Dengue fever is up- already exceeding the 5,000 mark in the first one and a half months of 2017. A total of 10,205 cases have been reported in January and another 4,975 this month, with the Western Province accounting for more than half the number. The Colombo Municipal area showed a total of 5,786 for the months of January and February as of Feb.23. Jaffna district had a sudden spurt in the disease in January (558 cases) bringing its total number (with February’s suspected cases (284,) to 842. Not far behind is the Eastern Province where an outbreak of dengue in January and February affected 817 persons. Other badly affected areas include, Ratnapura (593) Kalmunai (482) Kurunegala (624) and Galle (1,136) so far, according to epidemiology unit reports.
Early this week, on February 20 the nation was startled by reports of an outbreak in the Rambukkana district hospital where the DMO and 14 others who included ten nurses, a pharmacist , a statistical officer and two others, along with 20 in patients. The hospital already overloaded to the hilt had sent the patients for consultants’ opinions and lab tests to the better equipped Kegalle Hospital.
Leptispirosis
Parallel to Dengue epidemic is the rise in Leptispirosis. A total of 308 Leptispirosis (Rat Fever) patients were counted by mid February, the highest in Ratnapura (52) followed by Kalutara (32) Galle (30) Moneragala and Anuradhapura 19 each and Colombo and Galle 12 and 13 respectively. Disturbingly, the disease, endemic during and after rains is now showing a new trend where non endemic areas are being affected by the disease e.g. Colombo, Kalutara, Galle and Matara, health officials have noted, warning residents to stay away from dirt piles that draw rats, the main carrier of the disease, and for farmers to take adequate precautions by wearing proper clothing and taking the preventive tablets of Dioxcycilin as prescribed, before going out to work.
Measles and Hepatitis
On top of these two epidemics government epidemiology unit sources said, measles and hepatitis which also commonly occur during the early months of the year have begun surfacing, though not in large numbers in certain districts. In addition, officials in hospitals across the country have also reported a rise in the number of patients with respiratory (both upper and lower tract) problems visiting their out patients clinics, the majority of them being older persons.
Viral flu
As if this isn’t enough, we now seem to be having a full blown epidemic of viral flu the symptoms of which though very different from dengue fever ( DF) is sometimes mistaken for the latter, since it is difficult for an untrained person to see the difference, in its initial stage. The flu ( AH1N1) though not as dangerous as dengue fever, is also highly contagious and transmitted by nasal droplets and doctors have warned patients to stay at home, bed rest and avoid large crowds , while practising good hygienic practices like covering one’s mouth and nose when coughing or sneezing, disposing used tissues in covered bins, and washing one’s hands and face with soap and water frequently, and keeping a safe distance from anyone suspected of having suspicious symptoms .
AH1N1
Admittedly, the outbreak of most of the above mentioned diseases, especially, at this time around is not a rare occurrence since they are endemic and take place in peak periods.
Take the influenza virus now spreading like wild fire in the country.
Health officials have pointed out that these seasonal influenza viruses circulate and cause disease in humans every year. In Sri Lanka, for the last few years, it has been generally observed during April to June and again from November to January.
It spreads from person-to-person through sneezing, coughing, or touching contaminated surfaces. Seasonal influenza viruses can cause mild to severe illness and even death, particularly, in some high-risk individuals. Persons at increased risk for severe disease include pregnant women, the very young and very old, immune-compromised people, and people with chronic underlying medical conditions such as cancer, diabetes mellitus and heart diseases.
Likewise Dengue, Leptispirosis, measles are serious diseases that carry a high morbidity and mortality rate and which spike during certain seasons during and after rains.
The moot question is whether our hospitals and doctors battling these diseases, can cope, especially, with their limited resources when their in wards and out patients’ department already overflowing with dengue patients now have an additional number of infectious patients to deal with?
Kurunegala Hospital Director, when contacted admitted there was a dengue epidemic at the hospital. “I can’t tell you the exact figures but from December through January till now our dengue patients have been mounting,” he told the Sunday Observer.
While there had been a few deaths (he didn’t recall how many as he was out side the statistics room) he said, the patients who were of all ages had arrived too late to get themselves examined.
From where did these patients arrive?
“We are in the centre of the North Central and North Western Provinces. So they come from all neighbouring areas, he said.
The Director , Infectious Diseases Unit of the same hospital, Dr Chandrika Weerasinghe said the hospital had a proper surveillance system and any reported case of dengue or any other infectious disease was immediately attended to. Our Public Health Inspectors are also sent out to educate the public , householders and neighbours in the affected areas In addition, we have an education program for our medical officers of health and schoolchildren and teachers in 72 MOH areas.”
The number of dengue patients reported in January and February at the hospital is approximately 300, whose victims were mainly persons over 16 years, hospital sources said.
So, did the hospital have separate wards for these patients?
“No”, says the director. “We have several medical wards but no separate dengue unit. Other than that we have all the other facilities such as Rapid testing facilities etc. Our consultants are managing because the outbreak is under control. But, having a separate ward for dengue patients would be welcome”.
