Introduction:

Malaria is a dangerous and often difficult to manage disease caused by the parasite 'plasmodium'. There are 4 varieties namely Malariae, Vivax, Falciparum and Ovale. Disease caused by Pl. Falciparum causes the most serious problems and deaths.

The parasites are transmitted to humans mainly via a bite by a previously infected female anopheles mosquito. It can also be transmitted, though less frequently, through the use of infected blood for transfusions and also from mother to foetus.

Malaria has been known to man from antiquity. The ancient Greeks even correlated the disease with stagnant pools and commenced programs to drain the stagnant water. The discovery of the 'malarial parasite to mosquito' connection took place in India in the 1897 courtesy of a British army surgeon Dr. Ronald Ross.

Goa had its ups and downs with malaria. Old Goa was ravaged by malaria and Goan medical archives reveal the work done in the early part of this century by Professor Froilano de Mello in controlling malaria in Goa. Along with his protégé Dr. Luis Bras de Sa, Prof. de Mello concluded that the source of the problem was the galaxy of unused wells in Old Goa and promptly closed them down. Good preventive medicine and the then efficacy of DDT helped to control the incidence of malaria to a point where malaria became a thing of the past as far as Goa was concerned.

Malaria returns to Goa :

While the cases of malaria were rare, the mosquitos were not. These pests were breeding vociferously in all parts of Goa. Besides the hilly tracts there were urban areas which were popular with these insects. Among them were areas of Vasco eg Mangor and Baina, Margao eg Pajiphond and Khareband, Mapuca eg Gaunsavaddo and Panjim eg Miramar, Fontainhas, Patto and St. Inez-Tonca. The Goan populace exhibited their natural tolerance to these pesky blood suckers and even donated a pint or two of blood to them, ever so often.

Over the past 25 years, three other events took place. Collectively, these three events have contributed to the major malaria problem Goa has today.

1. Chaocracy in Government : After the death of Dayanand Bandodkar, Goa has been ruled by a string of corrupt, disorganized and ineffective governments. This state of affairs has led to an anything-goes situation in many areas. Some of these areas are coming home now to roost....eg malaria.

2. Disorganized construction and official negligence:

With the opening up of the Gulf as a vista for job opportunities, many Goans poured back money into the building of 'ownership or rent back flats' and bungalows. Besides the shoddy work organized by unscrupulous 'contractors' on behalf of the absentee-owners, many of these new 'ownership flats' were built in swamps. These cheap swamps and rice fields of Mirarmar, St. Inez and Tonca ( for example ) which were previously owned by the mosquitos, were now 'home' to scores of new dwellers. With the 'tourism goose' heating up, began indiscriminate construction on the beaches. But the mosquitos did not leave their haunts to the newcomers. They just feasted on them.

The demand for construction was high and the contractors brought in labour from the neighbouring states. As expected perhaps, no health certificate was required for employment. These labourers established new shanty villages in numerous parts of Panjim, Margao, Vasco and other areas of Goa. There were no sanitary facilities nor health controls established. The 'new dwellers' just gave back to the earth ! These areas were "disasters waiting to happen". But they were also 'voting banks'. So nothing was done to find appropriate accomodation for the migrant labour or to check the hygienic status of these settlements or their dwellers.

The Government and the Public Health department ( Health Services ) were and continue to be totally negligent by not adequately monitoring the status of communicable disease in Goa. So, it should not come as a surprise to anyone that, among other diseases, malaria returned to Goa, only this time around, it was Chloroquine-resistant. And the mosquitos! Well......they had a bigger feast !

3: The inadequacy of the Health Services:

Public Health is one of the most dynamic areas of medicine. Yet, like in many other parts of India and the developing world, it attracts a 'special set of physicians' into its cadre - the lackluster, adynamic, resistant to new ideas, complacent, politically expedient, just doing my job, and hypersensitive to criticism, civil-servant type who specialize in nothing special except announcements, pronouncements, World Health day, some other day and some drive or another. Very few in this cadre have done any form of specialty residencies or significant post graduate qualifications. And yet, the public is expected to be protected by this set of physicians. I wish to submit that Goa should look at the bright sparks within the Goa Medical College to head its Public Health Department. Otherwise, all one is likely to see is the 'civil service type' blame somebody or something else form of inaction or at best 'whitewash' in crisis situations.

