Date: Sun, 17 May 98 14:44:58 CDT
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Indonesia, Public Health Dengue Epidemic Adds to Economic Burden
By Charles Henderson, Blood Weekly, 11 may 1998
Armed with long-barreled sprays, Indonesian health officers are scouring neighborhoods and checking on house drains, with the aim of destroying potential bases for the small, deadly mosquitoes that cause dengue fever.
These armies of health officers are part of a national campaign to combat a rash of dengue hemorrhagic fever, which comes as Indonesia is hard-pressed to deal with its worst-ever economic calamity.
Already, the economic crisis has led to supply problems with basic medicines and health services, whose prices have also gone up since late in 1997.
The dengue epidemic, caused by the small, black mosquito with white spots called Aedes aegypti, has so far swept through 12 of the country's 27 provinces since February 1998. Some 430 people have died, and more than 20,000 people have been hospitalized, a health ministry official said.
The number of affected people is rising by 200 a day. The provinces most affected are Greater Jakarta, South Sumatra, South Sulawesi, North Sulawesi, Jambi, Lampung, Southeast Sulawesi, Central Sulawesi, Maluku and East Timor.
Medical experts said the spread of dengue fever is due to poor health services, medicine shortage and unsanitary living conditions.
The Aedes aegypti mosquito, which carries the virus that causes dengue hemorrhagic fever, lives and breeds in standing water found in tanks, buckets or even in puddles of water dripping from air conditioners onto tiles or cement floors.
The flooding reported in various places in Indonesia, as the weather changes, has also left a lot of idle water that analysts say is feeding the spread of dengue.
But these external factors are aggravated by Indonesia's weak economic condition, which means there are less resources for health care at a time when people are seeing sharp cuts in incomes.
The prices of medicines has soared five or six-fold. The high costs of imports, pushed up by the devaluation of Indonesia's currency, is hurting the health sector because Indonesia imports more than 80 percent of drugs and drug ingredients.
Dr. Rahman Maas, director of the Bandung Hasan Sadikin Public Hospital, said his hospital can hardly get thrombocytes and plasma expanders, which are essential for dengue fever treatment.
The lack of hospital rooms has prompted Jakarta administration officials to build temporary field clinics, as the number of dengue sufferers continues to rise. Many hospitals are now temporarily treating dengue patients in corridors.
Inadequate blood is another hindrance. Red Cross offices are unable to keep up with up the demand for blood, and the government has desperately called on the public to donate blood to be used for transfusions into dengue patients.
City Red Cross chief Uga WIranto said blood supply was very low, and her understaffed office has to toil round the clock to meet the demand.
But some experts are befuddled about the demand for blood, saying too many doctors are liberally prescribing unnecessary transfusions.
"Doctors who hastily recommend blood transfusions for dengue patients are inexperienced," said Zubairi Djoeban, head of the Indonesian Hematology and Blood Transfusion Association. He called the widespread practice of transfusions "misguided."
A. Haryanto Reksodiputro, a medical expert at the University of Indonesia, said blood transfusions are needed only if the patient is already suffering from internal bleeding.
"If there are no red spots on the patients skin, then there is nothing to worry about, even if the number of thrombocytes per microliter of blood is less than 50,000," he said, referring to the levels that show the seriousness of the illness.
As important as prompt treatment of dengue are efforts to make the environment inhospitable for the Aedes aegypti mosquito, experts said. Fumigation is not enough. "What we have to do is to cut the mosquito's life chain by getting rid of idle water," Reksodiputro said.
An increase in dengue fever cases in Indonesia comes in five-year cycles, the last of which came in 1993. Thus, doctors say government health officials should have been better prepared this year.
"They (health officials) are well-informed that the epidemic may come after five years. They should have done enough to anticipate it," one medical expert said.
World Health Organization officials say dengue fever is one of several old diseases recurring in parts of Asia. It is often diagnosed as ordinary flu, as both conditions are characterized by high fever. Other symptoms include runny nose, lower abdominal pain, nosebleeds and skin rashes.
If dengue fever is left untreated, it can be fatal. Medical experts said blood tests are still the most effective means of diagnosis.
The Aedes aegypti mosquito, whose origins have been traced to Egypt, first came to the region through the Philippines. WHO said dengue hemorrhagic fever was detected there in 1953.
Dengue fever was reported in Indonesia, through Surabaya in 1968. In the seventies it began showing up in Jakarta and Bandung to the south-east of the capital and other parts of the country.