Living with dengue

Dengue hemorrhagic fever, that treacherous mosquito-borne disease that comes with little warning to torment the unsuspecting, is with us again. Or so Jakarta's city health office warns us.

It is easy enough to sneer at the warnings issued by health officials about the dengue scourge. After all, many warnings that have come from the bureaucracy have been either off the mark or too late in coming to be of much help.

Unfortunately, though, the cold statistics reported in the media in the past few weeks, courtesy of the Jakarta Public Health Office, do indeed give reason to keep up our guard, keeping in mind the truism that prevention is the best medicine. This is especially true, given the alarming scale of the dengue outbreak that hit parts of Jakarta during the first half of last year.

In the space of just four days last week, the number of dengue cases rose dramatically from 197 to 263, which is an increase of 66 new cases within that short time. Not an overly alarming increase, one might say, considering that in February last year, at the peak of the 2004 outbreak, 472 new cases emerged within just three days, bringing the total to 2,518. But officials warn that the current outbreak is likely to reach its peak only next month, or possibly later.

February is the time of year when rainfall is at its highest and dengue outbreaks usually reach their apex. Statistics for 2003 and 2004, however, clearly show that there is nothing predictable about dengue outbreaks. Peaks can be reached well beyond the month of February, as late as March or April, or even May and June -- as happened in 2002, when 1,131 dengue cases occurred in the month of May alone, and again in 2003, with 2,685 cases recorded in June and 1,070 more the following month.

While the dengue mosquito, Aedes aegypti, is ready to attack anyone indiscriminately, dengue hemorrhagic fever primarily afflicts the underprivileged living in poor and unkempt places where all sorts of junk can be found for small pools and puddles of clear water to form, providing a welcome breeding ground for the mosquito.

Prevention of the disease, therefore, cannot be left to the public health office or the medical profession alone, but must involve the community as a whole. With that purpose in mind, the Jakarta administration has issued a number of instructions for public health officials to follow in the case of dengue outbreaks, hopefully with the support of all of Jakarta's citizenry.

The obvious first step is for every citizen and resident to prevent the Aedes aegypti mosquito from breeding by cleaning up their own immediate environment. Easy as this step may seem, few households appear to be ready to comply with the health office's instructions. Whether laziness or indifference is to blame, this clearly demonstrates the need to educate the public in the importance of clean living.

Overall, the work plan to fight the dengue outbreak this time appears to be helpful enough, at least on paper. The strategy calls for doctors and public health centers (Puskesmas) to immediately report all cases of dengue in their area of jurisdiction, even suspected cases, to the city public health office, which will then instruct the Puskesmas to take wider action.

If convincing evidence of dengue is found, health officers are instructed to conduct further examinations to determine whether or not the local case(s) pose a real risk in the neighborhood. The health agency will then decide what action to take to prevent the disease from spreading.

With all the necessary arrangements now seemingly in place, all that Jakarta's citizenry can hope for is that this time around the lessons of the past will have been learned and that the plan will prove effective in attenuating the effects of the current dengue outbreak on the populace. With the rainy season currently peaking and floods threatening whole neighborhoods all across the capital, Jakartans have no need for more catastrophes to upset their lives and livelihoods.