Few doctors trained to treat dengue fever
Few doctors trained to treat dengue fever
Dewi Santoso, The Jakarta Post, Jakarta
The Ministry of Health says many more doctors need training on
the detection and treatment of dengue fever, but due to a lack of
funds, physicians with private practices and fresh graduates were
missing out.
Dr. Rita Kusriastuti, the ministry's head of arbovirology,
said that intensive training on dengue fever treatment had been
conducted since 2000 at state and city-run hospitals.
But she lamented that those who worked in private hospitals,
among others, had not been trained. "The ministry's limited
budget for training is making the situation worse," she told The
Jakarta Post on Saturday.
The ministry refers to the World Health Organization's guide
on training doctors published in 1999. The guide provides
information on the tests that must be conducted to detect dengue
fever symptoms.
Rita said that first the patient's blood was tested every two
hours for three consecutive days. She said that if the patient
couldn't afford the tests, doctors sometimes ran them every six
hours.
"If a patient's condition is improving, the blood can be
tested every 12 hours," she added.
The normal hemoglobin count in blood is between 12 and 14
milligrams percent. If, in three days, the hemoglobin count was
dropping, then the doctor would conduct a thrombocyte test.
Rita said that usually a decreasing hemoglobin count was
followed by a decreasing thrombocyte count. However, it was
possible for the hemoglobin count to remain normal while the
thrombocyte count decreased.
The minimum thrombocyte count in blood is 100,000 platelets
per cubic-millimeter.
If both tests show that hemoglobin and thrombocyte counts are
decreasing, the patient must undergo a blood transfusion as these
are symptoms of internal bleeding.
If the patient has a high fever but hemoglobin and thrombocyte
counts remain normal, the doctor will use a tourniquet test to
detect bleeding under the skin.
"The test uses blood-pressure equipment. If the patient
develops a rash within five minutes of the commencement of the
test, like mosquito bites on the lower arm, then they have tested
positive to dengue fever," Rita said.
The last test is the hematocrit test, which takes between 24
and 48 hours.
"Once the doctor has confirmed that the patient is suffering
from dengue fever, they will proceed with three steps," she said.
First, the patient must receive a Ringer Lactate (RL)
transfusion to replace the amount of fluid lost. If the RL
transfusion did not help, Rita said, this indicated that the
patient had suffered massive fluid loss and a colloid transfusion
was necessary. If both transfusions failed, a blood transfusion
was necessary.
Rita said that if the hemoglobin count did not decrease but
the thrombocyte count did, then a thrombocyte transfusion was
required.
In the case of Maulidina Putri, 5 -- whose died last Thursday
due to dengue fever -- a blood test had indicated that her
thrombocyte count (blood platelet) per milliliter was around
200,000, but there was no data on her hemoglobin count.
Rita called on parents to monitor their children. If a child
drank a lot but urinated infrequently, parents should report this
to the doctor immediately, as it was possible that the child was
already experiencing fluid loss, she warned.
The dengue fever outbreak has spread to 19 of the country's 32
provinces, with the death toll approaching 200. In Jakarta alone,
the death toll is 38.
I-box
MEDICAL STEPS FOR DENGUE FEVER PATIENTS
Tests
1. Hemoglobin and thrombocyte tests at least every 12 hours.
2. Tourniquet test, to check for internal bleeding.
3. Hematocrit test.
Treatment steps
1. Ringer Lactate (RL) transfusion to replace the loss of fluid.
Doctors must monitor patients every two hours. If the patient is
getting better, the patient may be monitored every four to six
hours.
2. Colloid transfusion.
3. Blood transfusion, if the two transfusions above fail.
Source: The Ministry of Health