‘An insufficient community-consciousness and a disregard for the public good on the part of sections of the public are hampering Sri Lanka’s efforts at controlling infectious diseases. This problem is compounded by the fact that the country lacks legislation which compels people to keep their living environments free of squalor and pollutants, which are some of the chief causative factors behind the current spread of infectious diseases in particularly urban areas, Tropical Medicine Specialist, with special expertise in malaria control, Dr. Kamini Mendis said.

Stressing that irresponsible human behaviour contributes largely to the spread unhealthy living conditions and disease, Dr. Mendis told ‘The Sunday Island’ in an interview that proliferating urban congestion and squalor had reached such proportions that no inhabited area in Sri Lanka could be described as ‘residential’ any longer. ‘People live in or in close proximity to slums. Middle class houses co-exist with slums. Buildings are constructed haphazardly with no considerations for their health implications, contributing to massive congestion and a rise in mosquito-borne diseases in urban areas, like dengue and chicken gunya. Today the mosquito population in urban areas is high. This was not the case earlier’, she explained. Since some people completely disregard the health consequences of their actions for others, as in cases where they dump garbage virtually at the doorsteps of their neighbours, stringent anti-pollution legislation must be passed and firmly implemented, as done in countries such as Singapore.

Dr. Mendis who works for the Global Malaria Programme of the WHO in Geneva, recently delivered in Colombo, at the request of the College of Community Physicians of Sri Lanka, the first Dr. F. A. Wickremasinghe Memorial Oration on the topic, ‘Moving from Malaria Control to Elimination’. Dr. Wickremasinghe who passed away in 2006 was a one-time Director of the Anti-malaria Campaign who subsequently functioned as the Director General of Health Services in Sri Lanka and the Regional Malaria Advisor for the South-East Asian Region at the WHO regional office in New Delhi.

A: No, but we nearly did so in the sixties of the last century. It is not possible to ascertain for how long malaria has been prevalent in this country and in 1934-1935 there was a massive malaria epidemic in this country which claimed some 80,000 lives. Since then it has shown signs of decreasing and concurrently the WHO launched the Global Malaria Eradication Programme. With that Sri Lanka nearly eliminated malaria. In 1963 it was so successful here that the number of cases came down to just 17 from tens of thousands or perhaps millions. The whole world thought malaria would be eliminated in Sri Lanka. But this success could not be sustained and malaria returned, becoming a big problem once again, so much so in 1987 we had something like 700,000 reported cases. The number of actual cases could very well have been over a million. Now, once again, it is showing signs of decreasing. This year we had less than 200 reported cases. So, we are coming down to the former levels.

The country needs to make the decision as to whether we are going all out to eliminate malaria. That is, are we to, as usual, control the disease or enter the elimination phase. These are two different things; elimination is not more of control. It involves a change in tactics. In the discussions I have had with the Health Minister, a decision was made to move in the direction of elimination. So, a foundation has been laid for elimination. When I next visit Sri Lanka I hope to explore the feasibility of the elimination proposition.

A: Chances of elimination are good. One big problem that we have today, though, is the war in the North. Because for elimination we need rapid action on every patient and conditions in the North do not permit this. Malaria is endemic in the Dry Zone. Elimination involves having an extremely good surveillance programme. In real time you have to detect a patient. This requires some explanation. Generally, if a case is detected, for example, in Ambalangoda, you get the report routinely at the end of a week or a month. This would not do if you are to detect a patient in real time. Under this arrangement, when a case is reported, everyone concerned has to be alerted immediately. Teams have to go to the relevant location, find out how the patient contracted it, from where etc. Measures must be taken to ensure the disease does not spread, houses must be sprayed with insecticide, blood taken from parasites etc. The disease must be contained at the relevant location as one would a fire which is threatening to spread.

A: Under one method of control, the patient must be treated immediately, because it is the patient who transmits the parasite. This ensures that the patient is removed from being a source of infection. Another method is to destroy the mosquito. This involves spraying houses with insecticides and providing bed nets which are treated with insecticides. The latter method protects the person and results in the mosquito being destroyed when it alights on the net. These are the chief methods of control and they have proved powerful. In elimination too basically the same methods are used.

A: This particular mosquito is different from the mosquito which transmits dengue, chicken gunya and Japanese encephalitis, for instance. The malaria one is found only in the rural areas and mainly in the Dry Zone. It breeds in clear, unpolluted water. Some locations are slow-flowing streams which are unpolluted by garbage and human waste. This is why it is mainly a rural disease in this country. In Madras, on the other hand, it is an urban one. Here, in Sri Lanka, the disease is spread by the Anophelis Culcifacies mosquito.

Malaria is caused by a one-celled organism called plasmodium and this is of two kinds: P.falciparum, which is fatal and P. vivax, which may not kill but is difficult to control.

A: Infectious agents are also constantly evolving. They adapt to new situations. When you use a drug too, they adapt to it. This happened in the case of malaria where the infectious agents adapted to Chloroquine. As they pass through more and more humans they become tougher.

Largely, irresponsible human behaviour helps in the spread of infectious diseases. Today, mosquito-borne diseases like dengue and chicken gunya are prevalent in urban areas. This is because the mosquito population in urban areas is high. This was not so earlier. Today, people live in slums or in close proximity to them. Here there are no ‘residential areas’ any longer.

The unsafe disposal of garbage by urban dwellers and the haphazard, unplanned construction of buildings, for instance, which compounds congestion, increase health hazards. There are some sections of the public which dispose of garbage virtually at the door-step of neighbours or in unsafe public areas, thereby endangering public health. This way the conditions are created for the spread of disease.

Some sections are selfish. It is not sufficiently realized in countries such as our’s, that we live in a community and that we should have the public good constantly in mind. We lack a community consciousness which is essential for civilized living. Matters are made worse by the lack of legislation in this country to prevent irresponsible human behaviour which endangers public health, such as, the unsafe disposal of garbage. This is not the case in countries such as Singapore, where irresponsible behaviour, causing health hazards, incurs severe penalties.

It also must be emphasized that poverty and malaria are linked. Poverty makes people vulnerable to infectious diseases. Infectious diseases, in turn, make them poor. Poverty-stricken areas in this country, which I have visited in the course of carrying out my duties, and where diseases were rampant, had mud shacks as human shelters. Today, reasonably comfortable, presentable houses have come up in those areas and diseases are on the decrease. Thus development and poverty alleviation sees a decline in diseases.