Shawdesh Desk: Improper management of dengue patients at their critical stage by district-level hospitals and private hospitals in Dhaka are leading to worst consequences like catastrophic health conditions and even death.

Dengue reportedly claimed so far 124 patients this year including two on Friday while more than 61,000 were hospitalised.

Most of the patients died this year due to dengue shock syndrome, a critical stage of a dengue patient when different organs of the patient become damaged due to drastic pressure fall and plasma leakage, doctors said.

They said dengue patients who developed shock syndrome were being brought to the tertiary level public hospitals at the eleventh hour and they were being referred to these hospitals without ensuring proper fluid management.

Their stay-time at the public hospitals was short as they were already at a terminal stage and there were times when patients died on the way to the next  hospital after being referred by secondary-level hospitals or private hospitals.

‘Undertaking journeys for better treatment bring catastrophic consequences to critical dengue patients and they also include death,’ said Robed Amin, associate professor of medicine at Dhaka Medical College Hospital.

‘Blood pressure may fall drastically and fluid management become crucial for dengue patients at their critical stage, which could be difficult to manage during the journey,’ he said.

On early Friday, 37-year-old dengue patient Shahanara Khatun in Satkhira died on her way to Khulna Medical College Hospital after she was referred from the Satkhira Sadar Hospital.

Shahanara already developed dengue shock syndrome three hours before her admission to the KMCH, where she was referred to and which was some 60 kilometers away from the Satkhira hospital.

‘Blood pressure of Shahanara fell at an extremely fast rate… she was in shock syndrome for about three hours and we referred her to KMCH because we thought she needed ICU support which was not available in my hospital,’ Satkhira Civil Surgeon Abu Shahin told New Age.

Shahin admitted that taking such a journey for such a critical patient was impractical, but he said, ‘We failed to make her stable.’

On Friday afternoon, 8-year-old Ariyan died of dengue at Dhaka Shishu Hospital, about 15 hours after he was admitted there.

He died of dengue hemorrhagic fever. When he was admitted blood leaked into his urine.

Dhaka Shishu Hospital epidemiologist Kinkar Ghosh said the child was admitted at the critical stage after he was referred from a private hospital in Badda.

‘Referring such patients is of utmost risk,’ Kinkar said, adding that blood administering and fluid management of such patients were crucial at such a stage.

‘But we often get critical patients at the eleventh hour from outlying districts and private hospitals,’ he said.

Kinkar said, so far 12 children died of dengue at his hospital and nine of them were admitted following referral of these patients from hospitals in the outlying districts and private hospitals in the city.

Kinkar said death rate of dengue patients were high in the private hospitals due to improper care of such patients.

‘Private hospitals often hire doctors and they pay visit at a certain time once a day to the dengue patients, though such patients need intense monitoring of blood pressure, blood leakage and plasma leakage,’ he said.

On Thursday morning, 40-year-old Gias Uddin died of dengue at the ICU of Dhaka Medical College Hospital, about six hours after he was admitted to the hospital.

DMCH associate professor Robed Amin said when Gias was admitted he was already in shock syndrome and three of his organs were not functioning properly.

‘Transferring such patients to other hospitals is extremely risky since there are issues like fluid management, ventilation and blood administration of such patients, which are not possible when the patients are being transferred,’ he said.

‘Undertaking a journey in such a critical condition may bring catastrophic consequences and even death,’ said Robed.

He said the dengue management guideline advises not to refer such patients without making them stable and without ensuring fluid management, but DMCH was receiving more than one-third of patients from outlying districts who should not have been referred in such a critical stage.

Kinkar of Dhaka Shishu Hospital said sometimes patients’ relatives became worried about the health of their dear ones and preferred taking them to a better hospital.

But the doctors should counsel them about the consequences of undertaking such a journey that might badly affect the dengue patient, he said.

Health Emergency and Operation Centre Control Room of Directorate General of Health Services said on Friday that at least 1,446 new dengue patients were hospitalised in the past 24 hours ending at 8:00am Friday.

At least 6,035 dengue patients were under treatment on Friday.

So far this year at least 61,038 dengue patients were hospitalised and 47 of them died, the control room said, though unofficial reports said at least 124 dengue patients died this year.