viral outbreak

How rubber plantations are exacerbating the dengue outbreak in one north Kerala area

Anywhere between one-third and two-thirds of Koorachundu panchayat’s population has been affected by fever.

On Monday, 48-year-old Jolly pawned her gold ornaments for Rs 15,000. Jolly had just recovered from a bout of viral fever. But her husband, son, brother and sister-in-law still had fever and were being treated for it at the Koorachundu community health centre.

“All the members in my family are under treatment for fever,” said Jolly. “Even if they recover, they have to take rest for one month. I do not have any option but to pawn my ornaments.”

Many residents of Koorachundu, a hilly gram panchayat in Kozhikode district in north Kerala and 40 km from Kozhikode city, have been affected with fever in the last three months. Media reports suggest that about 12,000 residents have been infected with some kind of viral fever in the panchayat, which has a total population of 17,000. However, health officials say that this is an exaggerated figure as the total number of patients who visited the community health centre did not exceed 6,000.

“We have not done any official enumeration of the number of fever-infected persons,” said KS Divya, medical officer at the Koorachundu community health centre. “The figure should be less than 6,000.”

Kerala has been in the grips of a severe health crisis since June due to the spread of dengue and H1N1 or swine flu. The Integrated Disease Surveillance Project, the government’s disease monitoring system, indicated that 12 lakh people were affected by some kind of viral fever this year. The project confirmed 7,473 dengue cases till June 21. Thirteen deaths have been confirmed as dengue deaths while 51 others have been classified as suspected dengue cases. As many as 86 swine flu cases were confirmed in the state till June 21.

Thiruvananthapuram has been the district worst affected by fever followed by Kozhikode, where Koorachundu has registered the maximum number of fever cases.

The microcosm of the Koorachundu panchayat reflects the falling health standards across Kerala. On Monday, hordes of patients waited at the community health centre. They had been there since 7 am, a good two hours before the arrival of doctors, nurses and para-medical staff.

Long queue for blood tests at the Community Health Centre in Koorachundu. (Photo: TA Ameerudheen)
Long queue for blood tests at the Community Health Centre in Koorachundu. (Photo: TA Ameerudheen)

The health centre managed the crowd of patients and their relatives only with the support from volunteers, who distributed tokens and ensured everyone formed queues to see the doctors and to get laboratory tests done. The volunteers carried patients who could not walk or set them in wheelchairs and provided them with water, tea and rice gruel.

The community health centre administration has pressed three ambulances into service to shift patients with complications to the Government Medical College Hospital in Kozhikode and to other private hospitals. On Monday alone, 40 patients were shifted to other hospitals for advanced treatment.

The community health centre functions for 11 hours these days. “We have detected six confirmed and 66 suspected dengue cases,” said Vidya. “But what frightened residents was the death of five people due to dengue fever.”

Death report prepared by the medical officer at Koorachundu community health centre. (Photo: TA Ameerudheen)
Death report prepared by the medical officer at Koorachundu community health centre. (Photo: TA Ameerudheen)

Kerala has the lowest infant mortality rate in the country, with only 6 deaths for every 1,000 children born, which is equal to the infant mortality rate of the United States. The state also has the highest lifespan of 74.9 years among all Indian states. But the fever outbreak has exposed the chinks in this rather robust healthcare system.

The director of state health services RL Saritha said spurt in fever cases should not be construed a big problem with the healthcare system.

“Infectious diseases will increase during monsoon,” she said during her visit to Koorachundu community health centre on Monday. “The health department has taken all measures to check the spread of diseases.”

Saritha said the fever outbreak was under control even though the number of fever patients visiting hospitals is rising every day.

Dengue among rubber crops

Koorachundu is a predominantly farmers’ village. Rubber is the major cash crop and the farmers made good fortunes before the prices slumped sharply in the recent years. Now rubber cultivation is not profitable and farmers have stopped collecting the latex from rubber trees. The cups that they used to collect the latex with now get filled with rain water – the perfect breeding ground for Aedes aegypti mosquitoes that transmit the dengue virus.

Cleaning in progress in Koorachundu. (Photo: TA Ameerudheen)
Cleaning in progress in Koorachundu. (Photo: TA Ameerudheen)

Health officials in Koorachundu have requested all rubber farmers to remove the mugs from the plants. “Removing the mugs will deny mosquitoes a major habitat,” said KC Basheer, a health inspector attached to the community health centre.

Another reason for the spread of mosquitoes, Basheer said, is the fact that coconut farmers had not cleaned the crowns of palm trees, having neglected their crops after a fall in coconut prices. These fibrous stalks that remain on a palm tree also provide a good habitat for mosquitoes.

Basheer insisted that Koorachundu would become fever-free panchayat with active vector control measures.

Meanwhile, some residents attributed the the fever outbreak to unscientific waste disposal from pig farms in the panchayat and dumping of hospital waste from Kozhikode city on private land in the area.

Volunteers carry patients on wheelchair at the Community Health Centre in Koorachundu. Photo TA Ameerudheen
Volunteers carry patients on wheelchair at the Community Health Centre in Koorachundu. Photo TA Ameerudheen

“The medical waste contaminated water and provided ideal climate for mosquito breeding,” said aanganwadi teacher Jolly. “It made us all patients.”

Though the number of patients at the Koorachundu community health centre has slowly been coming down, some people who recovered from dengue have got infections for the second time.

Fifty-year-old Aboobaker recovered from dengue fever a week ago, but he came to health centre on Monday again with high fever.

