9,036 and counting

Dengue is back with a vengeance and Colombo District is the worst affected:

by Carol Aloysius

A critical dengue patient being treated

Municipal workers fogging a dengue site

The dengue carrying vector is apparently having a busy agenda flying to every nook and cranny in Sri Lanka infecting thousands of unsuspecting persons with its deadly bite.

By February 25, latest official statistics from the Epidemiology Unit (EPU) revealed 8506 suspected cases of dengue in just one month (January), while the number of cases for January and February amounted to 9036- more than fifty-five percent reported from the Western Province(WP).

Who is to blame for this rapid spread of a disease that can kill victims? Who is responsible when young children affected by its more severe forms of Dengue Haemorraghic Fever ( DHF) and Dengue Shock Syndrome ( DSS), die? What is the Health Ministry doing to contain its spread, besides taking to court and fining ‘dengue breeders,’ who they say are the main culprits for the spread of dengue?

Director, anti Dengue Campaign, Dr A.R.M Thowfeek said, “We have already graded and identified the high risk districts according to their case loads, and will initially start our next Dengue control program in the district that has the highest number of cases which is the Colombo District. The campaign will get underway from March 10-12. Thereafter, we will go to the other districts under the high risk areas such as Jaffna, Kandy, Galle, Kalutara, Kurunegala, Gampaha and Puttalam”.

The sharp rise in the number of dengue cases has also prompted Epidemiology chief, Dr Paba Pallihawadana to instruct officers and MOH’s to step up clearing up activities of all mosquito breeding sites. These instructions were sent to all regional and provincial heads with regard to taking care of dengue patients and alerting the 20 sentinel hospitals to stand by and have been accompanied by her usual request to the public to clear all mosquito breeding sites.

“This is an endemic disease following heavy rains. So our cleaning up campaigns are conducted on an on-going basis . We have already conducted 2-3 such campaigns recently with another coming up next month. However, the public’s co-operation is extremely vital in order to reduce the mosquito population islandwide.

If schools, householders, state and private offices, and everyone else participates in these cleaning up campaigns and ensures their immediate neighbourhoods don’t contain any material that attracts mosquitoes such as plastic lunch sheets, rigi foam boxes, coconut shells, discarded yoghurt cups, old tyres, and dead leaves , on an on-going basis, this problem can be resolved to a great degree”, she told the Sunday Observer in a hurried telephone interview.

Many irate house owners and other members of the public, however, are not prepared to take the rap for the dengue spread. Milroy B,(not actual name) a Colombo resident living at an intersection between Colombo 7 and Colombo 10, blames the CMC. He complains that the garbage in his house and that of his neighbours is often not cleared in time. “ When we informed the CMC we were told they would send a lorry to clear the garbage thrice a week. But sometimes they don’t come for a week. With three schools nearby, as well as three hospitals including the National Hospital, delaying to clear garbage down this lane is a death trap as it can expose both children and adults alike to this danger.”

Samali, a housewife living in an overcrowded shanty garden also has an axe to grind with the local Municipality. She told us, “When there was an outbreak of dengue in one of the houses in our garden recently, we informed the PHI. But he delayed coming for some reason. As we needed confirmation as to whether the patient had dengue or not, we delayed taking him to hospital. He is now critically ill and doctors don’t know if he will live or die”.

“The delay was taking the patient to hospital if he had fever for over two days. Even if there is a delay for the PHI to turn up, they should have taken the patient to hospital in the first place ”, says a municipal officer on grounds of anonymity. He also denied their Public Health Inspectors don’t respond to such calls.

“Our Department may be handicapped by a shortage of staff, but we always make sure that if we are informed of a dengue suspect, we immediately send out a team to investigate the matter. If a positive case has been identified, our officers go to the site and spray all the houses within 100 yards of the house where there has been a dengue case, to protect the neighbouring residents from being infected. We also give them advice on how they should clean the inside of their homes and outside”, Colombo Municipal Council Public Health chief Dr. Ruwan Wijemuni says.

