Dengue – a failure of medical leadership

by Gabriel

I refer to the news that Malaysia is seeing a higher death toll from dengue fever this year. Health Ministry’s Director of Disease Control, Hasan Abdul Rahman said 44 people had died in the first four months of 2007 from 16,214 cases reported, compared to 21 deaths and 10,244 cases in the same period last year.

Even more disturbing is the statement that the disease has seen a rise of 16 per cent in cases every year since 2003 with fatalities reaching record levels in 2004, when 102 people died.

The Ministry’s Deputy Director-General, Ramlee Rahmat further appears to have even identified the cause for the rise attributing it to unkempt construction sites, indifferent contractors and land owners, public complacency and ideal weather conditions for breeding the Aedes mosquito.

Primary health care officials, having already identified the problems, may need to do more if this plague is to be dealt with more effectively.

The time is appropriate for them to speak to the DPM and ask for emergency powers for they may have no clout if some of these problems fall into the domain of the Environmental Ministry or local councils who may take a lackadaisical attitude to this endemic plague which can very well rapidly escalate to be an epidemic if these erratic weather conditions continue to facilitate the exponential breeding of the Aedes aegypti.

How indeed memories are short for authorities do not appear to remember the other great mosquito scourge that swamped this country in its early years — malaria.

Malaria was first successfully shown to be controlled in Malaya by a government surgeon, Sir Malcolm Watson in 1901 who, faced with an epidemic of malaria, brought it under control by a program of jungle clearing and drainage in the town of Klang. This was one of the world’s first examples of successful malaria control by anti-larval measures.

But a far greater problem awaited Watson in Port Swettenham, opened in September 1901, where by the end of that year 118 out of the 176 government servants working in the port had gone down with malaria causing the port to cease functioning. On Watson’s advice – bunds, which stand till this day, were built around the area to keep out the tide and the area inside the bunds was drained and oiled. Malaria was soon brought under control and the port working again.

These two successful measures by Watson were the harbinger for the application of similar drainage methods including subsoil drainage in estates — so vital for the economy at that time, where malaria proved fatal to many of its Indian laborers.

Watson’s efforts were complemented by G.F Leicester, an entomologist at IMR, who helped him identify the different species of mosquitoes and this they did by actually going together into the jungle round Klang sometime in 1903 and catching Anopheles umbrosus, the mosquito vector responsible on flat land.

In 1911, the Malaria Advisory Board was formed with Watson as one of its members. The Board had a free hand and wide powers which included powers to coordinate, order and execute control measures.

Watson with his skillful methods of combining subsoil drainage and a suitable blend of oil was able to significantly reduce the incidence and subsequent mortality of malaria.

By careful observations and experimentation, he was able to recognize the vectors of the tidal zone, the coastal plains, the inland plains, and the hills and apply specific control measures adapted to their habits.

Many in Port Klang would remember its main trunk road which was named for him, Jalan Watson, now renamed Persiaran Raja Muda Musa.

The rise of dengue in our current ecological circumstances is not dissimilar to Sir Malcolm Watson’s analysis of the relationship between economic activity, landscape change, insect density and malaria in Central Africa in 1953.

Constant attention to the ecology of the local mosquito species in relation to control measures is critical if we are to curtail this rise in incidence and bring about its consequent reduction in mortality which is more related to reinfection rather then primary infection.

Our primary health care leaders need to demonstrate greater leadership qualities adopting more aggressive and proactive measures.

They must be further equipped with adequate powers to rope in other departments such as the DID, JKR, local councils, the police and the Environmental Ministry to effect the necessary environmental changes so required to eradicate the vector.

Fogging and fines are akin to treating the symptom unlike Watson and Leicester who went down to the field to treat the disease.

This country has a powerful tradition in overcoming many tropical illnesses basically because of its strong initial foundations since pre-independence days. Sadly we appear to have let slip this advantage and reading in the papers about children, golfers and lecturers dying of dengue is I am certain not something our forefathers would have been proud of.

The main reason dengue still kills is because we do not possess the medical leadership so critically required in surmounting it.

  1. #1 by DiaperHead on Monday, 7 May 2007 - 7:40 am

    It is not just dengue fever, it is also tuberculosis which is making a come back, typhoid, dysentery, diarrhea, cancer, HIV and aids, gonorrhea, herpes, syphilis and tooth decay.

  2. #2 by kurakura on Monday, 7 May 2007 - 7:46 am

    NEP’s side effect lah itu….

    Incompetent people get to manage things…all goes down to drain….worse still…tak malu….

  3. #3 by Jimm on Monday, 7 May 2007 - 9:05 am

    Health budget is not for plan for these. They are main aimed for infrastructure and equipment purchases. NEP works that way. Only when one of their own are affected by these ‘incident’, then only they will look into it, blame others for not following the law, blame the public for not keeping things ‘clean’ and blah.. blah..blah.
    Who are we ??? Another statistic number as legal Malaysia. LEt us pray for health and protection from ‘evil’ diseases …

  4. #4 by Unladen Swallow on Monday, 7 May 2007 - 10:39 am

    Now that is one point of history I don’t know. I was infected with dengue at one early point in my life, and it wasn’t very fun, and I spent a good half-a-week in hospital. Not too long after I was discharged, the government sent the foggers to smoke down the drainage areas near my school (presumably where I caught the disease).

    Yes, the government has a responsibility to combat dengue, as it did with cocksackie and JE some years back. Even if you can’t really shift the whole blame on them, considering the general unpredictability of disease, some of these efforts were often too late to be of any help. On top of that, a great number of building projects by irresponsible contractors have resulted in stagnant water pools, becoming breeding grounds for mosquitoes and et cetera.

