"Sobra kahadlok. Imong anak, makakita lang ka, di na nako madiscribe. Ingdako iyang tiyan, basta nagbleeding na siya nagsuka na. (It was frightening. Seeing your child like that, I can not describe the feeling. His stomach swollen, he started to bleed and vomited.) Mrs. Irma Lamparas (personal communication, November 1, 2015) stated when she told me about what happened to her son, Leo Serge B. Lamparas at the age of seven.
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| Serge Leo Lamparas recovering from dengue-tyhoid. |
"When he was seven years old gidengue man sab na siya. Four months mi sa ICU. "(When he was seven years old, he had dengue. We stayed four months in the Intensive Care Unit.) Mrs. Lamparas said. She also disclose to me Serge's situation during the first time he had dengue.
"Gi-ingnan mi sa doctor na sa 13 patients na admitted like his case, walay nabuhi. So gipadawat na sa amo, pero dili man jud ko. Mao na gi.ICU siya gi.abunohan ug dugo. Daghan kaayog dugo murag Christmas tree." (The Doctors told us that out of 13 patients admitted like his case, none survived. So, the doctor wanted me to accept it but I do not want to. He was admitted in the ICU and was transfused with a lot of blood. There were bags of blood that it looked like a Christmas tree.) Mrs. Irma Lamparas perorate.
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| Mrs. Irma and Serge Lamparas after my interview. |
Based on the testimony and experience of the Lamapara's, dengue is a serious disease, but before we go further, what is dengue?
World Health Organization (2009) defined dengue as a mosquito-borne viral disease and is rapidly spreading in the world. In the last 50 years, incidence has increased 30-fold with increasing geographic expansion to new countries and, in the present decade, from urban to rural settings. (P.3) Based on Frontiers in Dengue Virus (2010),
Dengue virus is the causative agent of dengue fever, which is one of the most common significant emerging disease to global public health. In recent decades there has been an unprecedented increase in the geographic range, incidence, and severity of infection.
As stated by the World Health Organization (2009), an estimated 50 million cases happen yearly and roughly 2.5 billion people populate countries prone to dengue. Even the World Health Organization (WHO) wanted its member states to be committed to dengue disease for it can spread widely even outside a nation's borders if not treated or handle well.
Dengue disease is boundless and even Asia can not elude from its menace. Based on a survey conducted by the World Health Organization (2009), 1.8 billion or more than 70% of the population with Dengue worldwide is widespread at South-East Asia Region or the Pacific Region. Eight countries namely Bangladesh, India, Indonesia, Maldives, Myanmar, Sri Lanka, Thailand and Timor-Leste announce Dengue cases. In 2004, the country's first outbreak betide at Bhutan and in 2005, Timor-Leste had a "high case-fatality rate" (3.55%).
The Philippines, as stated by the World Health Organization (2009), is one of the four countries (Cambodia, Malaysia and Vietnam) in the Pacific Region with multiple dengue cases and deaths between 2001 and 2008. The amount of dengue cases in the Philippines together with Cambodia in 2008 existed in its highest peak compared to other nations in the Pacific region. The Philippine Department of Health (DOH) reported to WHO a sum of 59,943 dengue cases from January to September of last year (2014) and 10.47% of the overall cases came from Northern Mindanao . As of this year (2015), dengue cases rise by 9.15% higher than in 2014 during the same span of time. Notwithstanding the increase number of cases, the DOH reported 168 deaths or 0.3% from January to August, which is lower than 2014 figure (217 deaths).
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| J. Gathany (Photographer). An Aedes aegypti from mosquito.Retrieved http://entnemdept.ufl.edu/creatures/aquatic/aedes_aegypti06.jpg |
The agent that disseminates the viruses that cause dengue fever is the Aedes aegypti mosquito. Through the bites of a contaminated female Aedes, the viruses are passed. The mosquitoes mainly obtain the virus while feeding on the blood of an affected person (WHO, 2015). These mosquitoes do not select its victims . According to Dr. Ismael H. Mohrein VI (Personal communication, November 1, 2015) "Fair ang distribution niya. As of now, diri sa hospital kay naa mi cases na adult naa sab sa bata. Bisan kinsa man ang pwede magkadengue." (The distribution [of dengue ] is fair. As of now, we have adult and children dengue patient.)
