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The grim watch over dengue victims

The grim watch over dengue victims

B ATTAMBANG  HOSPITAL - In the children's emergency ward here, most of the young

victims of dengue fever lie motionless, their only sound that of shallow

breathing.

Tense parents stand watch, stroking their children and trying

to soothe the few who are conscious enough to toss and turn and cry.

Few

words are spoken. There is nothing to do or say - for the parents, it is simply

a matter of waiting to see whether their child will live or

die.

Eighty-five children had died in the hospital, taking its dengue

fever mortality rate to around 10 per cent, as of last week.

Battambang

is one of hardest hit provinces in a national dengue epidemic which has claimed

142 deaths from 2888 reported cases. Experts say the real death toll is much

higher.

At Battambang hospital, more parents and sick children - anything

from five to 30 a day in the first half of July - keep arriving.

Signs

direct them to a white tarpaulin tent set up in the hospital grounds, where the

children are checked and sent to one of three wards.

"If they are

serious, we send them to the emergency room," said hospital director Dr Sor Beng

Tou.

"We usually have only 10 beds for dengue children, but now we have

30 beds in the emergency room alone. Some of them are outside the room, and if

the beds are full, they sleep on the floor.

"Today, it's not full, but if

you arrive here another day..."

Most of the infected children are aged

between 4 and 7. A dozen or so have been one-year-old or younger and some, in a

rarity, as old as 15 or 16.

In the emergency ward last week, Preoun Touch

sat watching her unconscious eight-year-old daughter on a wooden bed. Her eyes

closed and her breath a faint gasp, the child had not spoken for two

days.

"I am giving up hope," Touch said.

"When she first got sick,

we thought she was not too sick. Very quickly she got like this. Many other

children are like this as well, this year has been very bad."

She said

she initially got a local doctor to treat her daughter but "he said he could not

cure her" so he sent her to the hospital.

Outside, on a verandah next to

the emergency ward, Touch An gently stroked the stomach of her five-year-old son

Eout.

"He started to get a fever five days ago, but yesterday he got much

worse so I brought him here.

"I did not know about dengue until I got

here, but I knew I had to bring him to hospital," said An.

Two other

wards at the hospital, one specially set up, are also full of children with

dengue.

Between January and June this year, 637 children with Dengue

Hemorrhagic Fever - the more serious of two forms of dengue - were taken to the

hospital. Sixty-three of them, or one in 10, died there.

A further 271

children with the mosquito-borne virus were admitted between July 1-18.

Twenty-two died, five in one day.

That compares with six deaths of

children in dengue at the hospital in all of last year.

Dr Yves Coyette,

medical coordinator of Medecins Sans Frontieres (MSF) in Battambang, said the

province's real death count so far this year was likely to be about

200.

"If we counted all the deaths in Battambang, we would probably find

there are more deaths than in the Ebola epidemic in Zaire.

"We know how

many have died in hospital, but not in the villages. Some teachers say they have

lost three or four children in their classes."

Unreported deaths included

those of children never taken to hospital and others taken home to die after

being hospitalized.

Dr Coyette said it was common for Khmers, if a loved

one in hospital seemed certain to die, to take them home while still alive. One

reason was that moto drivers charge more to transport a dead body than a sick

person, because that is considered bad luck.

Dengue fatalities were

largely caused by lateness in getting victims to hospital in the first place, Dr

Coyette said.

Acute dengue Hemorrhagic Fever caused severe internal and

external bleeding and eventual death from shock - having "zero blood

pressure".

If caught early, dengue was easily treatable with a

carefully-monitored IV drip to give fluid and raise blood pressure, he

said.

But complications often arose when parents, or poorly-trained local

'doctors', treated children at home.

They often gave too much IV fluid,

causing breathing problems, or administered aspirin, which reduces blood

clotting and promotes bleeding. Paracetamol could also be dangerous, damaging

the liver, if given in high doses.

A further problem was the virus was

most dangerous when the fever itself began to reduce - and parents thought their

child was recovering, Dr Coyette said.

Dr Tou, the hospital director,

said parents often thought their children had "just a simple

fever".

"Most of them who have died were treated at private clinics, and

some at district hospitals, and were sent here too late."

One problem was

that district hospitals did not have the equipment - or even the electricity

necessary to conduct blood tests - and only sent patients to the provincial

hospital when they were severely ill.

Dr Coyette said education was the

way to prevent dengue and ensure victims were promptly

hospitalized.

World Health Organization officials visited Battambang last

week to examine the problem there, while the government launched an emergency

mosquito control program in the worst-hit provinces.

Experts say unless

urgent action is taken in those areas - Battambang, Banteay Meanchey, Phnom Penh

and Kandal - dengue cases will continue to increase till late

September.

Dengue can take two forms - dengue Hemorrhagic Fever and the

less severe Classical Dengue Fever - and is spread by the daytime Aedes, or

Tiger, mosquito. It primarily affects urban and larger rural towns. Adult

fatalities are rare, and foreigners usually get Classical

Dengue.

Dengue-infected mosquitoes breed anywhere where water is

collected, even in old tires, plastic bags and pieces of

bamboo.

Preventative measures promoted by the government and NGOs include

insecticide spraying of villages and removing or cleaning and covering all water

receptacles.

Dr Coyette said dengue epidemics occurred in cycles, usually

every two or three years depending on the mobility of people, the introduction

of new cell types of dengue and other factors.

The most severe recent

epidemic was in 1990, while 1992 and 1993 also had outbreaks.

Epidemics

occurred regularly in neighboring countries such as Thailand, but mothers were

well-educated about Dengue and acted promptly.

About one victim in 100

died in Thailand, compared to an average of about seven in 100 in Cambodia.

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