The Bhutanese Leading the way.
Phuentsholing hospital contributed the highest (77 percent) and people residing in Pasakha contributed the second highest case load
As of 5 September, dengue positive cases reported from 19 dzongkhags (except Lhuentse) in the country has reached to 2,640. Four deaths were reported so far due to dengue complication.
As per the report from the Ministry of Health (MoH), three dengue cases were reported from Bumthang becoming the second last dzongkhag to report dengue cases. However, all the three patients had the history of travel to Phuentsholing like in most other Dzongkhags.
Despite an immense effort for dengue outbreak containment by the District Health Rapid Response Team (DHRRT) and DeSuups with support from Dungkhag and Thromde, only a minor reduction in the number of dengue cases was reported at the Phuentsholing hospital.
As of 5 September, Phuentsholing hospital received 2,108 cases of dengue, including 849 cases from private clinics in Phuentsholing. Out of 2,180 cases, people residing in Jaigaon contributed the highest followed by people residing in Pasakha. Of the total cases of dengue positive, 19 cases were referred to JDWNRH in Thimphu.
DHRRT was formed and activated on 17 August. Phuentsholing Drungpa, Karma Rinchen, said that after the activation of DHRRT, and in collaboration with all the stakeholders, they have been conducting timely cleaning campaign and awareness programs (three times as of today).
The mass cleaning campaign destroys stagnated water and removes mosquito breeding containers such as PET bottles, cups, coconut shells and discarded tyres.
Volunteers, students from class VIII to XII from different schools (1,900 plus), DeSuups, communities, industrial employees are formed into groups with their own designated areas during the cleaning campaign.
In the beginning since there was no budget allocated, Thromde and Dungkhag shared the budget to conduct the program. They have now asked for financial support from industrial and private organizations.
“We exactly don’t know the area from which the maximum cases of dengue are reported. However, the hospital has identified few areas, of which Pasakha is reported as the highest for now apart from Jaigaon. So, we are taking care of identified areas with major preventive measures,” the Drungpa said.
Nonetheless, he said that the major challenges remains in covering the area in Jaigaon, India, as Bhutanese residing in Jaigaon are scattered and they are not able to reach everyone. He said, “If it was in one area then it would be easy for us to prevent the spread. But we are collaborating with the counterpart and they are quite supportive.”
In addition, he said that they are planning to write a letter to the employers who have employee residing in Jaigaon and they will be asked to give them the awareness and advocacy on dengue.
Future plans to prevent the outbreak before the onset of the monsoon is already being charted out. Thromde and Dungkhag will buy thermal fogging machines. They have requested the private organizations to contribute to their funds.
“For now the Vector Control Division has three machines which is not enough to cover all the areas at one go, and they also have a manpower shortage. Therefore, we will try to procure the machines and try to bring down the cases to the minimal,” he added.
Meanwhile, Chief Medical Officer (CMO) of Phuentsholing hospital, Dr Thinley Pelzang, said that the trend remains neck-to-neck everyday. He said, “People are getting to know about it which is why they come forward to check even if they have a fever, and thereby, the number of cases detected is on the rise.”
He said that all the staff members in the hospital are fully engaged with the treatment and case management and as a preventive measures, the Malaria technician conducts vector control surveillance and thermal fogging as per the set schedule.
He added, “We have mobilized the staff from other district hospitals for those purpose. However, the coverage of thermal fogging is not that effective because mosquitoes usually come in between 6 to 7 in the evening, whereby we are not able to cover all the area at that peak hour. And for that matter we are doing phase by phase everyday.”
The community participation is very poor, he said, adding that they are least bothered. They do not participate in any of the cleaning campaign and during their first campaign they only had 50 people cleaning the whole town, he added. He said that if they contribute then they can always control the source.
“Even after knowing there is a death case and increase in number of dengue cases, they do not have the fear and concern. I don’t know how to motivate them, and where we are actually lacking,” Dr Thinley Pelzang said.
In addition, he said that budget is always an issue during such an outbreak, whereby it is difficult to conduct any awareness program without any fund. However, it is good that private organizations are coming forward to support, both financially and physically.
District Health Officer, Phuentsholing Dungkhag, Passang Tshering, said that carrying out an awareness program is always challenging due to manpower shortage. At first they did not have volunteers to conduct a cleaning campaign.
“We conducted an emergency coordination meeting on 17 August involving MoH and have formed DHRRT and have developed an immediate dengue response plan. We also have a plan to identify the specific areas from where the high cases reported so that we can intervene on time,” he said.
In addition, he also said that they have plans to work out a long-term dengue strategy to counter future outbreak.
An official from MoH said that the dengue outbreak in Doksum in Trashiyangtse has been successfully contained. However, the DHOs and public were requested to continue the prevention and control activities and remain vigilant to avoid a second outbreak, which will be catastrophic.
He said, “We are continuously monitoring the situation and communicate with DHRRT leaders in all the districts to make sure that they remain alert and vigilant. We have conducted cross border meetings in Gelephu with Indian counterparts.”
In addition, to prevent such outbreaks in future, discussions on developing dengue operational plan for source reduction and destruction much ahead of rainy season were made and proposals have been developed on capacity building for dengue management, and SOP revised on developing early warning system and case investigation-SOPs have been revised, he added.
