Covid-19 prevention:

 

Revamp CMC’s crippled Public Health Services

By Dr. Pradeep Kariyawsam-November 24, 2020
Former Chief Medical Officer of Health / CMC

When the second wave of the Covid-19 epidemic started, it was inevitable that the wave would reach Colombo, as many other epidemics such as dengue fever, chikungunya, cholera, influenza started in Colombo and then spread to other areas. Here of course those who travelled from abroad obviously brought the disease to the country, and then it spread towards the city in no time. There are many who travel from Gampaha District to Colombo city area and they were the potential carriers of the virus.

Prevention activities should have been started from all fronts, especially in Colombo North and Central areas, as soon as we heard about the Minuwangoda outbreak; and without hesitating when it reached Peliyagoda which lies in the northern bank of Kelani river. Colombo North lies just a few hundred feet away in the Southern bank. True the CMC started carrying out PCR tests, but most of them were off target as hardly a patient was found initially. There is no point in crying over spilt milk now. The importance of Public Health Services should be recognized at least now, and that a proper service could save the city and country from economic collapse and social unrest. The latter mostly instigated by politicians. The deaths at home is a sign that all is not well with the prevention services. Unfortunately, some politicians and government servants do not understand this reality.

Around 40 years ago, the Minister of Local Government realized the importance and the necessity to organize the people in these areas, who actually lived in slums and shanties and the need to prevent communicable diseases and provided them with basic amenities. Hence under his direction the CMC went on to carry out surveys of the needs of the people through new recruits called Health Wardens. The Health Wardens formed Community Development Councils after having elections in the so-called Gardens (Wattas) where the people in them chose their leaders as the office-bearers to run the Councils. Women’s and children’s groups were also formed by the Health Wardens, and these GCE (AL) qualified youth were the acceptable officials to give instructions on any matter on health and welfare. I can remember they even arranged marriage registrations.

They teamed up with the Public Health Inspectors, Nurses, Midwives and Medical Laboratory Technologists (MLT), Health Education Officers, and formed a network that supported the preventive services to the hilt. In short, we were proud of our work and it was appreciated by UNICEF, WHO, UNCHS, etc. For example, when we had to get Colombo as polio free, all of them teamed up and with the help of Rotarians gave vaccines to all children under five years of age in the city in one day! In order to provide a proper service, the city needs at least 65 Public Health Inspectors, 35 Nurses, 175 Midwives, 35 MLTs and over 200 Health Wardens or Health Instructors as they are called now. (The Salaries and Cadres Commission please note!) These services are in a sorry state of affairs now, as the number of officers in service have dwindled so much that we no longer have a single maternity home that is operating at night, as only nine nurses are available, the PHIs have neglected food hygiene work, and Midwives are over stretched so much they are running a crippled service, the laboratories lack material and the poor people have to go to the private sector to get expensive tests done, when they could have got them done free at the CMC labs. But the most important aspects of all this, which are organizing the communities, health education, creation of awareness about communicable diseases, communicating with all and being the link between the people and the health units that were handled by the Health Instructors do not exist anymore.

There aren’t even Health Education Officers anymore, who used to supervise them. The information thus collected then can be analysed by the Epidemiologist to understand the vulnerable areas and direct prevention activities. Unfortunately, there is no Epidemiologist as the post of Deputy Chief Medical Officer (Epidemiology) is not filled during the last three years. That is what is lacking mainly in CMC’s Covid-19 prevention programmes today. It is not the ambulances that the people need as CMC already has two ambulance services; The ambulances run by the MCH Division and the 110-service are run by well-trained fire-fighters. The people need someone to be with them in their hour of need as it happened years ago, looking after their health and welfare needs, as Health Instructors were allocated to areas in which they were responsible for the people in slums, shanties and apartments.

Therefore, it is my humble appeal that the CMC, the Western Provincial Council, and the Ministry of Health get together and fill these posts, create higher cadres for these posts and appoint suitable persons immediately. We have to allocate vulnerable areas to these officers and get them to go to the people, organize them, look after their health and welfare needs and prevent a disaster happening as there will be more Covid-19 waves and new epidemics in the near future. This will definitely reduce deaths at homes. A stable Colombo, health-wise, will make the country stable in the same way. With all my experience I know that this is the only way to prevent this kind of disaster happening again, and this will be a feasible way of managing this crisis for the government to prevent and control this disease.