Dengue Surge in Luzon

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     When dengue cases peaked in July and August in Luzon and a number of children died, one angle that some media people in news and commentary hyped was the inaction of government in what they saw as a crisis. For the Department of Health, this was uncalled for and very much unjustified.

     For more than a decade that dengue mosquitoes have been attacking the country, the DOH has already institutionalized its dengue prevention and control program in public health and hospital services as well as in health promotion. But as the already-a-cliché goes, “the government cannot do it alone.” In dengue prevention and control, communities and the whole society should do their big part.

     Since the first day of June, the DOH has alerted the country that it was Dengue Prevention Month. Although dengue is no longer a seasonal disease, epidemiologic data in previous years still show that the onset of the rainy season cause the disease to rise. On June 15, it was not only the Philippines that conducted a massive anti-dengue campaign, but the whole ASEAN (Association of Southeast Asian Nations) as well. ASEAN Dengue Day was declared this year and would be observed every year thereafter to foster more awareness about the disease. This year’s observance has for its theme, “Dengue is everybody’s concern, causing socio-economic burden, but it is preventable.”

     On this day, the DOH urged top officials and leaders of the country’s public schools, churches, public markets, and communities to conduct search and destroy activities in their areas of jurisdiction to prevent dengue. Barangay officials, through the Liga Ng Mga Barangay, were also urged to seriously undertake government’s anti-dengue campaign by allocating a part of its budget for dengue prevention and control. At the launch ceremonies held in Kalookan City, Health Secretary Enrique T. Ona said, “Dengue is everybody’s concern, but with our concerted efforts, dengue can be controlled starting today.”

     And then it happened. Towards the end of July, a sudden increase of dengue cases happened in Metro Manila, Central Luzon and the Ilocos region. The nation, as what was being reported in media, was alarmed when a surge of about 2,000 new cases occurred in the first two weeks of August. This incident prompted officials to declare health emergencies in a number of areas in Metro Manila and affected areas of the country.

     Even with the Department of Health’s assurance that the total number of cases nationwide is lower than that of last year, the DOH National Epidemiology Center reported dengue cases at the National Capital Region, Region 1 and 2 nearly double, with 10,487 cases recorded in the first seven months of 2011 compared to 5,416 in the same period last year.

     An off-the-cuff remark of a reporter in a DOH press conference of having a “Ilocano strain” of dengue went haywire in the news and even attributed Secretary Ona for it. 

     This sudden rise in cases caused pressure and panic among public health facilities in Metro Manila, especially at the Quirino Memorial Medical Center (QMMC), where it was shown on television numerous affected patients sharing beds, hallways were converted to wards, and temporary wards were made outside the hospital premises to house dengue patients, most of were children aged 0-15 years. Adding misery to QMMC at this time was the fact that the nearby government and private hospitals were partially closed due to damages caused by the recent floods.

     On August 25, the DOH together with the Departments of the Interior and Local Government, Science and Technology, Education, Environmental and National Resources, and the Metro Manila Development Authority launched a new campaign against dengue dubbed, “Aksyon Barangay Kontra Dengue” (or ABaKaDa), in an effort to stir up community action that will be sustainable, target-driven and that can be adopted by LGUs with perennial threats of a dengue epidemic.

     ABaKaDa seeks to reinforce the country’s drive against dengue by going back to the basics of comprehensive vector control supported by environmental manipulation and modification. ABaKaDa calls for regular weekly clean-up drives spearheaded by the barangay leaders and includes the active participation of community volunteers, civil society and others in government.

     Lessons from past dengue epidemics showed that communities determine the dengue burden epending on their seriousness and commitment to eliminate mosquito breeding sites. Specifically, the campaign urges families, barangay leaders and youth councils (Sangguniang Kabataan) to do community clean-up drives and to aggressively seek and clean out possible mosquito breeding sites every week especially in areas that continue to experience clustering of dengue cases.

     At about the same time, the DOH and PhilHealth (Philippine Health Insurance Corporation) introduced and began implementing effective September 1, the new case rate payment scheme, where members would be able to predict how much PhilHealth would be paying for the services provided. Included in the new case rates is dengue, classified into Dengue 1 (dengue fever and dengue hemorrhagic fever (DHF) Grades I and II) and Dengue II (DHF Grades III and IV) with reimbursement rates amounting to P8,000 and P16,000, respectively.

     Complimenting the case-rate system is the no balance billing scheme which applies only to indigent patients covered by the national household targeting system for the poorest of the poor when they go to government hospitals only. Under this scheme, Philhealth beneficiaries no longer have to pay extra in case their medical expenses go beyond the amounts covered by the packages in the case rate system.

     Everything has been done by government to minimize the impact that dengue brings to the country - from advocacy campaigns to dengue fast lane in health facilities to scientific research altering the genes of the dengue carrying mosquitos to  clinical testing of a potential vaccine against the disease. This is not inaction in the part of government. What may truly be wanting is for people to change their behaviors and practice the recommended cost-effective measures to prevent dengue.

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