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