Dengue and viral fever have been taking its toll on the country this season while Dengue is said to be at its peak during the month of June. The Lady Ridgeway Hospital which is deemed to be the prime children’s hospital in the country, witness almost 70 dengue cases daily. In a press release issued by the World Health Organization (WHO) about the outcome of the Global Health Security (GHS) meeting in Bali, Indonesia in June, stated that a significant threat to GHS is due to the number of national health systems that are weak, fragmented and under-funded.
The statement notes that only about one thirds of the countries in the world have the ability to assess, detect and respond to public health emergencies. It further remarks that the true power of health systems is their ability to deliver timely and quality health services to those in need in a comprehensive way and on an adequate scale. These systems are especially important during emergencies and outbreaks when access to quality essential health services can be severely compromised. Is Sri Lanka prepared to face this outbreak of dengue and viral flu, especially as the figures have doubled compared to previous years?
Dengue cases doubled
According to the Lady Ridgeway hospital records, there has been an increase in dengue patients. “As of May 31, 2016 there have been 1340 dengue cases, out of which 211 were dengue haemorrhagic cases. There have been 2 deaths that were caused because the patients were transferred late. In 2015, there were 2561 dengue patients admitted to the hospital. So there’s a definite rise” Lady Ridgeway Hospital Director Dr. W. K. Wickramasinghe said.
Speaking to the Daily Mirror he added that there was an outbreak of dengue usually in June. “This is seasonal, but there was no such peak outbreak in the corresponding month last year.”
“After the floods the affected areas weren’t cleaned on time. The garbage was left unattended while tins and cans were strewn everywhere. These are breeding hubs. Mosquitoes can breed within a week. This has had an impact on this year’s outbreak,” he added.
“We have around 70 cases of dengue everyday and have six special wards where dengue patients are treated. All these wards have special units called ‘Dengue High Dependency Units’ where children found to be in critical stages receive treatment.
So the management has improved drastically,” he remarked. He added that children were often transferred to the LRH as it is the best place for dengue treatment in comparison to the private sector.
Preliminary Care Unit (PCU) for Dengue Management
When asked how the Preliminary Care Unit (PCU) established in 2015 contributed in managing dengue, he said “The Out Patient Department (OPD) is crowded these days due to large influx of patients.
Around 3000 children come to the OPD. Children in a critical stages are sent to the emergency unit (PCU) while the others are treated at the OPD by nurses who examine and prioritize the child patients.”
“Children sent to the PCU are examined, screened and monitored up to 4 hours after which the decision is made as to whether they should be admitted to the hospital or could be sent home.
A consultant’s view is needed to arrive at this decision. This is advantageous both to the patient and the hospital. If there was no PCU, the patients admitted at night would have to stay for at least 12 hours before they could go home.
“There are 20 doctors working in the preliminary care unit and 3 specialist residential paediatricians who look into dengue related cases. Even at the OPD, we have adequate number of doctors. Though the figures have doubled we are able to manage the situation.”
Dr. Nalika de Silva, Consultant Paedeatrician said, “The PCU is a 10-bedded unit with modern monitoring equipment where 20 Medical Officers (MO) and 3 consultants work around the clock. The objective of the PCU is to handle emergencies. We generally keep the child patient for a maximum of 4 hours in the PCU. In some cases a bit longer if he/she could be sent home. We act upon the child’s life-threatening complications as soon as possible and direct them to either the ICU or to the wards depending on the condition.”
Dr. Kosala Karunaratne, Consultant Paediatrician elaborated on the management of dengue in the PCU, “When a child comes in shock, the emergency management is carried out at the PCU. When a febrile child with low platelets come to our unit, we may get them down, sometimes several times a day to check if their platelet counts are constantly dropping. If the child enters the critical phase, then we admit him/her to the wards. However, most of the children with Dengue may not enter the critical phase.”
Dr. Neetha Pieris, Consultant Paediatrician spoke further on the management of a critically ill dengue child, “At the initial stage, dengue will have similar features to a viral flu. But, when a child is in the critical stage, he/she should be treated with careful fluid management. Children in the critical phase (leaking phase) can go into shock if not treated. Therefore it is important to recognize the children entering the critical phase.”
The Triage system
Dr. Karunaratne also spoke on the triage system, “Triaging means sorting out ill patients from relatively well patients. When a patient comes to Lady Ridgeway Hospital they are triaged by triage nurses stationed at the entrance. The Triage nurse would decide if the patient should either go to the PCU or the OPD. We want to go further and develop a scoring system, where the nurses score the children based on their vital signs. In other words, it is similar to a ‘traffic light’ system where the red and the yellow patients come to the PCU while the green patients go to the OPD. From the OPD the child would be able to go home after consultation. In the present situation where the number of Dengue cases are on the rise the triage system would benefit us immensely in giving immediate care for shocked children and clearing children with no signs of leaking.”
Viral Flu on the rise
“The number of patients with Viral Flu has also increased. As dengue is around, people are extremely concerned and they seek treatment immediately,” said the Director.
“There is a viral flu going around which is dominated by vomiting and diarrhoea. In some cases patients would not have diarrhoea but only vomiting.
This may be referred to as stomach flu (viral gastritis). In order to control these types of viral flu, it would be helpful to isolate the virus if possible where preventive actions could be taken,” said Dr. Karunaratne.
Emergency situations: Children with fever should come to hospital
“If a child has high fever for more than two days, he/she should consult the doctor and obtain a full blood count report as a precaution due to the increase in Dengue cases.
If this blood count reveals a ‘low platelet count’ and the child has persistent vomiting, abdominal pain, cold sweaty skin and is dehydrated, he/she should be brought to the hospital immediately.
However, if your child is 3 months old with a temperature running at 380 C or between 3-6 months with a temperature of 390 C or a child of any age who looks pale, sleepy, breathing fast or showing signs of dehydration should also be brought to the hospital as these groups of children are suspected to be at risk of serious illness,” said Dr. Kosala Karunaratne.
“We only ask parents to bring their children as quickly as they can. Delaying would have detrimental effects,” said Dr. Wickramasinghe, Director - LRH.
Pics by Nisal Baduge