Even as M. Dhanalakshmi feeds her year-and-a-half-old daughter, Prema, ahead of her discharge from hospital on Saturday afternoon, the family of 14-year-old M. Aravindan is getting ready to move him from the Tiruvallur government hospital to Rajiv Gandhi Government General Hospital in Chennai.
Aravindan, a Class VIII student, from a village in Uthukottai block, has dengue, and since his stool turned bloody, is being referred to the larger hospital, a doctor said. Prema, from Kaverirajapuram, too had dengue, but has recovered. Her mother is looking forward to taking her home: “She is our only child, born after 10 years of marriage,” she said.
The medical wards at the Tiruvallur government hospital are full: on every bed, patients talk about a fever they have had for a few days and the treatment. The hospital is one of the hubs for fever cases that have racked the district for over 10 days now, and as of Saturday afternoon had a total of 79 patients with fever, of whom 10 had been admitted on that day. Of these, two tested positive for dengue and doctors were planning to discharge 14. Over 100 patients with fever had been seen as outpatients on Saturday, a senior hospital official said. Apart from dengue, typhoid and leptospirosis, there has been a suspected case of scrub typhus, he said.
Patients with any kind of fever are being admitted, treated and discharged after observation, a doctor said.
A few days ago, a patient said, each bed in the ward had two patients. Another patient holds a dengue positive report from a private lab, but said the hospital has not confirmed his diagnosis.
128 patientsSo what is going on in Tiruvallur? In the last week, five children from the district have died after contracting ‘fever’, all at the Institute of Child Health, Egmore. In all, 128 patients with fever have been admitted to hospitals in the district and in Chennai as of Saturday.
While four of these deaths were of children from two adjoining villages — Kaverirajapuram and Adi Andhrawada — the fifth was of a child from Keerapakkam, near Ponneri. Officials say the deaths are not connected: at the two villages, the infections were mixed and included dengue and leptospirosis, while the fifth death was due to Hepatitis A, they say.
But for the anxious parents at the outpatient department of another government hospital, with their children in tow, any fever now is a huge cause for concern.
Tiruvallur district, with a population of around 37 lakh, has according to the 2011 census the third-highest population density in Tamil Nadu (1,098), and sanitation and hygiene are challenges.
“Certain areas that are highly populated are prone to outbreaks. Add to this the rain pattern, the cleanliness index and the health-seeking behaviour of people, and such outbreaks may take place,” said Director of Public Health, K. Kolandaisamy.
At Kaverirajapuram and Adi Andhrawada, there were open, filthy drains earlier in the week. The drains were being cleaned and new pipelines had been laid, but it is likely, a public health official had said, that their water had been contaminated.
Tiruvallur shares a boundary with Andhra Pradesh, a fact that could make it more vulnerable as any outbreak there could flow in, said Dr. Kolandaisamy. Also, certain areas of the district such as Minjur, Puzhal, Poonamallee and Villivakkam have a lot of development work going on, with workers migrating back and forth, working on construction sites, while at the same time, families continue to rear cattle and work in agriculture too, he said. These areas were being given a special focus to prevent any potential health problem. For the suspected case of scrub typhus, cold fogging has been carried out, he said.
Changing patternWith dengue in particular, no district is endemic to it — its pattern changes constantly, said Dr. Kolandaisamy. “Dengue is not linked to the monsoon. With rain, mosquitoes can breed in containers thrown outside, but even when there is no rain, open containers of water can become breeding sources. In about eight to 10 days, from eggs you have adult mosquitoes,” he said.
The district administration has planned a mass cleaning drive in the 14 blocks, five municipalities and 10 town panchayats. This will involve fogging, source identification and larval clearance, garbage and bush cleaning, as well as distribution of Nilavembu Kudineer and fever surveillance, said Collector E. Sundaravalli. “We are also planning to set up a control room number and a WhatsApp number through which the public can intimate us of any lacunae,” she said.
Anganwadi workers have been trained to inform the district administration of any fever or diarrhoea cases and on Friday, 2,000 school headmasters were summoned for an awareness programme, she said.
The health department and the district administration have been focussing on quacks and drugs sold without prescriptions. In the last 10 days, Ms. Sundaravalli said, six quacks have been arrested and a search is on for more. Some patients had seen private practitioners first, while others had gone to government health centres, and others had been referred to government hospitals from the private sector.
The Health Department is working with the Indian Medical Association as well as with other private practitioners to ensure protocols for fever management, investigations and rational guidelines for dengue are followed, said Dr. Kolandaisamy. “The Directorate of Drug Control is taking action against pharmacies that sell without prescriptions,” he said.
Ponneri GHAt the Ponneri Government Hospital too, the medical ward is full. A total of 17 patients have been admitted with fever and are undergoing treatment, but none have dengue, a hospital official said. Patients’ families complained that it was only just before the Health Minister’s visit on Friday that they had been given fresh bedsheets and mosquito nets. “Just a little while after they left, it was all taken away. Will the mosquitoes not come now that the officials have gone?” one mother asked.
Another mother said the official visit had been a blessing: her child received prompt treatment. Further up, the relative of a sick boy dabbed his head with a cool cloth. A few people had been sick in her village, she said. “He has had fever for 3 days. We admitted him today.”
Even as the district gears up for its cleaning drive, the grounds of the Ponneri hospital are a mess. Empty cups, coconut shells and garbage are littered across, with goats feeding on the trash.
