Dengue fever rising to its zenith:

Beware!

By Carol Aloysius

As the numbers of dengue patients sky rocket, authorities are blaming the public for not taking an active part in mitigating the dengue menace. Appeals to clear their surroundings have been ignored, authorities complain, as they struggle to get a grip of the situation.

Dedicated to Dengue: Kalubowila Hospital has entire wards dedicated to dengue patients as the number soars

At nearly 22,000 estimated Dengue cases islandwide, by June end, Dengue Fever (DF) is clearly running wild, since its escalation since December end last year. The monsoon rains have done little to ease the problem. Small pools of rainwater on pitted roads, and hundreds of water collecting receptacles that freely mingle with garbage mounds in heavily populated human habitats have been said to be proven culprits in dengue spread. Irritated by constant blame on local municipalities, Colombo Municipal Council Chief Medical Officer of Health Dr Ruwan Wijeymuni lashed back saying, “The real dengue breeders are the public who have not responded to our calls for sustained cleaning up of their environments.” His charge was reiterated by both, the Dengue Control Unit and the Epidemiology Unit.

The Western Province is the worst affected with 47.09% cases. Epidemiology Unit Chief Dr Paba Palihawadana, has thus reiterated her plea to the public to eliminate mosquito breeding sites, while assuring fullest support from the Health Ministry. Taking up the same plea, Community Consultant Physician , Dengue Control Unit Dr Preshilla Samaraweera said,, “That includes ALL water collecting containers like coconut shells, tyres, ant traps , flower vases, empty jam jars, yoghurt cups and lunch sheets. Even the tray under the fridge if it collects excess water can breed mosquitoes.” Since the dengue carrying vector can fly only four kilometres, she said, “ask your neighbours to get rid of their breeding sites as their mosquitoes can fly over your wall”.

Accelerated

To stem the fearsome rise in dengue fever, the Health Ministry said, it has recently stepped up Dengue Prevention Campaigns under an Accelerated Program.

Medical Officer , Dengue Control Unit, Dr Deepal Perera said , “These programs are now being held frequently. Out most recent program concluded yesterday ( Saturday) in the Western Province and in selected areas like Kandy, Galle, Matara, Gampaha and Kurunegala, coupled with a blanket fumigation program in Colombo and Gampaha”. However, he noted the biggest problem was the lack of sustainability on the public’s part in maintaining clean environments. “Sustainability is the key to reducing dengue. It must be a continuous process by all, not just the Health Ministry”, he stressed.

The good news is, the number of deaths and serious complications in very young children has been drastically reduced, thanks to the awareness raising programs and training of medical officers, nursing staff and even para medics, to detect and diagnose the symptoms. The Dengue Control Unit said, only 1-2 infant deaths had been reported , in the first six months of the year, which were from out of Colombo.

It was confirmed by Paediatrician, Epidemiology Unit, Dr Jayantha Weeramuni. He said, the number of deaths at the premier children’s hospital, the Lady Ridgeway Hospital ( LRH) was zero as of now, mainly due to the excellent team work of the hospital staff.

Allaying public panic as the disease mounts, Dr Weeramuni said fifty Sentinnel Hospitals had been set up islandwide with High Dependency Units in general wards equipped with multi monitors to check pulse rate, blood pressure, oxygen circulation etc.

Minister of Provincial Council and Local Government, Faiszer Mustapha meanwhile last week allegedly charged, the highest number of Dengue patients in Colombo were reported from Dehiwela and called for an immediate Accelerated Program in the area, especially targeting construction building sites and schools, said to be main ‘dengue breeders’.

CSTH

The Colombo South Teaching Hospital ( CSTH) at Kalubowila , the country’s second largest Teaching Hospital which has made its mark for its excellent management of dengue, when contacted had this to say.

Director , CSTH Dr Asela Gunawardana said, “This hospital looks after patients from Dehiwela, Ratmalana , Mt Lavinia and beyond. Spreading of the disease is the responsibility of the MOH. If there is a dengue case we notify the MOH, and in the hospital, we primarily treat patients.”

Preventive measures

With over a thousand in- patients daily, and 3,000 daily at the OPDs , we asked how the hospital managed to prevent the spread of dengue within its walls.

He said, “The problem is the high number of dengue patients, which has led to an inside spread of the disease. However, we are controlling it by fogging inside and outside the hospital every other day, and providing PPD to the staff members and patients. We also give mosquito repellents and mosquito nets to patients wherever possible.”

Explaining the treatment procedure of a suspected dengue patient, he said, “The patient’s first point of contact is the OPD doctor, who will go through the patient’s history, examine him, and decide whether to admit him or treat him at the OPD. If the patient needs admission, he /she will be admitted to a ward and the ward staff will take care of them. All the doctors and nurses have training in dengue management.”

Asked of a likelihood of misdiagnosis of the disease at its early stage, he said emphatically, “Misdiagnosing and giving wrong drugs have not been reported still at our hospital. However, to avert this we have laid down treatment protocols given by the Health Ministry which we should practise.”

He said, the hospital had an OPD fever corner and dengue fast track screening, as well as separate laboratory screening facilities for dengue patients with specialised staff trained in dengue management.

Dengue deaths

The CSTH has reportedly had no dengue deaths for this year. Asked the secret for its zero dengue mortality rates, Dr Gunawardana said, “The credit should go to the consultants, doctors, nurses, minor-staff and supportive staff who work 24hrs/365 days . Thanks to the dedicated ward management unit and team work of the hospital staff, we have prevented dengue related deaths. Unfortunately, last month a patient was brought in with complications developed at a late stage . We could have saved him, had he come earlier. The hospital staff worked tirelessly to save him and the parents later wrote to the newspaper ( Sunday Observer I think) praising our efforts even though their son had died in our hospital. “

Shortcomings

Dr Gunawardana said, the CSTH had a bed strength of 1,100, and only three medical units. “This is grossly inadequate to manage wards full of patients. A majority of the patients share beds and some patients have only chairs . We have two ICUs, with only 12 beds.”

We have the facility of detecting dengue antigen for a limited number of patients, but no virus isolation facility,” he lamented.

What the hospital needs right now he says, is a fourth medical unit and a dedicated unit for dengue patients management. We also need more staff- doctors, nurses and para medics.” He would like the idling Millennium building to be completed quickly.

Does a deterrent mechanism exist?

With fingers clearly pointing in the direction of the public for the current dengue spread, we asked the Dengue Control Unit if there wasn’t some legal mechanism to act as a deterrent to their un civic minded activities.

Consultant Dr Preshilla Samaraweera informed, “Legally, a PHI can now take an offender to court if he has a dengue breeding site,” but added, it hadn’t done much to deter the dengue breeders. Hence, a few Municipal Councils such as the Colombo Municipal Council ( CMC) had started a Rewards scheme to give green stickers to houses with the cleanest gardens. “But even that has failed to sufficiently motivate the public,” a CMC spokesman said.

So is this problem beyond solution? Can we become a dengue free nation by 2030?

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