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Dengue fever in New Caledonia

Year: 1989
Setting: We, island of Lifou, New Caledonia
Position: Private general practitioner

An epidemic of hemorrhagic dengue fever has struck the New Caledonia archipelago. People are dying at the Gaston Bourret Hospital in Noumea from the bleeding complications of the disease. Drastic measures are taking place to control the epidemiological situation. At the collective level, swamps are being dried up by public works companies; at the individual level, small reservoirs of stagnant water (old tires, saucers, etc.) are eliminated by the islanders to get rid of the mosquito larvae and break the vector reproduction cycle.

As far as dealing with adult mosquitoes, one morning I am confronted with the effects of an action plan designed by health authorities. It is a rather slow day at the office, but there are many people gathered next door for a children party. We hear the rumbling of a propeller plane fast approaching the villa where I work and live. The vehicle is clearly off-path to land at the airport and I, with all the people around me, wonder what is happening. Indeed, nobody has ever seen any plane flying over this part of the island. As soon as we spot it, we can see the smoke-like insecticide pouring down from its belly. In a few minutes, this unannounced, large-scale public health measure is causing physical distress. Some of the islanders have burning red eyes, some are crying, others are sneezing and/or coughing and a few can hardly breeze because they are having an asthma attack. In a snap, my ”slow” day has become quasi-frantic. All of the residents complain about the lack of warning for this rather dramatic spraying action.

Looking at the positive side, I am thankful to the civil servants on the main island. Their planning failure has, unknowingly to them, filled my waiting room on a sluggish day! This later becomes a favorite joke in meeting places: The public sector working for the private sector. Everything is possible under the sun!

Lesson for the doctor: In public-health crises, information is the cornerstone of any successful, large-scale initiative.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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