• Breeding death
• Appreciations
• Dump deal
• Seeing the need 
• Kala Korner by Dee Cee
• A mother's subtlety and a son's brightness
• History through inscriptions
• Stoking the fires of racism
• The beginning of the 'censere' 
• Their circle of life
• A home too far
• A philosopher among dancers
• Cartoon to gorgeous ballet
• Letters to the editor

Breeding death

By Faraza Farook

Three-year-old Ushahini died of Dengue last month after both her mother and the doctor she was shown to failed to recognise the symptoms in time. And in a telling indictment of the much-vaunted public awareness campaigns mounted by health officials, a month after her death, her family and neighbours remain ignorant of the disease that killed her. 

Ushahini's home is just behind the Police Hospital in Narahenpita among hundreds of shacks that line the rail track. A large drain and thick undergrowth close by provide an ideal environment for mosquito breeding. Adding to the poor sanitation is the Police Hospital garbage dumped on the other side of the wall. 

Many children, some as young as Ushahini, play alongside a drain in which hospital waste sometimes flows. 

Ushahini's death has left a void in this community, says her father, S. Aloysius (35), who was employed abroad as a machine operator and thus missed the funeral of his youngest daughter. Carrying somebody else's child, tears brimming in his eyes, he expressed fear that they would be struck by the same fate.

Ushahini showed all signs of Dengue - vomiting, high fever, red spots on her neck- but thinking her child had indigestion, her mother had her treated at a private medical institution. As there was no improvement, she was taken back to the same doctor the following day. The doctor concluded that the fever was due to phlegm and prescribed drugs accordingly. The fever subsided and Ushahini seemed fine for two days but then the high fever began again. She was once again treated for phlegm and was confirmed to be suffering from viral flu.

On the way home that day, after seeing the doctor, Ushahini became unconscious and was rushed to the Lady Ridgeway hospital where she was diagnosed with Dengue. "Four blood tests were done," says V. Gnaneswari, Ushahini's aunt adding, "she was also given saline." 

"The child's stomach looked puffed on one side," Gnaneswari noticed. Blood transfusions were given but it was too late. Hospital reports confirmed that the child had been suffering from Dengue for 16 days.

There are many similar sad stories, often associated with poor environment, sanitation, inferior housing and inadequate water supply. 

One of the problems associated with Dengue is that a majority of those infected hardly develop any symptoms. 

A few may have fever but this goes unnoticed because it resembles any other viral flu. Many patients may not know they have had Dengue and probably recover, but they are, however, a source of infection to others. Typically, the onset of Dengue is sudden with a sharp rise in temperature associated with severe headache and sometimes coldness.

Generally, the peak of the disease occurs in June/July with the onset of the South-West monsoon. A second outbreak from October to December associated with the North-East monsoon has also been reported. 

Since 1989, several hundred cases a year have been reported with a progressive spread to urban areas outside Colombo.

Medical Research Institute (MRI) statistics show a high number of cases in Colombo for this year with 750 suspected cases, 45 positive and two deaths. Matara ranked second with 88 suspected cases, seven positive while in Gampaha, there were 439 suspected cases, five positive and one death. Other areas reported a very low number of patients and a low mortality rate. Compared to 247 positive cases and 14 deaths as at the end of June last year, this year there have been 81 positive cases and 11 deaths.

Lack of attention, ignorance and panic have often led to late diagnosis of Dengue, which has proved fatal, Consultant Epidemiologist Dr. Nihal Abeysinghe of the Epidemiological Unit said. "Parents should closely monitor a child with fever, give continuous treatment and remain calm." Parents opting to go from one doctor to another could also lead to late diagnosis, he commented.

Observing of the patient during the third to fifth day of illness is vital because it is during this period that the progression to Dengue Haemorrhagic Fever (DHF) and Dengue Shock Sydrome (DSS) tend to occur.

But the question that troubles the public is why after so many years, Dengue is still claiming so many lives? Officials cite administrative problems, lack of staff, lack of chemicals etc., as reasons that may have also contributed to the spread of the disease but say that to some extent the onus is also on the public. Especially during an outbreak, individual efforts to ensure that one's surroundings are kept clean always can help to a large extent in controlling Dengue, health officials maintain.

A common complaint from the public is that the Municipality's mosquito control programme, chiefly the spraying of chemicals is not done regularly anymore. But health officials argue that it is not practical to use chemicals. "Chemicals have very little effect in Dengue control," Dr. Abeysinghe said.

Chief Medical Officer of Health of the Public Health Department, Dr. Pradeep Kariyawasam, gives the example of Colombo 7 which was once a potential Dengue danger area owing to the large gardens there. Now there are hardly any cases reported because residents have taken steps to keep their own gardens free from being mosquito breeding grounds, he said.

Today, canal banks are identified as areas more prone to infection. Weeds abound in the often stagnant water but the Public Health Department (PHD) and the Land Reclamation Division both pass the buck while the Dengue mosquito continues to breed. 

The Public Health Department is also faced with a severe shortage of staff (it has a permanent cadre of 27 PHIs while the cadre requirement is 47), limiting its efforts to educate the public on Dengue. The PHD's house-to-house inspection in the city is only done along main roads. 

As long as there is no concerted action by both health authorities and the public, Dengue will continue to surface regularly, claiming more innocent lives. Can we bear the cost? 

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