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MONSOON DREAD AND DISEASE
By Esther Williams
Have you caught the bug yet? At least one member in every Colombo household seems to have been afflicted with viral fever or flu, diarrhoea, cold and cough or the dreaded Dengue itself in the past few weeks. What is the cause of this spate of illnesses that has hospitals full and the Out-Patient Department (OPD) in every hospital and clinic overflowing?

The Lady Ridgeway Children's Hospital (LRCH) last week registered 3200 patients on a single day in their OPD and their recent records show an average of 300 children being admitted on most days for various illnesses - a marked increase in the average number of patients compared to normal.

As parents try everything from mosquito coils to repellents to protect children from Dengue, what can be done about the other illnesses that seem so common?

The Dengue menace:
While acknowledging that several diseases have emerged during the present monsoon rains, Director of LRCH, Dr. R. Wimal Jayantha points out that Dengue is no longer an epidemic but an endemic disease that we can expect not only during the monsoon but also the whole year round. There is clear evidence of the disease having become endemic as seen from the number of patients who sought treatment at the LRCH's Dengue Management Centre throughout the last year.

"The Dengue control programme should therefore be a continuous, year-long programme and not just during the rains," Dr. Jayantha states. Formerly, the occurrence was seen more commonly in the peak periods of June-July and November-December when rain left puddles in tins, plastic bags, tyres etc., creating rich breeding grounds for mosquitoes as they still do today.

Dengue is now considered an urban disease with the most number of cases registered from Colombo, Kandy and Kurunegala. Dr. Jayantha attributes this to the high-rise buildings that allow water to stagnate in blocked gutters. "These areas are beyond our control.” Residents have to be stricter about eliminating mosquito-breeding sites around their homes, he says.

What's more, when an uninfected Aedes mosquito (black with white spots) bites a person with Dengue and then bites a healthy individual, the disease quickly spreads from person to person. Dengue fever may be confused with other infectious diseases such as influenza or malaria. It can be confirmed by doing a blood count. Doctors look for two factors: if the platelet count drops dramatically and if pack cell volume increases, it proves beyond doubt that the patient has Dengue.

Some types of Dengue that can be fatal if not treated properly are:
Dengue Haemorrhagic Fever: A patient suffering from this will have fever, headache, severe muscle and joint pain, pain around the eyes, vomiting and abdominal pain. He/she will need to be hospitalised to avoid risk of fatal complications.

The condition will also give rise to red patches on the skin, bleeding from the gums, nose, and internal bleeding. The condition should be closely monitored and treated properly.

Dengue Shock Synd-rome: Although there is no bleeding in this condition there is leakage of fluid from vessels. The blood platelet count can drop and a patient can go into shock. Further, body temperature can drop and the person can become unresponsive. He then has to be hospitalised and given intravenous fluid and plasma.

Records show that when compared to those of 10 years ago the disease load has increased fivefold. From 200 cases a year, there are now 5000-6000 cases a year. However the good news is that because people have become aware of the management, the number of deaths has come down.

"Management of Dengue has most certainly improved even if cases have gone up," reiterates Dr. Jayantha adding that most people know that they need to have their blood platelet count done and fluid replacement to prevent death.
On our part, he thinks it is imperative that we keep our premises clean; identify, isolate and treat a patient properly and follow the Dengue control programme strictly.

Diarrhoea Epidemic:
Another condition that is increasingly being reported is Diarrhoea. When patients pass blood and mucous with stools they are said to have bacillary dysentery that is caused by a bacteria called Shigella. The LRCH has seen a few patients each day and today there are 30 inpatients undergoing treatment in the wards.

Bacillary Dysentery, a water-borne disease occurs in people living in poor sanitary conditions. With rain, the tendency for the disease to spread is high. Water invariably gets contaminated and this is compounded by food prepared unhygienically. The Director urges parents to be alert and watch out for the signs.
Diarrhoea can be prevented by good personal hygiene. At the LRCH's Diarrhoea Treatment Unit they see around 50 patients each day. On June 7, 183 patients registered with the problem. When it is diagnosed, patients are given a specific antibiotic to prevent complications. However it is mandatory to seek proper treatment.

How can we prevent diarrhoea?

Children should carry boiled and cooled water.
Food should be properly covered to protect it from dust and flies.
Consume homemade food rather than that which is bought on the road.
Refrain from buying ice cream from vendors.
Fresh fruits and vegetables should be washed properly.
Wash hands with soap before meals
Those who prepare food should cleanse hands properly before they start.
Proper disposal of faeces.

Another type of diarrhoea is the watery type that can most often be treated at home. Caused by a virus, the infection can be accompanied with fever, vomiting, and abdominal pain. Patients can be given fluids (king coconut, conjee water), oral re-hydration salts and good nutrition to treat the symptoms

Viral Fever:
This is a condition that has symptoms very much like Dengue - fever, headache, aches and pains, vomiting, loose motions. The disease spreads easily through droplets (when infected people cough and sneeze) that are contagious. Others in the home can catch it from close contact.

The cough and runny nose that comes along with viral fever stays on long after the fever subsides. "It is natural for it to take time to settle," Dr. Jayantha states advising patients to take antihistamines and cough syrups. But if the cough is accompanied with wheezing and yellow coloured sputum, it could have developed into a bacterial infection that needs antibiotics.
Since both Dengue and viral fever have similar symptoms, Dr. Jayantha suggests some simple steps we can follow while at home:

Patients are advised complete bed rest. Children should not be allowed to play.
Sufficient fluids - oral re-hydration powders and other fluids (King coconut, conjee water) should be given.
Good nutrition is essential, as immunity drops if you do not eat properly.
Treat symptoms: fever and cold with panadol, cough syrup etc. T emperature and general conditions should be carefully monitored. Severity and length of illness depends on each person's immunity.
If fever persists for more than 2-3 days after treating symptoms, seek medical attention.

Be alert to conditions as other complications can develop.

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