Dengue fever added fuel to the fire

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.