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Editorial preparedness Late
response threat Home
solutions
The
dengue windfall
Editorial Punjab and Sindh are facing epidemics and floods and the proportion of the population affected speaks volumes about lack of preparedness on the part of the government and the civil societies working in the health sector. The government needs to pay heed to early warning system to save people from epidemic outbreaks in future. In Sindh, flood-hit areas are crying for SOS. Medical teams are unable to reach beyond relief camps while the epidemics are multiple. Malaria and diarrhea are already there while authorities fear cholera if flood water keeps standing for long and the animal carcasses remain unburied. In Punjab, particularly Lahore, while there are laboratories that are conducting dengue tests at minimal charges, there are others minting money from the same. Where the epidemic has put people’s lives at risk, it is a source of business for others. While traders and private companies are piling up money by selling anti-dengue spray, doctors are happy that they are more in control of dengue now. People fear dengue bite and are taking homeopathic preventive medicines which have suddenly become popular in the city. The question is, will we be able to prevent dengue, malaria or diarrhea outbreaks in future? For that we will have to change our lifestyle. Vacant plots are garbage dumps, hence breeding grounds of diseases. Keeping a good front and piling dirt at the back has become a national character. The filth if not removed, is bound to spill over and smear us, which it has. And who can deny the importance of preparedness and forewarning. It’s time we learnt from experience.
preparedness Pakistan, like many other countries, has been home to medical disasters like outbreak of epidemics for long. The number of instances and the intensity of the disasters have both increased considerably over the years. On many an occasion, it has been observed that the government failed to foresee the scale and reasons of an outbreak and had to put in huge efforts to control the resultant damage. Much less resources would have been required to prevent these outbreaks had the estimations about scale been accurate and remedies worked out well in advance. Setting up disease surveillance, early warning and response systems for early detection and prompt response to outbreaks is one of the priorities during of the World Health Organisation (WHO). It asserts communicable diseases can be a major cause of morbidity and mortality and always calls for Disease Early Warning System (DEWS) a programme under which health care workers can detect signs of an epidemic at an early stage in order to prevent its occurrence. Ideally in case of a disease likely to become epidemic, periodic data from the reporting sites is collected by using a standardised DEWS reporting form. Health care providers are trained on data collection and reporting, and basic data analysis is done at the field level by local surveillance officers who then forward the data to the provincial or central level for further analysis and policy formulation. In Pakistan, there are several entities working or
trying to work on these lines of which the National Institute of Health (NIH),
Islamabad has a central role. The institute carries out medical research and
also suggests government action in case of emergencies. Muhammad Mukhtar, Head of Department of Zoonotic and Vector-Borne Diseases, Public Health Laboratories Division says the main Terms of Reference (ToRs) of NIH are to provide technical assistance to the Government of Pakistan for interventions and quality assurance of interventions. Implementers are provinces and districts and can only give guidelines and technical assistance to the government and also to some extent monitor the working to ensure the quality of interventions. The monitoring role of the institution can be seen in the shape of analysis done by Mukhtar of some measures taken by Punjab government. For example, he writes in a document that in the light of his research findings published by international journals steps like closing down of schools will not help much. His findings are that mosquitoes always/mostly bite when humans are in stationary condition or there is least or no movement. During vacations student will sleep at home for longer time (till 10:00 am) which makes them more vulnerable to bite of dengue mosquitoes. This, he says, is for the reason that when students are in schools there would be movements of human body all the time. This reduces chances of mosquito bites quite contrary to the existing perception. The local and international NGOs do also help government prepare for emergencies, medical or whatsoever. As per existing practice all international NGOs aspiring to do relief work have to register with the Economic Affairs Division (EAD). But to execute their projects they have to have a No Objection Certificate (NOC) from the provincial