The Special Report5th November 2000
Beating the stingBy Faraza Farook
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The Government also ordered the closure of schools for two days, to allow teachers and parents to carry out a cleaning up programme in and around the schools. Posters warning about the dengue outbreak had come up while public announcements were being made regularly and leaflets distributed by the Health Department.
A doctor and a schoolgirl were the only reported fatal victims of Dengue, in Matara according to Government statistics, but unofficial reports showed that at least 10 had died of the disease. Clinically diagnosed cases amounted to about 130 though the number could be higher as health officials were unaware of the cases being reported to private hospitals.
The two deaths appeared to have had a major impact on the people and whereever The Sunday Times team went the people were talking about it, with many fearing they could be the next victims. They appeared to be alert to the prevailing danger and gave priority to cleaning up their surroundings and engaged in 'Shramadana' programmes organized by the Health Department.
According to the Matara Provincial Health Department, the epidemic broke out towards the end of August with the first patients being reported on August 29 when two people from Mt. Lavinia and Gampaha visited Matara during the recently concluded general elections.
Matara Health Services Deputy Director P.L. Gunawardene said one reason for the disease to reach epidemic proportions could be due to patients being infected for the second time, commonly known as a secondary infection.
Unlike other viral infections such as polio, measles and rubella, no vaccine nor medicine is available for Dengue. The people have to do their utmost to eradicate mosquito breeding places as doctors can do very little in this regard, he said.
Meanwhile as part of the awareness programme the Health Department, the Matara Municipal Council, District and Divisional Secretariats met on Tuesday to discuss ways of controlling the present situation and prevent anymore outbreaks.
Accordingly, an integrated mosquito control plan was drawn up to attack the life cycle of the mosquito - the egg - larvae and pupa while the adult mosquito was dealt by fogging.
When the first Dengue patient was reported, fogging was carried out keeping a 100 m radius from the patient's house. But as the number of patients increased, mass scale fogging began using a vehicle mounted fogging machine, a Municipal Council officer said.
The first round of mass scale fogging began on October 22 and the second round on October 29. Fogging, also known as technical malathion is a method where liquid malathion mixed with kerosene is targeted mainly at the adult mosquito. The effect of fogging spreads to about 200m on either side of the operation site. Prior to fogging being carried out, an announcement is made asking people to keep their doors and windows open. Once the operation is carried out Municipal workers collect the garbage and clean up the area before the effect wares off, he said.
Other preventive measures adopted by the municipality included the crushing of garbage grounds with a road roller to minimise water retention and the introduction of a spot fine system to prevent people from throwing garbage on the roads .
To carry out the programmes lined up, the Municipality and the Health Department had to seek assistance from other districts by way of staff and equipment. These included an Automatic Blood Analyser, three fully equipped health education vans, two garbage compactors, a bus, a vehicle mounted fogging machine and more than 40 student Public Health Inspectors.
Commenting on the situation Matara Municipl Council Mayor Sugath Andramana said the municipality was faced with an additional problem as people began cutting down trees, and called the Municipality to clear up the trees. "Except for the routine garbage collection, we charge Rs. 250 a truck load of garbage being collected from the residences. However, now, we are forced to clear free of charge as people say they cut the trees because we asked them to clean their gardens to eradicate dengue breeding places."
The shortage of staff was one of the biggest problems he said. "The meagre salary of around Rs. 130 a day and sometimes pressure from children asking their parents to stop working as garbage collectors as they are being teased in school, are two reasons for the shortage of cadre," Mayor Andramana said.
Most workers preferred working outside on private contracts rather than for the Municipality because they were able to earn more than Rs. 250. Of the 110 workers only 60 reported to work regularly, the Mayor said. Now the Municipality has decided to take labourers on contract basis.
The Mayor said he believed that the polythene and other material used
for election campaigning and the monsoonal rains in September could have
contributed to the situation today.
When we visited some schools it was evident that both students and teachers were concerned about keeping a clean environment.
Meanwhile students and teachers at Sri Sangananda Vidyalaya in Kapparathota, Weligama took to the roads with placards calling on authorities to shift the garbage dump in front of the school elsewhere, before students fell prey to Dengue or any other mosquito transmitted diseases.
The protesters stood on either side of the road in an attempt to turn away any garbage truck that came along.
"The stench is unbearbale, so is the mosquito menace especially during rainy seasons," the school's principal K.H.D. Padmalal said. He alleged that even dead animals were dumped in the yard.
Several complaints to the Municipality have gone unheeded, Mr. Padmalal said adding that the Central Environmental Authority had assured to file action against the Municipality if they failed to clear the area.
But the Weligama Municipal Council said they had no other alternate dumping ground. "When looking for a dumping ground, we have to look into several facts and todate we have not been able to find a suitable site," Public Health Inspector Ananda Senadheera attached to the Municipal Council said.
