DENGUE FEVER IN TAIZ, 15 YEARS STORY OF SETTLEMENT

By: Abdul-Hamid al-Maqtari

Translated and edited by: Mahmoud Assamiee

SANA'A, Jan. 19 (Saba) - Since 1994, a strange and quite mosquito
has raised in Taiz. This kind of mosquitoes transmits the dengue
fever between people so that the pandemic raised in the city as the
mosquito settled.

The late journalist Najib al-Shara'bi did not know that he will die
in his village in Taiz city because of the virus. Some say
al-Shara'abi was infected with the syndromes resembles those which
are caused by dengue fever that has killed many of Taizi people.
Doctors affirmed what people said that he was died by the dengue
fever.

The death of al-Shara'bi was not a surprise to the journalist
Zakaria al-Kamali because he is still living the shock of his wife
Ruba's death who was killed by this disease. Ruba was studying law
in Taiz University.

If al-Shara'bi and Ruba, who are closed to journalism, how many
people this disease has killed and infected of other families in
Taiz where journalism hardly investigate the case there?

The wife of citizen Abdul-Razaq sacrificed herself for her husband
who has been infected with the fever symptoms. A relative of the
family says this wife " did not know the disease was waiting for
her, she was anxious about her infected husband and sat close to
take care of him but the fate chose her as another victim of the
dengue fever. She was infected with disease and died while her
husband recovered."

Another citizen called al-Shuqair was infected with the virus two
days before his marriage. Because he has already booked a hall for
the wedding, he was forced to go to the wedding hall and instead of
taking his bride to his house, he took her to the hospital to
complete the medication.

Physicians are not excluded

Despite differences over the number of infection with the disease
and death cases, all agree that the disease has inhabited Taiz and
plagued the city amid ignorance of concerned bodies despite of the
fact that its danger is increasing.

"If concerned bodies have interfered early, the matter would have
been easier. We ignore the disease, its reasons and the environment
in which it reproduce. We do not even know the protection against
the disease because we have not known it is dengue fever only
lately," said a Taizi citizen.

Meanwhile, Saeed al-Mikhlafi affirmed that three of his sons have
been infected with dengue fever without knowing the disease. "I have
suffered from the costs of the medical tests required by physicians.
While one said it was the beginning of dengue fever, another said it
did not exit. Ultimately, they administrated only anti-biotic
medications and pain-relievers led to hide of the virus to in tests'
results," he said.



Saeed indicates the city is full of hospitals and the sewages have
overflowed. "Spraying campaign has come only after the disease had
exacerbated."

Mohammad Ahmad, another citizen infected along with his son says:"
the disease was intensive on me and was feeling great pains in my
head till I thought it will be explode and also experienced a
strange fever," he said.

He adds that the Ministry of Public Health and Population and other
concerned bodies are negligent. The city suffers from impurities, a
matter led to the spread of the mosquito and the disease.

Ali Naser, lab-technician, infected with the disease recalled his
sufferings and how they were complicated." I have been infected with
severe fever and headache as a result I was hospitalized several
times. Every hospital demanded different tests which led to sharp
decrease of blood platelets and I only recuperated my health after
transmission additional blood platelets," he said.

This health cadre calls on his colleagues working in the hospitals
to be merciful while treating patients, not to impose additional
burdens on them and consider their health and economic conditions.

Sheltering vis-à-vis frightening

Physician Samir Sufian, the director of Al-Rawdha Hospital reveals
the size of the catastrophe affirming that public and private
hospitals receive case of dengue fever.

"Like any other public and private hospitals, we perform our duty
and receive many cases, whether infected with Dengue fever or other
cases suffer the same complications of the disease," he said.

"We have been receiving more than hundred case a day, all of them
are not necessary infected with the disease but there are similar
cases. Only 72 cases have been hospitalized in the hospital and gave
them blood platelets as the disease reduces the blood platelets to
under 60, 000 units. All these cases have been recovered," he said.

Over capabilities, Dr Sufian admits that there is a lack of improved
equipments to carry out tests but he says:" We conduct tests via
special test slices like NTG and NTBD and through them we are making
sure of infection with dengue fever recently. We have been
conducting Diango tests and every case was followed up to the latest
sage to make sure of infection with dengue fever."

Over mortalities, the director of Al-Rawdha Hospital indicates
that death cases have been occurred with the disease spread but
indicates "death could happen if there are accompanied diseases."He
estimated the number of mortalities has reached only seven and there
are similar death cases in other hospitals.

