Dengue has a penchant for headlines. As inflated numbers of confirmed dengue cases do the rounds,
Dr N K Yadav,Municipal Health Officer,South Corporation,surveys the situation from his 18th floor citadel,far removed from the hunting grounds of the mosquitoes,relying on hard numbers reported daily by his teams.
At the MCD Civic Centre,the public health department begins work at 9 a.m. every day on the Vector-Borne Disease programme. The programme that started out as an anti-malaria drive in 1953 was rechristened in 1996 after the first dengue epidemic scare in Delhi. Since then,teams have fanned out into the city every year during the disease transmission seasonApril to Novemberto prevent and contain vector-borne diseases.
The programme,Yadav explains,has two arms of operationvector control and disease control. The common vector-borne diseases prevalent in Delhi are malaria,dengue and chikungunya. In the vector-control activity,which is conducted round the year,the idea is to deprive mosquitoes of breeding spots. If they cant breed,they cant proliferate. All stagnant water bodies,indoors and outdoors,must be drained out since they are active sources of breeding for mosquitoes. Besides water collected during the rains,coolers,overhead tanks,flower pots,containers,open drains,old tyres all these are potential sources for breeding, he says.
A strange case of tea cup breeding occurred at the campuses of IIT and Delhi University in 2010,he recounts. Thousands of used tea cups floating on the campuses became breeding spots for mosquitoes because of water collection and stagnation that monsoon. That brought the importance of solid waste removal into focus,says Yadav.
All the 272 wards of the Municipal Corporation of Delhi (excluding Cantonment and NDMC areas) are divided into malaria circles. Each circle comprises a team of an anti-malaria inspector,assistant malaria inspector,domestic breeding checkers and field workers. The domestic breeding checkers (DBCs) are an army of health workers (3,200 for the 272 wards) who move door-to-door checking for breeding,contamination and disinfecting sources in case breeding is found.
Field workers carry hand-held fogging machines to douse contaminated houses with insecticides. And now,which is the peak transmission period,vehicle-mounted fogging operations are carried out in selected wards. There is also a vector surveillance team,randomly checking on wards and reporting back to the headquarters with findings.
A small standee with the days agenda sits on Yadavs mammoth deska hard-to-miss reminder among the numerous files. After monitoring the situation in all the 104 wards under the South Corporation,Yadav turns his attention to other pressing matters such as preparing daily reports for the Delhi Government.
This year there have been 368 vector-borne cases reported in Delhi,he says. As of September 29,there are 68 confirmed dengue cases from Delhi and 57 from other states receiving treatment in Delhi. Last year,1,138 confirmed cases were reported. And in 2010,6,259. The low numbers reported this year might have something to do with a leaner monsoon and increased surveillance and monitoring efforts but,Yadav says,its more to do with the natural history of the disease. Dengue peaks once in three to four years and the numbers will show then,he says.
A congested main road,flanked by the Metro station and markets on either side,leads into the green,gated and prosperous communities of Green Park in South Delhi. A team of DBCs,their biometric attendance done,move out into the quiet streets; registers under their arms,dengue-awareness pamphlets in their hands and blue caps sitting pretty on their heads.
Soma Rani,38,signed up for the activity in 1996 when the epidemic broke out. Many of the DBCs are old-timers. When the activity began,the DBCs were employed for a month at most. Now,they work the whole year but are still on contract. Soma,who lives in Moti Bagh,works from 9 a.m. to 5 p.m.,with a break for lunch. In a day,she covers about 60 houses.
She draws a small chart on the compound wall and scribbles with a pencildate,sign and result of the visit. Many times,we are not allowed to come in. The help opens the door and turns us away. But still,weve come here five times from April for fumigation, she says.
An irate resident hollers that he hasnt seen them even once. However,the chart on his wall tells a different story.
A few more houses later,the field workers busy themselves with open drains and other large water bodies in the area. Wielding hand-held spray machines and rakes,they carefully pick out clothes and plastic items from the cesspools. Stagnation is frowned upon; the water must run and not stand still.
The contrast is telling. Tucked miles away,behind rows and rows of fortified,grandiose farm houses on the Cariappa Marg,Sangam Vihar is a thriving,illegal settlement,ready to break at the seams. The first dengue death in the season was reported yesterdaya 9 year old from Sangam Vihar. For the DBC teams,the problem in Sangam Vihar is basic. Water. With no Delhi Jal Board to supply water,people here rely on expensive private tankers and store water for days on end in open tanks,allowing mosquitoes to breed and thrive.
The DBCs arrive at Malaria Karyalaya,ward no. 60,Devli gaon (Sangam Vihar) at 9 a.m. for their attendance. But the biometric machine that marks their attendance has broken down. The DBCs shuffle out into the colony,followed by an MCD-hired auto dressed in dengue-awareness posters and mouthing altered dialogues from Munnabhai MBBS. Every day,the DBC teams find at least five to six cases of mosquito breeding. In some of the houses,the breeding is far too advanced for the Temephos granules to work. The sewers are pale gray and stagnant.
Dr L R Verma,Deputy Health Officer of the South Corporation wards,explains that in the life-cycle of the Aedes mosquito from egg to adult (the dengue culprit),the larva stage is the weakest link. The entire life-cycle lasts 7-10 days. The DBCs have to ensure their rounds to the houses to catch the mosquito in the larva stage to be able to arrest the breeding.
Green Park and Sangam Vihar may have little in common,but one problem that plagues both areas is that of construction. The DBCs and field workers are doubly careful in their inspection of these sites. As they go about their business,poking their heads in open drums and containers,crowds gather,complaints pour in and so does chai.
At 5 p.m.,the team here,as elsewhere,wraps up and heads home. Yadav heads to the last meeting of his day at the Civic Centre and Verma finishes a meeting with all his ward members to discuss insecticide stocks at Green Park. In the distance,a tanker starts up and the vehicle-mounted fogging operation begins,spraying the streets with insecticides,killing the adult mosquitoes instantly. For them,work has just begun.