He claimed that municipal workers regularly sprayed a chemical in the dump to keep away mosquitoes. He believed the burning of garbage by someone had triggered the school protest.
Meanwhile some schools in the district were forced to light a coil or burn Khohomba leaves/seeds with citronella oil to keep away mosquitoes.
The sight of lit coils or burning Khohomba leaves or seeds greeted us in most of the classrooms at Sujatha Vidyalaya (primary and secondary).
"The parents, when they come to drop the child in school light a coil before they leave," primary school Principal Greata Weerasinghe said.
She also said primary grade students had resorted to wearing jeans to protect their legs from mosquito bites.
The attendance in both the upper school and primary school had dropped drastically following the death of Niluni Wickremaratne a year 9 student she said.
The year 13 J class in the Upper school had no students at all while
in some classes the turn out was limited to five students and others from15-20.
A comparison with last year's statistics on Dengue patients showed an increase of more than 700 suspected cases while deaths had increased by 11 .
This year saw a total of 2465 suspected dengue patients and 25 deaths compared to a total of 1688 patients and 14 deaths last year Epidemiologist T.A. Kulatillake attributed the high number to changing weather patterns which has resulted in the outbreak all over the world.
Dengue outbreaks have currently been reported from Matara, Ratnapura, North Colombo, Karapitiya, Kurunegala, Batticaloa and Gampaha according to the Epidemiologial Unit.
Meanwhile the Colombo Municipal Council has begun prosecuting residents
if mosquito-breeding places were still found after a seven-day notice to
clean the area was issued. While only 10 people were prosecuted last year,
650 notices have been sent to residents this year of which 96 have been
prosecuted, Dr. P. Kariyawasam, Chief Medical Officer of Health said.
The only child in the family, her absence created a void not only at home but also in school where she earned the praise of many.
An active participant in the awareness programme on Dengue conducted by the school, Niluni volunteered to take the lead in talking to people in and around the school. She participated in the programme with her schoolmates on October 17.
Niluni had not told her parents about the programme as her mother out of concern had told her not get involved in any programmes regarding Dengue.
On the day of the campaign Niluni was so involved in preparing a speech that she had even skipped breakfast, her grieving mother recalled.
On October 19, Niluni had told her mother that she was having fever and had taken two panadols while at school.
When Niluni's mother Chandra took her to a private clinic down the road, the doctor had said it was probably a viral fever and prescribed drugs for which the fever subsided, Chandra said. On Saturday (October 21) morning, Niluni came down with fever once more and began throwing out what ever she took in.
On her neighbours advice, whose husband was a doctor, Chandra had taken the child to the Matara General Hospital.
At the OPD Niluni was examined by the same doctor who had seen her the previous occasion.. "This time too, the doctor said it was a viral fever and that she would be fine in a few days. Yet, she suggested that I get a blood test done.But I couldn't hand over the blood sample to the lab because it was closed on a Saturday," Chandra said.
On the following day, Sunday (22), Niluni looked weak and Chandra found Niluni curled up in bed when she returned after marketing. "I asked her to have something but she refused and said she was feeling drowsy," Chandra said.
Chandra got an appointment with her neighbour where Niluni was patient number 71, the last for that day. As she had not taken any food for the day Chandra had pursuaded Niluni to have some porridge before leaving for the clinic.
"She was restless that afternoon but conscious of everything," Chandra said describing Niluni's behaviour that day.
At the clinic, the doctor confirmed that Niluni was suffering from Dengue Shock and wanted her admitted immediately. She was rushed to hospital in a van after giving her a bottle of Saline.
"On Monday (23) morning when I visited her in hospital, she seemed okay and didn't want to hang around in hospital beyond visiting hours," Chandra said.
Recalling the last moments of her daughter's struggle for survival Chandra said, "On Tuesday, however, she looked scared and she had also bled.
"When I went back in the afternoon, her stomach had bloated. In the evening, she complained of feeling dizzy and cold. She was also shivering.
"She was very restless and from about 5 p.m. onwards she was struggling to call out to me hardly able to talk with the oxygen mask and ECG wires running all over her. The doctors in the hospital struggled but to no avail.
"The doctors said the next 24 hours would be crucial and if Niluni survived
that period she would be through. But Niluni gave up her struggle at 9.p.m.
that night," said a grief stricken mother.
In a communique the Public Health Department said it was distributing leaflets and posters, inspecting residential, commercial and govt. buildings and sending notices to all owners of neglected bare lands.
The department is also initiating legal action against offenders under the Mosquito Borne Diseases Ordinance.
The department will be conducting a dengue control programme today at the Anderson Flats.
The department has purchased new equipment and material to conduct fogging programmes in the evenings in selected areas.
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