An "isolated" side-room, but only by name. The transparent window panes and the open door do little to seperate this patient from the rest of the Intensive Care Unit. We sidle in one by one, until there are about a dozen of us around the bed. The discussions begin.
A dark, vertical line across her abdomen confirms that she was pregnant until three days ago. Having lapsed into a coma shortly after delivering, she has yet to see her baby. She was admitted to the hospital two days earlier, complaining of fever, headache and generalised aches. Now she is unconscious, and bleeding. In fact, she hasn't stopped bleeding since giving birth. 15 units of blood, three times her circulating volume, have been transfused. But we are only buying time, and at a very high cost.
The problem with dengue is that it can make you bleed for a week, sometimes two. That's an awful lot of blood. It may well be that she's unconscious because of a bleed in her brain as well, but an ambulance transfer to a scanner, when you're connected to a ventilator and being transfused, is not a feasible option. It's far from obvious what the next step should be.
Out of the two crossed conversations taking place, I try to block out the Vietnamese and concentrate on the English. My mind invariably drifts back to the fascinating sounds and intonations of the Vietnamese, which try as I might I cannot yet reproduce; the only word I can make out is "dengue". Like the mosquito-borne virus it describes, the word has spread from the African continent (dinga, Swahili for "cramp") to most of the tropics. Some say that the Swahili origin was influenced in the West Indies by the Spanish dengue, meaning "prudent" - a reference to the gait adopted by sufferers. The muscle and joint pains which account for this gait have also earned dengue the nickname "break-bone fever".
Today dengue accounts for 50 to 100 million infections every year. Repeated infection can lead to life-threatening dengue haemorrhagic fever - while our patient only has a milder form of this bleeding disorder, the coincidence with her labour could yet prove fatal. There is no cure for dengue: all we can hope to achieve is prevention, hopefully through vaccination.
If and when dengue becomes a rare disease of Ancient Times, its name will perhaps serve to remind us of the suffering it caused for centuries.
Progress towards a dengue vaccine (Webster, Farrar and Rowland-Jones)
A dark, vertical line across her abdomen confirms that she was pregnant until three days ago. Having lapsed into a coma shortly after delivering, she has yet to see her baby. She was admitted to the hospital two days earlier, complaining of fever, headache and generalised aches. Now she is unconscious, and bleeding. In fact, she hasn't stopped bleeding since giving birth. 15 units of blood, three times her circulating volume, have been transfused. But we are only buying time, and at a very high cost.
The problem with dengue is that it can make you bleed for a week, sometimes two. That's an awful lot of blood. It may well be that she's unconscious because of a bleed in her brain as well, but an ambulance transfer to a scanner, when you're connected to a ventilator and being transfused, is not a feasible option. It's far from obvious what the next step should be.
Out of the two crossed conversations taking place, I try to block out the Vietnamese and concentrate on the English. My mind invariably drifts back to the fascinating sounds and intonations of the Vietnamese, which try as I might I cannot yet reproduce; the only word I can make out is "dengue". Like the mosquito-borne virus it describes, the word has spread from the African continent (dinga, Swahili for "cramp") to most of the tropics. Some say that the Swahili origin was influenced in the West Indies by the Spanish dengue, meaning "prudent" - a reference to the gait adopted by sufferers. The muscle and joint pains which account for this gait have also earned dengue the nickname "break-bone fever".
Today dengue accounts for 50 to 100 million infections every year. Repeated infection can lead to life-threatening dengue haemorrhagic fever - while our patient only has a milder form of this bleeding disorder, the coincidence with her labour could yet prove fatal. There is no cure for dengue: all we can hope to achieve is prevention, hopefully through vaccination.
If and when dengue becomes a rare disease of Ancient Times, its name will perhaps serve to remind us of the suffering it caused for centuries.
Progress towards a dengue vaccine (Webster, Farrar and Rowland-Jones)
No comments:
Post a Comment