By Dr R Neerunjun Gopee
The great success story of Mauritius in matters of health and medicine is not the treatment of disease some of which have been given star status (heart disease, cancer, diabetes) but the control of diseases caused by microbes, otherwise known as infections or communicable diseases. They are much more serious because they have the potential to spread very rapidly in the population, and affect and kill large numbers within a short time. In other words, they are practically instant killer epidemics. And the credit for this success goes to the unsung heroes and pioneers who prefer to work quietly behind the scenes, in what is known as the Public Health (PH) division of the Ministry of Health and Quality of Life (MOH). PH or Preventive Medicine is the fundamental pillar of the health system of any country, because it ensures the enabling environment for human existence and a country’s development. Think of the plague that devastated Europe in the pre-Middle Ages, or the epidemic of yellow fever that decimated almost half the population of Gambia in the 1960s, and you get the picture.
The Gambian epidemic transformed the country’s then Medical Director and probably only surgeon – a Fellow of the Royal College of Surgeons of Edinburgh – into a convert to Public Health. He was Dr Ebrahim Samba, who went on to serve three terms as the Regional Director of WHO in the Africa Region (AFRO); he told me this story in his own words when I was interviewed by him (one of five interviews I went through) for the post of WHO Representative in 1999.
Our more than honourable track record in PH has robust origins, because no less that the discoverer of the malarial parasite, Sir Ronald Ross, who received the Nobel Prize for Physiology or Medicine in 1902 for his work on malaria, came to Mauritius a few years before winning the Nobel Prize and studied the malaria situation. He produced a comprehensive report with recommendations that were applied, and that set us on a course towards the elimination of malaria, the first country in Africa to do so as far back as in 1973, a feat which is acknowledged and cited as a model of best practice to be emulated by AFRO. Sir Ronald Ross also served as Honorary President of the Mauritius Medical Association which was affiliated to the British Medical Association.
Our recent successes concern the AH1N1 pandemic, chikungunya, and dengue, as also food-borne infections, the control of which is done within the framework of a rapid Alert and Response system. Around the time of the AH1N1 pandemic, we received the visit of a team from the Maryland School of Medicine, USA, and they were amazed at, and all praise for our tracking system – surveillance – because within 24 hours of their arrival they had been contacted by the Regional Health Office to get an update on their health status.
And so it is with the HIV-Aids situation in Mauritius. Driven by government from the very beginning, because very early on after the detection of the first case in 1987 an AIDS Unit was set up, the latter has ably handled it task. Its first head, Dr Clement Chan Kam, went on to become one of the regional directors at UNAIDS, surely a great honour for Mauritius, and has retired a couple of years ago.
It is worth highlighting a few salient facts about the local situation:
- The prevalence of HIV-Aids is less than 1% – it is 0.97%;
- It is a concentrated epidemic i.e. it occurs mostly in certain high at risk groups such as commercial sex workers, and in certain geographical locations;
- The number of new cases peaked in 2005 (921) and has since showed a steady decline to reach, in 2010, 568;
- Similarly, the percentage of injecting drug users (IDUs) infected by HIV peaked in 2005 (about 92%) and last year, 2010, was about 74%;
- It is noteworthy that the estimated population of IDUs, which was for many years wrongly publicized as being over 20 000, has in fact been revised downwards by an expert, Dr Lisa Johnson, to about 10 000, based on a more rigorous methodology;
- All aspects of prevention, diagnosis and treatment for HIV-AIDS are offered entirely free at hospitals, health centres, drop-in centres and the Harm Reduction Unit at Barkly, Beau-Bassin;
- Anti-Retroviral drugs (ARV) are being taken by an increasing number of detected cases, and this includes pregnant women so as to prevent mother-to-child infection; the cost of ARVs in 2010 amounted to Rs 14.7 M.;
- Harm reduction through Methadone Substitution Therapy has already reached nearly 4000 IDUs – i.e. about 40% of them; according to WHO norms, reaching 60% of IDUs is tantamount to gaining control, and starting reversal, of the disease: we are well on the way to meet this target within a couple of years.
There are quite a few more facts and figures about our local Aids situation which are available from official documents, but the message is clear: the government-driven HIV-Aids control programme is highly effective, is benchmarked on international standards, is well-funded, has commitment at the highest level and is carried out within a forward-looking piece of legislation – the HIV-AIDS Act – which is kept under continuous review to bring any amendments that may be necessary as the situation evolves and demands.
Our situation parallels what is happening at global level, apparent from the latest information on the matter:
– Since 2001, annual HIV incidence has fallen in 33 countries, 22 of them in sub-Saharan Africa.
– The number of AIDS-related deaths worldwide is steadily decreasing from a peak of 2.2 million in 2005 to an estimated 1.8 million in 2010.
– The latest report by the WHO, UNICEF and UNAIDS Report on the global HIV/AIDS response indicates that increased access to HIV services resulted in a 15% reduction of new infections over the past decade and a 22% decline in AIDS-related deaths in the last five years.
As a country, we are committed to continue with our efforts to keep not only HIV-Aids but all communicable diseases under control, and I reiterate that the real transformation in health and medicine in Mauritius, as indeed in the rest of the developed world, has come about by Public Health interventions.
To come back to HIV-Aids, those who would care for an insider story about the beginnings of the malady, its evolution and the intricacies relating to its identification, detection and its ramifications would do no better than to read Elisabeth Pisani’s The Wisdom of Whores, subtitled Bureaucrats, Brothels and the Business of Aids.
* Published in print edition on 2 December 2011