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Essay Dengue Still A Threat

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32. www.wbhealth.gov.in. - government of health, west Bengal official website.

The trauma of that afternoon comes back to me in three lucid snapshots, each more alarming than the last.

First, a cheap hotel room in Hue, central Vietnam. It's dusk, and I'm in the bathroom leaning on the sink, looking in the mirror at a face I don't recognize. Staring back from the mirror is a pair of fretful eyes set deep in a wax mask — clammy, shiny with sweat, a yellow pallor to match the mustard-colored tiling on the walls. I'm mouthing breathless expletives as my head starts to spin.

Second, the hotel stairwell, 15 minutes later. I'm lying on the floor yelling for help. My arms are in agony; my legs are numb. My teeth are chattering, my stomach lurching. I'm stricken, hyperventilating, losing control, and the expletives have coalesced into a single repeated profanity: "Shit, shit, shit, shit..."

Third, a corridor of Hue Central Hospital, and a medical emergency cliché: I'm on a gurney, looking up at several masked faces against a stark white ceiling, exchanging urgent words in a language I don't know.

I can see that corridor now in glassy cinematic detail — the frowning faces, the strip lights throbbing 1, 2, 3 across my blurred field of vision. It was around that point that I resigned myself to the fact that I was probably about to die.


My work as a travel writer had taken me all over the developing world, to regions where diseases nonexistent or unknown in my native Britain were endemic. I was a regular at the local travel clinic, frequently popping in to stock up on vaccinations and antimalarials. Overseas, I knew the drill — drink bottled water, apply bug repellent at sundown — and for years I dodged the bullet. As time went on, I'd become less concerned about the health warnings enumerated in the back pages of travel guidebooks, detailing the myriad diseases that still thrive amid the poverty and humidity of tropical places.

Finally, in late 2011, my luck ran out. In the Himalayan foothills of Uttarakhand, India, I'd come down with typhoid. Transmitted in contaminated food and water, typhoid is a nasty, potentially lethal bacterial disease. But my case had been mild, characterized by nausea and a persistent crushing enervation. More indisposed than genuinely infirm, I'd convalesced in a hill-country estate where Mahatma Gandhi once founded an ashram, reading my way through back issues of the Himalayan Journal and combating the illness with antibiotics, bed rest, and a bland diet of rice and radishes.

A few weeks later, I arrived in Vietnam feeling strong and recuperated. Hue, the old feudal capital straddling the green banks of the Perfume River, was a stepping stone on the long road between Hanoi and Ho Chi Minh City. With a few days to kill between assignments, I'd envisaged leisurely afternoons spent strolling around the city's main diversions: a decaying citadel of tombs and temples still pocked with bullet holes and shrapnel scars from the Vietnam War. I never got to see them.

When the first flu-like symptoms surfaced on the overnight bus journey from Hanoi, I dismissed it as a minor bug of a kind I'd had countless times before while traveling overseas. Only around 6 o'clock that fateful evening, after vomiting for the 10th time in less than an hour, did I begin to fear that I was seriously unwell.

That worry turned into bug-eyed panic when the violent nausea gave way to physical agony. Suddenly all of my extremities  —  fingers, toes, nose  —  began to tingle, and an excruciating pain shot through my limbs. The pain progressed inward, leaving behind digits that I could no longer feel, as though I were being dipped in a paralyzing liquid with a film of excoriating acid on its surface.

It was this physiological curiosity, what I'd later discover was a particularly aggressive "rigor" — the exaggerated shaking and cramps that attend serious fever — that propelled me onto the floor outside my room, where an Australian couple found me whimpering in the hall. I don't remember much between that and the hospital corridor. A taxi, a race to the hospital, another collapse before I could make it through the door — all was fog and ferment.

The typhoid had been a breeze, but this was something entirely different. This was something much worse.


The next rigor hit as I was wheeled into the ward: a savage, caustic pain searing through my arms.

I recall this moment in disembodied snippets, as if I were witnessing the drama from the other side of the room. There I was, convulsing on the gurney as if possessed, both spectator and star of my very own horror film. I bucked and yelped, clawed at the doctors' lab coats, pleaded with the masked faces to explain what was happening to me.

Then a dozen hands were fighting to hold me down. There was a needle, urgently readied. The stern, masked faces on either side of me began to melt as I slipped into unconsciousness.


I woke up 24 hours later, on oxygen and an IV drip, weak as the day I was born. Whatever illness this was had turned me into a human rag, too feeble to move, voice reduced to a geriatric whisper.

Clinicians came and went. The masks were gone; the furrowed brows remained. It was another day or so before I discovered the cause of my suffering, when a strident head nurse, blunt-faced with a blunter manner, swept in from the clamorous hallway outside holding a sheet of paper. Over the coming days, though I never learned her name, this matriarchal woman would prove to be a savior, her no-nonsense optimism a constant source of reassurance throughout my recovery. In this, our first interaction, she relayed my diagnosis in shattered clauses: "HAVE DENGUE," she half-yelled. "VIRAL FEVER."