governments and coordinate the provincial disaster management authorities. The purpose of this exercise is to ensure that there is no unnecessary overlapping of work and priority be given to the sector where help is most needed. There is a National Disaster Management Authority (NDMA) in place which oversees the disaster mitigation activities. The authority’s spokesman Ahmed Kamal tells TNS there’s National Health Emergency Preparedness and Responsiveness Centre based in the Cabinet Secretariat, Islamabad which leads from the front in case there’s a chance of spread of a disease at a mass level. The centre recently devised a comprehensive medical response plan for Sindh which is at risk of epidemic outbreak due to floods and presence of stagnant water all over, he says. The authority was part of the campaign as well. Haider Yaqub, Country Director, Plan Pakistan a subsidiary of international relief organization Plan International suggests only concerted efforts by stakeholders can help the country overcome its woes. He says when large number of incidents of a particular disease happens at the same time in a particular community, then that disease is epidemic. There are other diseases, in addition to dengue fever, like measles, bird flu, viral conjunctivitis (red eye; eye infection), gastroenteritis, hepatitis C and B, which may spread widely if not controlled. HIV infection is one which is potentially epidemic or certain localities are at high risk, he adds. Haider says no doubt health systems in Pakistan do have early disease surveillance and warning systems. However, these are at the moment compromised in their functioning as per their Standard Operating Procedure (SOPs), especially after the 18th amendment in the constitution where such centrally placed system providing lead role has now been devolved to the provincial structures. The improvement in the situation will need time and come if political will is timely challenged by civil society organisations and the media. Haider says his organisation has experience and skills and Pakistan at the moment requires resources, human and financial, in the form of formal agreement/or understanding (MOU) with organisations like Plan for revitalisation and enrichment of existing SOPs in Early Warning and Surveillance Systems at the provincial levels engaging district governments. “There is need to have accountability or follow up system to assure efficiency.” He says his organisation intervenes at local levels and supplies mosquito nets, medicines and information, Education and Communication (IEC) materials for awareness sessions and for that purpose has signed MoUs with NDMA on different occasions. Dean, Punjab Institute of Public Health (IPH), Prof. Dr Yaqub Qazi asserts efficient early warning and surveillance systems exist in the federal and provincial health departments and medical research institutions. There are sufficient bacteriologists, entomologists, epidemics control specialists etc on board, he says, who are always on their toes to fight menaces like dengue, malaria, gastroenteritis etc. For example, he shares it with TNS that posts like Director General (DG) Communicable Diseases Cell (CDC) have been specially created in the health department for this purpose. On the working of IPH, Qazi says, whenever a medical problem is reported in a particular geographical area the institute raises the alarm and immediately informs the government. If the number of reported cases hints at a rising trend, teams of experts are sent to the area to take samples of water, air etc, observe the patients and identify the causes of the spread of the disease as well as suggest remedies to the government. Qazi says sometimes the scale of a disease is so huge that it becomes difficult for the government to generate resources to tackle it. This does not mean it has failed or the early warning systems are inefficient. In fact, the resource-constrained countries like Pakistan have to look for cooperation of the outside world in case of medical emergencies, he adds. “However, this dependence can be reduced by educating our masses and involving the community on the whole in the struggle against the onslaught of epidemics.” He is not ready to believe the Punjab government has failed to respond to the alarm raised by medical experts about dengue outbreak. The disease, he says, has spread due to reasons which were beyond government’s control. The unhygienic lifestyle of people, the unattended filth deposits at public places, disrespect towards civic laws, the attitude of not learning from previous experiences etc have led the countrymen to see this day, he adds. Qazi says the Sri Lankan team of dengue control experts found existence of mosquitoes at tyre shops, under-construction structures, sewerages and almost every manhole during their visit to Lahore. How can the government eliminate mosquitoes from all these places with community participation even if it has the best early warning and surveillance systems? He questions.
