By Maya Trotz
Dr. Maya Trotz is an Associate Professor
of Environmental Engineering at the
University of South Florida.
11/13/13. Woman succumbs: Tobago reports first dengue-related death in 2013 – Trinidad & Tobago Express.
10/11/13. Barbados: More than 600 Dengue Fever Cases Confirmed – Prensa Latina.
10/10/13. St. Lucia on ‘high alert’ following suspected dengue death – Caribbean360.com.
9/27/13. Grenada Ministry of Health expresses concern about Dengue Outbreak – Spice Islander.
Dengue. Aching bones, high fevers, fatigue, even death. Spread by certain species of mosquitoes within the genus Aedes, dengue currently impacts the lives of many in the Caribbean, especially in urban areas. Eliminating breeding grounds, standing water in particular, is the most affordable, sustainable and sensible way to stop the human infections. Yet we let our drains clog, our roof gutters fill with leaves, our outfalls silt up, and we let open containers fill with water in our yards and garbage heaps. In Guyana we are six feet below sea level along the coast and an adequate and well-functioning drainage system is critical, but drains don’t work, most are filled with garbage and weeds (unless there is some special occasion or some route that has to be temporarily cleared because some dignitary or other big one is visiting and is driving by), gutters and trenches are filled over for construction (much of this is probably illegal, raising questions of who issues these permits and who inspects these sites, and who is ever held accountable in our fair land), so the water has nowhere to go when it rains. But we hate when our drains overflow and it floods, we think garbage heaps are disgusting, and we certainly hate mosquito bites. Or so I think.
Failing water and garbage infrastructure are common in the Caribbean, with much detachment of citizens from their proper functioning. In fact there is much detachment of citizens from understanding the need for this type of critical infrastructure throughout the world and I see it as the biggest failure and current challenge of the Civil and Environmental Engineering profession. Dengue is also on the rise in the Caribbean with not enough public awareness about what it is, how it spreads, or the impact it has on human health and productivity. Blood tests confirming dengue infection are likely lower than actual incidence. Many don’t know what dengue is or even aware that they have it. Many doctors don’t test for it. Data is difficult to obtain, if it is even reported. Even more difficult is an idea of areas across the Caribbean and within each country where cases are occurring.
Usually found between the Tropic of Cancer and the Tropic of Capricorn, dengue plagues not just the Caribbean. In Lahore, Pakistan, there were approximately 20,000 cases of dengue recorded in 2010 with over three hundred deaths. For 2013, the number of recorded cases is but a few hundred. Many credit mobile phones and a computer scientist for this dramatic decrease in Lahore. Umar Saif, a computer scientist who was named a Young Global Leader by the World Economic Forum in 2010, created a dengue monitoring, prediction, and action platform. Using Google maps, the locations of dengue cases from hospital reports are overlain with hot spots for mosquito larvae from surveillance activities. The surveillance activities are routinely conducted in Lahore and the surveyors use the smartphone to indicate where the larvae were present. Algorithms are then used to predict where the next outbreak might be and the government agency in charge of services then pushes action on the ground. An inspection officer takes a photo of the area before any intervention and then another photo after a sanitation worker who he is supervising completes a clean up activity (e.g. clean drains, trash). The sanitation worker’s picture is included in that image and all of the photos are submitted via the smart phone app. In 2012, 67,000 such interventions were photologged by supervisors. This example of how mobile phones and computer technology combine with clean up actions does make one wonder if it can be translated to other places, including our very own Caribbean.
Given that government budgets are slim where water and waste infrastructure and services are concerned and what we pay as citizens for those services are even slimmer, the Caribbean probably will not get very far with an approach that relied on an inspector to take a picture of a worker cleaning up our surroundings. Given that we don’t monitor for dengue larvae and we hardly track where dengue cases are coming from, as well as the small percentage that do get tested, we probably should not rely on these formal mechanisms to gather data, share it, and do something.
