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Dr. Adil Bhatti - Society of Health & Social Development

Dr. Adil Bhatti

Research Associate

Society of Health & Social Development

Interview by Kamran Rafiq (ISNTD)

Dr. Adil Bhatti is a Medical Entomologist working as a Research Associate at Pakistan’s Society for Health & Social Development. In this exclusive interview, Adil speaks about the changes he has witnessed in vector-borne disease prevalence and distribution throughout Pakistan as well as the successes and shortcomings of initiatives to improve public health. For Adil, documenting his experiences through photography is not only important scientifically, but also an effective way to engage the public and wider communities in control efforts, and recently, and recently, Adil has won an ISNTD Award for Photography for his images.

What is your current role & what has been the focus of recent research?

As a research associate for the Society for Health and Social Development in Pakistan, we work for the promotion of research on vector borne diseases. Currently we are looking forward to working on insecticide resistance/susceptibility status of Malaria vectors all over Pakistan.

How has dengue incidence and control evolved in Pakistan in recent times? In your opinion, what have been some successes in dengue control in Pakistan?

When dengue first emerged in Pakistan, although the transmission was very minimal but an increased mortality was recorded in earlier outbreaks. Earlier interventions were not so effective either, partly because of policies, lack of technical knowledge and professional staff such as Medical Entomologists. Community knowledge was also one factor that has helped current seasonal outbreaks to a minimum.

Implementation of Integrated Vector Management has proved much successful in controlling dengue, community based abatement programs have also helped in providing awareness to vulnerable population.

Dengue cases are increasing annually, every year more cases emerge which has to do a lot with climate change, unplanned urbanization, chemical resistance against the current use of vector control. Asymptomatic patients are often off the radar and they also contribute in the transmission but reporting nowadays has become very efficient which allows prompt, but not accurate, diagnosis.

Given the recent cases of mosquito-borne diseases including dengue, chikungunya... what types of challenges are you expecting in Pakistan. Has inter-regional cooperation in terms of disease surveillance and control been effective and how could South Asian cooperation be improved?

Pakistan recently reported its first Chikungunya case - although these are the first cases to be reported to WHO, there is no doubt that the population could be affected with other mosquito borne viruses such as Zika and Yellow Fever.

Like I mentioned earlier, we do require an effective and accurate diagnostic techniques or tools so that we can timely report for other arboviruses other than dengue and can also diagnose asymptomatic patients as well.

The other challenge is regarding the injudicious use of insecticide, resistance/susceptibility has not been evaluated against the current control methods.

Other biological methods and genetic tools have not been exploited yet such as release of Wolbachia infected mosquitoes in endemic regions to control vector population. Pakistan is a growing country, both in terms of economy and population, more and more people choose to live in urban regions, an increased push and pull factor would result in an unplanned or illplanned urbanization which is one key factor in transmission of dengue, Chikungunya, Zika etc. More population requires more use of natural resources and deforestation for urban development which could expose us to more zoonotic diseases.

There is definitely more room for regional cooperation and partnership amongst South Asian countries since we all share same geographical, seasonal and climatic conditions that favours the transmission of diseases. We could share data/research and knowledge to formulate better control strategies and of course richer neighbours could always help out their poor neighbours in need. Since Sri Lanka has managed to become Malaria free, it can provide technical assistance to its neighbours for an effective disease management.

Who would you like to partner with in terms of research as well as operations in the field?

Both government and private sector should partner for an effective and efficient disease and vector management. More funds should be allocated for research and development, health and education should always be a priority alongside other projects. I don’t have a specific choice over who to partner with but it all depends on how a certain project would benefit people. I would definitely like Oxitec to explore opportunities for vector control in South Asia and evaluate the possibilities for genetic control of mosquitoes.

You have recently won the ISNTD Festival Award for your photography - congratulations and well deserved! Could you tell us how you decided to document your work through photography and why this is important both to you personally and, in a wider sense, for your discipline?

I have always been interested in photography but never participated in any contests or exhibitions. I admire the works of other great photographers out there in the field. I never thought I would document anything like that until I was told I could do such a thing, and when I actually went there in the field and took pictures of people I noticed a certain gap between understanding a disease and knowing how it actually affects a population. These people have an access to a weaker health infrastructure, they are devoid of facilities such as drinkable water, proper sanitation and healthy food.

We do know all about their conditions but we normally do not see it or feel it and therefore to most of us it is insignificant. Imagine a family run by a single working person, who got infected with dengue somewhere in his or her workplace or at home. This person’s hospitalisation would put his/her family’s life at standstill. The cost of all this would be much more than just financial. Just put yourself in that situation and try to feel how would it affect you? A picture taken would not only show a person or an activity being done to control such diseases, it would speak out for itself.

As a Medical Entomologist, our duties are not limited to studying insects only and finding ways to control it. Involving communities and helping them grow stronger is important as well. Being a local, we can reach out to people who have no access to information, improve their understanding for vectors and through pictures we could involve fundraisers and potential partners to understand the situation a little better.

Are there any other issues which you would like to highlight either about your work or dengue control in general?

Working in developing countries is difficult if there are lost priorities. We tend to ignore health and education throughout and convince ourselves that there are more important things to worry about other than that. Dengue is serious matter, although the situation has improved a lot over the past years i.e. mortality has decreased but the number of cases continues to grow. There is huge gap between research and its implementation in public sector. Although we know what possible controls could be adopted to help manage diseases, there aren’t enough funds or will to do such.

Capacity building is one important point for an effective vector management, we need to have more trained professionals in Medical Entomology and consider their importance seriously. It’s not just Dengue or Malaria that we need to worry about, Leishmaniasis and CCHF area as significant. It would be too early to say but I do think we should look out for possibilities of Zika in Pakistan. Zika is not just becoming an economic burden but a social and emotional burden too, babies born with microcephaly would require facilities more than normal and more than half of the population lives under the poverty line. It would be difficult for families to look out for these special children, and if they are ignored and not provided enough to survive, social malpractices can be exploited such as beggary or child labour. As Medical Entomologists, we have a duty to consider all these outcomes.

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