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.