Late
response Muhammad Kamran, a shopkeeper in one of Lahore’s congested localities, is firm in his belief that the Punjab government is simply not able to deal with dengue, or with any other epidemic for that matter. He bases his view on headlines from the print and electronic media and a few cases of dengue patients in the neighbourhood. “The government is not prepared in any way to control the epidemic,” he says with conviction, pointing to the headlines of an evening newspaper. One can agree with Kamran or not but the fact remains that the common man is visibly scared of the dengue threat. Kamran believes that the way dengue fever is being dealt with, another outbreak of an epidemic will further expose our health institutions. “It is time the government developed proper guidelines for hospitals to adopt to deal with epidemics, and train medical staff to handle such cases,” he says. In the light of public apprehensions, the question
remains, is our health sector—both public and private institutions—
adequately equipped and prepared to deal with the spread of an epidemic,
such as foot and mouth or Congo fever? Are we too slow when quick action is
needed? After the incidence of dengue fever in the country, mostly in Lahore, people’s already low confidence in the health sector has been shaken to the core. Understandably, preparedness and ability of public and private health institutes to deal with an epidemic, has been called into question. That is not to say that we lack dedicated doctors and other medical staff. But looking at the bigger picture of how we’re dealing with the crisis, it seems there is a lot of room for introspection and a considerable cause of alarm in view of likely occurrence of epidemic outbreaks, such as Congo fever, bird flu, and foot and mouth disease, etc, which we are not a stranger to. Spread of epidemics, such as malaria, is not unlikely as floods have already threatened the displaced people and with Eid-ul-Azha just around the corner, an occasion sometimes associated with Congo fever and foot and mouth disease. Employees of livestock department and those handling sacrificial animals are usually the first casualties of the disease. Waterborne diseases are making flood victims in Sindh desperately looking for medical help. It is now abundantly clear that if measures are not taken in time, outbreak of fatal diseases is very likely. Even after floodwaters eventually recede in Sindh, infections among flood victims are not going away. Temporary camps where people take shelter on higher grounds are breeding grounds for diseases such as cholera, malaria and gastrointestinal diseases. Scores of lives have been lost due to dengue fever so far. Statistics paint a bleak picture. According to a news report, 685 new dengue patients have surfaced in Punjab. Of these patients, 353 are from Lahore alone. According to reports, there are around 1,075 confirmed reported cases in Lahore. Prime Minister Syed Yousaf Raza Gilani pointed to the enormity of the crisis when he said the other day that Pakistan needed to develop a national coordination mechanism for controlling epidemics such as dengue, which has claimed many precious lives in Lahore and elsewhere. Why are we so late in doing that in the first place? Experts have warned that Pakistan is in danger of another endemic disease called Congo fever or Congo Crimean Haemorrhagic Fever (CCHF), which is a fatal viral disease caused by domestic and wild animals and has claimed precious lives in the past, including doctors. At this point in time, health officials from the government and the private sector claim they are committed and prepared to handle epidemics at present or in the near future. Are they telling the whole story? “We have done a commendable job at the curative side,” says Dr Muhammad Nadir Khan, Senior Blood Transfusion Officer, Services Hospital Lahore. Khan believes the situation is “coming increasingly under control as almost all major public health hospitals have cell separators and making hundreds and thousands of mega platelet kits,” he says. “We have made 2000 mega platelet kits at the Services hospital alone. The situation is not very different in other hospitals,” Khan says. He hopes the situation has made the authorities alert and ready for any future epidemic. Dr Qutbuddin Kakar, WHO’s Focal Person on dengue/malaria Control, says the “WHO has been doing its homework for the prevention and control of epidemics for the last eight years, from 2003 to the present day. Kakar says the organisation, besides research, is working as a bridge between the Punjab government and international medical research organisations to be able to keep pace with the latest research on the subject of epidemics. Kakar informs different epidemics need to be tackled differently with varying pre-empting and preventive measures. Mukhtar Ahmed, Focal Person from the Department of Vector Borne Diseases, National Institute of Health, claims the guidelines are there about how to deal with an epidemic but the problem lies with the implementation part and, more importantly, lack of awareness among the common people, “the media has blown the crisis out of proportions. Instead of giving them a clear picture it has created hype and spread panic among the common people,” he says. “We should have carried out sprays in the last week of July or first week of August but we did not do that. Spraying at this point in time is a little too late as mosquito breeding and hatching has already taken place,” he said. Ahmed concludes that awareness among the common people as well as timely implementation of policy guidelines can effectively minimise loss of precious lives in future.
