Dengue fever added fuel to the fire

By Ida Indawati Khouw

JAKARTA (JP): In addition to all the other troubles assaulting them in the monetary crisis, Jakartans were socked by a widespread dengue fever outbreak.

So extensive was the disease, which is spread by the aedes aegypti mosquito, that numerous deaths and hospitalizations were recorded. The city's hospitals were stretched to the limit.

As with most parts of the country, the virus spread so fast in Jakarta that by April the number of dengue sufferers admitted to hospitals and public health centers reached an average of 200 per day.

This year's outbreak constituted by far the most serious in recent history. A tally of 131 deaths and 15,142 infections was recorded as of Dec. 17, the city health agency said.

In comparison, the previous worst rate of infection was in 1988, when 111 died and 10,647 others were infected.

The disease, known locally as demam berdarah, is no stranger to Indonesians since it was first detected here 30 years ago.

Nevertheless, people's ignorance about the disease and its symptoms persist.

Many of the ill were brought to the hospital in advanced stages of infection because they and their family members misidentified it as influenza or other common ailments.

Overextended hospitals were forced to utilize facilities designated for other treatments.

The city's 99 hospitals and 474 public health centers occasionally had to turn away patients because they were full.

Patients receiving treatment in hospital corridors was a common sight in major hospitals, like state Persahabatan Hospital and the Indonesian Christian University Hospital in East Jakarta and Cipto Mangunkusumo General Hospital and Saint Carolus Hospital in Central Jakarta.

Many patients weakened by the disease, which causes acute muscle aches in its advanced stage, were lucky if they could find a mattress to rest on.

The virus increases the permeability of blood cell walls and reduces the number of thrombocytes in the blood. As a result, water contained in the blood permeates into other tissue more easily, hampering circulation.

With the huge demand and cost, it was difficult to obtain Ringer Lactat intravenous plasma, usually the first treatment administered to patients when admitted to hospitals and clinics. Dengue patients need fresh plasma, not regular blood.

Fifty of the fatalities occurred in April alone when 6,504 people were infected.

At the time, the Jakarta chapter of the Indonesian Red Cross (PMI) was also at a loss because of the demand for blood.

Every day, dozens of relatives were forced to spend hours at the PMI office in Central Jakarta either to donate blood or receive blood from donors. The understaffed office had to toil round the clock to meet demand.

"We could take around 30cc of plasma from 100cc of fresh blood. It takes up to 10 hours to process until the plasma is ready for use," a PMI staff member said.

The government, alarmed by the rising death toll, called on the public to donate blood.

However, medical experts criticized as "inexperienced" the doctors who hastily recommended blood transfusions for all dengue patients. They argued that only sufferers with internal bleeding needed transfusions.

With a looming health crisis on its hands, the city administration launched massive operations to eradicate the virus, including fumigation and distribution of Abate insecticide.

The administration threw its muscle behind a massive antidengue fever operation, begun on April 26.

Every Sunday, communities were urged to do their part to stop the life cycle of the mosquitoes, which live and breed in clean water. They can flourish in tiny amounts of liquid.

Residents were urged to empty and scrub household water tanks, buckets, pets' drinking bowls, vases and water reservoirs. They were also instructed to bury empty cans.