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| Sunday, 23 June 2002 |
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Features |  |
| News Business Features Editorial
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Dengue fever - prevention and detection A dengue epidemic is now raging in different parts of the island. At present the number of dengue cases is said to be around 3000 with 16 deaths resulting from the virus. Children are particularly vulnerable to this killer disease. There is no vaccine to prevent dengue. The only way to prevent it is by eliminating the two mosquitoes Aedes egypti and Aedes albopictus which carry the disease. Dengue fever is caused by four types of related viruses. One type of virus, which causes the disease on one occasion, does not offer protection against subsequent infections by any of the other three. There is evidence that infection by a second or third virus increases the risk of the complications referred to below (DHF and DSS). The virus is transmitted from man to man by mosquitoes, which breed in containers where water collects. The mosquito that conveys this infection in Sri Lanka is mainly the one called Aedes egytpi, Aedes albopictus being the other one. Aedes mosquitoes are generally small in size. They are dark in colour and have white spots and bands on different parts of the body and legs. They are identified by characteristic markings on their bodies, which look like the stripes of a tiger - 'tiger mosquito'. They bite only during daytime. Features of the infection The illness may present with high fever lasting 4 to 6 days, sometimes the fever is moderate and subsides in 3 to 4 days. Other features include, severe aches and pains of the body ('break-bone fever') tearing from the eyes, red eyes, nausea, vomiting and a loss of appetite. In some cases a rash may appear after a few days, and there may be slight enlargement of the lymph glands. Dengue Haemorrhagic Fever (DHF) This occurs mainly in children - occasionally in adults. The highest incidence is in Greater Colombo. It is reckoned that one out of 200 patients with dengue fever may develop this condition. The early features include mild bleeding in stomach, bowel, nose, eyes and gums. This may result in vomiting, described as 'coffee ground', because the vomitus looks like brewed coffee, dark tarry stools may occur. In some patients there are tiny bleeding points into the skin. The liver is enlarged unlike in DF. At this stage, fluid may pass through the blood capillaries into the tissues around them, this causes a state of shock. This complication is called the Dengue Shock Syndrome (DSS). In this condition there are many complications in the brain, kidneys, heart and circulation. These complications may result in death in 24-48 hours. DSS can occur without DHF. Temperature drops, but the child is more ill - cold, clammy, and pale, with a rapid low volume pulse. Rush to hospital. Laboratory investigations. A platelet count below 100,000 and an increase of the Packed Cell Volume (PCV) by 10-20% supports a diagnosis of the disease. The Department of Virology, Medical Research Institute, Colombo can establish the diagnosis in about 90% of cases, if a sample of blood is sent during the illness, to establish a diagnosis in the remainder, a second blood sample should be sent, preferably about two weeks after the onset of the illness. There is no specific drug to kill the virus. Antibiotics do not kill or inactivate viruses as they do with bacteria. Drugs, such as paracetamol, are given to bring the fever and ease the aches and pains. Asprin should not be given to either children or adults as it may aggravate the illness. Prevention Revolves around the control of the mosquitoes. Compared to the other three major mosquito borne diseases in Sri Lanka (malaria, Japanese encephalitis, and filariasis), dengue is the only disease where the transmitter mosquito could be controlled by adopting simple preventive measures. This is because these mosquitoes, referred to as container breeding mosquitoes breed mainly in small collections of clear water in containers such as discarded tins, coconut shells and husks, discarded rubber tyres, plastic bags, bottles, machine parts, water storage barrels and jars,blocked roof gutters, flower vases and pots, and anti-traps. A period of drying does not kill the eggs of the mosquitoes. All litter containers, tin cans, etc., should be buried. Water in flower vases and ant-traps should be changed at least once in 6-7 days, it is advisable to add some salt to these vases and ant traps. H.A. Aponso et al from 'your child your family' How the Dengue virus spreads 1. Infected mosquito bites human passing on dengue virus in its saliva. 2. Virus replicates in body tissues before spreading through the blood to infect white blood cells. 3. Virus infects other feeding mosquitoes. 4. Virus replicates in the mosquito gut before moving to the salivary glands. Facts ú Two week incubation peried. No vaccine. ú Mild infection leads to week long fever. ú Severe form "Dengue hemorrhagic fever" causes shock and generalised bleeding How to get rid of the mosquito problem? 