But he criticizes tries of hiding the victims "I do not understand
reasons behind this concealment, like any other disease, death cases
are expected the case is fate and divine decree."

He says there is practical foundation affirms that the mortality
level of dengue fever is one to three in every thousand case
infection. "This means if we have thousand infected cases, there is
only one or two death case."

" All of us responsible on the society with its all categories,
health office is not the sole responsible on deterring the disease
and it is not our responsibility to exaggerate on the size of
infection and death cases," said Sufian.

However, the Technical Director of Al-Safwa Hospital Abdurrahman
Saeed affirms that the hospital has received hundreds cases during
the past two months but he indicates that infections with disease
have become rarely during the past month. He expected that death
cases in Taiz are estimated by tens. "In our hospital, for example,
three death cases have been registered."

He makes it clear that the virus causes complications breaking blood
platelets but differs from one to another according to the strength
of person's immunity system. "The disease could cause bleeding or
failure of respiration system. The syndromes could be severe or
light, they could lead to death or complete recovery."

Over diagnosing infected cases, the director of Al-Safwah Hospital
says it could be diagnosed by laboratory tests or via other
specialized sets.

Afflicted governorate

The Secretary General of Health Syndicated Abdul-Jalil Azuraiqi says
"the disease was not new, if concerned bodies have intervened early
in 1994, the situation would have been better. The disease is now
rampant terribly and there are no enough efforts for combating it."

Over the victim of the disease, Azuraiqi says: " The number of
infected cases has exceeded 100,000 and 50 infected died. Seven
physicians have been infected and one of them died."

Over state statements that the infection with the disease does not
exceeded 950 case and only one death case has been confirmed, the
Secretary General of Health Syndicate says " there are 45 public and
private hospitals in Taiz governorate, 400 private clinics and 122
health centers even though government concerned bodies have not
approved any statistic coming from these facilities and only
approved cases coming from the central laboratory even they are
view. Hover, we got our information from colleagues in those
hospitals, clinics and centers."

Azuraiqi accuses local authority of suppression: "On contrast to the
reality, the governorate is inflicted with the disease. There are no
efforts fighting the disease appropriately and there is late
spraying campaign has came lately and has not cover even the
infected area."

CSOs have ineffective role

Civil Society Organizations are known to have a role complementary
to of the government's efforts in all issues concerning the society.
Because dengue fever pandemic is one of the most issues concerning
the society, some CSOs have tried to be present in this field but
officials say they are absent and have limited duty.

Hamid Khaled, a fellow of Human Rights Center for Information and
Qualification, says "we have not been absent, no one ask our
contribution. Coordination between different civil society
organizations is needed away from unplanned work. Even though, we
are ready to do what we requested to help fighting this pandemic and
cooperation with any body, given that the pandemic has settled in
the city and evoked fear and terror among people."


A strategy to eradicate the disease

Deputy Minster of Public Health and Population for health and
planning, development and Jamal Nasher says the ministry is working
with its office in Taiz to limit the pandemic by curing all cases
and helping the office to find diagnosis means to know dengue fever.

For his part Deputy Governor of Taiz for Technical Affairs
Abdul-Qader Hatem says that the governorate has adopted special
strategy to fight dengue fever in Taiz.

"The issue has put all concerned bodies on alert to combat the
disease. We and the ministry's office here made a strategy includes
all duties of concerned bodies because fighting the disease is not
only the responsibility of the health office but also all concerned
bodies," he said.

According to him, the strategy aims at eradicating the environment
where the mosquito spread the dengue fever via exterminating reasons
led to the mosquito settlement in the city. These reasons are topped
by personal conduct, like storing water for a long time due to the
lack of water in the city, and wastes of workshops, houses and car.

Based on these reasons, the strategy is divided into two parts, the
first one concerns solving water crisis while the second is to clean
the city from all wastes to get rid of the mosquito which spreads
the disease in addition to awareness campaigns on the dangers of the
disease and how to protect themselves against it.


Director of Taiz Health Office Abdul-Naser al-Kabab says the
diseases settled in the city and water crisis is the main reasons.
He said the first rise of the disease in Taiz city was in 1994 with
one approved case another case found in Jeddah, Kingdom of Saudi
Arabia in that time. The disease raised again in 2007 when 220 cases
infection have been registered. While the disease spread in 2008
with360 cases have been confirmed, the pandemic has become rampant
in 2009 to the degree that Taizi people have become terrified. The
number of infected cases has reached 906.

