Handling Dengue in Puttaparthi

Last updated on 17th Nov. 2014

Note: I put up this post on this spiritual blog as some Sathya Sai devotees visiting /living in Puttaparthi may be interested in this topic.

Over the past few weeks I have heard of some cases of Dengue (pronounced as Dengee by some and as Dengu by most Indians I discussed it with), http://en.wikipedia.org/wiki/Dengue_fever, in Puttaparthi. I also read about recent Dengue cases in Mumbai. From the wiki link on Dengue given earlier:

Dengue fever, also known as breakbone fever, is a mosquito-borne tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs.

...

As there is no commercially available vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites.

Treatment of acute dengue is supportive, using either oral or intravenous rehydration for mild or moderate disease, and intravenous fluids and blood transfusion for more severe cases.

--- end extracts from wiki page ---

One important issue/problem with Dengue is that there is no "medication targeted directly at the virus". So those who contract an acute form of the disease ideally need hospitalization with IV drip and blood platelet transfusion for faster recovery and better chances of recovery.

Puttaparthi, at least outside-ashram Puttaparthi where I live, does have fair amount of mosquitoes. While one can and should take suitable precautions in one's flat to keep mosquitoes out, it is not possible to ensure that one may not be bitten by mosquitoes when one is outside. [Coincidentally, I received an email today advertising a (wearable) mosquito repellent band gadget, http://www.gizmobaba.com/Products/Household-Gizmos/Gizmobaba/GB137-Gizmobaba-Mosquito-Repellent-Band-Gadget!-Set-of-6-SEE-VIDEO!/pid-6594764.aspx. First time I heard of something like this.] Now, my understanding is that even if one is bitten by a Dengue infected mosquito it is not necessary that one will contract dengue (or an acute form of dengue). I guess that may depend on the state of one's physical health/immune system.

But what does one do if one or one's friend/relative, God forbid, does catch dengue, especially an acute form of dengue, in Puttaparthi? One source told me that when a patient reports high fever (like 103/104 degrees Farenheit), joint pain etc., it is not clear what is the cause. It could be viral fever, typhoid, dengue etc. So the doctors typically prescribe paracetamol for a couple of days. If the fever does not subside over these two days then the doctor may suspect dengue. This source told me that doing the dengue (blood) test privately costs a thousand rupees! I was surprised to note that the test is so expensive.

However, it is good to know that the blood test for dengue can be done privately in Puttaparthi even if it costs a thousand rupees. I mean, if one has high fever for a couple of days or more which is not being controlled by paracetamol then, those who can afford a thousand rupees can get this test done and know whether it is dengue or not. There may be a question of reliability of the privately done test but I think they do seem to have the equipment and access to a trained technician to do it.

If somebody does contract an acute form of dengue (and is tested dengue positive) then if the ashram hospital is able to provide the hospitalization and treatment, it will be the best option. But sometimes the hospital could be full and so may not be in a position to admit the patient. What are the available options then?

The best option then, for those who can afford it and have care-givers who can accompany them, is going to a private hospital in Bangalore.

However, many people in outside-ashram Puttaparthi are single & live alone (like me) and many are elderly. They may have some friends who are willing to provide them care but are not in a position to travel and stay for long in Bangalore. For such people, even if they can cough up the money, going to a private hospital in Bangalore is not a workable option.

What about small private hospitals in towns close to Puttaparthi like Kothacheruvu or Bukkapatnam, which are easily accessible by Auto, and so friends based in Puttaparthi can provide support with some Auto commuting? One source told me that all these private hospitals are run by R.M.P. doctors. Now R.M.P. seems to stand for Registered Medical Practitioner but it is a lesser qualification than the standard minimum allopathic doctor qualification in India nowadays which is M.B.B.S. (Bachelor of Medicine, Bachelor of Surgery). So some doubt was raised about the quality of medical care provided in such private hospitals in Kothacheruvu and Bukkapatnam.

What goes through my mind is that if one or two of these private hospitals in Kothacheruvu & Bukkapatnam, which cater to the local populace, have acquired a good reputation among the locals, one could explore that option, if the Bangalore option is ruled out. Would they not be able to provide safe "intravenous rehydration" and "intravenous fluids" (IV drips)? However, blood platelet transfusion may be beyond them or it may not be very safe to get it done there even if they provide that facility.

P.S. Here is an article about a dengue vaccine discovery, Dengue drug can give Sanofi $1-bn India biz, http://www.business-standard.com/article/companies/dengue-drug-can-give-sanofi-1-bn-india-biz-114111000045_1.html.

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Given below is a correspondent's response (slightly edited to fix a typo). My response to it (slightly edited) is shown with the prefix Ravi, indented and italicized :

There is a widely-accepted remedy for the lowering of platelets which occurs with dengue. This is to take the juice of a green papaya leaf regularly (once or twice a day). From what I can discover, the remedy was discovered in Malaysia and has been studied empirically there for its effect. It certainly seems to work, but the mechanism is not yet known.

Green papaya juice is meant to be extremely bitter, even more so than bitter gourd (karela).

This will treat one of the more unfortunate symptoms of dengue, the lowering of platelets which can make the person vulnerable to other infections. I do not know if it has any effect on those who suffer from dengue shock syndrome in which major organs start to fail in a short time.

