A Child With Dengue
If you or someone you love has a suspected case of dengue please consult the medical links at the end and see a real doctor.
As a parent living in the tropics, my biggest fear is dengue. It’s the perennial wildcard, dealt out randomly by ubiquitous mosquitos, sometimes passing over you as a mild fever, sometimes shutting down your organs in a river of blood. I’ve had dengue and my wife has had dengue and while it fells people our age, our biggest fear is for our children. Now that fear has come true.
My infant daughter has dengue as I write this. I’m sitting on the hospital cot while she’s in the bed, thankfully recovering but with catheters and canulas from every major limb and orifice. It’s the hemorrhagic type, the bad one, the one characterized by ‘leakage’, a gentle way of saying that your blood is breaking down, spilling plasma across cell walls and organ boundaries.
This is needless to say bad.
The scary thing about dengue is that it’s a disease that you can’t fight with medicine or surgery. The only weapon we have is knowledge. Dengue is essentially fought with king coconut and two measuring cups.
If you don’t have this knowledge, dengue can quite easily and subtly kill you. The first fever goes away and leaves you feeling fine. Then you get a second fever which also goes away. At this point you think you’re done, but — if you have the hemorrhagic type — this is the point where you blood starts to melt, invisibly and off-stage. Most patients would feel generally fine until their body goes into severe shock as organs start to shut down, followed shortly by death.
Thankfully, tragically, Sri Lanka has acquired this knowledge over time and it has spread across the population, along with the disease. Dengue cases have increased from 2,000 in 1990 to over 50,000 in 2018. In my lifetime I’ve seen the level of knowledge and care increase dramatically to the point that most hospitals, especially the public hospitals, are quite well equipped to manage the disease. They have all too much experience.
Because of this, our daughter is fine, mashallah. As parents, we knew what to look out for. We got a dengue test and, that being positive, took our daughter to the doctor and then hospital (Ninewells, if you’re wondering). There, they knew to start fluid management (basically just measuring and balancing what goes in and out) and to do an ultrasound for leakage. Finding that, they knew to move to a controlled saline drip and to monitor vital signs (blood pressure, cold extremities, platelet levels).
Dengue has an invisible if predictable calendar and there is something called the critical phase, around 48 hours where a patient can appear fine but quickly tip into shock. The doctors and staff here (and everywhere in Sri Lanka) know this and thus began monitoring our daughter hourly as this peaked.
Throughout this this only treatment is again knowledge, and liquids. You keep a worksheet of exactly how much liquid is going in (either orally or through a drip) and how much is going out (measuring pee pee in cups, or through a catheter). The key is not to ‘drink a lot of liquids’, but to imbibe the exact right amount to keep your besieged system intact. To repeat, fluid overload is an equal threat to your organs, so balance is key.
I thankfully don’t know what happens beyond fluid management. I know people (children actually) who have gotten blood transfusions, but by that point it’s a very inshallah type of situation.
We are lucky that knowledge and care has progressed to this point, that we as parents know what to look out for and when to get help, and that the medical professionals know exactly how to help. But it still really sucks that we’re here. I hate living with this disease constantly buzzing around. A few missed signs can kill you and sometimes even if you do everything right it kills you anyways. Dengue can also cause intense pain (like your bones are breaking) and leave patients tired for months — thankfully fates we seem to have avoided for right now.
I say all this as my daughter is still technically in the critical phase, as people are still worried and praying for her, as we are still with her every moment, cuddling her and touching her feet and watching and feeling for every sign of life. I hate this disease and this is no way to live.
Soon the public health inspectors will come to our neighborhood and look for mosquito breeding grounds and spray, but the mosquitos fly from all over and they will return. Because of this we barely let our children play outside already, something which was unheard of in generations past.
Dengue is here and only getting worse. If it rains heavily, you know that mosquitos will breed wherever the water collects and that cases will spike in the weeks ahead. And it rains heavily at least twice a year. It rains randomly. We fear puddles.
Dengue doesn’t stop. I’ve had some sort of viral fever twice, I know people that have had it the maximum amount (four times, the total amount of strains). Mosquitos are everywhere and dengue is everywhere and we just live with this.
The current standard of treatment, as good as it is, is not good enough. We shouldn’t be balancing the sanctity of our children’s internal organs and hoping for the best. It’s quite a task, but the goal should be zero mosquitos and zero mosquito borne disease. Difficult in a tropical country, but we seem to have zeroed or come close to zeroing out many creatures from this earth, so it’s not beyond humanity’s ken.
Until then, keep you and yours safe and please be aware of dengue. The only weapon we have right now is knowledge, so I hope you learn enough to recognize the signs and to quickly seek help from medical professionals that know more.
For further reading, some of the best information in the world comes from the Sri Lanka Department of Epidemiology:
Again, if you think you or someone you care for has dengue please don’t be an Internet doctor. Go to a real doctor now.