At the dimly lit wards of the Tiruvallur Government Hospital, a worry still persists. Every case of fever has been screened, checked and discharged or admitted accordingly. 40-year-old Karthi from Chengaram, who has been admitted for a fever, is relieved that critical patients have been shifted to the Egmore Government Hospital. Like many other patients in the ward, he is recovering slowly, and praises the district collector for her timely intervention.
"It is too premature to say that the six deaths in the district have been caused by dengue. It seems to be different strains and we have sent them to a lab," the Deputy Director said, adding, “It could be dengue or leptospirosis or a combination."
For the last few days, confusion has been brewing in the sleepy village of Adiandrawada on the Tamil Nadu-Andhra border. Its residents have lost 4 of their children after two tested positive for dengue. “We don’t have dirty water or a bad drainage system. We always keep our houses clean. We keep the tanks clean. Where are the mosquitoes coming from?” asks Navin Kumar, who lost his 5-year-old brother, Mohan Rao, after days of uncertainty.
At least 140 homes in the village are beginning to learn that dengue isn’t a dirty water problem – it’s a stagnant fresh water one. The disease is caused by the Aedes egypti mosquito that breeds in stagnant fresh water. Rains aggravate the problem because rain water is fresh water, and when it starts stagnating in tanks, tyres or pots, it has to be cleared. Especially pot water has to be changed once in three days or it can turn into a breeding ground for the mosquito. Rats are also a possible problem in the area.
Shanthi, who lost her youngest child, a nine-year-old, to dengue in the second death that was reported, is skeptical of the mass cleaning drive that the government has adopted. “Is it okay if they put medicine in the water tank? Are they tricking us?” she asks.
A major concern, health officials say, are open tanks, pots of water and empty coconut shells that are found littered in the interior roads. This is not the first scare that the villagers have had – Navin says a fever broke out among at least a 100 people last month after a few spells of rain.
But Adiandrawada bounced back with paracetamols prescribed by the primary health care doctor who services three villages in the area. They, however, weren’t prepared for a worrying situation. Ahead of Adiandrawada is Kaverirajapuram, where the first case of dengue was reported.
Dengue is transmitted by the bite of a mosquito infected with one of the four dengue virus serotypes. The Aedes mosquito’s eggs can hatch into a larva in less than a day. There is no specific medicine or antibiotic to treat it, the only treatment is to attend to the symptoms.
As of Monday afternoon, 88 persons are currently undergoing treatment for fever, 24 have reported fever, 2 are critical and 26 patients have been discharged. 120 persons had been seen as outpatients so far.
Numbers have considerably come down, doctors say. “14 teams have been formed, we have deputed doctors where inpatients are high. They are strategically located. Entomologists have been deployed and 5 fogging machines have been making the rounds. At Kaverirajapuram and Adiandhrawada, there were open, filthy drains earlier in the week. The drains were subsequently cleaned and new pipelines were laid, but it is likely, a public health official said, that their water had been contaminated.
The district administration has been trying to contain the situation from multiple fronts.
Sanitary workers have been engaged and self-help groups have been mobilized. “We think that somewhere on the grassroots level, there is absolutely no awareness and focus on sanitation, and waste that has piled up has not been cleared by the local panchayats,” says Sundaravalli, the District Collector.
“We cannot pinpoint cross-migration as a cause. Mobility of cattle and people is high and many workers migrate to Tamil Nadu to work in construction sites. We have got cross notifications from Andhra, and high cases have been particularly reported from Nagari in AP. We have collaborated with Andhra. Kaverirajapuram has the most cases,” says Kolandaisamy, the Deputy Director for Public Health. All cases from Adiandhrawada and Kaverirajapuram are being directly referred to the Chennai General Hospital.
Another problem, District Collector Sundravalli feels, are quacks. So far, 9 quacks have been arrested – 4 in Tiruttani, 2 in Ponneri and one in Tiruvallur. “These quacks are “allopathic” doctors with a 12th grade education. They tend to prescribe a large dosage of analgesics, which can prove fatal and cause internal bleeding. Painkillers like ibugesic, normally prescribed for fever, should be avoided because of the tendency of the dengue viruses to cause hemorrhages,” says a senior health official from the Medical and Rural Health Services. Further, the possibility of many pharmacies selling over the counter drugs without a prescription has also been considered, and the district drug control department is currently tackling the problem.
“We have started a mass cleaning here in Tiruvallur to kill adult mosquitoes and clear garbage. Clean drinking water stalls have been set up. 14 vehicles from the health department have been performing awareness rounds across villages. We’ve shared WhatsApp numbers for people to inform us about fever or quacks in their area. We are focusing on anti-egg activity, by using anti-bleaching powder in sumps and tanks. A fever monitoring unit has been set up. We are likely to contain the situation by September 2nd,” says the District Collector.