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.
