siem reap town, Siem Reap province – Local hospitals are running out of space and resources to deal with a dengue fever epidemic.
Unlike the Phnom Penh area, where the disease seems to have been contained, parents from all corners of Siem Reap province and beyond are rushing their children to hospitals.
“I brought my boy in the middle of the night,” said Ros Theap. His 13-year-old son Lim Raya had been sick for four days before he decided to make the long trip from Oddar Meanchey province to Jayavarman VII Children’s Hospital in Siem Reap. By the time they got there, Lim Raya was vomiting blood. “I was very scared,” his father said.
“When they come to us, sometimes [children] have been sick two to three days,” said Yay Chantara, a doctor at Jayavarman VII. “Some children don’t eat anymore. Others lie still…or are in shock already.”
With some roads to Siem Reap nearly impassable during the rainy season, it’s easy to understand why parents hesitate about making the trip with a sick child. Often they try home cures first. “When the kids get high fever, parents give them [too much] paracetamol and the children get poisoned by medicine,” said Yay Chantara.
Four-year-old Puon Namun was in shock when she arrived at Angkor Hospital for Children. “She vomited blood and had blood in her stool,” said Ngeth Pises, a doctor at the hospital
Puon Namun was saved. “Many children come from very far—Kralanh, Samraong [in Oddar Meanchey province], Sotr Nikom—by the time they arrive, it’s often too late,” Ngeth Pises said.
The number of cases in Siem Reap have been climbing steadily during the rainy season. Angkor Hospital admitted 33 patients in June, 86 in July and 67 during the first two weeks of August. Wards at Jayavarman VII Hospital are filled with children lying on mats on the floor, transfusion tubes in their arms. Jayavarman VII admitted 538 patients in July and 338 by the second week of August, said Beat Richner, the hospital director.
Lim Raya was not the first member of his family to get the disease. “My five children got dengue fever one after the other,” Ros Theap said. The dengue fever virus is not contagious, but the Aedes species of mosquitoes that carry it can spread the disease from one person to the next.
In contrast to nocturnal Malaria-carrying mosquitoes, dengue-carrying mosquitoes are at their most active in the early morning and late afternoon—times when most people go about their daily activities.
This makes it difficult to fight the disease, said Pyai Win Gaung, a pediatrician at Angkor Hospital. Health authorities sprayed insecticides in some northern provinces earlier this year. But systematic spraying of the country would mean that, whenever there is a case of dengue fever, health authorities would have to spray the house of the sick person, and maybe the one where that person and his family take refuge while their house is sprayed, to make sure that the mosquitoes, which tend to hide in dark corners, are destroyed. “You just can’t go and spray every place” because the cost would be far too high, Pyai Win Gaung said.
One weapon against the viral disease, for which there is no specific vaccine or medication, is to kill mosquito larvae in the still water where they grow. In early May, the World Health Organization and the National Malaria Center launched a distribution campaign of the larvicide Abate to put in the large jars often used to hold drinking water.
Chang Moh Seng of the World Health Organization believes that the two rounds of Abate distribution may have prevented a far worse epidemic. Through Aug 13, the Ministry of Health was reporting 4,522 suspected cases of dengue fever this year, compared to 10,406 cases in 1995 and 16,216 in 1998. The disease had claimed 95 victims by mid-August; there was 424 deaths in 1995 and 475 in 1998, Chang Moh Seng said.
But Chang Moh Seng added that rural areas are still in the middle of an epidemic. Siem Reap and Banteay Meanchey provinces have accounted for nearly half of the dengue cases this year. The Phnom Penh area has had comparatively few cases, perhaps because special attention was paid to urban areas during the larvicide distribution campaign.
