Chikungunya Notebook: Mitigate and Educate

aedes aegypti mosiquito

The Minister of Health, Dr. Fenton Ferguson, is scheduled to address Jamaicans some time this afternoon or early evening.  I have no idea why this address wasn’t done on Friday, when it was announced, because really there need not be any pomp or any more vague information from him.  The viral fever chikungunya is now out of hand — it is an epidemic — and a lot of work is needed to get things under control.  Dr. Ferguson is no longer worthy of the trust or expectation that he can lead the work that needs to be done.

First

Today Minister Ferguson should be appearing on televisions and radios to announce his resignation and then immediately introduce the person who will take over the coordination efforts to control the chikungunya epidemic.  That should be followed closely by Prime Minister Simpson-Miller announcing the (at minimum) interim Minister of Health.  Fade to black, Dr. Ferguson; thanks for your 40+ years of public service but you have failed as Minister of Health (it’s not just his inept leadership regarding the chikungunya response), and it is simply best that you no longer lead things.  Why resign? Because Dr. Ferguson is now the very public face of an abject public health failure and of a Ministry that is rightly mistrusted by many in the population he is meant to protect and serve.  He has compromised the well-being of 2.8 million people.  His resignation is the first step for accountability in this mess.  It is neither a grand gesture nor mere optics, it is simply what is necessary so that the country can move on to mitigation and education.

A note: because a resignation from Dr. Ferguson is a first step for accountability, it means that others should also consider stepping down from their leadership posts.  Or they should simply be fired.  Dr. Ferguson is the Minister of Health so I firmly believe that he bears most of the responsibility for yet another mess that Jamaica has to dig itself out of, but he’s not alone in creating this mess.  I’m sure there are many advisers and others who also took this virus lightly.  And “ordinary” Jamaicans also need to look at how they literally contributed to the mess that allowed chikungunya to rampage; the nastiness and callous disregard for the environment is intolerable.

Next: Mitigate & Educate

WANTED: Someone who’s competent and forthright to coordinate with parish councils, Members of Parliament (MPs), National Solid Waste Management Agency (NSWMA), Jamaica Medical Doctors Association (JMDA), Medical Association of Jamaica (MAJ), Nurses Association of Jamaica (NAJ), Press Association of Jamaica (PAJ), and the Jamaica Environmental Trust.  Actually I think it may be best if someone from the Jamaica Defense Force (JDF) coordinates all of these efforts because I think, currently, they are the best equipped in Jamaica.  No need or cause for full-on militarization but we need the JDF’s competence, organizing skills, and no-nonsense attitude to mitigate the ongoing damage of the chikungunya epidemic.

Then: Address Immediate Needs

(1) At least month-long island wide cleanups of streets, drains, and gullies AND proper disposal or storage. No burning.  Heroes’ Day is coming up in Jamaica on October 20.  That’s an easy date around which to build an awareness and public health campaign: clean up X-percentage of breeding sites or X-number of the most vulnerable communities  by October 20, 2014 with an extra push on the day.  Heroes’ Day can also become a logical starting point for Phase 2 of clean up efforts, taking us through Christmastime when people are already focused on “fixing up” for the New Year. Take advantage of that cultural preference; build on it.

(2) Garbage collection or designated drop off points since money is scarce.  We need a regular collection or drop off schedule at least through December 31, 2014.

(3) Simultaneous public health campaigns:

(a) about why clean ups are important for destroying breeding sites using: radio & TV messages every hour; clear, short newspaper spots online & off; Facebook & Twitter; town criers morning & evening throughout communities; health officers and easy to understand  messaging at transport hubs and in each school in Jamaica;

(b) that are clear.  Stop lying and stop hiding information.  Clearly state the illnesses going around (dengue, chikungunya, the flu, and another illness).  Clearly state how each is transmitted + what’s being done to identify the other unknown illness; there’s no sense in denying that someone else is afflicting Jamaicans and it is dangerous and reckless to not address it openly and forthrightly;

(c) about how to treat and take the medication properly, a note that home remedies may work but be careful, a note to not overdo any treatment, and a note about which medications not to take; 

(d) about who in the population is most vulnerable and why, and what special care or attention is needed; and,

(e) about long-term care and effects of dengue and chikungunya, and the importance of follow-up care with a health care professional.

That is just to start.  A lot of other things need to be done.  A lot of work still to do once things are under better control.

