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Not long ago, in my childhood, we witnessed a lot of public health problems in the Maldives that are almost forgotten now. Houses and Edhuruge/Madharusaas were infested with bedbugs. Corners of the pillows and mattresses as well the beds and other furniture were seen blackened with bedbug faeces and eggs. Louse infestation was common among children and adults alike. Upon a closer look, most children would be seen harbouring hundreds of nits in their hair like specks of white sand. Children were commonly seen with scabies and continuous scratching due to intense itching. Pungent smell of sulphur applied on scabies affected areas had its associated taboo and stigmatization. Intestinal worm infestation was so common that children would often pass worms through their mouth and at times is seen creeping into the nose too. Widespread hookworm infestation had lead to nutritional disorders in many affected children.

Nationwide public health efforts by Community and Family Health Workers as well as betterment of socio-economic status, increase in literacy and improvement of sanitation have all contributed to near disappearance of these public health issues. And now we have almost stopped being on alert and even talking about it! Most of the current generation kids and youth would have neither experienced nor witnessed any of these. Little do we realize that it takes vigilance and continuous efforts to keep it that way!

General sanitation and hygiene have gone down in certain subgroups of the population. Male’ has become an urban slum where a lot of people live in unhygienic and inappropriate living conditions. The public health problems I mentioned above will re-emerge wherever there is congestion and poor hygiene. Recently there have been indications that in fact, it is becoming a reality. Dermatologists in IGMH have reported increases in scabies cases in certain population subgroups. School health checkups are seeing increase in head louse infestation. Though not reported, perhaps there is also increase in bedbug infestation in Male’. Last week, I have seen bedbugs in the seats of BML Majeedhee Magu branch, an evidence to suggest this! It may already be harbouring nests there, or it could have been an isolated bug unknowingly carried by a customer. In fact, that’s how it spreads across the island & the country.

In today’s highly social and interactive world, the living conditions of our neighbours and lower socio-economic groups will affect our health as well. Moreover, it’s not only how the locals live that matters. We don’t seem to be bothered by how we treat the huge labour force we have in Male’; how & where they live. These people have come from extremely poor areas of our neighbouring countries where all the public health problems I have mentioned are highly prevalent. With them they will carry the eggs and adults of lice, bedbugs and intestinal worms. If they live in congested & unhygienic conditions, it will be a ‘haven’ for these pests and pathogens to multiply and increase in number. These people come to work in our homes, get services in the banks and other places as we do, and that’s how the chain of spread would then continue, ultimately invading and infesting a larger part of the island. We need to learn lessons from the recent experiences in the UK and USA where there have been ‘invasions’ by bedbugs, reminding us that we must always be on watch and that they will comeback stronger and more ferociously whenever we become careless!

Health cannot be ensured unless we take a holistic approach and address health affecting conditions and environments. We should start specific and targeted interventions to improve the living conditions of poor people. We must improve living conditions of expatriate workforce. The companies and people who are responsible for them should be made accountable on their welfare and made to treat them like ‘humans’. We must understand that unless we ensure that they live in pest and pathogen free environments, we (including their rich masters) cannot be disease free. We must understand that unless we address each and every corner of the society, the community cannot achieve good health. We must also understand that public health needs continous efforts, technically correct approaches and extreme vigilance. If not we can never win the war against disease causing organisms!