As an example, it took the persistent and often solo determination of a Goan surgeon Dr. Sharad Vaidya to do something about the tobacco problem. And yet, it is a major Public Health problem. The department of health in Goa was gloriously eloquent in its silence and inaction on the matter .....for years,

Health leadership:

Over the past several years, there has been a constant battle between Mr. Pratapsingh Rane(Chief Minister) and Dr. Wilfred deSouza(Minister of Health ) . It does not take a rocket scientist to note that Mr. Rane is not trained to have a clue regarding health and yet appears to be interfering with the working of the Health Ministry. When it comes to the health of Goa and soon, of international travelers, Mr. Rane stands to gain the title of being the director of this 'malaria tiatr' which is unfolding in Goa.

Recommendations :

1. The Goa Government should take full responsibility for their failure to provide adequate health protection to its people.

2. The Directorate of Health needs to be restructured with major input from the clinicians at the Goa Medical College. Public Health is no longer a subject which deals only with toilets, sanitation and food hygiene. There are major and ever-changing health issues which need attention. Many of these issues are global in nature and warrant a different kind of leadership. I recommend that whoever the Government picks to form the top core or directorate of public health, should be from among the brightest and best. They should be seconded for the MPH program (Master in Public Health ) in Calcutta or any other centre in India and later at an international centre, either at Johns Hopkins or Harvard with a short stint at the Centre for Disease Control in Atlanta. If the need is appropriately put on paper, there are enough funding agencies to cover the cost of this venture.

Upon the return of these fully trained physicians, the Government should envisage giving them an appropriate salary and more importantly, the ability to work without political interference. As an example : Some years ago, the island of Jamaica had a moderately serious public health problem developing at one of its main tourist airports. A problem which could have been easily fixed by the Public Works Department. After weeks of reminders, the head of Public Health ordered a closure of the airport, citing public health violations. The Government supported the physician and his action, even though it was bang in the middle of a busy tourist season. And PWD fixed the problem in a matter of 6 hours. That physician, incidentally was a Goan, Dr. Antonio de Souza, who now lives and practises in the UK.

While the restructuring of the Health Services is taking place, ideally over a period of 4-5 years, the best possible input available to deal with the malaria crisis, should be availed of. An ad-hoc committee of experts consisting, among others, of specialists in Infectious Diseases, physicians from the Malaria Research Council and from physicians in Goa should be constituted. The Goa Government will have to understand that it has been negligent and 'fiddling' like Nero, while Goa was being ruined. So, it will have to be patient with all the criticism it will receive from this group of experts and be prepared to act on its advice. If necessary, Goa should approach the Centre or even the WHO for assistance.

This talk about what Goa cannot afford is total nonsense. Just skip one of the scams and we will have enough of money to fund this program.

As far as the Goan community at large, I am more than confident that every single Goan will assist if requested to.

3. The Goa Govt. must introduce with immediate effect, a system of mandatory health checks for all categories of migrant labour. This is a very good advance warning device re: infectious and communicable diseases. Most Goans are normally covered by their family physician. The regulation regarding 'the notification of infectious diseases' should be stringently applied and defaulting physicians have the book thrown at them.

4. All shanty towns and other constructions which pose a health risk, should be reviewed by the Health Department and appropriate steps taken to control the spread of infectious diseases.

The various media outlets should be utilized to make known ' the preventive measures against malaria ' as well as ' the signs and symptoms of malaria '. And yes ! the residents of Goa and the tourists should be warned of the malaria problem in Goa !

All stagnant pools should be drained. Now that the Goa government, rather the CM Mr. Rane, has taken the decision and begun fogging with the pyrethroid Deltamethrin, it is mandatory that the Health Department oversees the project and restricts it to limited areas and sees to it that the chemical is not sprayed in areas which drain into water resources.. It must be borne in mind that this product, if applied to areas which drain into the fish ponds, will destroy the fish and the ecological environment. Goa had enough of problems with the pesticide factory dumping waste into the waters and killing off the fish. This time around, this chemical is set to have problems for humans too.

The Government of Goa has a choice. It either takes the necessary action or resorts to the present attitude of " don't believe the statistics, gather some more statistics, have meetings and more meetings, make some speeches, and do some tree-planting ". Never mind the arm-chair philosophers but the chickens are now coming home to roost and Malaria is just the first act in this ' non-eeshstop tiatr' also known as Goa !

Regards,

Jose Colaco
Send comments to: jcolaco@bahamas.net.bs