Ravi response: A friend of mine, based in Puttaparthi, who recently contracted dengue, was hospitalized in the ashram hospital here, recovered and got discharged, told me about this remedy too. He said that he used it, and that it, in addition to blood platelet transfusion (from blood donors who came forward to assist) and other medical aids, contributed to his platelet count getting back close to normal or normal. Your mention of the same remedy confirms it for me.

My interest in dengue grew when my wife and I had it at the same time about four years ago. She had it in its usual form and was weak for about a month. In my case it started off other problems and I was out of commission (mostly in bed at home but also in hospital) for over three months.

Ravi: Oh Lord!

Dengue is avoidable. Local bodies need to spray against the mosquito and eliminate all pools of standing water. Houses need to be sprayed against the mosquito. All this means work that local bodies tend to avoid until there is a public uproar, by which time it is too late and they do not have the right kind of insecticide and what they do have is substandard (all of which has happened in Pune). It is no excuse to say 'dengue is spreading everywhere, what can we do?' We must all do what we can locally. An aedes mosquito from Puttaparthi is not going to come and bite me in Pune but one from the water collected in the neighbouring building site probably will.

Ravi: Thanks for these words (as well as the rest of the response). They spur me to do what I can, within my limitations, to raise this matter with local outside-ashram Puttaparthi municipal authorities. I will also talk about it to my building manager to eliminate any local pools of standing water (especially near a small garden that we have), and perhaps have some spraying done around the building privately (not waiting for municipal people to do it).
I use Hit mosquito spray for my small flat/apartment. I now plan to spray my flat with it on a regular basis.

--- end correspondent response (and my response to it) ---

The same correspondent later passed on this article, Papaya Extract to Treat Dengue: A Novel Therapeutic Option?, from NIH, USA journal, Annals of Medical & Health Sciences Research, dated May-Jun 2014, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071726/

Two small extracts from the concluding part (titled Discussion) of the above mentioned journal article:

From the various reports published in scientific literature, it appears that C. papaya L. leaf extract does have beneficial properties in dengue. It has been shown to bring about a rapid increase in platelet count. This could be possibly attributed to its membrane-stabilizing property.

...

Papaya extract no doubt offers a cheap and possibly effective treatment for dengue. However, currently, it is also necessary not to rely entirely on the leaf extract and ignore standard treatment for dengue until the benefits are established. Large scale randomized clinical trials in dengue-confirmed patients is necessary to establish their usefulness.

--- end small extracts from journal article ---

Small further update:

A Puttaparthi based correspondent wrote (slightly edited):

As far as I know no patients are rejected (in ashram general hospital) due to lack of space, if they really need hospitalisation.

--- end Puttaparthi correspondent response ---

Ravi: Today (12 Nov. 14) evening I asked about the charges for the "dengue test" in a private Puttaparthi clinic. It is Rs. 800/-.

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Updates (Nov. 14th & 16th 2014):

A little while back I bumped into my municipal councillor on the main road of Puttaparthi. He noted the info. about the two dengue cases I knew of near where I live. He informed me that a general body resolution was already adopted in the (Puttaparthi) municipal corporation to acquire two fumigation devices/equipment (don't recall the word he used). Sometime this month itself he said that fumigation will be done in all areas of Puttaparthi as a measure against mosquito borne diseases like dengue.

I told him about the high cost of the dengue test in Puttaparthi private clinics (Rs. 800/-). He told me that he will check whether that test is being done at municipal hospitals in this area, and explore options to make such tests available at lower cost. So next time we bump into each other he may provide me info. on that.

I also checked today with a local private clinic doctor (not sure whether he has M.B.B.S. qualification though he clearly is an authorised medical practitioner), Dr. Gopal Reddy, who has acquired a very good reputation among locals in Puttaparthi. He told me that he does (organizes) the dengue test, and also can organize hospitalization treatment. I did not feel it appropriate to quiz him on further details at this point of time. I must also add that he speaks fluent English, seems knowledgeable and has the air of a very efficient and can-do person.

Later I came to know that an M.B.B.S. doctor called Dr. Rama Krishna comes to his clinic in Puttaparthi in the late afternoon. I was told that he and his wife (also M.B.B.S.) have a small hospital in Kothacheruvu. So that is another option. Dr. Rama Krishna's clinic here can also administer IV drip when he is here.

There is also Dr. Damodar's polyclinic where an M.B.B.S. qualified doctor may be available. IV drip during day time can be done there as well.

It is important to also mention the government homoeopathic hospital which is currently handled by a very experienced, capable and friendly doctor. He surely is worth consulting on dengue cases, IMHO. He may advise hospitalization (in allopathic treatment hospitals) for patients who are in need of such treatment, and may be able to provide advise on which hospital is suitable given the background of the patient.

Note that government run allopathic primary health centres are also available, I am told, in nearby Enumalapalli village as well as in Kothacheruvu town. Anantapur, the district headquarters town/city, about two hours drive from Puttaparthi (and so far less convenient for commuting than Kothacheruvu which is much closer and well connected by Auto & Bus to Puttaparthi), has a full fledged government hospital, and, I believe, well equipped private hospitals too.

So I get the impression that Puttaparthi locals who can afford some level of hospitalization expense (much lesser than Bangalore private hospital expenses, I presume), do use services of private doctors like Dr. Gopal Reddy. Dr. Rama Krishna (as well as the current govt. homoeopathic doctor) for diagnosis and treatment of diseases like dengue. If my impression is right then Puttaparthi is better equipped to handle many cases of dengue (exceeding limited capacity of ashram hospital) than I had thought earlier.