Health Watch

Intelligent mosquitoes and ignorant citizens!

Nadira GUNATILLEKE

According to the World Health Organization (WHO), dengue is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 3 - 14 days after the infective bite. Dengue fever is a febrile illness that affects infants, young children and adults.

Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. There are no specific antiviral medicines for dengue. It is important to maintain hydration. Use of acetylsalicylic acid such as aspirin and non steroidal anti-inflammatory drugs such as Ibuprofen is not recommended.

Dengue hemorrhagic fever (fever, abdominal pain, vomiting, bleeding) is a potentially lethal complication, affecting mainly children. Early clinical diagnosis and careful clinical management by experienced physicians and nurses increase survival of patients.

The National Mosquito Control Week just ended. It was implemented countrywide by the government authorities. This is the fourth National Mosquito Control Week implemented in the country. Dengue is still claiming precious lives. All are doing their part to curb this disease. But why have we failed to eradicate it completely?

The latest findings of the Health Ministry and the Medical Research Institute (MRI) says blocked gutters, construction sites and industrial waste have become a threat when it comes to dengue control. The latest MRI inspection discovered that blocked gutters, construction sites and industrial wastes pose the biggest threat to dengue control in urban areas, especially in the Colombo city. Controlling dengue has become an impossible task with industrial waste collected all over the Colombo city. According to the latest findings, over 75 per cent of schools located in the Western Province have ‘excellent’ mosquito breeding sites!

Roof gutters should be cleaned everyday

Industrial waste is everywhere in and around Colombo, especially in Panchikawatta, Maradana, Kolonnawa, Dehiwala and Mount Lavinia. MRI carried out inspection tours and found many mosquito breeding sites located in such places. Discarded computers and computer parts, discarded photocopy machines and their parts, motor spare parts are main industrial waste items were found during the study. Industrial wastes have been dumped at home gardens, state institutions and premises that belong to private companies. Industrial waste and motor spare parts help store water, making it an excellent environment for mosquitoes to breed in.

Earlier MRI found construction sites and half-built buildings with concrete slabs which provided excellent environment for the mosquitoes to breed. The largest number of mosquito breeding sites was discovered from Dehiwala and Mount Lavinia Municipal Councils during the previous inspection.

Public responsibility

Dengue is on the rise and part of the responsibility goes to the public, especially those who turn a deaf ear and blind eye to the continuous appeals made by health and environmental authorities. That is why we always fail to achieve the benefits of prevention programmes.

Although almost all homes and buildings have gutters and sometimes roofs that harbour water, there is no proper mechanism to clean them. Even the families of dengue victims do not seem to have understood the gravity of it. According to the latest findings, dengue mosquitoes can bite you at any time of the day and they can breed in any type of water. You can get dengue if a mosquito which bites a dengue patient bites you. Many people are not aware of this. This means dengue can be spread if there is a dengue patient in places where there are dengue mosquitoes.

Very often people get the disease from one place and blame another place. It is very easy to blame others but it is very difficult to prevent dengue. It is adequate if there is one dengue mosquito breeding place left in one area.

There are many other small factors that should be taken into consideration. Even though dengue has claimed so many lives, still the public does not seem to have taken the problem seriously. Still there are parents who let their children play, attend school and even tuition classes when they have fever. Still there are many adults who tend to neglect their health and work as usual no matter whether it is dengue or a viral fever. It is very pathetic to see that still many persons do not understand the importance of following the advice of doctors and taking a rest during a sickness.

If you are ignorant and lazy to fill the cut bamboo tree with sand and do not feel like resting while you have fever, what can the health authorities or environmental authorities can do about it? You are responsible for your life more than the others.

Media Coordinator to the Health Ministry, W M D Wanninayake says when a person gets fever, he or she needs to seek medical treatment without any delay. It is better to seek medical treatment from a state hospital or a government dispensary. This is because such institutions have a proper follow-up programmes for suspected dengue patients. Seeking medical treatment early from a state hospital is vital. All essential life saving drugs are now freely available at state hospitals to treat dengue patients.

He pointed out the importance of cleaning the hidden mosquito breeding sites such as fallen tree leaves, especially the parts of banana trees and similar trees. Banana trees also hold clean water which is the breeding ground of dengue mosquitoes. In some houses tables are being kept on small water pots in order to prevent ants climbing to the table. These water pots are excellent breeding grounds for dengue mosquitoes. Dengue larvae can survive in a dry environment for a period of one year. Even after one year these larvae can produce dengue mosquitoes when they receive water. This shows the danger of keeping unclean surroundings.

The other important fact is 35 percent of the dengue patients are non-working women and 25 percent of them are school children which means they had been infected when they were at home or school. The dengue mosquito can fly only 500 metres. According to the information coming from the public, there are many problems with these grass root level inspection teams. Maybe the same problems exist everywhere in the country without the knowledge of the next level committee, the Grama Niladhari Level Committee or the Divisional Secretariat level committee. Some grass root level ‘committees’ hinder the government’s effort to eradicate dengue!

It is very interesting to see the problems exist with the grass root level inspection groups which inspect dengue mosquito breeding sites located in homes and other places. Many of these groups consist of persons who are aged and retired, without proper employment or just house wives. Some of them get tired easily due to their age and unable to carry out inspections actively for long hours. They are from the same area which they carry out inspection. Just like any other human beings, they have their own friends and enemies.

The responsibility is in the hands of the public. Unbiased inspection is a must when it comes to dengue control. Dengue cannot be eradicated even if the Government import one million liters of BTI bacteria if certain homes are allowed to keep dengue breeding sites by the community itself. Our heroic armed forces played a wonderful role in implementing dengue control programmes. Above problems do not rise when security forces are involved in inspection.

