– Ramsammy stresses at PAHO/WHO’s first sub-regional workshop
THE response to dengue must not be a one dimensional approach, as it will not work in the fight against the public health scourge, which is exasperated by climate change and the lifestyles and behaviours of people themselves: said Health Minister Dr. Leslie Ramsammy. He was addressing the participants of the Pan American Health Organisation/ World Health Organisation’s (PAHO/WHO) first Sub-regional Workshop for the Elaboration of Integrated Management Strategy for Dengue Prevention and Control.
Ramsammy said, “The contributions of climate change and lifestyles and behaviours represent a grave danger to populations present and in the future…these are not speculations we see the impacts already and it can only get worse.”
However, all is not lost and the Health Minister maintained that the workshop is an opportunity to affect the necessary changes to “stop the danger in its tracks.”
“We have the tools and the knowledge, but the question is do we have the will,” Ramsammy questioned.

Climate Change Link
Ramsammy told the Guyana Chronicle that the threats to health because of climate change are diverse and vector control should be a priority in minimizing the impacts of this link.
He said there has been a consistent increase in the incidences of dengue, but noted that this increase is because of a genuine rise in the number of cases and because of the increased capacity to confirm the dengue cases.
The Health Minister noted that in 2007 there were 46 dengue cases per every 100,000 persons and in 2010 that number was 196 per 100,000 persons.
“We are dealing with an old disease, but we are dealing with a genuine increase in the incidence in virtually all countries,” he said.
Ramsammy pointed out that in the niches that have not dealt with dengue in modern times are beginning to record dengue cases.
He added that dengue is becoming a global health problem, with as many as two to three billion people at risk.
The Health Minister acknowledged that public health has not always responded to changes in lifestyles and behaviours, but said responding to the dengue threat is a complex issue.
According to him, the role of the citizenry is brought needs to be highlighted, in light of the fact that lifestyle and behaviours of the general population is what aggravates an already major problem.
“Citizens have a role too,” he posited.
He stated that the lifestyles and behaviours of the today’s people have created the environment for breeding the vector.
Ramsammy bemoaned what he described as a love affair Guyanese have with old containers and tyres, which are both breeding grounds for the vector.
However, he suggested that a revamped and robust information and communication strategy would hopefully change this paradigm.
Ramsammy underscored the importance of involving schools and stressed the importance of engaging children in vector control knowledge and activity – all part of the efforts to minimize the impact of the climate change link to the dengue threat.
“The vector is widespread and the parasite is increases. Countries like Guyana must act now…we must abandon the one dimensional approach,” he stressed.

Multi-dimensional Approach
The Health Minister said Guyana has made some headway in addressing, but maintained that a multi-dimensional approach is an absolute requirement to reduce and possibly eliminate the dengue threat, which ravages populations and causes significant losses.
According to him, several of the things needed are:
* Early diagnosis and treatment of dengue;
* Biological control by revamping the use of BTI (Bacillus thuringiensis israelensis), which is a bacteria used as biological control agents for larvae of the Aedes Aegypti mosquito;
* Chemical use, in particular to facilitate and increase in fogging activities; and
* The use of robust vector control.
Ramsammy observed that not enough is being done and the different methods to address the dengue threat are not advanced in an aggressive manner.
A particular method under-utilized, he said is the use of DDT, which is virtually banned in many countries.
The Health Minister said the use of DDT needs to be reintroduced and pointed out that the non-use of DDT was based on the effects its use had in the agricultural sector – since DDT had a dual purpose, for agriculture and for vector control.
Ramsammy contends that there is not sound evidence which indicates that DDT as a vector control method is a hazard.
He also called for emphasis on two particular areas: increasing capacity that and decentralizing the same to ensure widespread response to dengue; and ensuring that at all levels relative to clinical management of dengue the requisite capacity exists.
“We have an opportunity here,” the Minister opined.
The five-day workshop and seeks to prepare a draft Integrated Management Strategy for Dengue Prevention and Control for Guyana (IMS-dengue Guyana), building on PAHO’s regional dengue programme, IMS-Dengue.
The regional programme aims to promote the functional integration of six key components for dengue control at the national and regional levels: social communication, integrated vector management, epidemiology, laboratory diagnosis, clinical case management and environment.
Similarly, the workshop’s focus was to ensure that Guyana has a plan that will serve as a prototype for adaptation in-country.
An Implementation Plan of Action to ensure appropriate monitoring, supervision and evaluation of IMS-dengue Guyana’s implementation is also expected to be developed by the end of the workshop, as well as a comprehensive Preparedness Plan of Action for dengue outbreaks and epidemics in Guyana.
Vector-borne diseases constitute a major health sector problem in Guyana and Ramsammy contends that addressing the challenges posed by such problems require the engagement of all stakeholders who make use of the best approaches.