The children, the young and even the elderly are not unassailable. These small insects impregnated our community with a malady that rise into a large amount of number.
On the word of the World Health Organization (2012), when you are infected with dengue virus, the illness begins abruptly and in patients with moderate and severe disease is followed by three phases - febrile, critical and recovery. (pp. 1-3)
Febrile phase
Acute febrile phase usually lasts 2-7 days and patients typically develop a high-grade fever suddenly. In this phrase the patient will experience facial flushing, redness of the skin, generalized body ache, pain in one or more muscles, pain in one or more joints, retro-orbital eye pain ,utmost sensitivity to lights, rubeliform exanthema and headache. Other patients may have a sore throat, an injected pharynx and conjunctival injection. Loss of appetite for food, nausea and vomiting are common. In this phrase, the liver of the patient may be enlarged and tender after a few days of fever and a progressive decrease in total white cell count will occur. Medical complications can happen in this stage such as neurological disturbances and febrile seizure.
Critical phase
In this phase, instead of improving with the subsidence of high fever, patients with increase capillary permeability (the capacity of a blood vessel wall to allow for the flow of small molecules or even whole cells in and out of the vessel) may manifest with warning signs, mostly as a result of plasma leakage. Persistent vomiting and severe abdominal pain are early indications of plasma leakage. The warning signs mark the beginning of the critical phrase and these patients become worse around this time when the fever decrease. When the temperature drops to 37.5 to 38 degrees Celsius or less and remains below this level, usually on days 3 to 8 of illness, progressive leukopenia followed by a rapid decrease in platelet count and usually precedes plasma leakage. When a critical volume of plasma is lost through leakage, shock could occur. Weakness, dizziness or postural hypotension occurs during a shock state. Medical complications can also arise in this stage like severe haemorrhage and organ impairment due to shock from plasma leakage.
Recovery phase
As the patient survives the critical phase, a gradual reabsorption of fluid takes place in the following 48-72 hours. Generally well-being improves and appetite returns. Some patients have round spots that appear on the skin, described as "islands of white in the sea of red" and the white blood cell count usually starts to rise. If intravenous fluid therapy has been excessive and has extended into this period, medical complications like Hypervolaemia and also an acute pulmonary edema can transpire.
Dengue disease brings hardship to its patients and the anguish twofold especially when complications aggravate. For instance, Serge Leo Lamparas at the age of seven had an air block in his throat due to dengue. At that time, they went to different hospitals and were diagnosed with asthma. His mom, Mrs. Irma Lamparas, had trouble accepting the diagnosis because their family is not asthmatic. So, Mrs. Irma called their Doctor in Cebu and planned to traveled but at that time no vessel was available from Ozamis (where they were admitted at that moment) to Cebu due to a typhoon so, they admitted to another hospital. Having the same diagnosis and situation, Mrs. Irma Serge firmly decided to take Serge in a hospital in Cebu City then the following day they traveled from Ozamis City to Cebu. Arriving in the hospital, the doctor told them that it was too late; the problem was Serge's airway. Medical practitioners of the hospital quickly did an operation to save Serge.
"Kung grabi akong kaguol sa Dengue, mas grabi pa karun. The operation was 5-6 hours. Paggawas sa Doctor I thank him then the Doctor replied na ‘Unsay thank you ma’am? The more ka mahadlok ani kay airway na ni. 50-50 imong anak sa OR.’"(If I was worried about the dengue, now I'm a lot more terrified. The operation was 5-6 hours. When the doctor came out from the operating room, I thank him. The doctor replied" why thank me ma ' am? The more you should be frightened because it's already the airway. Your son has a fifty-fifty chance of surviving. ") A statement from Mrs. Irma (personal communication, November 1, 2015) as she recalled what her son undergo because of dengue.
Many complications seen in clinical cases are preventable if team members are alert to the physiological problems of the three different phases. Base by the World Health Organization (2012) causes of complications in dengue include:
-Missed diagnosis at the frontime
-Inadequate monitoring and misinterpretation of vital signs
- Inadequate monitoring of fluid intake and urine output
- Late recognition of shock leading to profound and / or prolonged shock
- Late recognition of severe bleeding
- Too much or too little intravenous fluids ie not following or understanding the treatment guidelines
These causes of complications can lead to life-threatening situation such as prolonged and profound shock, severe bleeding, fluid overload, respiratory distress and failure, multi-organ dysfunction of liver, kidneys and nervous system and irreversible shock and death.
