Rain in Sindh, especially in Karachi, came as a nightmare this year. The suffering of people due to roads and whole localities turning into pools of water has been uncountable since days, but overall, the number of avoidable deaths occurring because of electrocution and other reasons has been the most depressing. This story not only repeats every year, but the situation is compounded as we are hit with poorer infrastructure and equally unprepared each time round.

In the aftermath of the rain, with so much of filth and stagnating water providing for excellent breeding ground for flies and mosquitoes, there was first a remarkable rise in diarrheal and respiratory tract infections, followed subsequently by rising number of cases of dengue fever, malaria and chikungunya reporting to hospitals and clinics.

Infectious diseases in the offing! Fear for one of the worst epidemics of dengue and malaria this year in Karachi is not unjustified. Our public health system being a total failure, the innocent masses are forever entangled with one or another health issue mostly because of no fault of their own. The memories of the recent HIV outbreak in Larkana and its surrounding areas are still fresh, as are the cases of Congo fever being reported from different corners of country and the issue of extensively drug-resistant (XDR) typhoid fever having spread from a poor locality of Hyderabad because of contamination of water supply with sewerage water. Physicians like myself are increasingly being confronted with such difficult to treat and resistant cases, every now and then.

Dengue is a mosquito born viral disease, the global incidence of which has been on the rise recently with more than half of the world population in some 100 countries at risk. According to WHO estimates, 390 million dengue infections occur per year, but only 96 million manifest clinically - the remaining go unnoticed. Pakistan has been having dengue epidemics regularly since the 2010 floods, but the reported numbers are far less than the actual incidence because of lack of proper data collecting and reporting systems.

Dengue is transmitted by the female mosquito species Aedes aegypti mainly - this bug is notorious for transmitting chikungunya, yellow fever and zika infections as well. Dengue usually results in a flu like illness and contrary to what it is commonly thought, is seldom fatal. High grade fever with severe headache, pain behind the eyes, muscle and bone pains (break bone fever), vomiting and skin rash are common. The symptoms appear 4-10 days after the bite of an infected mosquito and last for 2-7 days. Blood cells, especially platelets, fall and liver functions may alter. Most of the cases do not even require hospitalization. Occasional cases take a dangerous course and may develop bleeding tendency and or shock i.e low blood pressures requiring intensive care. There is no specific treatment but early detection, supportive care, plenty of fluids, watching for danger signs and avoidance of unnecessary treatments is important. The first dengue vaccine has been approved for use in some twenty countries, in populations between 9-45 years in age, especially for those who have had a previous attack of dengue (seropositive cases).

Whether our government plays their part or not, what we can do as residents of Karachi can be invaluable and can help save thousands of lives as well as prevent the development of an epidemic like situation. Small steps can add up to huge changes. As we know, prevention is better than cure and for dengue, till now, prevention is the only cure. Since, mosquito breeding takes place in stagnant waters, we can start from stopping to throw further trash in the water collections which have developed in the streets. Each street can set up a committee which can work in conjunction for self-help. The soil piles can be added to the water collections to absorb all the water. The moist soil can then be disposed easily. An alternate option is to spray the stagnant water with slaked lime, locally known as “chuna”. This will abolish breeding areas of mosquitos. The residents can collect money and contact agencies to spray insecticides regularly. Another step that can prove to be very helpful and can be taken at domestic level is to – close all doors and windows of the house and burn “lauban” in the house for 15-20 mins, 1-2 times a week (ensuring that family stays out of the house for the duration). This will kill the mosquitos already present in the house and is a cheap and easy way to play our part in mosquito control. Also, avoid letting water collect anywhere, even if it is a small amount. Keep all your water sources well covered. Regularly use mosquito repellants to avoid mosquito bites and cover yourself properly when going out to ensure minimum area of body is exposed to flying mosquitos. These small steps can help us all against dengue and malaria.

As far as typhoid is concerned, all the inhabitants are highly encouraged to get vaccinated against it. Additionally, avoid eating outside, specially at places where hygiene is questionable. Wash vegetables and fruits thoroughly prior to their consumption. Always wash hands after entering home and before eating anything. Boil water before drinking, even if it is bottled water from renowned companies. And another very important piece of advice for healthcare workers is to avoid prescribing unnecessary antibiotics, as this practice leads to the development of resistance in bacteria against antibiotics which is what the reason behind bugs like XDR typhoid is.

To sum the discussion, rather than waiting for government officials to come to the rescue of our city, for which the chances seem slim, it is better that we rescue our own city. We own it. This city is ours. Her people are ours. Let us prevent further damage. Get up and get up now and play your part.

Dr. Khalid Mahmood

The writer is the Former Dean and Meritorious Professor at the Medicine Dow University of Health Sciences, Karachi.