    I could go into a tirade on construction areas, but that’s another story for another time. We have the resources, the manpower and the community (it doesn’t take much to combat dengue, seriously). I haven’t been around for a while, but are the dengue awareness campaigns still going on?

  5. #5 by Godamn Singh on Monday, 7 May 2007 - 10:54 am

    It is not a failure of leadership but the appearance of a wrong kind of leadership. I was told of a conspiracy between UMNO and their sidekicks to get rid of all opposition to their policies. If any opposition party leader were to go missing and die tomorrow his death could be attributed to dengue. What a clever idea, don’t you think so??

  6. #6 by ENDANGERED HORNBILL on Monday, 7 May 2007 - 1:02 pm

    There is hardly any mention in the mainstream press about the worsening epidemic!

    Chua Soi Lek – does ‘No news’ mean ‘Good News”? As with all things BN, the public is kept in the dark until the problems blow their tops and spill all its gruesome innards.

    Soi Lek – shape up or ship out, man!

  7. #7 by smeagroo on Monday, 7 May 2007 - 2:56 pm

    go ask DBKL if the Malathion they used have been diluted or not la.

  8. #8 by Jonny on Monday, 7 May 2007 - 4:40 pm

    Jimmy, you’re right on target:

    “Health budget is not for plan for these. They are main aimed for infrastructure and equipment purchases.”

    The nation is getting sicker by the day. ALL ministerial departments to small agencies, city councils – they’re main aim is to see how much rent could be squeezed out from all deals related to infrastructure and equipment purchases.

    We all know well that human capital wise, we are eons backward compared to Singaporeans.

    One day very soon in less than 5 years, their GDP shall overtake ours.

  9. #9 by accountability on Tuesday, 8 May 2007 - 5:01 am

    in msia, even the ambulance service is unable to rescue patients/victims on time…

    …what makes you think our medical leadership can tackle tiny mosquitoes?

  10. #10 by accountability on Tuesday, 8 May 2007 - 5:02 am

    as long as our govt is run by incompetent fools, all we will get are money-wasting fancy campaigns and slogans

  11. #11 by abbas gany on Tuesday, 8 May 2007 - 10:02 pm

    The Medical Fools are playing hide-and-I seek with the malaysian mosquitos, They breed the mosquitos and tell them you go hide and we will come seek you by sending fogging machines. The ruckus the machine makes not only mosquitos close their ears even humans like us have to tolerate the din. I think the mosquitos have become more smarter than the health fools and possibly saying LOOK AT THE STUPID HUMANS who should be looking for our nursery rather than wait for us mosquitos to become adults and then start chasing us merry-go-around. CATCH US IF YOU CAN.

    HELLO HEALTH GUYS look la for the source not sauce, Everyday people complain of clogged drains, uncleared rubbish, clogged sewage, stagnated ponds and pools WHY PUT THE CART BEFORE THE HORSE, HEEELLLOOOO WAKE UPPP MY HEALTHY FRIENDS IN THE HEALTH MINISTRY.

  12. #12 by abbas gany on Tuesday, 8 May 2007 - 10:07 pm

    DBKL is looking at MARATHON and Not MALATHION I dont think they even know what malathion is used for and how it should be used

  13. #13 by Jururawat on Wednesday, 9 May 2007 - 12:10 am

    The dengue disease needs to be controlled. As long as the Aedes mosquitoes are around, this disease will also be around. There is a need for continuous control and not just when it happens, then somebody does something. When nothing happens, nothing is done. Also when the local government is doing something to the drainage system, they must have in their mind a kind of drainage system that will drain and not harbour the Aedes mosquitoes. Don’t just concentrate on the rich men’s area. Give some thoughts to the places where poor people live.

    I doubt if any disease can be totally terminated from the face of this world. Tuberculosis cases are also on the rise in US.

    The Ministry of Health cannot be complacent. If there are so much works to be done, get your people doing it. Don’t just let them go off enjoying themselves elsewhere when their country still needs them. There is something very wrong with the Ministry of Health. Unless somebody truly wants to rectify the problems, these problems will be around for the next many years to come. Not everyone in MOH are fools. They are not given the chance. They are being sidelined. They are purposely ignored because they must not be cleverer than the morons.

  14. #14 by ArenCoomarasamy on Sunday, 8 July 2007 - 1:57 pm

    Dear Sir/madam,

    Topic : Cure for Dengue using natural medicine

    Malaysia is now experiencing their worst Dengue situation in recent years. After reading the papers about it, I want to help Malaysia solve their Dengue problem. I am writing to you because i need to find a way to create awareness.

    Currently in Malaysia, Prof. Dr. Ananthan Krishnan of AK Pharmacy of Naturopathy has conducted clinical case studies with Dengue patients over the years and has had 100% success rate.

    Professor Dr. Ananthan Krishnan uses spice to heal people. It is all in capsule form. So far with all the dengue patients who have taken these products have been discharged from hospital within the first 48 hours upon consumption of these spices.

    Professor has documented evidence that taking these tablets will improve the blood platelets of a dengue patient.

    Please view the website below for more documented evidence.

    web site –

    Click Alternative Medicine Research Institute
    Click case study
    Click on treatment for Dengue

    Professor Dr. Ananthan Krishnan can be contacted at the address below :-

    AK Pharmacy & Naturopathy Center
    10 – B, Jalan TK 1/11A, Taman Kinrara, SEK 1
    47100 Puchong, Selangor Darul Ehsan, Malaysia

    h/p no: 017-6802336

    Hope to hear from you soon. We need to move fast to help the dengue patients in Malaysia


    Aren Coomarasamy

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