Dengue fever is raging in Lahore and spreading across the Punjab. The numbers that are being reported in the papers and on television, quoting government officials as the source, are either just numbers that have tested positive at government facilities, or have been admitted in government hospitals. But since a lot of people do not go to government hospitals for testing, and using private hospitals and laboratories for tests, and/or are not admitted, or are not admitted in government facilities, the numbers are a likely to be a gross understatement.
Anecdotally, even in the small circle of friends/acquaintances that I have, there are at least ten people who are suffering from dengue. My acquaintances might be a particularly unlucky set right now, but over the Eid holidays as I met a lot of people, I checked with them too and everyone seemed to know of someone who was suffering from dengue. So, how can confirmed numbers be a mere 1500 odd that had been reported till the evening of Sunday September 4th?
Dengue is quite dangerous. It can be fatal in a number of cases, but even when it is not fatal and even in its mildest form, it is quite debilitating, can weaken the body a lot, reduce platelets and lower immunity to the virus in future or for some other illness to strike. The threat of dengue should be taken seriously. But this is where things seem to be completely off kilter. While dengue has been spreading rapidly, and this surely is a public health issue, there has been no leadership that has been shown by the Punjab government. One would have thought they would have tried to nip the possibility of spread of dengue before it started raging. But there has been nothing.
The government could have a) carried out widespread insecticide sprays in Lahore and other affected parts of the province, b) made local administration remove garbage more diligently, c) force Wasa to pump out stagnant water pools (due to the rainy season this was especially important) and focus on reducing even fresh water pools, d) run programmes on television, radio and advertisements in papers on how to take preventive measures, how to quarantine people who fall sick, how to take care of the sick, and how to manage things if people become too sick. The government could also have advised people on where to go for getting tests done at reasonable prices and where they could get decent quality care at reasonable rates.
But the silence on the issue has been deafening. Did the government go to sleep in Ramzan and over Eid?
People do not know enough about dengue. Most people are not taking the precautions they could easily be taking if they were aware of the danger they are running and if they knew how widespread the problem is. They could work on keeping their homes and surrounding free of garbage and standing water (fresh or not). They could spray insecticide in and around their dwellings, they could use a lot more mosquito repellent, cover their arms and legs, especially at crucial times when the dengue virus laden mosquito is supposed to be more active (early morning and dusk).
People also need information on what to do in case they do fall ill. What symptoms should they look out for? Should they have themselves tested as soon as some symptoms appear? Should they go to hospital immediately? Are there foods they should take or avoid? Should they drink a lot of fluids? What medicines, if any, should they be taking? What symptoms indicate that the illness has become more serious and they should head for the hospital? How often should they get blood tests done?
All this information would be invaluable for people to have. There is tremendous fear of dengue, and rightly so: it can indeed be fatal. But, most cases of dengue, if caught in time, are quite manageable. Knowing this would be very useful in dispelling some of the myths about dengue and giving people more realistic expectations.
It has generally been argued that our bureaucracy, traditionally, has been very good at managing crises but has difficulty organising effective governance in non-crisis situations. They are organised and geared for enforcing the will of government, managing unrest, managing disasters and so on, but delivering effective governance to people, though this is their main task, is difficult. Some commentators find the cause for this in the colonial legacy and the main task of the colonial bureaucracy: extracting rents and managing peace. Whatever the cause, it does seem that we are seeing another example of the government not moving in time, not acting when things could be managed well before they become a crisis, and almost waiting for the crisis to happen before they get the incentive to move.
The cost of dengue, with thousands of people already suffering, is going to be huge: for the people and families who will suffer, in terms of expenses on tests, medicines and hospitalisation, lost time and wages and even potential and actual loss of life. A lot of it could have been avoided. A lot more could still be avoided. But it will require leadership from the government of Punjab to manage the situation. But thus far the actions of the government, or rather, the lack of actions from the government leave a lot to be desired. If we do not manage the situation well, not only could it get much worse this year, it could create more problems for us next year.
The writer is an Associate Professor of Economics at LUMS (currently on leave) and a Senior Advisor at Open Society Foundation (OSF). He can be reached at [email protected]
