Dengue cases on rise: Buzz becomes menacing

CHENNAI:  Despite numerous measures to curb and control dengue by the state health department, new cases of deaths due to dengue were witnessed on Tuesday.

While a P. Anbukodi from Namakkal killed her six-month-old ‘dengue affected child’ Sharvin and committed suicide, a 27-year-old police constable Thangaswami from Madurai succumbed to dengue. In view of recent dengue deaths, Deccan Chronicle analyses major challenges faced by patients and doctors at the government hospitals in the city owing to the failure of dengue control initiatives.

Delayed sample collection and laboratory tests
Though 24/7 fever clinics have been set up in all government hospitals to check dengue at the earliest, clinical laboratories are flocked by fever patients for blood tests and other clinical tests throughout the day.

The pathology and laboratory personnel are available only for three hours in the morning, 9 am to 12 pm at many government hospitals including Kasturba Gandhi Government Hospital. Nurses and ward boys on duty for sample collection, who are mostly medical college students, usually send back the patients even before the usual timings.

“Doctors available for collecting sample for tests say that they would get late for college and stop accepting OP slips by 11:30 am itself. I came from Tiruvallur and need to travel again to give the samples tomorrow despite being sick,” said R. Kavya, a patient at a government hospital.

Though claims of deploying 35,000 health workers to fight the dengue battle may seem a big initiative, a more collaborative effort is needed to actually check dengue. 

Delayed reports and late referrals
Extending clinical tests is not where the issue ends, blood reports are not given immediately at most of the hospitals for outpatients. Though hospital authorities at Rajiv Gandhi Government General Hospital (RGGGH) said that reports are given within an hour of the test, duty doctors at Institute of Child Health (ICH) said that though lab technicians are available round the clock, reports get delayed even for 24 hours. 

Blood test reports for all fever outpatients are given only after a day delaying the diagnosis of the infection. ICH dean, Dr Ravichandran said, “People neglect fever and self-medicate, but undiagnosed fever and late referral is the major responsible factor for spike in dengue deaths recently.”

However, delay in blood test reports by hospital laboratories itself, not only delay the diagnosis, but it gets quite late for patients to be referred for tertiary care if they are dengue positive.

Overcrowding hospitals
As per the instructions of State Health Department, dengue positive patients should get treated at government hospitals for better treatment and tertiary care facilities. 

“Primary Health Centres have been issued a circular to not to treat any fever patient as inpatient if the platelet count is less than 50,000. We mostly refer dengue positive patients to city hospitals to avoid risk of spread of infection,” said a medical officer from Villupuram Medical College.

Public Health director K. Kolandaisamy had stated that dengue patients were given treatment as per the protocol set up by World Health Organisation, increasing the work pressure for doctors and nurses.

Owing to lack of tertiary care at private hospitals, PHCS and secondary care centers, a large number of patients from neighbouring districts and states such as Tiruvannamalai, Tiruchy, Tiruvallur, Villupuram and Madurai. This has led to overcrowding at government hospitals, with increased paper work and protocol management.

While people have to lie on floors and open places in hospitals owing to large footfall, rains have worsened the scenario. Stagnation at most of the hospitals including Stanley Medical College and ICH becomes breeding ground of mosquitoes and makes it difficult for patients to lie even in open places.

Construction sites being a common place for breeding of mosquitoes, government hospitals with new blocks and buildings under construction are also serving to be the same.

Sending samples to specialised laboratories
But a major challenge faced by patients from other districts is carrying the test samples to specialised laboratories such as King’s Institute located in Guindy. Relatives and patients from other districts not only lament being unaware of the surroundings, but also complain that hospital authorities deny sending samples directly. Ideally, it is the hospital authorities that need to send the samples to laboratories, but doctors say that kin of the patients are ‘concerned enough’ to submit the samples on their own at specialised laboratories even if they are located far away from the hospital premises.

“I have come from Tiruvannamalai with a three-month-old child suffering from suspicious fever. Doctors asked me to go submit the blood and urine samples at King’s Institute in Guindy. How can I leave the child alone and go?” rues 64-year-old Jayanti.