How not to fight Chikungunya

Chikungunya is a viral disease that has reached epidemic proportions in Karachi and is now spreading all over Sindh. Hundreds of people are turning up every day at government hospitals, clinics and other medical centres for help. And yet, there is little help available.

Most doctors in Karachi do not know how to deal with Chikungunya. There are no facilities to test the blood of infected patients. As a result, there is a high chance of being misdiagnosed.

Chikungunya is a disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pains. Other symptoms include muscle pain, headache, nausea, fatigue and rash.

In some instances, doctors cannot tell the difference between dengue, Zika virus and Chikungunya. And yet, dengue requires the patient to be given aggressive medical treatment. In the case of Chikungunya, the prescribed treatment is to give the patient painkillers to alleviate the symptoms.



Whether it is dengue or Chikungunya, the issue is that of failure on the part of the government to ensure basic sanitary conditions. Karachi is one of the largest cities in the world and yet it lacks a proper health department that can monitor and fight disease and tackle outbreaks.

The problem is Karachi’s inability to govern itself. While health is a provincial subject, sanitation and sewerage are technically areas handled by the local government. And yet this city does not have a local government. What it has are disempowered councillors and a hapless city mayor.

With the lack of accountability, MPAs and MNAs have ruled without any check. Mr Zardari and his cronies have milked the city for over a decade by allocating municipal contracts and violating all possible municipal laws in order to make money. Vested interests continue to deny Karachi a functional local government.

Nowhere in the world do we see such a large city that doesn’t have some sort of local ownership. This is a joke on the people of Karachi and is being played for several decades now. While General Musharraf tried to fix Pakistan’s local government system, the country’s vested interests ensured that the most basic of local government powers — the police, magistrates and tax collection, be kept away from the elected councillors.

As a result, local governments remain beholden to bureaucrats for running the city. What is feared now is that given the lack of proper sanitation and trash collection in most cities of Sindh, Chikungunya will only spread all over the province in a matter of months.

Only recently has the new chief minister hired a Chinese firm to start cleaning the city. While the firm has been able to make some difference, the bigger challenge remains unanswered. Karachi needs an efficient yet, local waste disposal system. The Chinese are a temporary solution. A nine-member team of the World Health Organisation (WHO) last week recommended the government to take radical measures to safeguard the city from increasing incidence of Chikungunya. So far nothing has happened.

The WHO team comprised epidemiologists, entomologists and observers. They exchanged their findings with Sindh health ministry officials after completing a three-day mission in which they visited some of the city’s largest lower income areas — Orangi, Korangi, Lyari, Bin Qasim and Malir.

The team called for effective and integrated vector control interventions. They highlighted the need to improve environmental conditions by removing piles of garbage and fixing sanitation problems.

Despite the lack of knowledge and expertise, doctors continue to treat patients as best they can. The only problem is that for most it’s a guessing game.

Corruption continues to play its part. In its research, the WHO team focused on Ibrahim Hyderi, a lower income fishing village located on one edge of the city which has seen a rise in incidents of Chikungunya. Donated pesticides and insecticides to the local authorities were not used for a spraying exercise. Instead they have been sold off by corrupt officials.

The bigger issue isn’t Chikungunya. It is vision and a will to rise to the challenge. One can only wonder whether Murad Ali Shah will do what Shahbaz Sharif did with dengue in Punjab a few years ago. Sharif’s drive has become a case study for other countries of the region on how to fight the problem. Maybe in Sindh, the case study would be the opposite — how not to fight a problem.

Published in The Express Tribune, May 8^th, 2017.

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