For someone convinced he was in the grips of some hemorrhagic, gut-liquefying malady, the news brought a measure of relief. At least I'd heard of dengue fever, a mosquito-borne disease endemic to more than 100 countries. I knew that severe episodes could kill — annually, dengue is estimated to claim over 20,000 lives. But in the vast majority of cases, symptoms subside once the virus has run its course.

In my case, however, there was a complication. The typhoid I'd contracted in India had played merry havoc with my immune system. My white blood cell ratio, I'd learn from later conversations with the doctors, had plummeted to 16 percent of normal levels. My resistance was already undermined; when the dengue struck I'd been floored. I would get better, the doctors assured me, but I'd feel like shit for a long time.

The next two weeks in Hue Central were a rigmarole of tedium and pain. I spent it all in a private room, devoid of furniture but for the bed I'd been allocated. I didn't know whether I'd been granted isolation because the doctors had feared contagion before diagnosis or because they knew that as a foreigner, my travel insurance would cover the cost. Either way, the walls of this sterile white cubicle were all I knew for three days. Only thereafter could I summon the strength to prop myself up and peer through the wide window to my right.

Beyond the glass was a sprawling ward: a hundred or so beds tight-packed in ranks. No partitions, no privacy — just an acre or so of human misery, nurses slaloming in and out attending to the ill and very ill with perfunctory efficiency.

A girl in her late teens lay in the bed closest to the window. Lying on her side, legs pulled up under her chin, she looked as ragged as I felt — her face translucent, her skin matte and papery. When I caught her eye, she held my gaze, unblinking.

I'm still haunted by that stare. Emotionally broken, ashamed of my privilege in my private room, seeing portents in everything, I read in it a reprimand for every step I'd ever taken in developing countries without fully comprehending the jeopardy of foreign lives.


Few things, I was discovering, accentuate a sense of Western guilt quite like sitting in a private hospital room, in someone else's country, while the natives of that country suffer en masse outside.

Many of us travel, so we claim, to broaden our understanding of the lives of others. That was certainly my line, before the dengue. But it wasn't until that moment that I really started to accept how abbreviated my perspective had been, how convenient and self-excusing. In a decade of swooping in and out of impoverished regions, I'd been exposed to crushing poverty. And I'd frowned, offered sympathy and a few coins, then moved along and forgot.

Enthralled by foreign cultures, often disdaining the shortcomings of my own, I'd never fully digested what it must be like to live and raise a family in a place where health, our most precious possession of all, is so easily compromised. A place where something so ubiquitous as a bloodthirsty mosquito momentarily settled on a bare patch of skin can leave you hospitalized and weeping for home.

Now, lying in my room remorseful and alone, I saw my travels for what they were: a voyeur's indulgence, salved with a compassion that was merely cosmetic. For billions, I realized, illnesses like the one that had landed me in this hospital are an inescapable menace.


Dengue belongs to the group of so-called "neglected tropical diseases"(NTDs), a catalogue of 17 parasitic and bacterial infections that tend to be most prevalent in areas of poverty, overcrowding, or inadequate sanitation.

Diseases like trachoma, an inflammatory condition that causes the eyelashes to curl inward, scarring the eyeball and leading to irreversible blindness; like lymphatic filariasis, which leads to horrific disfigurements; like rabies, which causes acute inflammation of the brain and is almost always fatal once symptoms have appeared.

Collectively, these afflictions are a scourge, affecting one in six people around the world and claiming 500,000 lives a year. Yet these are diseases you seldom hear about. Restricted to the vulnerable and the voiceless, they remain neglected because they warrant little research or charity, neglected because the wider world hardly cares.

But earlier this year, the wider world seemed to take notice. In June, at the 41st G7 Summit in Germany, the world's most powerful countries issued a declaration. Henceforward, German Chancellor Angela Merkel announced on behalf of the dignitaries gathered in the shadow of the Bavarian Alps, the G7 would step up investment in the prevention and control of NTDs. "Many countries are simply too poor to roll out their own health systems," she noted, "which is why we have to help them do it."

The G7 pledge was welcome and ostensibly noble. The Global Network for Neglected Tropical Diseases heralded the announcement as "promising," thanking Merkel for "devoting much needed attention and dialogue to an issue that affects the most vulnerable and neglected populations across the world."

But for me, the positive news was tarnished by the lesson in selective empathy that I'd learned in that bed in Hue: that most of us in the developed world only truly care for as long as the dreadful thing happening far away seems like it might pose a threat to us. Because to understand the G7's heightened disquiet about public health in poorer nations, you have only to look to West Africa.

