Wednesday, September 11, 2013


It used to be that in Lianga a bout with fever unless it was determined to be really a high grade one where one's body temperature rises to at least 39 degrees centigrade or higher, it was considered more of a nuisance rather than anything really serious. Nothing that regular doses of paracetamol or any of the other antipyretic drugs that help reduce fever cannot remedy in conjunction with rest and increased fluid or water intake.

The exception, of course, was made for children (especially the very young), the elderly and those already in poor health who even  in the more remote and far flung barangays or villages are immediately rushed to the local health center or hospital.  That is, if their families have the financial resources and the capability to do so. Otherwise, it may be up to the local mananambal (the local folk healer or practitioner of traditional medicine) to come up with some cure hopefully by using the appropriate herbal remedies and not some form of arcane yet useless sorcery.

Nowadays, any instance of elevated body temperature in both adults and children can now be a cause for panic. This is because there has been, for the past few months, an outbreak of dengue fever in this town and this health scourge has claimed several lives including that of the municipal vice-mayor of Lianga, Robert "Jun" Lala Jr., who passed away last August 17.

Now dengue, for those who know little or nothing about this deadly tropical disease, results from the bite of mosquitoes from the genus Aedes particularly the A. aegypti which is said to be responsible for transmitting the virus that causes the fever.  After an incubation period that can last from a few days to two weeks, the infected individual will often experience high fever, muscular aches and pains and perhaps a measles-like rash.

If the patient survives the critical phase where there may be complications like fluid accumulation in the abdomen and chest, gastrointestinal bleeding, shock or (if dengue hemorrhagic fever develops as it occasionally does in about 5 percent of cases) severe internal bleeding then recovery begins to occur after about four to seven days. Children often suffer a higher risk of complications although paradoxically the initial symptoms may be mild.

Mortality rates in the case of dengue cases are said to range from just one to five percent but it is clearly prompt and competent medical care that can spell the difference between pulling through and dying from it. In rural and provincial areas like Lianga where specialized care for seriously ill dengue patients including blood transfusion facilities are not available, that can be a major problem.

In the week following the death of Vice-Mayor Lala, an epidemiology team sent by the Region XIII regional office of the Department of Health  (DOH) in Butuan City had detected critically high levels in the population densities of mosquitoes noted for the transmission of the dengue virus in many areas around the town. The same team had recommended fogging operations which was carried out a few days later but even then they still warned residents that the outbreak will continue unless repeated fogging operations are scheduled and that local health authorities lead and assist the local townspeople in identifying and cleaning up mosquito breeding sites.

The tragedy, of course, of the dengue outbreak in Lianga was not only in the several deaths that have been clearly attributed to the disease but also in the fact that the municipal government and local health officials have been inexplicably slow in responding to the emerging health crisis when it first started.  It is, for example, recommended procedure for municipal health offices in the event of a confirmed dengue case in their areas to immediately raise local alert levels, to quickly institute monitoring procedures and undertake preemptive measures designed to identify and sanitize dengue hot spots in their localities.  If so needed, the technical assistance of the DOH regional office could have been sought and requested.

In the case of this town which has not been exactly a stranger to similar but more milder and smaller outbreaks in the past, it would have been logical for the local health office under Dr. Leo Sarmen, to quickly move to seek the assistance of the municipal government (under his brother, Mayor Roy Sarmen) and the DOH regional office in Butuan in order to fight and nip the outbreak in the bud before more local residents could have been infected and lives lost. Instead, I had been reliably informed that the DOH epidemiology personnel came to Lianga on their own initiative and only after receiving reports of the dengue cases here directly from concerned local residents.

Perhaps the majority of the townspeople here should also share part of the blame for the general indifference that allowed the outbreak to grow and eventually claim lives.  In the aftermath of the initial fogging operations supervised by the DOH, there were reports of locations within the town that were confirmed to be ideal mosquito breeding sites. In one incident, technicians handling the fogging machines found in the backyard of one of the houses just a short distance from my own residence a large pile of assorted glass bottles, many of them containing water residue which could provide an optimum breeding environment for mosquito larvae.

At this time, the number of dengue cases within the municipality are said to be tapering off and but even local health officials are not keen on declaring it as being over any time soon. They are however hoping that the number of dengue victims and fatalities from the disease will eventually fall to zero as more and more local residents have taken the DOH health alerts to heart and have began to clean up their immediate environments aside from making sure that suspected dengue patients quickly get the specialized medical attention and care that they may urgently need.

Personally, I now see the recent and ongoing dengue outbreak in Lianga as a sobering lesson in how lives can be needlessly lost and an entire town thrown into helpless panic because of a local government and its health officials who were caught napping and unprepared in the face of a sudden public health crisis. It also illustrates pointedly how a more civic minded local population could have helped avert a serious disease outbreak simply by cleaning up its immediate environment and observing the most basic of sanitation procedures - actions that, as individuals and as members of any self-respecting and health-conscious community, people here should have been doing regularly, as a matter of course.


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