Hospital resources are stretched thin across the Kingdom by an explosive dengue fever

outbreak that has surpassed epidemic proportions and caused the deaths of 84 children.

Fatalities have eclipsed previous years' totals. The death toll is rising daily.

Over 6,000 cases were reported by the end of May.

"We cannot stop the outbreak, because it is already here," said To Setha,

head of the dengue control and research center of the National Center for Malaria

(CNM). "All we can do is try to suppress it."

Kantha Bopha Hospitals, the country's main treatment centers for dengue cases, recorded

3,275 severe cases in May this year compared to 740 in 2006. Angkor Children's Hospital

in Siem Reap had already treated 360 dengue victims by June 14, more than their total

number of cases for last year. Kandal and Kampong Cham provinces have been the hardest

hit with 1,108 and 900 cases respectively.

Setha told the Post this is the worst outbreak he has seen in 19 years of work at

the CNM.

"We are very worried," he said, "All staff are working overtime here

and in the provinces."

Waiting in a line of over 4,000 at the front of Kantha Bopha IV Childrens Hospital,

five-year-old Soeun Chan Dara lies limply in the arms of his father. His mother stands

behind, crying as she holds the intravenous drip flowing into her son's veins. Five

days ago, Dara was admitted to a private clinic in Takeo with dengue symptoms.

His father said the family had to borrow money from neighbors to pay the $10 daily

fee that did not include medication. Later, they had to borrow more to hire a taxi

to take them the capital. As he awaited placement in one of the overcrowded wards,

Dara's case became critical. The father voices concern that his remaining four children

that wait at home may also be vulnerable to the virus.

Upstairs in the blood-testing unit, the team have over 1,000 blood samples awaiting

tests, the majority for dengue fever.

"The numbers have tripled since the dengue outbreak," said Beat Richner,

director of Kantha Bopha. "Yesterday, we employed 50 more staff to deal with

the demand."

Dr Rob Overtoom, of the Swiss Red Cross, reported that in the last two weeks the

60-bed Kirivong Referral Hospital was unable to accommodate its incoming rush of

170 patients. At present, there are two patients per bed with others sleeping on

the floors and in the corridors. Tents have been placed outside the facility to treat

a daily influx of new cases. Ang Roka Referral Hospital has been forced to transform

its building for HIV/AIDS services into an extra ward for dengue patients, Overton

said.

Srey Acha, director of Me Sang district referral hospital in Prey Veng province,

reported 58 new cases in the past two weeks. Without blood supplies, Acha said they

cannot treat the severe cases but instead must refer them to hospitals in Phnom Penh.

Two of the 58 died during transportation.

In severe cases, predominantly occurring in children below 14 years, patients experience

haemorrhagic complications that lead to blood problems: plasma leakage, lack of blood

platelets and circulatory failure.

At this stage, part of the treatment includes breathing assistance and blood transfusion.

Richner reported that at Kantha Bopha IV, as many as 45 transfusions are now needed

per night. He claims that 90 percent of those hospitalized with dengue fever would

die without treatment.

In response, the Ministry of Health has imported 50 tons of abate-a non-toxic substance

that is now being added to all water that could provide a breeding ground for mosquitoes

in the worst-affected areas.

Setha cited a lack of funding for the delay in chemical prevention methods. He claims

that the most severe outbreaks may have occurred in rural areas such as Rattanakiri

province that were outside of the planned treatment zone. Doung Socheat, CNM director,

said they are conducting a program to raise awareness through TV, radio, schools

and in poor villages to educate people about the need of sanitation and mosquito

nets.

"It's hard to change attitudes," Doung Socheat said. "It's a poor

country - people are so poor they don't pay attention to health care, but during

dengue season everyone must take precautions."

Health officials believe the severity of the outbreak has been caused by a new dengue

strain, population movement aiding the countrywide spread of the virus, early rains

and an increase in stagnant pools-left by construction sites and relocations-which

are perfect for mosquito larvae.