22-year-old with dengue fever and a faulty healthcare management system

A flawed health care management system fails to control and treat an annual epidemic: dengue fever. This begs the question, have we not learned the lessons of the Covid-19 pandemic?

06 November 2022, 08:50

Last modification: 06 November 2022, 09:26

After a deadly pandemic recently pulled out its claws of death, we are once again faced with an epidemic, a familiar enemy. This photo was taken recently at Dhaka Shishu Hospital. Photo: Rajib Dhar

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After a deadly pandemic recently pulled out its claws of death, we are once again faced with an epidemic, a familiar enemy. This photo was taken recently at Dhaka Shishu Hospital. Photo: Rajib Dhar

Rotna ran down the halls of Shaheed Suhrawardy Medical College Hospital last Wednesday, her husband Sajjad’s test reports clutched tightly in her hands.

Reports indicate that Sajjad has dengue fever and his platelet count has dropped to 14,000 (for men the average count is between 135,000 and 317,000 per microliter of blood).

Rotna was desperate to get her husband admitted to the hospital and was looking for an available bed. After an hour, she took Sajjad to a private hospital in the capital’s Mohammadpur district.

“We thought it was a seasonal viral flu, and we didn’t take it seriously. After a week, while the fever hasn’t gone down and he hasn’t urinated for almost 12 hours, I got scared and had it tested.

The doctors said I had to get him admitted immediately,” Rotna said, her voice shaking.

On the sixth floor of the hospital, there are five dengue fever units, all overflowing with patients. The neurosurgery department has been transformed into a dengue fever department. Neuro patients have been moved to other departments.

Dr Taha, on-call doctor in the dengue fever unit, said: “We see dengue patients every day and it doesn’t look like it’s going to stop any time soon. Over 20% of these patients are in serious condition.”

According to him, almost 90% of dengue patients are from Dhaka, while 10% come from other districts.

It has been 22 years since dengue first appeared in Dhaka. It has remained, more or less, a metropolitan disease for all these years. However, things seem to have taken a turn. After a deadly pandemic recently pulled out its claws of death, we are once again faced with an epidemic, a familiar enemy. But this year, dengue fever is no longer confined to the metropolitan area. It spread to suburbs and villages.

And, the death toll broke all previous records.

Photo: Rajib Dhar

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Photo: Rajib Dhar

Photo: Rajib Dhar

As of Friday morning (November 5), the Directorate General of Health Services (DGHS) has recorded a total of 167 dengue fever deaths in the country, which is higher than the figure for the past two years combined. Nine dengue deaths, the highest in a single day this year, were recorded on Thursday.

From January 1 to November 5, DGHS has recorded 42,199 dengue cases and 38,295 recoveries so far this year. Among them, 28,275 people are in Dhaka and 13,924 outside Dhaka.

3,737 dengue fever patients are admitted to various public and private hospitals across the country. Among them, 2,254 are in 53 hospitals in Dhaka. The remaining 1,483 people are under treatment in other departments outside Dhaka.

Doctors and health experts have cited comorbidity (suffering from multiple illnesses) and late hospitalization of dengue fever patients as the main reason for the increased death toll. One factor to note here, many patients travel to Dhaka for treatment.

Again this year, two new variants have appeared – Den 3 and Den 4 – which are deadlier than the previous variants and appear to attack and dangerously affect everyone, including children and women.

Overburdened hospital wards and distraught patients’ loved ones can work like flashbacks, even triggering memories and fully reminding us of the last time the healthcare system was overwhelmed. Not much time has passed since we met and experienced the Covid-19 pandemic.

Now, when the shattering effects of Covid in hospitals have been largely tamed after almost three years, it begs the question: aren’t we supposed to have a well-organized healthcare management system in place? nowadays ?

Photo: Rajib Dhar

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Photo: Rajib Dhar

Photo: Rajib Dhar

This would include, but not be limited to, intensive care units with necessary equipment, well-trained nurses and doctors properly distributed in upazilas and suburbs, and adequate diagnostic capabilities.

But what we are seeing is that more and more dengue fever patients are coming to Dhaka for treatment. Does this speak to the fact that we are still unprepared to deal with emergency medical situations?

Public health expert Prof Dr Be-Nazir Ahmed said: “This means that we have learned nothing from our previous mistakes. We have absolutely no preparedness locally.” He further added that Gaibandha still has no intensive care beds even after being one of the Covid-19 prone areas.

Doctors outside the capital have not received adequate training in dengue fever management. The DGHS has trained some 2,000 doctors, but all are in public hospitals in the capital; they are not upazila-level doctors.

According to media reports, district and upazila level doctors do not have the necessary quantity of dengue fever test kits (NS1 antigen test kits). Introduced in 2006, the kit allows rapid detection from the first day of fever, before antibodies appear five or more days later.

Why haven’t they received proper training or been given NS-1 kits? When we contacted several DGHS officials with these questions, they either did not respond or refused to answer our questions.

We reached out to Dr ABM Abdullah, Professor Emeritus and the Prime Minister’s personal physician, for answers. He said, “You can’t blame just one party here. Both the people and the administration have flaws. Dengue fever is not something new here in Bangladesh, so we have an idea of ​​how to deal with it. But what happens with the patients is that they think the capital has better health opportunities; they simply cannot trust local health complexes and hospitals. »

According to him, upazila-level doctors are also doing good, but patients still don’t trust them. And then some can afford to travel to Dhaka for treatment and admission to private hospitals. I believe that’s the main reason why they come from outside Dhaka.”

Dr. Abdullah and Dr. Be-Nazir pointed to a few other underlying reasons for this year’s death rate. Dr Abdullah said it depends on the type of fever or virus. There are four types of dengue fever: Den 1, 2, 3, 4. Den 3 and 4 are extremely deadly. Those infected with Den-3 are most at risk.

Photo: Rajib Dhar

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Photo: Rajib Dhar

Photo: Rajib Dhar

“And the second reason is that most people who die [possibly] had already been infected with the virus once or twice. And each time an individual is infected with this virus, their immunity [system] weakens, hence the third or fourth time it becomes serious for the person,” explained Dr. Be-Nazir Ahmed.

Dr. Be-Nazir, also a former director of the DGHS, further added that doctors are not yet trained to fight this virus. “We always consider platelet count as the main parameter for testing for dengue fever. No one is talking about PCBs [packed cell volume] or the hematocrit ratio test, which is more effective in determining the virus. This ratio should be below 40, but if it increases, the patient should be hospitalized immediately.”

The two also talked about comorbidity and how it can increase the likelihood of the dengue variant causing more harm to the body, once infected. Comorbidity, in this case, means that a person already suffers from diseases like diabetes, blood pressure, stroke, etc.

On how to tackle this problem, Dr Be-Nazir said the focus should be on prevention and also on capacity building. “Dengue has a connection with the environment – a specific amount of rainfall and humidity. This year the monsoon has lasted a long time. It may continue until December,” he explained, adding that a clean environment is crucial.

“Only entomologists can figure out what steps to take. Nebulization is not enough. A larvicide must be used to kill the larvae. A general fogger will not understand this science. We must deal with it immediately,” said Dr Be- Nazir, moreover. adding, “Every municipal corporation, local government and hospital needs to improve its human resources by hiring more entomologists. They need well-equipped laboratories, necessary chemicals and pesticides, and well-trained doctors and nurses. And for all this, we need a well thought out budget.

Now it depends on the government whether or not they will focus on strategic planning.”

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