September 1, 2010

Honduras' 2010 dengue epidemic (2 of 2)

How to control dengue in Honduras"Woman, someone needs combat the mosquito!"
"Be tranquil. Let the government come!"
(Cartoons by Dario Banegas)

Why is Honduras being hit so much harder by dengue than other Central American countries with similar climates and terrain? From part 1 of this article:
As of week 31 (August 12), in all of Central America, 75% of the total deaths from dengue had occurred in Honduras, and 50% of the total deaths had occurred in Tegucigalpa. Comparing Honduras [~45,000 cases] to its neighbors, Costa Rica has had only a little over 17,000 classic cases, the same as El Salvador. Guatemala, with almost double the population of Honduras, has had only about 7,500 cases of dengue clásico, 104 cases of DH and 15 deaths. Honduras represents about 18% of the Central American population.
Here are some of my thoughts:

1) There is little or no personal responsibility among many people. Like the cartoon above indicates, every problem is somebody else's responsibility. Most Hondurans know how and where mosquitoes breed (in standing water). The dengue mosquito (Aedes Aegypti) does not travel far in its lifetime. On every authoritative website I've read, the number one effective recommendation to prevent dengue is to clean up trash and any receptacles that hold water on your own property.

A common breeding ground is among plastic rubbish that holds water. With nothing more than some trash bags and a few machetes, shovels and rakes, neighbors could work together to eliminate breeding grounds in their colonias. But very few neighborhoods take those simple actions that they could take to make their areas a little safer. To sit back and expect that any government can or will clean up every neighborhood is unreasonable; in Honduras, it is just plain stupid.

2) Actions taken by the government are expensive and ineffective. The manner of fumigating (thermal fogging) is scientifically one of the least effective methods and most enlightened governments have discontinued its use. I liken it to running down the street with a fly swatter trying to rid the world with flies while ignoring the garbage pile breeding flies in your backyard.

Experts from the US, the Pan American Health Association, and possibly other organizations have been here to analyze the effectiveness of Honduras' methods and the chemicals used. One of the issues discussed was whether or not the Aedes Agypti mosquito has become resistant. I have not been able to find that the results of those reports have ever been made public.

dengue fumigation HondurasThe chemical may (I'm not even entirely sure about this) kill all mosquitoes unfortunate enough to be out and about at that exact time and in the direct path of the spray, but that's about it. Authorities have said that the spray is only effective for a couple of hours. They can't expect to be able to spray every neighborhood and inside every house (which they do!). I'd be surprised if any neighborhood ever gets sprayed twice in a year, so what happens to all of the mosquitoes that are born the next day or the day after or next week or next month? Use your head! Fogging is a waste of money.

Two weeks ago a friend was in the San Pedro airport midday waiting for his flight to La Ceiba when all of a sudden white "smoke" starting coming through the ceiling vents right on top of the people sitting in the waiting area! Some people started panicking while others sat there unconcerned engulfed by the "smoke". Finally an announcement came over the speakers saying not to worry, that they were fumigating and there was no reason to leave the area as it was a non-toxic chemical. Enjoy!

dengue fogging HondurasEl Jefe had his own experience of being fumigated along with a lot of food that was sold to an unsuspecting public at a 2007 university function. Not one word of warning was given to the hundreds of students and visitors before a truck drove through the event spraying the public.

On the news, I see schools, houses, kitchens, cabinets, restaurants, day care centers, dishes, food, etc. etc. being engulfed in this smoke. I even see people with happy faces standing amid the fog, pleased that their house is being fumigated. Since everyone is convinced that this chemical is non-toxic, do you suppose that anyone washes the dishes, the school desks, or the kids' toys before they put them in their mouths?

Despite looking for years, I have never seen the name of the chemical used. It may or may not be less toxic, but I am 100% sure it is not being used as recommended. When was the last time you read any chemical insecticide label that said, "Go ahead and spray people and food with this"? Professors at the National University and several large businesses have refused to allow fumigation. Maybe they know something that we don't.

What should they do, in my not so humble opinion?

Honduras President Lobo cartoonPresident Lobo in front of the IMF and World Bank
with hat in hand. Fill 'er up!

1) The government needs to stop waiting for crises before acting. Money is no excuse. It costs more to deal with an emergency than it does to try to prevent one from occurring. If they came up with a decent plan, I'm sure that the money would flow in to help them implement it.

A serious educational and clean up campaign should start immediately to prevent another epidemic next year or the year after — which we all know will happen. Patronatos (neighborhood associations) should be contacted to set up neighborhood meetings. Use doctors, teachers, or others with authority to present a standard educational program to the neighbors and schoolchildren. Train the military to help organize the volunteers to clean up the colonias with the highest incidence. My guess is that those educational programs as well as programs for school children have already been developed in other countries. Don't reinvent the wheel when there is no need to do so.

