Indian Capital Struggles to Control Dengue Fever Outbreak
By THE ASSOCIATED PRESS

NEW DELHI — At dusk, the foggers come out to spray their sticky-sweet clouds of diesel smoke and insecticide across the Indian capital. Mothers scold their children for wearing short sleeves. Posters glued to signposts warn about the perils of neighborhood puddles.

Such efforts to stop mosquitoes from spreading dengue fever in New Delhi have failed to keep the city from its biggest outbreak in almost two decades: more than 10,190 registered cases, including 32 deaths. Experts say it didn’t need to be this way, and blame health officials for being slow on both prevention work and medical response.

They say, for example, that the Delhi municipal government should have started much sooner and anticipated a longer-than-usual mosquito-breeding season months ago, when weather forecasters predicted this year’s monsoon would extend beyond September.

“If they clean up in time, if they have those anti-mosquito, anti-larval measures on time, they can contain dengue,” general physician Devendra Jain said in the small single room, crammed with patients, where he operates his private practice in south Delhi.

Some officials reject the idea that the high numbers are a result of neglect, and instead say they prove the city is simply conducting more tests. Some infections go unreported every year because some people with dengue fever don’t seek medical treatment, and others visit doctors who don’t report cases.

Health officials also note that while the number of cases this year has almost surpassed the 1996 high of 10,252, the death toll is far lower than the 423 who died from dengue 19 years ago. There are no statistics on dengue for years before 1996.

Three weeks into October, new cases were still being reported. The Holy Family Hospital alone said it was still detecting about 27 cases a day on average, down from a September peak of 75 cases a day.

Dengue leaves its victims exhausted and in great pain, though it is rarely fatal, claiming less than 1 percent of those infected. There is no cure; patients need rest and to be monitored and treated for symptoms, including high fever, dehydration, skin rash, exhaustion and a low blood platelet count.

“It is not rocket science,” said Manish Kakkar, a researcher at the Public Health Foundation of India, a research and consulting group. “We know what we have to do, but what happens in India is that the public health measures are not adequate both in terms of quantity and quality.”

The dengue outbreak has highlighted India’s striking health-care inequalities. It is home to a $4 billion medical tourism industry — offering everything from bargain tummy tucks to experimental stem-cell treatments — and to hundreds of millions of impoverished Indians who still have no access to trained doctors or basic medicine.

When two young boys died last month after their parents said they were denied treatment at private hospitals, India’s Health Minister warned the government would yank licenses from any hospitals who turned patients away.

State-run hospitals canceled doctors’ vacations, ordering them back to work. Delhi capped the cost of lab tests at 600 rupees ($10) and set up 55 “fever and dengue clinics” to handle the throngs of patients crowding into hospital foyers. Just one of those clinics, near Jamia Millia Islamia university on the southern outskirts of New Delhi, reported screening 800 patients a day.

Some doctors complain that many people seeking medical attention don’t need it, and blame the media for hyping the outbreak.

“Basically there is a panic and patients are very scared,” said Dr. Sonika Bali, the medical officer in charge at one government clinic, whose own 12-year-old daughter was among those infected. “We can’t have every patient come in and ask for a blood test. It is becoming very difficult to convince patients that their symptoms are not that of dengue.”

Some who truly have dengue, meanwhile, wait before seeking treatment, worsening their symptoms.

Noor Jehan had aches and pains for days before seeking help. By the time she finally visited the clinic, she had become so weak her husband had to pick her up from her housekeeping job and take her home in a wooden cart.

“My legs hurt,” the 40-year-old Jehan said. “I would get chills at night.”

Tejaswi Sharma, a 34-year-old software engineer, waited even longer for a diagnosis — until his body went into shock and his kidneys malfunctioned.

“When I first had a fever, I went to my doctor,” but he didn’t test for dengue and instead told Sharma he probably had the flu, he said. “My health deteriorated so fast that I started having breathing problems.” That’s when Sharma’s mother took him to Holy Family.

Argentine lawyer Laura Vassallo was struck with dengue during the first week of her six-month “dream trip” to India, and said her own country was much more proactive in fighting dengue. No water is left to stagnate, she explained. “They are very, very strict with the cleaning, and no throwing garbage on the streets.”

People who live outside the areas covered by the city’s anti-mosquito program try to ward off mosquitoes any way they can — including hiding under mosquito nets or generating plumes of smoke by burning egg crates, incense or whatever is at hand.

“Certainly this is a peak year for dengue,” said Babita Bisht, chief entomologist of the North Delhi Municipal Corporation. Her teams are working through weekends to visit all city neighborhoods, fumigating foliage to kill mosquitoes and spraying puddles to kill their larvae.

They also hold events to inform citizens of the risks, urging them to cover up in clothing and mosquito repellent. Newspapers, meanwhile, carry full-page discussions on which perfumes or house plants might keep mosquitoes at bay.

“Spraying outside in the open may not kill so many mosquitoes,” Bisht said, “but it makes the public aware.”

印度新德里 逾萬人染登革熱

美聯社報導，印度首都新德里爆發近廿年來最嚴重的登革熱疫情，已有10190多人感染，32人死亡。專家說，疫情不應失控，都怪衛生官員的防疫和醫療反應太慢。

專家說，新德里市政府應提早預防登革熱，而且幾個月前氣象預測今年的雨季會持續到9月過後，當時就知道今年的蚊子繁殖季較長。

擠滿病患的私人診所「聖家醫院」的醫師傑安說：「如果他們及時打掃環境、展開消滅蚊子和孑孓的措施，就能抑制登革熱。」

但衛生官員反駁因疏忽造成病例增多的說法，他們說，病例變多只是因為做檢驗的人增多了。每年都有登革熱病患未就醫，或就醫後醫師未通報的情況。

衛生官員指出，今年的病例雖然超過1996年的10252例，但死亡人數遠低於當年的423人。在1996年之前，沒有登革熱的統計數字。

10月已進入第3周，仍出現新病例。聖家醫院平均每天檢驗出27個新病例，9月的高峰期每天有75例。

印度公共衛生基金會研究員卡克卡爾說：「這不是難事，我們知道該做些什麼，但印度公共衛生措施的質和量都不夠格。」

登革熱疫情凸顯印度醫療的貧富不均。印度的醫療觀光產值高達40億美元，從廉價的抽脂到實驗性的幹細胞治療，應有盡有。但仍有幾億的窮人得不到受過訓練的醫師照護和基本藥品。

上個月兩名男孩死於登革熱，他們的父母說，私人醫院拒絕收治他們。為此，衛生部警告，將吊銷拒收病患的醫院執照。

為對抗登革熱，公立醫院取消醫師假期、政府規定檢驗費不得超過600盧比（台幣300元），並設立55家「發燒和登革熱篩檢診所」，其中一家每天篩檢800名病患。

原文參照：
http://www.nytimes.com/aponline/2015/10/19/world/asia/ap-as-india-dengue-.html

2015-10-20．聯合報．A13．國際．編譯田思怡