Dengue fever epidemic and the government responsibility

Dengue fever epidemic and the government responsibility

Azas Tigor Nainggolan, Chairman, Forum of Jakarta Residents
(FAKTA), Jakarta

This nation has been exposed to a host of disasters. In the
past two years. Indonesians have suffered through earthquakes,
floods and, more recently, an epidemic of dengue hemorrhagic
fever. This disease, transmitted by Aedes aegypti mosquitoes, has
been raging since early January.

According to media reports, until late February over 17,700
people had contracted dengue fever all over the country and from
this number, 325 people have lost their lives. In Jakarta, the
city worst hit by this epidemic, over 6,200 people have been
afflicted by the disease and 50 of them have died.

In Indonesia, dengue hemorrhagic fever was first detected in
Jakarta and Surabaya in 1968. Since then, it has become an annual
phenomenon as serious efforts to provide short-term, let alone
long-term, disease management and assistance have not been made.

As the disease returns every year (usually close to the
beginning of the dry season), the country's medical authorities
should actually possess good knowledge about how the disease
spreads and how best to deal with it. They should actually have
sufficient experience to be able to take important steps to take
early preventive measures against the disease. The community
should be mobilized to clean up places where Aedes aegypti
mosquitoes are likely to be found.

A proper system should be devised to ensure speedy assistance
for dengue patients. The fact that thousands of people have
become dengue patients and that many of them have died of this
disease only shows the absence of an effective system for short-
term management of the disease.

Likewise, the government has not consistently carried out
long-term efforts to stop the spread of dengue. Ministerial
Decree No. 581/1992 on the eradication of dengue hemorrhagic
fever seems completely toothless. The decree stipulates that it
is mandatory for the government to involve the public in
eradicating the disease. This decree also obliges the government
to devise a strategy to stop the spread of dengue.

Unfortunately, the government has clung to its old system and
every time simply waits until the epidemic is over. It has never
done anything to ensure that this disease is eradicated once and
for all. It has done virtually nothing beyond repeating that a
dengue epidemic occurs in a five-year cycle.

Devoid of any concrete action, the government has busied
itself placing advertisements in the mass media to comfort the
public with an empty appeal that the public should clean up
places where Aedes aegypti mosquitoes are likely to be found,
cover water storage containers and bury things that may harbor
these mosquitoes.

Indonesia should learn from Singapore in managing endemic
diseases. Singapore has taken action to eradicate a number of
life-threatening diseases. This city-state is generally noted for
its strict discipline and clean and healthy environment.

Some time in 1964, there was a dengue epidemic in Singapore
but the number of victims was minimized as a result of the
Singaporean government's concrete actions. They took systematic
and integrated measures in dealing with the victims and made
concerted efforts to free the country from the disease.

In their short-term management of the disease, they
established a system to provide assistance to the victims and
prevent the spread of the disease. In terms of a long-term plan,
they devised law enforcement measures to maintain a healthy and
dengue-free environment. Singapore combined these two steps and
implemented them in tandem.

They also set up medical and law-enforcement task forces. The
medical task force was assigned to provide immediate assistance
to the patients and also to prevent the spread of the disease. To
this end, Singapore issued its Destruction of Disease-Bearing
Insects Act.

Members of the medical task force visited houses, schools,
office buildings and public places to destroy anything that was
likely to harbor Aedes aegypti mosquitoes. If they happened to
detect a house or a place where the mosquitoes were found, the
owner would be penalized for endangering not only his own life
but also the lives of other people. Singapore implemented this
strategy consistently and has since 1996 declared itself dengue-
free.

Indonesia should use Singapore as a model in dealing with the
present dengue epidemic. In fact, the ministerial decree contains
steps to be taken to deal with the dengue epidemic. In this
context, the Jakarta provincial administration, for example, may
draft a regional regulation based on this ministerial decree and
then devise a system to provide assistance to the victims and set
up a task force to remove or cover water sources where Aedes
aegypti mosquitoes are likely to be found. Later, the central
government may issue a law that stipulates sanctions for citizens
that provide an environment where dengue mosquitoes can breed.

What is needed on the part of the central and provincial
government is but a sincere willingness to take responsibility
for their own residents and citizens. The Jakarta provincial
administration, for example, has been able to employ strict
measures to ensure that its Transjakarta (busway) program runs
smoothly. It has allocated a huge budget for this program and
devised strict regulations to facilitate the implementation of
the busway program.

While the Jakarta provincial administration can have anybody
that violates this regulation arrested and penalized, it should
actually do the same in the case of the dengue epidemic that has
claimed many lives to demonstrate its responsibility for its
citizens.
Appeals placed in the mass media, pamphlets carrying the picture
of the governor or reports stating that the President was shocked
at the spread of this epidemic are sorely inadequate. What is now
needed is a willingness to help the patients and eradicate the
source of this epidemic roots and all.

As residents and citizens, we all are obligated to push the
government to assume responsibility and take concrete action to
eradicate this dengue epidemic. There are many ways to do this,
such as by providing input to the government, criticizing the
government or filing a lawsuit against it for neglecting its
responsibility. Let us make this country a healthy place to live
in and let us not give room for a dengue epidemic or any other
disease.