Dengue, endemic in Central America, is a viral disease transmitted by mosquitoes of the genus Aedes. Symptoms are similar to flu, with headaches, fever, nausea, abdominal pain, and rashes on the skin. Its most severe form, hemorrhagic dengue, causes bleeding and can lead to irreversible shock and subsequent death.
In Honduras, cases of the simple form of dengue have significantly increased in 2010 compared to the previous year, with more than 50,000 cases already reported. However, the most alarming feature of this outbreak is the prevalence of hemorrhagic dengue, with more than 1,500 cases reported and 160 deaths—a massive 1,850 percent increase from 2009.
To ease the overcrowding in Ministry of Health facilities and help prevent more illness, Doctors Without Borders/Médecins Sans Frontières (MSF) has launched an emergency intervention in Tegucigalpa, the country's capital, where the majority of cases have been reported.
In hospital, treatment for children includes hydration and rest. There is no vaccine or specific medicine for the virus, so all the MSF medical team can do is to control the symptoms and treat the consequences while waiting for the body to stabilize.
Anthony, who has spent several days hospitalized in San Felipe Hospital, had a relapse after a slight improvement. "I am concerned because his platelets have dropped," said his father, Victor, who has also stayed with his child day and night. "They rise, they decrease, and so it goes. All we can do is wait."
Lucía, five years old, is ready to be discharged. After five days in the hospital, she waits impatiently for the doctor with her packed bag, and says, "I want to go home and play, I want to color and draw."
Though the treatment may sound simple, oral hydration involves certain complexities; fluids need to be administered carefully to avoid a fluid overdose, as dengue alters the permeability of blood vessels and there is a risk of fluids invading other parts of the body, causing complications such as pulmonary edemas.
Before she started to recover, four-year-old Angelina stayed in bed and cried every time a member of the medical team approached. Only her mother was able to give her the necessary serum. MSF health staff teach the children's parents and carers how to administer the fluid to their children. "In my opinion, the success of this medical intervention mostly relies on us collaborating with the parents," said MSF physician Elisabeth Bragança, who is in charge of the emergency ward.
In addition to providing medical care, MSF is fighting the dengue outbreak with vector control. This means tackling the mosquitoes that spread the disease. Along with the Ministry of Health's vector control body, MSF mobile teams are at work in the Manchen settlement, on the outskirts of Tegucigalpa, where the highest rates of affected people have been reported.
An MSF team is going house-to-house through neighborhoods in the affected areas, looking for potential sources of infection and explaining to residents how to keep stored water free from mosquito larvae and avoid rubbish accumulating, so as to stop mosquitoes from breeding and spreading the virus.
Among these mostly poor families, waste management is no easy task. María, 89, explained how ever since one of the rooms in her house had collapsed, she had been unable to get rid of the rubble and useless furniture. "I am poor, and to throw this away costs money, this is why I cannot do it," she said. If rubbish and rubble are allowed to accumulate, they too can provide a breeding ground for mosquitoes.