampong neighborhoods is most likely to be presented with the sickening sight of clogged, open sewers and residential complexes that are far from clean and tidy. It appears that many of Jakarta's residents are still ignorant of the importance of environmental health, which they seem to consider second in importance to earning their day-to-day income.

There are those who speculate that the public's ignorance could be seen as an apathetic response to the constant exposure to anti-dengue fever campaigns on televisions, which have been aired for years. New diseases, such as Severe Acute Respiratory Syndrome (SARS) may have diverted public attention away from the dengue scare.

Unfortunately, concrete data to substantiate such conclusions does not exist. Therefore, a study by local health offices in cooperation with local administrations is needed, in order to find out why people have failed to protect themselves against dengue fever attacks, despite repeated warnings.

People are usually jolted and become aware of the hazard of dengue fever only after members of their family or neighbors are stricken by the disease. Another factor could be that the authorities' efforts to help the public curb the spread of the disease have been inconsistent. We have heard complaints from residents about the difficulty of getting help from either their district or subdistrict offices, whenever cases of dengue are reported by the public. What residents usually do in such cases is act on their own to raise funds to pay for fumigation in their neighborhood.

Implied in this complaint, apparently, is the suspicion that fumigation and other efforts to eradicate mosquito larvae might be a profitable business for at least some of those in charge of health affairs at the subdistrict or district level. In short, the public cannot rely on the authorities to combat dengue outbreaks.

One doctor in Jakarta revealed that in 2001 the government set aside only Rp 2 billion (approximately US$225,000) for fumigation to eradicate mosquitoes. The ideal amount was Rp 9 billion to Rp 10 billion. That is why it is important that the public is made aware that it cannot rely on the authorities for prevention of the disease, but that they must take the initiative themselves.

It is imperative that everyone in the city be aware of the danger of the disease and thus maintain the cleanliness of their environment. In the meantime, we can only hope that the authorities will be more proactive and vigorous in their efforts to prevent the scourge by improving their databases on everything related to the disease.