Collapse of Covid-19 preventive services in Colombo

More than half of the Covid-19 deaths have been reported from the Colombo city limits, according to a news item, quoting a trade union, which wants a probe done. Some had died in their own homes, without receiving medical care and not knowing they had the Covid-19 infection. Daily, scores of Covid-19 patients are found, after PCR tests, which show that large numbers are infected in Colombo. In fact, a negative result doesn’t rule out the infection by the virus. Although the govt. has decided to lift the curfew, Colombo North and Central will continue to be locked down. Particularly, residents in Methsanda Sevana, Mihijaya Sevana, Ranmini Sevana, Mutwal, Sirisanda Uyana, Dematagoda, NHS complex, Maligawatta will not be allowed to move out, or even go from one building to another.

Unfortunately, one cannot deny that there seems to be a breakdown of preventive health services in the area. When the Bandaranayake Mawatha outbreak occurred, the Colombo Central MOH Dr. Chandrapala, and his staff, and nursing staff, at the Maternity Home, took great pains to see that all patients, and contacts, were subjected to PCR tests, and sent to quarantine centres although they lacked Personal Protection Equipment (PPEs). When they came to the breaking point, they stopped work as it was dangerous for them to continue to work. Later, when sanity prevailed, they received the PPEs from Town Hall and work was resumed. However, recently the entire PHI staff, at this same office, had to be quarantined, and the reason was that some of them got the virus and others were the first contacts. They had got the infection from the staff of the Health Education Unit, at Slave Island, where one worker, who had the disease, gave it to all others in the unit. So much for Health Education!

In 1978, the late President R. Premadasa, who was then the Minister of Local Government, ordered recruitment of GCE A.L. qualified youth as Health Wardens (at present called Health Instructors) to mainly uplift the public health of the people, living in marginalized lands in Colombo. 150 Health Wardens were recruited and their task was to organise the communities and form Community Development societies, create children’s societies, improve hygiene practices and sanitation, provide basic amenities, look into the nutritional aspects and train the women in preparing nutritious, safe but cheaper food items, etc. During my period as the CMOH, they helped me to control cholera and dengue and chikungunya epidemics, and eradicate polio from the city. They were the link to the poorer marginalized people in the flats and slums. During the last 40 years, officers were recruited only twice, and this service also suffered once the CMC came under provincial rule. Gradually, with the retirement of officers, their numbers dwindled to around 25, and while the Provincial Council was saying that the CMC should recruit them, CMC officials were saying otherwise. This service was only available at the CMC and it was another reason for this tug-of-war. Anyway, knowing the value of this service, I got the cadre increased to 185 before I left the service of the CMC, but on my return to the CMC, as a Councillor, to my utter dismay, I found that the cadre has been reduced to 75, by the powers that be, who I am sure lacked foresight and the knowledge of the importance of preventive health.

Despite this, I brought in a resolution, almost two years ago, to recruit youth to these posts and got it passed in the Council, but beyond that nothing happened due to bureaucratic bungling and lethargic attitudes of officials. If we had recruited these youth, today we could have utilized their services for better communication, and mobilized the community through the Community Development Councils,in preventive work, especially in the above-mentioned housing schemes where hundreds live in small spaces, and no one knows how they can survive this ordeal without the help of the Health Services. I am sure there will be some more deaths, at home, where the dead would not have known what hit them. It is time that cadres in this service and other services, such as midwifery and public health nursing and inspectors in the CMC, and also the post of Deputy Chief Medical Officer of Health (Epidemiology), which is not filled for almost three years by now, are filled soon, as the epidemic is expected to go on for at least another two years; and I am afraid Colombo is an ideal place for it to thrive and spread to other areas in the country –  with the lifting of the lockdown.

Dr. PRADEEP KARIYAWASAM

Former CMOH/CMC