Friday, August 18, 2017

At ground zero in Yangon’s dengue fever epidemic

Some children are screaming. Others, further gone in pain or exhaustion, lie limp in their parents’ arms. They are all waiting to see a doctor.

A family walks out of Yankin Children’s Hospital, which is currently flooded with a spike in dengue cases. (Aung Myin Ye Zaw/The Myanmar Times)A family walks out of Yankin Children’s Hospital, which is currently flooded with a spike in dengue cases. (Aung Myin Ye Zaw/The Myanmar Times)

This was the scene at Yankin Children’s Hospital’s outpatients’ department on July 3, and very likely every day since then.

The children have dengue fever, or their parents fear they do. Nurses in red longyi and security guards rush around, trying to control the flow of patients. The nurses take the names of the children and add them to the list of patients awaiting a blood test to confirm the presence of the virus.

Experts say that the rate of dengue haemorrhagic fever – a severe and potentially deadly form of the disease – is rising, and may get worse as the rainy season progresses. As of June 26, there had been 10,918 confirmed hospital admissions for the disease so far this year, and 45 deaths, according to the Ministry of Health.

The highest rates were in Ayeyarwady, Yangon and Mandalay regions and Mon State, according to the figures. However, many more cases are not reported, or patients seek treatment at private clinics and hospitals.

Dr Khin Nan Lon, a project manager with the ministry’s dengue hemorrhagic fever unit, said incidence tends to rise in the wet season.

“During July and August the rate could increase to match the 2013 outbreak. People should be alert to the risk: Keep your homes clean and make sure there is no standing water in which insects can breed,” she said.

This year’s figures are significantly up on last year’s. Between January 1 and May 26, 2014, 3667 patients contracted the fever, of whom eight died. During the same period this year, the corresponding figures were 5092 and 17, more than doubling the death rate. However, this year’s figures are still below 2013’s, when a region-wide spike resulted in at least 20,200 people contracting the mosquito-borne virus, including 89 deaths.

Dr Than Naing Soe, assistant director of the Department of Public Health, said in an earlier interview that he suspected the current uptick may be connected to a paucity of rain last year, which prompted people to store water in unhygienic conditions.

Children are most susceptible to the effects of dengue. In Yangon, the 1300-bed Yankin Children’s Hospital bears the brunt of the epidemic, as it is relatively well-resourced in terms of both staff and equipment.

This year, it is full to bursting. Hospital officials decline to give figures, but a noticeboard on the wall shows that the medical ward received 516 patients in May, of whom 149 were treated for dengue haemorrhagic fever – almost double the dengue cases treated the previous month.

When Ko Kyaw Oo brought his son, who was suffering from a high fever, to the hospital on June 29, the boy was forced to share a bed with another child.

“That night my son was admitted with a high fever and the hospital was full of child patients, but there were not enough beds,” he said. “We did not want to share a bed but we had no choice because this was the best children’s hospital – it has more equipment and staff even than the private hospitals. I have heard some children transfer there from the private hospitals.”

When The Myanmar Times visited last week, Daw Yi Mya and her 14-year-old her daughter, Ma Win Lae Yee, who come from Insein township, were queuing in front of the hospital laboratory for a blood test.

“My daughter has had a fever for the past six days. Today, she broke out in a rash, so we came here to find out if she’s got dengue,” she said, as laboratory staff loudly called out the names of patients to take the test.

On the basis of the test results, doctors decide whether the patient should go home or stay in the hospital. Ma Win Lae Yee has to stay, because she is found to have the potentially deadly dengue haemorrhagic fever. Of the 30 suspected dengue patients, she is one of two referred to the medical ward.

Each of the 30 beds is full, so Daw Yi Mya and her daughter have to wait until one becomes free. Sometimes, two children have to share a bed. Finally, Ma Win Lae Yee is allocated one in a dark corner of another room.

Despite the wait and overcrowding, Daw Yi Mya said she was impressed by the diligence and care provided by the doctors and nurses.

“This hospital is much better than the other public hospitals,” she said.

The senior medical superintendent at Yankin Children’s Hospital, Dr Myint Myint Than, was not available to discuss the dengue fever epidemic or overcrowding at the hospital with The Myanmar Times.

But Dr Aung Myint Lwin, who was the hospital’s senior medical superintendent until last year, said the situation was not new.

“It’s the same in other hospitals, too,” he said. “Middle- and working-class patients rely on state hospitals but in Yangon hospitals have not expanded to match the growth in population.”