Fellow tweeter @gocharms suggests a few alterations to my list above and, on the whole, I agree with her.  Her suggestions below (my comments follow in bold):

  • With respect to my suggestion #3: Not pushing social media as much, focusing instead on music and social groups (e.g., churches).  She accurately points out that it’s the non-readers of the Jamaican population that are at greater risk.  I agree about focusing on existing social groups and pushing social media down the list of targets, but I still feel strongly that social media must be used. It cannot be ignored or pushed off the list. As @kelster notes, there’s been a lot of misinformation on social media. That’s understandable.  So, I’m still for clear and targeted messages on the popular social media platforms, but getting into churches and other civic organizations’ spaces is important too and likely to be more effective.  Music is of course a an asset for Jamaica; Jamaicans will create a song for anything.  Actually there’s already a chikungunya song and it’s the best thing I’ve seen come out of this mess.  Use it well.

  • With respect to #s 1 and 2: Partnering with businesses (a Public Private partnership-like model) to focus on cleanups particular communities (e.g., Carib Cement focuses on Harbour View).  There would be “built in labor” (I think she means in the form of the companies’ own employees + there can be incentives for community members and the companies to participate.  She links this, rightly but frustratingly for me though I referenced it above, to the dire financial straits of the country, which has shown up, for example, by the lack of garbage collection.  Agreed.  A year ago when I visited home garbage collection was scarce, and many turned to throwing garbage in gullies or piling it up along the streets.  (That’s the kind of nastiness that contributed to the epidemic.)  From my observations of tweets and conversations with friends and family it appears that this has worsened, and the best NSWMA seems to be able to do is say that they have no money.  Perhaps it is time to do more with less.  O, and I’d also include embassies, consulates, and diplomatic missions in the partnerships.  Mosquitoes do not discriminate.
  • With respect to #3: Using existing professional organizations to train people already in place in organizations to deliver public health messaging.  Agreed.  As I’ve said many times now, we can no longer wait for Jamaica’s Ministry of Health to act first. Existing willing working and credible professional and other organizations must step into the gaping public education gap and provide necessary information.  The JMDA, MAJ, and NAJ can create guidelines and fact sheets and run the initial training, then provide a support role for the professional organizations as they go out spread the word.

Urgency

Questions like these

must be answered quickly.  It is a valid and logical question, highlighting the woeful public education on chikungunya.  The answer is relatively easy to give.

To say that watching the creation of this epidemic is frustrating is an understatement.  I’ve closely watched the Ebola outbreak in Liberia, Sierra Leone, and Guinea (to a lesser extent too in Nigeria), and it is hard to miss the (lack of adequate) response to it. It is also hard to miss many of the same missteps repeated in Jamaica as the chikungunya arrived and spread.  I’ve also seen much of the same distrust develop among the population including health care professionals, a distrust rooted in superstition, lack of education, knowing “the runnings,” and fear.  It’s times like these and government needs to step in and do, and it’s when we should be able to trust the government.  Alas, the epidemic demands immediate attention but there is so much work to be done because this is a system error for which CTRL+ALT+DELETE is insufficient.

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This post is based on tweets I made earlier today in response to @jcankash’s challenge

Comments
8 Responses to “Chikungunya Notebook: Mitigate and Educate”
  1. petchary says:

    A friend in Haiti told me that many weeks ago they started a texting campaign, sending simple basic information. Our people never thought of that.

  2. Kelster says:

    I’ve been to a lot of people about this all weekend. I wrongly assumed that people knew how this was transmitted. It’s easy to write it off as the “non-readers” and those with less access to information who are misinformed. However, I spoke to several persons who have multiple degrees who insisted that this was not being transmitted by mosquitoes. We prefer to rely on hearsay rather than listen to official sources. Why Google something when you can just listen to a coworker?

    Someone else mentioned that there have been announcements on the radio from both MOH or PAHO. However, we don’t listen/dismiss it.

    • Can you describe the announcements broadcast on radio? Because I want to understand HOW the communication is being done and how often. So much. I may seem harsh or nitpicky with GOJ but this is about people’s health and is actually life or death for some.

      • Kelster says:

        I haven’t heard them (not in Jamaica) but I’ll ask those who mentioned them how often they heard them and the details. At least one persom who mentioned them to me dismissed the information.

  3. Our-Shores says:

    Hi, I just came across your blog, and lovign it. keep up the good work. see my post on the subject. Blog format: the published article can be found on my link. http://ourshores.org/2014/10/21/high-o-ebola-low-on-chikungunya/

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  1. […] Miraculously, I have not (yet). Fellow blogger Cucumber Juice suggests a workable strategy here: https://cucumberjuice.wordpress.com/2014/09/28/chikungunya-notebook-mitigate-and-educate/ Others want the Health Minister to simply resign. Here is the text of Minister Ferguson’s […]

  2. […] containing the spread of both the virus and misinformation about the disease. Blogger “Cucumber Juice” admits that the “ordinary Jamaican” has played a part in the Chikungunya […]

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