Engage Engineers, Not Doctors, To Control Dengue

by M. Bakri Musa

Florida in the summer has the same hot and humid climate as Malaysia. Its topography too is like Malaysia, with plenty of swamps and other stagnant bodies of water. Unlike Malaysians however, Floridians are not regularly threatened with outbreaks of dengue.

The secret is not that Florida has more and better doctors than Malaysia (although that is true) rather that Florida engages its civil engineers and not medical doctors to control vector-driven diseases like dengue. That is much more effective as well as cheaper, both in financial costs and human suffering.

While it is commendable that Dr. Ismail Merican, the Ministry of Health’s Director-General, is spearheading public awareness of dengue during this latest outbreak – the most severe – he is not the best person to do that. Neither his professional background nor his regular duties prepares him for this awesome responsibility. His ministry is not the most appropriate agency to undertake this monumental task.

Like Florida, we should engage civil engineers in local councils and the Ministry of Works, instead of medical doctors in local hospitals and the Ministry of Health. If those engineers could get away from their air-conditioned offices, they would notice those stagnant drains, silted ponds, and ditches with overgrown weeds. If those officers could brave the stench and examine closer, they would see mosquito larva luxuriating in the stagnant waters.

The solution is not to pour toxic chemicals into the water or fog them into the air. Yes, that would be effective, but those same chemicals could eventually leach into our water tables and poison us, that is, if we have not already inhaled them. Get rid of the stagnant water and you would kill off the larva. No larva, no adult mosquitoes, and no vectors to spread the dengue virus.

There is of course a major role for the Ministry of Health. The most obvious is to educate the public and health professionals in recognizing and treating the disease early. The other is in collaborative research with international agencies for prevention (as in vaccine development) as well as treatment. Its Public Health Division could develop sophisticated surveillance strategies using the Internet, GPS, cell phones, and traps laced with chemicals to attract pregnant mosquitoes so as to get real-time information so we could initiate effective and immediate interventions, as the Brazilians are doing.

Learning Favors The Prepared Mind

Many Malaysian doctors, engineers and civil servants visit Florida. What they remember of their experiences there are Mickey Mouse and the Magic Castle. Few would notice the well-trimmed parks, underground drains, and smooth flowing streams. And of course, the absence of pesky mosquitoes!

Those visitors would not realize that the beautiful marinas with their posh waterfront restaurants they patronized were once mosquito-infested swamps. Through the marvels of modern civil engineering, those once sources of pestilence are now major tourist attractions.

Malaysia spends considerable sums sending its officers abroad so they could learn how to improve things back at home. However, to modify Pasteur’s famous quote, learning favors only the prepared mind. You have to know ahead what you want to learn; you have to know your deficiencies so you could actively seek out to remedy them. Meaning, there would have to be considerable preparations beforehand and at home if you were to maximize the learning potential of your overseas trip. If it is only a vague notion of “wanting to learn something new,” then you would only be a tourist.

I once had some senior civil servants visit me at my modest suburban California home. They were impressed with the neighborhood, and yet when I queried them what exactly they found attractive, they could not answer.

Only when I pointed them out would they realize that there were no overhead power and phone lines (all underground), no open storm drains (all covered), and no front yard fences or tall walls to blight the open, park-like ambience of the neighborhood.

When they saw the clean sidewalks and well-trimmed side-street lawns, they attributed that to American city councils being efficient providers of municipal services. That may be true. However, I reminded them that homeowners are responsible for keeping the sidewalks and lawns well cared, for if they do not they would not only be fined but also have to reimburse the city for doing that job for them.

When living in Johor Baru in the 1970s I paid my gardener extra to cut the weeds and unclog the drains outside my compound. He initially reminded me that those were the responsibilities of the Town Council. However when I gently chided him in not wanting to increase his income, he readily complied. He could not comprehend why I would do something that should have been done by the “authorities.” He could not appreciate the benefits I would enjoy. At the very least I would not have to endure the stench of clogged drains or risk my children being bitten by snakes.

I could readily excuse my poorly-educated gardener for his narrow perspective. However my neighbors there included a banker and a corporate executive; they too shared my gardener’s view!

I once suggested to my father’s neighbors in Seremban that if they were to contribute a few thousand ringgit each, their neighborhood could have sidewalks and covered storm drains. That would reduce the mosquito population, as well as the stench and unsightliness of plugged drains.

They balked at the added expense, rationalizing that they have already paid their cukai pintu (assessments). It is the responsibility of the Town Council, they argued like my gardener earlier, in between slapping themselves trying to kill the pestering mosquitoes. Yet the costs of these “common space” improvements would be a fraction of what they spent for their gilded gates and high brick fence walls. Had they gone beyond their narrow concerns, they would have gotten not only a functionally wider streets but also safe sidewalks, quite apart from making their neighborhood healthier.

They would also recoup many times more their investments through the increased in property values.

Septic tanks are also major breeding grounds. They should be banned in urban areas anyway; houses and buildings there should be connected to a central sewer system instead. Nevertheless, an engineer from East Malaysia successfully invented a system (light Styrofoam balls placed in the venting pipes of these tanks) that would allow gases to escape but not mosquitoes. This device should be mandated in all septic tanks.

Then there are civil engineering innovations as having V-bottom storm drains with a U-shaped channel in the center so as to maintain fast flow during low volumes. The usual flat-bottom channels would have puddles of stagnant pools during the dry season.

Personal Actions

Mosquitoes have a range of about half a mile. Even if you were to keep your drains flowing and your yards trimmed, but if your neighbors were slothful, you still would have to endure the nuisance of mosquitoes. Hence a neighborhood approach is needed.

Those factors notwithstanding, there are still many things that individuals can do to minimize the threat of dengue. Installing screens on doors and windows is one; another would be using insecticide-impregnated or even plain mosquito nets, though that is more effective against malaria rather than dengue, which is spread by daytime mosquitoes.

Covering your body as much as possible is also protective. You do not need to be in a burka if that is not your sartorial style; light-colored long-sleeved shirt or blouse, with a sarong, long skirt or pants would achieve the same result.

Even an umbrella is useful. Not only does it protect you against the blistering sun, the constant movement of the umbrella causes micro turbulence underneath it, enough to discourage mosquitoes.

Our officials need not venture far to learn these things. If they have paid attention to their colonial predecessors, our officials would know the importance of cleaning up drains during the dry season so that they would not be clogged with the inevitable rains. I learned that during my childhood days watching those coolies employed by the Public Works Department scraping the drains. And this was long before I even heard of Florida and Disneyworld.