IDH
The Infectious Disease Hospital ( IDH) at Angoda being the main hospital for treating patients with communicable diseases from all parts of the island, the Sunday Observer spoke to Dr Ananda Wijewickrama, a leading authority in the field.
Did he see a rise in the number of dengue patients this year?
“Yes” he said. What about measles? Chicken pox? Rat fever? “We have had some cases but there isn’t a significant rise in the number of patients with these diseases. What we are seeing at present however, is a definite spike in respiratory viral infections. More patients affected by viruses of the upper and lower respiratory tract are being brought here for treatment, due to climate changes, etc”.
Shortages
So, is the hospital staff able to cope with this extra load of patients?
“We are managing with difficulty as we have only 60 percent of the cadre of nursing staff for dengue. The Health Ministry sent us ten nurses who are waiting for their appointments. In addition, we have eight nurses. But our actual cadre is much more”.
Beds? Did the hospital have enough beds to go round?
“We are overcrowded. Sometimes two patients share a bed. But, this problem should be eased when our new 60 bedded ward comes up by June end.”
Issues
The main issue he believes is the lack of public education with regard to the preventive aspect of these diseases.
Citing the sharp reduction of diarrhoeal diseases compared to ten years ago, due to extensive education programs, he said, “Education holds the key. The Education Ministry should include Health in the routine education curriculum for children starting from a young age. At present, Health is an optional subject which few students offer. Make it compulsory for all grades”.
Educating mothers
Echoing the familiar saying, “When you educate a mother you educate half the world’s population,” he said, including health as a component in the Grade 5 Scholarship exam would benefit both, the mother and the child, as most parents who study along with their children will also learn more about the basic lessons on health and nutrition. Yet, how many questions are Grade 5 students asked to answer on health when they sit this exam?” he asked.
On the kind of questions that should be included in a curriculum, especially designed for health education, he said, “Education is a very wide field.
So it should comprise different components of health, because everything we do as well as our own environment has an impact on our health”. Due to new tropical diseases now being reported , he suggested there should be regular reviews of such curriculum to ensure students receive updated information.
Message
Asked if he had a message for those with symptoms of dengue and viral flu now on the rise, he said, “ Anyone having fever for three days should go to a hospital for screening tests and a blood platelet count. Even if the fever settles they should get themselves re-examined after 24 hours.
For patients with dengue fever we recommend bed rest, and plenty of liquid including king coconut water. And only take paracetamol as prescribed by your doctor”.
We asked him about the efficacy of papaya juice which has been promoted by certain non traditional health workers. Categorically refuting it had any benefits he said, ‘No medical body in the world has supported this claim or recommended it as a cure for dengue as there is no scientific evidence to prove this”. Kalubowila Hospital woes
Kalubowila Hospital Director, Dr Asela Gunewardene said, although the number of dengue patients had come down , the hospital was still overcrowded . “We are managing - but barely. All our six units for dengue patients are full and our 250 beds are just not enough.
The ICU ( we have two) are also inadequate but there is no room to build another in this already congested hospital. On top of this we have patients with measles, chicken pox, hepatitis , rat fever , and respiratory infections. Our OPD is full of viral flu patients.”
Asked about staff shortages he said , “ We are operating with just half our cadre of trained nurses . We need 1,200 but have only 600 who have to work overtime when there is an outbreak of some disease like dengue.”
However, he feels with the construction of the new Dengue ward built on special orders by the Health Ministry which will come up next month will somewhat ease the problem . “We will then have 15 additional beds to admit critically ill dengue patients only”, he said.
Health Ministry’s views
Director General Public Health Services, Ministry of Health, Dr Sarath Amunugama when asked what the Ministry was doing to control the spread of infectious diseases, said, a surveillance system was in operation where the hospital was expected to report a contagious disease. “We have also set up High Dependency wards in most of our provincial, base and general hospitals.
The Health Ministry also conducts Mosquito Control programs regularly and our PHIs do fogging and cleaning of breeding sites in high risk areas. At the same time we conduct education programs on mosquito control, and advice vulnerable persons like pregnant women and cancer patients to visit a qualified physician if they have fever for over 3 days.”
He warned that with sudden climate swings, more outbreaks of infectious disease were likely, adding, there were no major outbreaks this year of any disease. “We can keep it that way if the public supports us “, he said.
Conclusion
In a tropical country like Sri Lanka infectious diseases are regular occurrences. The tragic fact is that these communicable diseases have now overtaken non communicable diseases in this country.
The question to ask is how do we halt this dangerous trend?
As this writer sees it, there are two options. One is to provide every child and adult equal access to quality health care facilities at minimal cost.
The Wellness Centres set up by the Health Ministry across the country which allows for free screening tests for most diseases including HIV/AIDS, is one. The other is for the Education Ministry to seriously take note of Dr Wijewickrama’s suggestion for a compulsory health component in the school curricula.
If our goal is to have a country with the lowest number of infectious diseases, there is no doubt that Education is the key.
Informing, educating and instilling good healthy habits in children, parents and teachers is to arm them with the best protection they can have against contagious diseases in the future.
Over to our readers
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