Over the death cases, he affirms that there is no single case has
been approved died because of Dengue Fever and there are may be
death cases whether in hospitals or at homes because of the disease
or other reasons. He cited that the office has distributed forms to
hospitals to report on death cases because of the disease or other
reasons and they have not received any notification or death
certificate from any hospital.


Over the procedures taken for facing the disease, al-Kabab said " we
have assigned operation rooms to follow up everything new and then
communicate with different concerned bodies we have focused on the
enlightenment since that protection against the disease depends on
awareness on reasons behind the spread of the disease and the
environment individual lives in.

House to house spraying campaign have been also carried out in the
three more infected districts.

Over negligence to early fight the pandemic, he admitted there was
carelessness from all bodies which "led to this condition". The
responsibility does not lie on the health office but all concerned
bodies, including media, have to play their roles to stand against
the problem.

Facts on Dengue fever

Dengue fever is a disease caused by a family of viruses that are
transmitted by mosquitoes. It is an acute illness of sudden onset
that usually follows a benign course with headache, fever,
exhaustion, severe joint and muscle pain, swollen glands
(lymphadenopathy), and rash. The presence (the "dengue triad") of
fever, rash, and headache (and other pains) is particularly
characteristic of dengue.

Dengue (pronounced DENG-gay) strikes people with low levels of
immunity. Because it is caused by one of four serotypes of virus, it
is possible to get dengue fever multiple times. However, an attack
of dengue produces immunity for a lifetime to that particular
serotype to which the patient was exposed.

Dengue goes by other names, including "breakbone" or "dandy fever."
Victims of dengue often have contortions due to the intense joint
and muscle pain, hence the name breakbone fever. Slaves in the West
Indies who contracted dengue were said to have dandy fever because
of their postures and gait.

Dengue hemorrhagic fever is a more severe form of the viral illness.
Manifestations include headache, fever, rash, and evidence of
hemorrhage in the body. Petechiae (small red or purple blisters
under the skin), bleeding in the nose or gums, black stools, or easy
bruising are all possible signs of hemorrhage. This form of dengue
fever can be life-threatening or even fatal.


Risks of Dengue fever

Dengue is prevalent throughout the tropics and subtropics. Outbreaks
have occurred in the Caribbean, including Puerto Rico, the U.S.
Virgin Islands, Cuba, and Central America. Cases have also been
imported via tourists returning from areas with widespread dengue,
including Tahiti, the South Pacific, Southeast Asia, the West
Indies, India, and the Middle East.

Dengue fever is common and may be increasing in Southeast Asia.
Thailand, Vietnam, Singapore, and Malaysia have all reported an
increase in cases. According to the World Health Organization, there
are an estimated 50 million cases of dengue fever with 500,000 cases
of dengue hemorrhagic fever requiring hospitalization each year.
Nearly 40% of the world's population lives in an area endemic with
dengue.

The signs and symptoms of dengue

After being bitten by a mosquito carrying the virus, the incubation
period ranges from three to 15 (usually five to eight) days before
the signs and symptoms of dengue appear. Dengue starts with chills,
headache, pain upon moving the eyes, and low backache. Painful
aching in the legs and joints occurs during the first hours of
illness. The temperature rises quickly as high as 104° F (40° C),
with relative low heart rate (bradycardia) and low blood pressure
(hypotension). The eyes become reddened. A flushing or pale pink
rash comes over the face and then disappears. The glands (lymph
nodes) in the neck and groin are often swollen.

Fever and other signs of dengue last for two to four days, followed
by rapid drop in temperature (defervescence) with profuse sweating.
This precedes a period with normal temperature and a sense of
well-being that lasts about a day. A second rapid rise in
temperature follows. A characteristic rash appears along with the
fever and spreads from the extremities to cover the entire body
except the face. The palms and soles may be bright red and swollen.


Treatment

Because dengue is caused by a virus, there is no specific medicine
or antibiotic to treat it. For typical dengue, the treatment is
purely concerned with relief of the symptoms (symptomatic). Rest and
fluid intake for adequate hydration is important. Aspirin and
nonsteroidal anti-inflammatory drugs should be avoided.
Acetaminophen (Tylenol) and codeine may be given for severe headache
and for the joint and muscle pain (myalgia).