threat All the three children of Soomal, a 25-year old Scheduled Caste (Dalit) peasant woman at Hyderabad’s Sabzi Mandi camp of flood affected people were suffering from severe diarrhea but the condition of her younger one-year-old son Mukesh was quite serious. She had to rush Mukesh to Civil Hospital for an emergency treatment because of his deteriorating condition. The already feeble baby remained in the hospital for the whole night receiving medical treatment for gastroenteritis and in the morning the doctors discharged him to get further treatment at the camp. But due to severe dehydration and malnutrition his physical condition was still not stable and he was lying in semi-conscious condition when I visited the camp the other day. Belonging to a rain and flood-hit area of Mirpurkhas district, the low caste peasant family of Soomal had to leave their homes along with other families of the village to a nearby raised area due to rains followed by floods. They first took shelter at an open place near their village because their houses had collapsed and floodwater was gushing in the area. The villagers had to move from one place to another to save their lives because no dry land was left because of floods from all sides and torrential rains from the sky. For few days this family stayed at the raised area of the now defunct railway track near Jhuddo town. But here also they were not safe as water level was rising and it was continuously raining. The poor family did not have any shelter or a tent to cover their heads. One morning the railway track also came under water. Her first child caught diarrhea while they were living at the railway track because of the consumption of polluted rain water. Finding no other option the villagers had to move to
Hyderabad in a small caravan of a goods truck. On the way to Hyderabad the
second child also fell prey to diarrhea. The younger one, who is
breastfeeding, also contracted gastroenteritis by the time the family
reached Hyderabad camp. Gastroenteritis or cholera, skin diseases and malaria are common ailments among the flood affected internally displaced persons (IDPs) at Hyderabad’s largest IDPs camp, confirmed Dr. Chandan Kumar, a medical doctor at a dispensary in Sabzi Mandi IDPs camp. Estimated 4000 people are living in this ill-managed official IDPs camp. Similar is the situation in other relief camps in the affected areas of Badin, Mirpurkhas, Umarkot, Sanghar, Benazirabad and Tando Allahyar but a large majority of the affected people is not living in these camps. They are forced to live under the sky at open spaces or in tents along the road sides or raised dry places because no space is available in the official camps. All this population is very prone to disease because of consumption of contaminated water. Women and children are the most vulnerable section of this population which can catch diseases. Women are already malnourished and anemic and the children are hardly any better. Even though the government claims it provides adequate medical relief to the rain affected people, many deaths have been reported because of widespread malaria including cerebral malaria, cholera and even dengue. As rain and flood water is still standing all around, causing increase in mosquito population, malaria is widely spreading and every next person is sick. Unfortunately, safe drinking water is also unavailable in many areas and people are consuming polluted water, which is increasing the number of patients. According to National Disaster Management Authority’s (NDMA)figures, due to various water-borne diseases, 54 people have lost their lives by mid September due to malaria and gastroenteritis. NDMA statistics point out that out of the total 85,404 malaria infected people, conditions of 1660 patients was serious, whereas 71,857 flood affected people are suffering from throat infections and 35,300 are diarrhea patients, while 13,843 are suffering from dysentery. At least 59,763 of the flood hit people are suffering from various skin diseases and 16509 have contacted eye diseases. Many non-government organisations and local leaders dispute with the official data and claim that the condition in the affected areas is even worse. Every other person in these affected areas is sick. Women and children are hit hard. A large number of domestic animals have also died mainly because of non-availability of fodder and diseases. Carcasses of buffalos, cows, donkeys and dogs can be seen scattered everywhere. With the passage of time dead animals’ germs may also cause disease epidemic. There is no system of disposal for animals’ bodies because very little dry land is available even for burying human beings. The municipal system does not exist and where there is some system, the administration is not bothered to take any steps. No measure has been taken to prevent diseases. “While Malaria is widespread because of mosquitoes right from the beginning of this disaster, there is a fear of outbreak of cholera now as the quality of standing water is further deteriorating,” said Dr. Bahar Ali Wassan, a medical doctor of mobile medical dispensary of Pakistan Institute of Labour Education and Research (PILER). Thousands of people are stranded in the flood water and there are many areas where even mobile medical teams could not reach, so the health conditions of people in those areas is very serious and no one is taking care of such large population. The government’s health facilities are available only in the relief camps or at Basic Health Units in town, but a huge population is either stranded in water or living in open spaces or in tents and do not have access to healthcare facilities. Dr. Wassan fears if cholera and gastroenteritis break it would be difficult to control. Leading NGOs like UNICEF, Save the Children, Health and Nutrition Society (HANDS), Thardeep Rural Support Programme, National Rural Support Programme (NRSP), Red Crescent, Ghareeb Nawaz Trust and many other NGOs are also working in health sector in flood affected areas and providing medical support to the people. Save