Commenting on the methods used, Anti Dengue Campaign Director Dr Thowfeek says, ‘ methods depend on each case. The usual methods are fogging and spraying (we now do wall spraying mostly in low income homes)) and larvicide spraying . We also help to clear up debris .

In all our main campaigns we are assisted by the Tri Forces, Police, and our own PHIs.”

Receptacles attracting mosquitoes

Listing some of the most common receptacles that can attract mosquitoes and facilitate their laying of eggs, he said, “Dengue is a small container disease. So avoid throwing used yogurt cups, plastic plates, cups, rigifoam boxes, in your garden.” Did he have any useful tips with regard to disposing of these materials.?

“Buy only biodegradable plastics as they remain in the soil for upto a hundred years. Put everything in a garbage bag and leave it out only on days the garbage collectors come. Empty coconut shells can be burned or buried. Blocked drains are another source of attraction for mosquitoes., So are blocked roof gutters. Clean your roof gutters of all leaves. If there are overhanging branches from trees, cut them down. Remember it takes only a drop of rain water which if allowed to stagnate for a week can breed hundreds of mosquitoes “.

Roof gutters

The Ministry of Health some time ago announced a proposal to ban roof gutters in all new homes and buildings including hotels. While admitting that the use of roof gutters was a time honoured custom in every house for the past many centuries, it is also a fact that overflowing gutters are also one of the commonest reasons for water entering houses during heavy rains.

Asked for her comments, Dr Pallihawadana said, “ Gutter-less homes is not the answer to the dengue menace. Besides, unless these gutters are cleaned at least once in two weeks. They will continue to attract mosquitoes”.

As she points out , “The answer lies in the public’s accountability and willingness to take responsibility for their own premises and keep them free of mosquito breeding sites. Not only dengue even Zika can be spread as the same dengue carrying mosquito is also responsible for spreading Zika.

However, we have no reports of any patients with Zika here as yet, though we are ready to face any emergency”, she added. Anti Dengue Campaign sources also said they were discouraging people from using gutters on roofs.

That said, we wondered whether the Health Ministry could offer new house builders some tips on how they could still retain their roof gutters- and at the same time prevent water collections that attract mosquitoes as well

They may do well by taking heed of what Dr Thowfeek says:

“Make sure the gutters are not flexible and don’t bend easily.

In general, we tell house builders who seek our advice, they should make only tiny holes or gaps for the water to run out and make sure the slope is properly maintained. If a gutter is ten inches long, a one inch angle or gap is more than enough”

Why?

“Because a very small opening for rain water from a gutter to fall off to the ground, will prevent large amounts of water spilling in pools below which will attract mosquitoes as they take a long time to dry. Tiny drops will drip to the ground and if the sun comes up in a few minutes, it will be easier for these drops to dry out”.

Meanwhile Health Ministry sources have offered the following guidelines to detect symptoms of dengue and its more severe forms and the golden rule to follow in patient care at home;

What are the common symptoms of Dengue Fever? Says a Consultant community physician from the Anti Dengue control Unit::

“If you have at least two of the following symptoms you need to suspect having Dengue Fever. With high grade fever,

*Headache and pain behind the eyes(retro-orbital pain)
*Generalised muscle pain and joint pain
*Nausea and vomitting
*Red spots on the skin and bleeding tendencies.

If you are living in a highly endemic area it is also an important factor to consider

When you have fever what should you do?

*Adequate physical rest; don’t send your child to school during the illness.
*Paracetamol should be given in recommended doses.
*Tepid sponging for fever.
*Avoid all NSAIDS and steroids. (Mefenamic acid, Ibuprofen, Diclofenac)

*Adequate amount of fluid such as rice cunjee, fruit juices, Jeewani, milk, soup are preferable to water.

*Take usual meals if possible, avoid red, brown, black coloured foods.
*Consult a qualified doctor If you have fever for more than two days.