1. Mobilise Community participation. e.g. Involvement of school children, youth clubs, women's groups, etc., for activities like shramadana for clearing mosquito breeding places, awareness programs, promoting householders to clean up their gardens and drains, cover up broken cesspits, etc and to help them to sustain these practices. 2. Make field level staff accountable to the community. eg. The calendar of spraying should be provided in advance so that the community could supervise it. The assistance of community leaders like priests, school teachers, Grama Niladharis, Samurdhi Niyamakas etc., could be obtained. Regular cleaning up campaigns could be organised in consultation with them. 3. Media coverage The press and electronic media could be used to mount a continuous campaign throughout the year to make people more positively activated towards the control of mosquitoes in their own gardens and neighbourhoods. 4. Encourage non-governmental organisations (NGO) and community based organisations (CBO) to undertake mosquito control projects in their localities in collaboration with stage agencies. 5.Conduct intensive awareness/ motivation programs at all levels. eg., Farmers Organisations, Youth clubs, Women's Groups, Schools, Offices, Trade unions, Religious Groups, etc. 6. Educate community on importance of obtaining treatment for Dengue. 7. Increase diagnosis facilities as an urgent measure in areas where a high incidence are reported. Courtesy: Ministry of Health Sound health - a prerequisite for good driving by Dr. Gamini Karunanayake,Chairman, National Transport ,Medical Institute "Demons on Wheels", "Motorbike bus collision, two dead", "Driver held in fatal accident" are just a fraction of the captions which stare at us from newspapers in the mornings. These are not uncommon in our country. After the recent collision of two buses near the Town Hall, an article Demons on wheels in the Sunday Observer of 19th May, quoted the Director of the National Hospital as saying that indiscipline, or inexperienced driving, disregard of traffic signs and high speeding, were the commonest reasons for road accidents. In the same article statistics released by the Police revealed 140 accidents per day in Sri Lanka with 6 fatalities on an average. According to the Police the most common causes for accidents in Sri Lanka were negligence, carelessness and drunken driving with buses and three-wheelers being the most involved. Could accidents be prevented? How could they be prevented? The direct and obvious answer to these questions would be "by having concerned safe drivers" behind the steering wheels. Who then is a safe driver? I would say a safe driver is one who is well trained not only in driving vehicles, but also well versed in traffic rules, and road courtesy, and medically fit physically, mentally and psychologically, carelessness, negligence and irresponsible driving would all come under the purview of mental/psychological factors. Driving under the influence of liquor could be as a result of psychological or behaviourial factors, or physical factors such as fatigue. In almost every case the driver is produced before a court of law, remanded for a short period of time and/or bailed out. But never does one hear of an errant driver being produced before a Medical Board for an examination, which could reveal medical reasons for change in employment, temporary suspension of driving duties cancellation of his driving licence, or termination from employment. I would like to share with the reader's instances where fatal accidents and some near fatal were caused due to medical reasons. 1. A Colombo District Judge driving his car along Reid Avenue Developed an epileptic fit, lost consciousness, and crashed headlong into an oncoming CTB bus. Three people died in this accident. 2. A six-year-old child standing on the pavement was knocked down by a private bus driven by a person suffering from weakens of his arm due to Poliomyelitis. The driver was charged for reckless driving, but the fact that he was suffering from poliomyelitis and weakness of the arm was known only unofficially. 3. An ex-CTB driver who was medically condemned as he had a Cataract and vision in only one eye was driving a private bus. He was involved in an accident with a tractor killing the tractor driver instantly. 4. In a fully loaded private bus coming from Badulla to Colombo, the driver developed a Heart Attack and collapsed at the wheel, an alert passenger who was on the side pulled the brakes and stopped the bus before it went over a precipice. 