the Children has issued a warning that the lives of about 2 million people is at risk. Half of them are children. According to the Health Initial Rapid Needs Assessment Report of the 22 flood affected districts of Sindh (from the period between Sep 8-12), out of total of 839 health facilities 224 (13% of Basic Health Units and 11% of Rural Health Centres) are non-functional due to inaccessibility, submersion in water or infrastructure damage. The report jointly prepared by Federal Government and World Health Organisation indicates the supply of essential medicines was found to be adequate, the supply of clean potable water has been disrupted in almost all the flood affected districts. The Disease Early Warning System (DEWS) has detected 193 alerts out of which 36 were confirmed outbreaks but were responded through the Rapid Response Team and contented within 48 hours. While the local and international organisations are providing health facilities to the flood affected people, the destruction of the communication system and standing water are hindering access to these facilities. The government and United Nations organisations can play an effective role in prevention of a deadly outbreak. Home
solutions Beep, beep. And I got another message in my inbox prescribing some homeopathic medicines and Papaya leaves to stay healthy. Many people in Lahore have received such messages prescribing homeopathic and herbal remedies that can keep the dengue fever away. Papaya leaves and fruits are selling like hot cakes these days and are considered as precious gift one could offer to dear ones fighting the dengue fever. Papaya trees in Lahore have failed to match the swelling pool of dengue patients and people are forced to order for the fruit and leaves from other cities to fight the deadly mosquito. “I have brought papaya fruit and leaves from Peshawar as I could not find them in Lahore,” says Shafiq Ahmed, a Lahore-based businessman. “These leaves are effective in staving off the threat of dengue. The juice of these leaves keep the dangerous mosquito away and help the patient fight off the dengue fever.” While Hakeems (herbal medicine practitioners) prescribe
papaya leaves and other fruit juices as preventive remedies, conventional
doctors spurn the idea saying there is no scientific evidence for the
benefits of these leaves. “These are just myths and have nothing to do
with the cure of dengue fever,” says Dr Salahuddin, a general practitioner
in Lahore. “However, orange and apple juice helps with digestion,
increased urinary output, promotes antibodies for faster healing and
recovery of platelet counts. Juice gives energy and vitamins that fight the
fever.” “Aedes mosquitoes are the carrier of dengue viruses. These mosquitoes can be easily distinguished as they are larger in size with black and white stripes on their body, so it is sometimes called tiger mosquitoes. They usually bite during day time. They breed in artificial accumulation of fresh water, such as broken bottles and tins, flower pots, coconut shell, tree holes etc,” Dr Salahuddin informs TNS. Homeopathic physician Dr Aftab Afzal claims, “Homoeopathic system of medicine can treat and prevent dengue fever without any side and adverse effects. Homeopathy has been used successfully in other countries apart from India in the past. The selection of homoeopathic drugs in these cases depends upon the individual symptoms and response to infection. The symptomatology of a patient is studied to decide about the curative and preventive homoeopathic medicines for any patient as well as epidemic as a whole.” “There are about 25 homoeopathic drugs available for the treatment of dengue fever. The present epidemic of dengue fever in Lahore is of two types. One is simple dengue fever having no mortality, self-limiting course and the patient usually recovers within five to seven days. The most useful medicines for this type of dengue fever are Arsenic Album, Bryonia, Eupatorium Perf, Gelsemium, and Rhus Toxicodendron. The second type is of dengue haemorrhagic fever (DHF), which is a severe type of infection and can be fatal. It usually develops in patients who are already sensitized with dengue virus. The high grade fever is usually associated with severe nausea vomiting, abdominal pain and bleeding from nose, gums, blood in vomiting and stools. This type of dengue fever (DHF) can be treated with Crotalus Horridus, Ferrum Metallicum, Hamamelis, Ipecac, Lachesis and Secale Cor. These medicines are required to be used in 30 or 200 potency as per the indications and under the supervision of qualified homeopathic doctors.” Muhammad Akram, a businessman, is quite happy with the homeopathic formula, saying he has administered the homeopathic remedies to all his family members. “Thank God, all my family members are safe from dengue. These easily available homeopathic remedies work wonder.” Most of the people queuing up outside hospitals were found cursing the government for its failure to tackle the menace well in time. “The Punjab government is wasting public money on ill-conceived schemes such as Green Cab and Sasti Roti while playing havoc with the people’s health. The government has loads of money to build roads and flyovers, but cannot find money to buy anti-mosquito spray. It is joking with the suffering masses,” laments Ghulam Rasool, waiting for his turn outside a government hospital to be examined. Visuals of crowded hospitals with wailing patients on TV channels are sending shivers down the spine of Lahorites who are trying every tip that can keep the deadly dengue away. Going to a government hospital for a lab test or medicine is like visiting hell and people find it more convenient to try some home-made recipes. Clergy is also out to undo the crisis by suggesting some particular verses from Quran to stay safe. Most of the television savvy clerics have put together all the possible arguments to prove that God is angry and the devastating floods in Sindh and dengue outbreak in Punjab warrant humble repentance. True, we are being punished for our own negligence.
