Even when we think they have been brought under control, they can come back or re-emerge as the jargon goes
By Dr R Neerunjun Gopee
‘Infectious Disease and Public Health: Mauritius 1810-2010’ is the title of a book by Raj Boodhoo, a historian with an interest in health and disease, particularly infectious disease. This is his second book; the first one was focused on the health of Indian immigrants during the indenture period. This new publication, which was launched last Saturday afternoon at Le Pavillon in Quatre Bornes by the Ag. President of the Republic Paramasivum Pillay Vyapoory, is a first of its kind in the medical history of the island.
As the author writes in his Introduction, ‘This work attempts to investigate major infectious diseases affecting Mauritius during the last two centuries, covering British rule (1810-1967) and Independent Mauritius (1968-2010)’, taking into account ‘the response of the colonial and post-colonial governments as they developed public health policies and strategies to confront epidemics and pandemics’.
A quick perusal of the book will show that it is a comprehensive account of the struggle that has been waged to control infectious diseases, beginning from a time when even their causes were not known and there was therefore no adequate strategy for their prevention, let alone appropriate treatment. This is a struggle that will never stop for, given that we live in a mega-sphere teeming with microbes which outnumber human beings by the trillions, the potential for disease-causing ones to flare up and attack individuals in isolation or on a large scale leading to epidemics or pandemics is ever-present and immense. New microbes, such as the HIV-virus, Zika, Ebola viruses can make their appearance and spread rapidly; but even older ones, such as the influenza virus, can morph into new forms and cause havoc, as was the case with the AH1N1 pandemic that triggered worldwide concern in 2010.
But even when we think they have been brought under control, they can come back or re-emerge as the jargon goes. This applies to, for example, tuberculosis, which has made a comeback in developed countries in specific areas because of altered socio-economic conditions. What is more worrying is that the re-emergent form of the tuberculosis bacterium shows resistance to the existing antibiotics, and new ones must be developed to deal with it. This not only takes time but can be expensive as well, so that people most in need of the new antibiotic may not have easy access to it, thus prolonging the duration of the disease and perpetuating it in the affected population, with the clear possibility of further spread.
A more recent example is the surge of measles in the US, where a movement by people spreading scare about the measles vaccine led thousands of parents to refuse getting their children vaccinated, as part of an ‘antiVax’ campaign, giving headache to the health authorities attempting to limit the spread of the disease, and having to launch targeted campaigns to counter the false narrative being propagated, and to convince parents to have their children immunized. For that matter, even in Mauritius last year we had an outbreak of measles that affected nearly a thousand people, many of them adults, and there were a few deaths too.
The lesson is that we must be ever vigilant and continually beef up our surveillance systems.
How this was done by leaps and bounds initially, and then more systematically from around the middle of the 20th century because of greater awareness based on expanding scientific knowledge in both the basic and applied sciences, comes through clearly in Boodhoo’s book. It is set out in a chronological and thematic order, since ‘each disease has its own particular history’, so different chapters examine one epidemic disease at a time, ‘explaining its origin, its introduction into the island, its impact on the community, and the success or failure of medical treatment provided’. The most important diseases of the past dealt with are smallpox, cholera which caused a pandemic in 1819, malaria which has now been eliminated, the plague pandemic of 1899, the Spanish influenza of 1918, tuberculosis and poliomyelitis.
The more recent ones such as HIV-Aids, chikungunya, dengue and AH1N1 epidemics are also analysed. Belatedly, the AH1N1 episode, in which I was personally involved at the time at the Ministry of Health and Quality of Life gave the opportunity to recruit an experienced epidemiologist Dr Deoraj Caussy (till then this country had no epidemiologist) who had recently retired as Regional Epidemiologist of the World Health Organisation. He came in at the right time to assist the local team to cope with the pandemic. For the first time in my career as a clinician I was able to appreciate at first hand the thoroughness and professionalism of our existing Public Health personnel, the dedicated and knowledgeable doctors and scientists without whom we would not have been able to overcome the pandemic so promptly and efficiently. As clinicians we tend to be indifferent to the public health dimension of our profession, and this is a great mistake.
Indeed, it became clear to me at that time that it is this dimension which is critical in ensuring the conducive environment within any country, without which we would not be able to survive let alone carry out all the activities of daily living as safely as we do on a routine basis – without realizing how this safety comes about in the first place. As we had defined it in the Health Sector Strategy, which was initially prepared with the participation of a broad swathe of stakeholders and has been updated (2017-2021), ‘Public health, in its broader perspective, aims at protecting and improving the health of the population through preventive medicine, health education, control of communicable and non-communicable diseases, application of sanitary measures and monitoring of environmental hazards, while at the same time ensuring emergency preparedness and response’.
Together with Primary health care, which ‘is the first level of contact of individuals, the family and the community with the national health system. It brings health care as close as possible to where people live and work and constitutes the first element of the continuing health care process’, to which all Mauritians have access, our Public Health policies and strategies have allowed us to not only maintain but also to continuously improve the salubrious conditions which allow us to remain healthy and to be able to work productively. Otherwise, the scourge of infectious disease would decimate us. As it is, we are now confronted with its counterpart known as the non-communicable diseases or NCDs, equally assuming very rapidly epidemic proportions – and whose surge is negating all the benefits we have gained in controlling the infectious diseases!
In general, very few doctors show an interest in medical history, especially practising clinicians. They pick up bits and pieces during their studies and training, and that’s about it. But a basic familiarity with the history of medicine gives us invaluable insights into the evolution of concepts and ideas that underpin our practice and inform health policies and strategies, as well as introduce us to the pioneers who doggedly pursued the problems and found solutions that have saved and improved hundreds of millions of lives. Such a sense of history also humbles us, for it gives us the larger perspective against which we are able to evaluate ourselves, and acknowledge how much of ground had already been laid by those who went before us.
That is why I think that this book is a must read for all health professionals, and I would add doctors in particular. However, it should also interest anyone who wants to have a balanced view of his country’s development, which tends unfortunately to be dominated by its politics with its salacious and scandalous manifestations. It is surely better to delve into the more positive aspects of our national life and silently salute the work of the dedicated individuals who contributed critically to lay the solid foundations for the country’s forward march.
* Published in print edition on 14 June 2019