Divya, the medical officer, is worried by these cases of repeat infections. “Four serotypes of the dengue virus are in circulation,” she said. “Persons who get infection for the second time should be very careful. The second infection might have caused by a different serotype.”

Fever patients waiting for consultation at the Community Health Centre in Koorachundu. Photo credit: TA Ameerudheen
Fever patients waiting for consultation at the Community Health Centre in Koorachundu. Photo credit: TA Ameerudheen

This reporting project has been made possible partly by funding from New Venture Fund for Communications.

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

Relying on the power of habits to solve India’s mammoth sanitation problem

Adopting three simple habits can help maximise the benefits of existing sanitation infrastructure.

India’s sanitation problem is well documented – the country was recently declared as having the highest number of people living without basic sanitation facilities. Sanitation encompasses all conditions relating to public health - especially sewage disposal and access to clean drinking water. Due to associated losses in productivity caused by sickness, increased healthcare costs and increased mortality, India recorded a loss of 5.2% of its GDP to poor sanitation in 2015. As tremendous as the economic losses are, the on-ground, human consequences of poor sanitation are grim - about one in 10 deaths, according to the World Bank.

Poor sanitation contributes to about 10% of the world’s disease burden and is linked to even those diseases that may not present any correlation at first. For example, while lack of nutrition is a direct cause of anaemia, poor sanitation can contribute to the problem by causing intestinal diseases which prevent people from absorbing nutrition from their food. In fact, a study found a correlation between improved sanitation and reduced prevalence of anaemia in 14 Indian states. Diarrhoeal diseases, the most well-known consequence of poor sanitation, are the third largest cause of child mortality in India. They are also linked to undernutrition and stunting in children - 38% of Indian children exhibit stunted growth. Improved sanitation can also help reduce prevalence of neglected tropical diseases (NTDs). Though not a cause of high mortality rate, NTDs impair physical and cognitive development, contribute to mother and child illness and death and affect overall productivity. NTDs caused by parasitic worms - such as hookworms, whipworms etc. - infect millions every year and spread through open defecation. Improving toilet access and access to clean drinking water can significantly boost disease control programmes for diarrhoea, NTDs and other correlated conditions.

Unfortunately, with about 732 million people who have no access to toilets, India currently accounts for more than half of the world population that defecates in the open. India also accounts for the largest rural population living without access to clean water. Only 16% of India’s rural population is currently served by piped water.

However, there is cause for optimism. In the three years of Swachh Bharat Abhiyan, the country’s sanitation coverage has risen from 39% to 65% and eight states and Union Territories have been declared open defecation free. But lasting change cannot be ensured by the proliferation of sanitation infrastructure alone. Ensuring the usage of toilets is as important as building them, more so due to the cultural preference for open defecation in rural India.

According to the World Bank, hygiene promotion is essential to realise the potential of infrastructure investments in sanitation. Behavioural intervention is most successful when it targets few behaviours with the most potential for impact. An area of public health where behavioural training has made an impact is WASH - water, sanitation and hygiene - a key issue of UN Sustainable Development Goal 6. Compliance to WASH practices has the potential to reduce illness and death, poverty and improve overall socio-economic development. The UN has even marked observance days for each - World Water Day for water (22 March), World Toilet Day for sanitation (19 November) and Global Handwashing Day for hygiene (15 October).

At its simplest, the benefits of WASH can be availed through three simple habits that safeguard against disease - washing hands before eating, drinking clean water and using a clean toilet. Handwashing and use of toilets are some of the most important behavioural interventions that keep diarrhoeal diseases from spreading, while clean drinking water is essential to prevent water-borne diseases and adverse health effects of toxic contaminants. In India, Hindustan Unilever Limited launched the Swachh Aadat Swachh Bharat initiative, a WASH behaviour change programme, to complement the Swachh Bharat Abhiyan. Through its on-ground behaviour change model, SASB seeks to promote the three basic WASH habits to create long-lasting personal hygiene compliance among the populations it serves.

This touching film made as a part of SASB’s awareness campaign shows how lack of knowledge of basic hygiene practices means children miss out on developmental milestones due to preventable diseases.

Play

SASB created the Swachhata curriculum, a textbook to encourage adoption of personal hygiene among school going children. It makes use of conceptual learning to teach primary school students about cleanliness, germs and clean habits in an engaging manner. Swachh Basti is an extensive urban outreach programme for sensitising urban slum residents about WASH habits through demos, skits and etc. in partnership with key local stakeholders such as doctors, anganwadi workers and support groups. In Ghatkopar, Mumbai, HUL built the first-of-its-kind Suvidha Centre - an urban water, hygiene and sanitation community centre. It provides toilets, handwashing and shower facilities, safe drinking water and state-of-the-art laundry operations at an affordable cost to about 1,500 residents of the area.

HUL’s factory workers also act as Swachhata Doots, or messengers of change who teach the three habits of WASH in their own villages. This mobile-led rural behaviour change communication model also provides a volunteering opportunity to those who are busy but wish to make a difference. A toolkit especially designed for this purpose helps volunteers approach, explain and teach people in their immediate vicinity - their drivers, cooks, domestic helps etc. - about the three simple habits for better hygiene. This helps cast the net of awareness wider as regular interaction is conducive to habit formation. To learn more about their volunteering programme, click here. To learn more about the Swachh Aadat Swachh Bharat initiative, click here.

This article was produced by the Scroll marketing team on behalf of Hindustan Unilever and not by the Scroll editorial team.