The
dengue windfall Medical stores have doubled prices of insecticide sprays, preventive lotions and medicines. According to them, wholesalers and dealers have revised the prices. Regular insecticide sprays that were originally priced at Rs100-200, now come for a whopping Rs400 or more. Lotions worth Rs50 or more now cost more than a hundred. Since the demand is much greater than the supply, black market has also thrived, and the suppliers are minting money. They are allegedly hoarding and significantly marking up on these items. In the wake of the threat, private fumigation companies have had a windfall. Last Monday, the city district government registered eight cases against traders selling fumigation machines and spraying medicines at high prices. Not only private companies, but even individuals with manual pumps, insecticides and sprays are now offering their services door to door, and ask for hefty sums in return of their services. Since there is little trust in the government and yet the times are desperate, many people buy whatever is sold, often being duped in the process. These sprays and insecticides are supposedly more
efficient and kill mosquitoes and other insects quickly. And the fear of
dengue drives people to take this expensive measure, especially when there
are children in the family. But these private endeavours can easily prove
toxic since these chemicals are not monitored by experts or regulators. Not
only are many of these sprays cancerous, they also persist for a long time
making underground water bodies, soil and other surfaces poisonous.
Long-term exposure is hazardous. If the spray is not effective enough, it
might make the mosquitoes more resistant and deadly. Therefore, if private
fumigation firms are to operate, they should ideally be regulated under the
law and the public should be made more aware about the usage of such
chemicals. Many people resent that the government has not been efficient in spraying and hence prefer private firms since the latter do often wipe out insects swiftly, no matter what the side effects. Nonetheless, the quicker these sprays wipe out pathogens and the wider their range, the more toxic they might be to human health. And the mosquitoes from other areas can and sometimes do re-appear in your vicinity after some time. Rana Mehmood, owner of the fumigation company Rana Spray Corporation, says that his company is actually protecting the citizens from dengue by filling the gap left behind by the government. He particularly prides in the efficiency of his sprays as compared to the Government and denies exploiting or gouging anyone. He charges two thousand for fumigating a ten-marla building and a thousand more for a double storey building. But he admits that the spray he uses can be expensive for some. Laboratories are adding to the patients’ miseries. Some are still charging more than the government assigned price for the CBC test. However, two of the city’s major labs have faced closure when caught over-charging by the government and apparently more people are now availing of the government subsidy. Usually, when the government fixes a price, it subsidizes for the owner too; in this case the pharmacies are paying the difference from their own pockets. Some labs have reduced their testing capacity and others don’t accept the blood samples till offered extra money. This is usually just seventy to hundred rupees more than the official price. But all medical businesses have not thrived since the outbreak. Some have paid a heavy price. One pharmacy worker denied any fluctuations in sales and prices. However, an official from a well-known pharmacy chain told TNS, “Small and individual stores fake shortage to ask for the price they want. The bigger stores and chain pharmacies can lift medicines from other cities, like we just attained Panadol from our Kasur outlet, where the epidemic is less intense.” He confesses that sometimes prices are increased from the distributor’s end, but the retailer can also charge an additional ten rupees. Mospel was Rs105 now it is 110; Mortein spray was Rs 160 now it is 170. Khwaja Nazir Ahmer, the PR manager of Shaukat Khanum says the hospital was loosing 300,000 rupees (which could be used for cancer patients) daily for these dengue tests. He said the original cost is Rs240, whereas they are forced to charge only Rs90. However, Muhammad Ilyas Rana, manager Zeenat Labortries says the test costs Rs110 and the yearly profit of most laboratories can allow for such limited cross-subsidies during a genuine emergency. “It is just 10 to 15 rupees that we reduce, and we do some 35 or so tests. It is somewhat affordable for the moment.” The prices of apple juice, papaya juice and lemon juice, which are being used to cure dengue, have also gone up in the market since the spread of dengue virus. The leaf of the papaya tree is also being sold in the market for Rs100 to Rs200 per leaf. Since the imposition of Section 144, a ban on washing cars has left thousands of car washers for private houses and petrol pumps, jobless. This was because of the fears that standing freshwater puddles might create more dengue cases. The government has defended its situation saying these are exceptionally critical times and tough decisions have to be made. Yet these daily-wagers have been left struggling for bread and some might resort to crimes out of desperation. The times are indeed critical and drastic policies required. But in a hurry to avoid dengue, we should not overlook the impact our short-term decisions can have on the people.
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