5. Some years ago, in the famous Dowa accident, a CTB bus went over the precipice killing several people and many were injured. The driver of the bus was found to have been driving after taking liquor. He was also fatigued and driving recklessly. The transport system of any country should be geared to provide commuters a safe reliable and efficient science, with priority given to the safety of human lives. It is imperative therefore, that drivers of vehicles such as buses, vans and lorries are physically fit and mentally and temperamentally suited to their job, with a sense of awareness of the responsibility he has towards the thousands of lives of, bus commuters and other road users. The National Transport Medical Institute, which was established by an Act of Parliament in 1997, was formerly known as the Transport Medical Institute, which was the medical division of the CTB. It was the authorized body for medical certification of driver applicants for commercial and heavy-duty vehicles. At that time drivers who were condemned by the Medical Board of the Institute, were removed from the CTB before they could cause serious accidents. As a matter of interest I would like to mention that from 1978 to 1990, 1,456 CTB drivers were condemned by a Medical Board and retired from service before they could cause accidents. The main causes for removal from service being. * Coronary Heard disease * Defective vision * chronic alcoholism * Mental illness * Cerebro vascular disease (strokes) Epilepsy apart from other illnesses. However a follow up survey revealed that medically condemned drivers of the CTB were driving private buses and other heavy vehicles and had been involved in fatal accidents. It was also found at that time, that many of the drivers who were medically unfit had undergone training at some of the driver training schools scattered throughout the country. It is also a matter of concern that drivers who obtained their licences before 1986 could avoid being medically examined for life, in spite of the fact that as at that time none of them were subject to proper medical fitness test. It is quite possible that they may be causing quite a number of accidents in this county. Sixteen years or more (prior to 1986-2002) is too long a period of time, for heavy-duty vehicle drivers to be without medical examinations, for many changes would obviously have taken place in them physically and mentally. It is also regrettable that most of the drivers, who have been involved in several fatal accidents, continue to hold their driving licences without having to undergo medical tests. According to the standards laid down by WHO, a driver should have a good standard of vision. He should not be suffering from any disease or ailment, which would make him feel giddy (Vertigo) or make him subject to sudden loss of consciousness. If a person suffers from any of the medical ailments listed below, he is unfit to be a heavy vehicle driver. Coronary heart disease, epilepsy, uncontrolled diabetes, uncontrolled hypertension, vertigo or giddiness of any form, chronic alcoholism, deformities and disabilities of limbs, poor vision, thyrotocicosis, tabes dorsalis, mayas taenia gravies, bronchiectasis, hernia, large or irreducible, drug addiction, schizophrenia and addition's disease. Fatigue is another important cause of accidents. A joint WHO-ILO study has recommended that drivers of heavy vehicles should not drive for more than 10 hours in a period of 24. There should also be a rest period of 8 hours, before each spell of driving duty. The study also recommended that after 4 hours of continuous driving, there should be a half hour period of rest so as to minimize fatigue. Our institute has adopted the recommendations and a standard set by the WHO and presently carries out the following medical examinations: 1. Pre-employment medical examination. - This is to ensure that the driver applicants have the minimum standards of physical and mental fitness. 2. Periodic examination of drivers over 40 years of age every 3 years. - To determine whether they suffer from any physical or mental disability, which could contribute to accidents. 3. Examination of drivers for renewal of licenses. - This requirement which was enforced every 3 years had been changed to every five years, in December last year at the request of the RMV. This is a shortsighted move, not taking into account, that within 5 years, so many changes can occur in a drivers mental and physical make up. In addition to the examinations carried out, we would be re-introducing measures, which were very useful in the prevention of accidents many years ago. This would be in the form of a four pronged psychological screening program for drivers, categorised under. 4. Examination after serious and fatal accidents. - To ascertain whether the drivers suffer from any physical or mental disability, which would contribute to accidents. 5. Psychological screening of accident - prone drivers. - To determine their temperamental suitability to drive heavy vehicles. 6. Testing of drivers for alcoholism and reasons for the addiction. 7. Special medical board examination every month to decided on medically unfit drivers and have them removed from service. Our Institute, the National Transport Medical Institute could play its role effectively to cut down the accident rate, in our country through the field of medicine and psychology. Our efforts to prevent accidents would be of little use without the co-operation of the Police. Therefore Police officers would do well to take stringent action against the miscreants, whenever the opportunities arise. |
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