But there are people who have dengue in the Caribbean. And they are using social media to share their experience, to get guidance on their care, and to learn about options for dealing with the problem. Some in St. Lucia have even created a google map to post who has it and where. Three posts are now there, but there is no link to anything that explains its purpose. There are people who have lost loved ones to dengue in the Caribbean, and they are using social media to share their experiences and offer guidance to those currently experiencing it, usually stressing to readers that it should not be taken lightly. These interventions all remain individual and independent, except for those within their virtual circles who give support, provide advice and share their stories. The region may lack money to pay personnel to do surveillance of our surroundings for mosquito larvae. It may lack the money to pay personnel to fix all of our water, wastewater, and garbage infrastructure so that they not only work, but no longer breed mosquitoes. What the region does not lack is people who like to interact, socialize, and talk with each other. Surely that is a huge resource.
Beatdengue.org is an initiative that we hope to launch in early 2014. It is about people. It is a smart, people-centred approach to reduce flooding & improper storage of water, improve how we deal with garbage, and in the process stop dengue infections in the Caribbean. The idea started a month or so ago and is driven by the experience of someone from Guyana that drove me to find out more about dengue in the Caribbean (close to a week of misdiagnosis of the symptoms for food poisoning ended up with hospitalization and a thankfully short stay in the ICU, where a simple test finally revealed dengue infection). Through social media, it became obvious that many people had similar questions and many people had the tools to help roll out such an initiative. Some of the people who have so far volunteered to help include Dr. Kenfield Griffith and Mr. Louis Majanja of mSurvey (http://msurvey.co.ke/), a Kenyan based company that makes sense of data through a wide variety of automated interactive experiences on a simple mobile phone. A few hours after asking them for help Mr. Majanja sent a number for me to send a text with the word “dengue”. Immediately after I did that I got a three question survey asking me whether I had it, what were the conditions of drains etc. in my area, and where I was located. Dr. Asante LeBlanc, a Trinidad and Tobago based doctor associated with Victoria Clinic (http://www.victoria-clinic.net/) which works to promote healthier lifestyles, has also generously agreed to share her wealth of knowledge on health indicators and treatment, including her recommended dosage of papaw/papaya leaves to increase platelet counts when suffering from the illness. More volunteers are needed, especially those with graphic arts and multimedia skills to create educational and action oriented materials that make sense and that represent Caribbean contexts, and that can do this in a manner that can reach the widest number of people as possible.
In the absence of a public education campaign, and lack of consistent and adequate information from public health officials across the Caribbean, we need to be aware of dengue and the danger it presents. This is not the scaremongering some may want to make it out to be – there was a dengue related death in Tobago last month; To date in Barbados there are 676 confirmed cases with two deaths; in Guyana persons are falling ill with dengue right in Georgetown.
And let us put our heads together to work on a comprehensive plan to beat dengue across our region. The Caribbean Science Foundation held its third annual workshop at the Grand Coastal in Guyana on December 2nd and 3rd, 2013 (http://caribbeanscience.org/). Innovation from Science Technology Engineering Mathematics (STEM) was a recurring theme. The above discussion hopefully places some light on how our everyday challenges in the Caribbean can use STEM tools along with those from multiple other disciplines to develop solutions that are innovative and that can even transcend our island boundaries. This is something that secondary school students who participated in the 2013 Sagicor Visionaries Challenge were asked to do: Solve local challenges and show how they used STEM to come up with a sustainable solution. Students from the Saraswati Vidya Niketan school in Guyana proposed, “Eradication of mosquitoes using Bacillus Thuringiensis”. Given that many residents in the village of Cornelia Ida as well as other villages on the West Coast of Demerara complained of mosquitoes, the students set up aquariums to test the ability of a bacterium to kill the mosquito larvae that one would find in a trench or body of standing water. According to them the bacteria secrete toxins that kill the larvae, but would not harm aquatic life like fish. Students at the Leon Hess Comprehensive Secondary School in St. Lucia titled their community based clean up and education campaign, “Mosquitoes Be Gone.” The Leon Hess students surveyed 15 houses in the vicinity of their school and found roughly 50% had persons with dengue in the past few months. They also found that about seventy students at the school had dengue over the past three years. The younger generation is probably much more in tune with using mobile apps and online programmes and may end up being one of the more critical groups to really beat dengue in the Caribbean and beyond.