An interview done by Ephraim Jericho Tabamo (2015) with Mr. Gary Lamparas, of the environmental sanitation department of the City Health of Oroquieta, elucidate the actions taken by the city to prevent dengue. Some of these actions are fogging, larva survey, clean up drive and school dengue brigades. They also have programs like the 'Four S'. 1. Search and destroy - examining possible breeding places of mosquitoes and destroying it, 2. Seek early consultation - parents should be aware of the symptoms of dengue and once they observe indication of the disease, they should consult a doctor immediately, 3. Self -protection measures - using of mosquito net at night and lastly 4. Say yes to fogging when there is an outbreak. For people to be informed about dengue, the City Health of Oroquieta notifies the residence through radio broadcasting and giving of leaflets. Also, they have IEC (information-education-communication) programs which help the community to be aware of dengue.
REFERENCES
World Health Organization. (2015). WHO | The Mosquito.
World Health Organization. (2009). Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control [E-Reader] Available from
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| Mondoy, N (Photographer). Unsanitary environs around Oroquieta City. |
One of the cities in Northern Mindanao, specifically the capital of Misamis Occidental is Oroquieta City - my hometown. Oroquieta City being known as the City of Good Life was not spared from the holocaust of dengue. In 2014, Misamis Occidental Provincial Hospital reported 100 dengue cases and as of November this year, they already handled 135 cases. The number of cases are rising and one of the reasons why this is happening is because of the unsanitary environs. No proper garbage disposal, grimy canals and denude stagnant water, these are scenarios that are just blatant prevailing in our nation.
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| Mondoy, N. (Photographer). A canal near Misamis Occidental National High School. |
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| Mondoy, N (Photographers) Garbage along the street. |
Dengue is a serious disease and one's life can be taken away if not treated well, this disease is carried by small insects yet give humanity a big burden. But as we come to think of it, dengue spreads because of mosquitoes infected with the virus and these mosquitoes breed in places with stagnant water in which, we disregard to clean. We are the ones who will ultimately suffer with this disease nevertheless, we take part in augmenting the root of it. In the end, we should take care of our environment because once we do, we are also taking care of ourselves.
Lion being the king, cheetah being the fastest and elephant being one of the largest are not the only animals that can cause impairment to us because evidently, mosquito being one of the smallest can also take a life with just one bite.
Lion being the king, cheetah being the fastest and elephant being one of the largest are not the only animals that can cause impairment to us because evidently, mosquito being one of the smallest can also take a life with just one bite.
REFERENCES
Geronimo, J. (2015, September 04). Dengue on the rise: 55, 000 reported cases so far in 2015 in Rappler . Retrieved from
http://www.rappler.com/nation/104736-dengue-cases-january-august-2015
Interview by E. Tabamo [Transcript]. November 23, 2015
J. Gathany (Photographer). The Aedes aegypti mosquito. Retrieved from http://entnemdept.ufl.edu/creatures/aquatic/aede_aegypti06.jpg
http://www.rappler.com/nation/104736-dengue-cases-january-august-2015
Interview by E. Tabamo [Transcript]. November 23, 2015
J. Gathany (Photographer). The Aedes aegypti mosquito. Retrieved from http://entnemdept.ufl.edu/creatures/aquatic/aede_aegypti06.jpg
Misamis Occidental Provincial Hospital, November 18, 2015
Timothy P. Endy, Scott C. Weaver and Kathryn A. Hanley (2010). Frontiers in Dengue Virus [E-Reader Version] Available from http://www.horizonpress.com/dengue
World Health Organization. (2015). WHO | The Mosquito.
World Health Organization. (2015). WHO Representative Office Philippines.
Retrieved from
http://www.wpro.who.int/philippines/areas/communicable_ diseases/dengue/continuation_dengue_area_page/en/
Retrieved from
http://www.wpro.who.int/philippines/areas/communicable_ diseases/dengue/continuation_dengue_area_page/en/