2) The government should do some scientific research. I don't mean set up a commission of 'notables', hire million dollar consultants, or task the universities to develop "new science". Collaborate and find out what has worked in Central America and other tropical countries and use the best of those methods. Don't be so arrogant as to think that the way things have been done here are the way they have to be done forever. If it isn't working, admit it and change it. It wouldn't surprise me one bit, nor I'm sure most Hondurans, to find out that the chemical used is not because anyone even thinks it is effective but rather because someone made a dirty deal with someone else for the equipment and supplies.

dengue fumigation Honduras3) Promote the simple, natural things that people can do at no or very little cost, but again, investigate before you recommend them. We use more chemicals than ever before and have more dengue than ever before so what does that tell a logical person? There are some plants and herbs that when used properly, work pretty well for repelling insects for those who can't afford DEET, and most people in Honduras cannot afford it. Australia had success by encouraging children to place a certain type of water bug which consumes the mosquito larvae into their water storage containers (pilas)!

But don't invent ridiculous things that have no scientific basis. When I see so-called experts on TV suggesting that sticking cloves in a cut lemon and setting a couple of them around your house will prevent mosquitoes, I just want to scream at the stupidity. Better to spend that limited money on a trash bag and use it.

4) The government and/or municipalities should take responsibility for the things that individuals can't do anything about, like potholes that hold water, non-existent trash pickup in many poor areas, water systems that constantly leak, and sewage systems that don't drain causing permanent swamp-like conditions in some neighborhoods. But here again, if the government doesn't do it, the people have to do something. That can be as simple as borrowing a shovel and filling up a hole or digging out a ditch so that it no longer holds standing water. It can be done and it doesn't take an epidemiologist to do it.

5) The municipalities should consistently and fairly enforce the laws already on the books about maintenance of private properties. They should increase the fines so that they can afford to enforce them. This should be looked upon as a break-even activity, where the fines imposed are enough to pay the inspectors' salaries and the clean up crews. No one should have the right to put their neighbors at risk because of their own negligence.

This wouldn't be a popular move, because as El Catracho wrote [Google English translation], he places much of the blame on the municipalities for lack of trash pick up and street repair. He believes that the income from the fines would be used to finance political campaigns. El Catracho also believes that this would be an unfair burden on the middle class and businesses, since the poor can't pay and the rich and important will never be fined.


Death from dengue HondurasPlease don't think that I have no sympathy. Like almost everything else, this affects the poor more than anyone else. Seeing the heartbroken, sobbing parents who have lost a child on television brings tears to my eyes. I'm angry that people go through this year after year, especially because it is so darned unnecessary.

The government needs to reevaluate and stop being so stupid and arrogant. Obviously, they do not know what works or do not have the will to make it happen. And citizens need to realize that they have responsibility, too, and that since the government cannot protect them, they need to take steps to protect themselves and their children, even if it means that they spend a Saturday or Sunday every now and then cleaning up their own neighborhoods.

Will any of these common sense steps be taken?



Because this is Honduras and that is how we do things here. Corruption and incompetence invade every aspect of life. For any solutions that you or I could come up with, I can tell you how corruption could overtake the process preventing success. A hundred times more effort would be put into figuring out how to rip off the government or aid funds than would be put into doing something that works. That is true from the top levels of government all the way down to the people who are supposed to be helped. Oh, there are exceptions, but not enough to make a difference.

Honduras President Lobo cartoon(Cartoon: President Lobo, "To unite, we have to share.")

If, for example, the government was to provide trash bags for clean up campaigns — because there are people who actually cannot afford to buy a trash bag — first a lot of political hiring would occur. They would need nice offices and cell phones and cars. Then the person in charge would set up a fake bidding process in which he would give the contract to a buddy in return for a kickback. The now expensive bags might sit in a warehouse until they deteriorated or maybe they would already be of such low quality that they are virtually worthless.

If the bags were delivered to the towns, probably the mayor or other city employees would divert a bunch of them and they would show up for sale somewhere. If the bags made it to the colonias, you'd probably see the patronato president and his friends with nicely bagged trash for the next months or see them for sale in the neighborhood pulpería. But, we would be treated to a special press conference in which a smiling president or minister of health would be personally delivering the bags to a mayor. Oh, and I forgot to say that the extra expense of having the bags printed with someone's picture or a political party emblem would undoubtedly be incurred.

The number of cases will diminish and not so many people will die. There will be no research, no plans for the future, no effective educational programs. Oh, there might be some million dollar program with a bunch of unqualified, highly paid political appointees from which all the money will disappear. The government and the people will forget that dengue exists .... until the next time when we will again see the authorities waiving their arms in the air and lamenting all the deaths and the lack of money to do anything about it, and begging for help from your tax dollars. The people will be clamoring for the government to fumigate their neighborhoods and kitchens, and the newspapers will be asking where all the money went.

Too negative?

Or too realistic for comfort?

Check back in a couple of years.

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