The curious case of frozen foods

Aditha Dissanayake

Remember that joke about frozen food? What one frozen carrot said to the other frozen carrot? “Lettuce rest I am feeling beet”. And the second carrot replied “I can’t I am searching for my roots”.

If they really could talk, there is little doubt that they would have talked more on the lines of their health than on anything else. The first carrot would have sighed with relief and said “Now that I am in the freezer my vitamin C levels are steady. If I had been outside, on that shelf near the window for another day my vitamin levels would have dropped so drastically I would have been in grave trouble”. And the second carrot would have said “Yes. We are lucky to have found our way into the freezer.”

“It can happen”, says Nutritionist Dr K D Renuka Silva, Dean, Faculty of Livestock, Fisheries and Nutrition, Wayamba University. “The nutrient value of vegetables is retained when they are frozen. If food is frozen straight after they are harvested, it can retain more nutrients than stored fresh food. For example, fresh vegetables can lose 10-20% of their vitamin C within one day of harvesting.”

Even though logically, food in its most natural form ought to be healthier, things are not as simple as they seem to be. Undoubtedly when food is picked as soon as it has ripened and is purchased straight from the farmer, it is in its most nutritious state. But unfortunately the fruits and vegetables on the shelves of supermarkets or at the Sunday fair have often been plucked before they are ripe as this helps them to face the ravages of transport, and on each day that passes after being harvested the nutritive value depletes more and more.

This is why, though grouped together with fast food as unhealthy substitutes for “real” food, often placed at the top of our “do not eat” lists, frozen food may yet be a healthy alternative in the modern world. Especially when it comes to finding a solution to the dilemma of losing out on the nutrients, during the interval between a ripened fruit or vegetable being picked and the time it is placed on our dinner table.

Sri Lankan conditions

Especially in a tropical country like Sri Lanka, according to Dr. Silva, “in Sri Lankan conditions (with high temperatures and high humidity levels) nutrient losses can easily occur in fruits and vegetables during the period between harvesting and consumption”. In other words if you keep vegetables and fruits outside on your kitchen shelf for a long time, they lose some of their nutritional value. Whereas, if you freeze them the moment you bring them home from the market you can actually retain more nutrients.

Whilst agreeing that fresh fruit and vegetables often taste better than frozen ones, and can have a better texture Dr Silva points out that in order to get their full nutrition values they have to be eaten as soon as they are harvested. “One should remember that the nutrient levels in fresh food, especially fresh fruit and vegetables, decline after a few days of storage.” warns Dr Silva.

He believes freezing which is an ancient technology for preserving food has an excellent overall safety record. “Freezing halts the activities of spoilage micro organisms in and on food while preserving some micro organisms for long periods of time. Research suggests that many pathogenic micro organisms may be destroyed or inactivated by freezing.”

In Sri Lanka, where fruits are relatively expensive and where consumers throw away considerable amounts of food because of damages during transport and inefficient storage, Dr Silva says using frozen fruit and vegetables and frozen, pre-prepared meat, when only the amount required can be taken out of the freezer while the rest remains frozen, would mean less waste than with fresh food. “Frozen food generally needs less preparation than fresh food, and produces fewer trimmings and other waste. The freezing process means that the food (especially fruit and vegetables) take less time to cook, potentially reducing energy use”.

Recommendations

“If people can stock fruits and vegetables in the freezer they can minimize shopping.” suggests Dr Silva. “Due to their busy lifestyles people in urban areas do not have time to do their shopping for fruits and vegetables on a daily basis. As a result they stick to rice, dhal, potatoes and other food which are less perishable. This has lead to lesser fruit and vegetable consumption in our country.” Recalling the recommendations of the World Health Organization to eat five fruits and vegetables per day (approx 400 g), he says “this is never achieved in our country causing nutritional deficiencies as well as cardiovascular diseases, cancers and diabetes.

A word of caution, “Consumers need to read the label to find out the amount of energy, fat (especially saturated fats and trans fats - which are generally unhealthy), salt (high salt can increase blood pressure)contained in the frozen product” adds Dr Silva. “It is necessary to carefully inspect any frozen products which may have been accidentally thawed by the freezer going off or the freezer door being left open.”

When preparing frozen vegetables experts say it is best not to thaw them. Vegetables retain more vitamin C when cooked from their frozen state. Frozen fruits are usually good for up to 12 months, and frozen vegetables are good for 12 to 24 months. Whether fresh or frozen is selected, the best tip is just to eat a wide variety of both, because some vitamins and minerals are always better than none.

The final argument, to quote Dr Silva, “Eating frozen fruits and vegetables are better than not eating them.”

Let the curious case of frozen food rest with this last hearing. If you are already into frozen food you are bound to have heard this, if not, you will like it all the same. “One morning, as he went to the freezer door, a man asked his wife, ‘What should I take out for dinner?’ Without a moment’s hesitation, she replied, ‘Me.’

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Regulating drugs in Sri Lanka

Continued from last week

Several articles appeared recently in the newspapers with titles related to the first part of the above title. These articles referred to NMDP, NMDRA, Drug Policy or New Drug Policy from time to time.

It appears that one is not quite sure as to what the focus of these articles are. There are many rolling reports week after week about shortages of drugs, expiry of container loads of drugs, quality failures, smuggling, cold chain break downs and adverse reactions. Sometimes whole townships are mortally frightened of an imaginary drug reaction. The Healthcare Minister, Maithripala Sirisena in double quick time has identified that regulating and managing drugs in our country needs an overhauling.

We will go on and on adding still more confusion unless the correct diagnosis of the malady is arrived at, coupled with an awareness as to what is happening around in the rest of the world in the management of pharmaceuticals.

To be continued