When the Ebola epidemic reached a crescendo around this time last year, a world that tends to overlook Africa-specific health issues could think of little else. At the height of the scare, as the 24-hour broadcasters deployed helicopters to film infected returnees being wheeled into American and British hospitals, the prospect of personal risk temporarily pierced our apathy. "If the outbreak is not stopped now," said President Obama, "we could be looking at hundreds of thousands of people affected, with profound economic, political, and security implications for all of us." It was, for a few weeks at least, the most important topic in global news.

Now, two years after the first cases were detected in Guinea in December 2013, the Ebola outbreak has been largely contained. In September of this year, the World Health Organization announced that initial trials of a vaccine developed by Canadian scientists had proved 100 percent effective at keeping the virus at bay. Months of panic and hysteria had yielded results: the prospect of effective immunization against a disease that had sown misery throughout Guinea, Liberia, and Sierra Leone, and fear throughout the world.

Yet for all the apparent success of the multilateral response to Ebola, an uncomfortable truth remains: Without the specter of global pandemic — without the Hollywood script of the unstoppable airborne contagion, the quickening spillage of red ink spreading inexorably over the world map — we probably would have turned away.

How many more developing world diseases could be vanquished if the G7's resources — what Merkel described as its "strong economies," its "high level of scientific expertise," and "values that stress the indivisible nature of human dignity" — were fully brought to bear on the causes?

"It takes less than 50 cents per year to treat and protect one person against the most common NTDs," says Dr. Peter Hotez, president of the Sabin Vaccine Institute and a leading advocate for NTD control. "We have seen progress, but currently treatment programs are only reaching about 40 percent of people at risk. We need to reach over 1.7 billion people." With sustained funding, campaigners like Hotez insist, several NTDs could be entirely eliminated within a matter of years.

In the meantime, these obscure pathogens will continue to ravage invisible lives: leprosy, a bacillus that mutilates the body just as it scrambles the nervous system; leishmaniasis, a virulent parasite transmitted by the bite of single sandfly; dengue fever, the prevalence of which has increased 30-fold in the past 50 years.

My fortnight in Hue left me feeling complicit in my ignorance. Had I been seeing real people as I traveled the tropics, or merely exotic ornaments to garnish my own experience, people who, through their poverty and difference, added color to my journeys? These two weeks of painful atrophy taught me more about the reality of life on the other side of the economic divide — the peril, the desperation, the crime of our indifference — than a decade of cheap seats travel ever could.


During my fortnight in that room, as the early fits of delirium and vomiting gave way to self-pity, the days fell into a routine of gruel-like food and hourly ministrations from the nurses: two of them each time — one to brandish the syringes to prick and plunge and pull, another to hold me down. Bloods out, antibiotics in, hour after hour, day after day. I tried to be grateful.

I'd just been lucky, I realized, as I slowly dragged myself back to the world of the living — lucky that the fever had taken hold in Hue, home to one of Vietnam's largest hospitals. A week earlier, I'd been in the Laotian jungle.

A week passed before I could walk unaided, another fortnight before I was capable of dragging myself out the door. When it was time to leave, I sought out the strident head nurse who'd revealed my diagnosis. She smiled, momentarily indulgent, then reacquired her equanimity with a curt handshake as if to say, "Off you go, melodramatic foreigner."

I watched her march back into the packed ward, where a hundred other patients were silent and supine. The girl in the next bed was still there, still wide-eyed and inert, as I turned to leave.


Back home, I was a medical marvel.

"So you had typhoid and dengue fever?" asked the specialist in a central London consultation room. "How wonderful," he added with undisguised delight, and prepared the blood beakers.

But still there was nothing — even in the expert hands of London's Hospital for Tropical Diseases — to hint that there was yet another disease still loitering in my system.

In the end, it would be three years until this final protagonist in my trio of tropical diseases finally revealed itself. In the lead-up to last Christmas, I started pissing blood.

A subsequent endoscope showed up several red and angry lesions stippling my bladder wall, and a biopsy revealed the culprit: a schistosome, a microscopic larva common to sub-Saharan Africa resulting in a condition known as schistosomiasis (also known as bilharzia or, in honor of the little mollusks that serve as the larvae's vector, snail fever).

My schistosomes had hitched a ride somewhere among Africa's Great Lakes region, burrowing into my foot before migrating to my bladder. And there they had loitered undetected, laying eggs, multiplying — just another potentially lethal NTD I'd never heard of, doing its thing.

The last time I'd been in the region, and the time I concluded I'd probably picked up my mollusk hitchhikers on the western shores of Lake Malawi, was just a couple of months before I'd come down with typhoid in India.

I guess providence had it in for me in late 2011.

In sub-Saharan Africa, I learned later, schistosomiasis affects more than 200 million people annually. Untreated, it can lead to chronic illness, renal failure, and death. Its cure, available to me on prescription from the National Health Service?

Just three film-coated pills.

Henry Wismayer has written essays and travel features for more than 60 publications, including the Wall Street Journal, New York Times, and Time Magazine. Follow him on Twitter @henrywismayer.


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