Secretary's death in malaria: High time to be precarious travelling abroad

Commerce Ministry Secretary Mahbubur Rahman died of severe cerebral malaria soon after he returned attending a World Trade Organization conference in Cameroon. His family has alleged that the government top official was not given any warning about the risks of malaria before the trip. The question arises, is this just an untimely death, or is it the end of a precious life due to the failure of state protocols?

Commerce Ministry Secretary Mahbubur Rahman died at the age of 58 while undergoing treatment at the capital's Square Hospital on the morning of April 17. This officer of the 13th BCS Customs and Excise cadre represented Bangladesh at the 14th WTO Ministerial Conference held in Cameroon from March 26 to 29.

He fell seriously ill just 13 days after returning home (April 11). He was admitted to the capital's Square Hospital on April 13 due to a rapid decrease in blood platelets. Then his condition gradually deteriorated and he never returned.

Cerebral malaria is the most severe form of malaria, caused by the parasite Plasmodium Falciparum, which blocks blood flow in the small blood vessels of the brain. It causes neurological symptoms such as high fever, seizures, abnormal behavior and coma. Without prompt treatment, death can occur within 48 hours. Doctors say that the malaria parasite in Africa is very powerful and different—which is why despite the best efforts, the secretary could not be saved.

Cameroon is one of the world's highest-risk countries for malaria. At least one in four citizens there is infected with the disease or is at high risk of contracting it. The US Centers for Disease Control and Prevention (CDC) has listed the country as a 'Level Two Travel Health Notice (High Risk of Malaria)'. The CDC guidelines clearly state that there is a risk of malaria everywhere in Cameroon and that delegates are advised to take antimalarial drugs—such as atovaquone-proguanil or doxycycline—before and during their visit.

The European Parliament and EU health agencies that attended the conference had issued special health protocols for their delegates. The official logistics note of the WTO also officially advised delegates to take necessary medicines to prevent infectious diseases. So where was this warning from Bangladesh?

Professor Dr. Moni Lal Aich Litu said that just taking two chloroquine tablets as a preventive measure could have saved a precious life like Secretary Mahbubur Rahman.

Ministry to Airport—No one warned

For passengers traveling abroad from Bangladesh, the government and airport authorities are supposed to follow specific instructions according to the protocols of the World Health Organization and the International Civil Aviation Organization, considering the health risks of the destination. An international certificate of yellow fever vaccination is mandatory to travel to the African country Cameroon, Congo or some South American countries. This vaccine and certificate are issued by the Directorate General of Health Services (DGHS) located in Mohakhali, Dhaka and must be obtained at least 10 days before the trip.

However, no vaccination certificate is required for malaria; rather, the emphasis is on preventive medicine and personal protection. Secretary Mahbubur Rahman had the yellow fever vaccine. But no one, neither the airport authority nor the Ministry of Commerce or the health department, warned him about the risk of malaria.

An inquiry at the airport health office revealed that services are provided only in case of emergency - services such as information on which country is experiencing an outbreak of a disease or what preventive measures should be taken in such a case are not available there. When asked, the staff on duty could not provide any more information.

Wife's complaint

The secretary's wife, Dr. Farhana told Views Bangladesh that her husband was completely unaware that Cameroon was a high-risk country for malaria. She is also not sure whether her husband was given any advance warning or instructions from the Ministry of Commerce.

Dr. Farhana also said that the airport authorities did not inform her husband about malaria either. She believes that the government's negligence is largely responsible for her husband's death.

No statement could be obtained from the Ministry of Commerce on these matters.

What the experts say

Moshfiqur Rahman, an epidemiologist with the government's malaria eradication program, told reporters that despite best efforts, the secretary could not be saved because the malaria parasite in Africa is very strong and different.

Administrative liability: There are rules, no monitoring

Md. Babul Miah, Secretary General of the Bangladesh Administrative Service Association and Head of the Agriculture, Water Resources and Rural Institutions Division (Additional Secretary) of the Planning Commission, told the media that there is no lack of protection in the law when traveling abroad. When an official goes to a country, there are protocols of that country—they have to be followed. There is a huge gap between the existence of theoretical laws and their implementation in the field.

Public administration expert and former bureaucrat Mohammad Firoz Mia told the media that officials have to follow the rules and regulations in their own interests when traveling abroad. In case of risky countries, vaccines or preventive measures for any disease should be taken as health measures.

He said that the government can issue a directive to make officials aware of this. It is necessary to emphasize on certain mandatory things to be followed before traveling abroad so that no one has any opportunity to be negligent in following health protocols and such tragic incidents do not happen again in the future. If necessary, it can be made mandatory to seek advice from the Directorate General of Health Services before traveling to any risky country.