Thursday, September 22, 2005

MP Dr Tan Cheng Bock's plea to the government in Parliament on measures to "prevent dengue patients from infecting others"

The following article extracted from Electric New Paper (21 Sept 2005). Another potential "I told you so" about the government's refusal to hospitalise/quarantine all suspected and confirmed dengue patients.

"My body was covered with tubes and drips
That's why I feel for dengue sufferers, says MP Tan Cheng Bock. He was seriously ill with meningitis in July. Yesterday, he gave hospitals an earful in Parliament for the way they treat people with dengue
HE was speaking as a doctor who had just gone through a life-and-death struggle himself.
By Clarence Chang


21 September 2005

HE was speaking as a doctor who had just gone through a life-and-death struggle himself.
Unknown to many, the affable Dr Tan Cheng Bock, 65, had been struck down by viral meningitis, an infection of the brain, in mid-July.
He was at Singapore General Hospital, his 'whole body covered with tubes and intravenous drips', for two weeks.
He lost close to 7kg, and had to learn to walk properly again before he could return to work at his GP clinic just a fortnight ago.
That was also when public fears about the dengue outbreak reached its peak.
'I remember when I was ill, I couldn't follow so well at first because my head was splitting,' Dr Tan told The New Paper.
'Initially they also thought it was dengue, but it turned out not to be so. So I have special interest in this.'
True to form, the always passionate backbencher made a heartfelt plea in Parliament yesterday for local hospitals to admit, not send home, every dengue-infected patient - even just suspected ones.
His concern: 'You are bringing in a reservoir of infection, who should be in hospitals and sheltered, back into the community... It is a very dangerous practice.'
Most of the Government's measures so far, said the veteran Ayer Rajah MP, is aimed at 'catching the mosquito'.
'But what measures are we taking to prevent dengue patients from infecting others?'
From what he's seen, he told The New Paper, even high-fever patients with a blood platelet count of about 100 are being 'released', although the all-clear should only be given once they regain a healthy level of at least 150.
And these patients, tired and weak, could still be in their five-day 'infectious' period. So one bite from an Aedes mosquito which later bites someone else is all it takes for re-infection to happen.
That's why mindful of the chronic shortage of hospital beds (see report below), Dr Tan wants the inter-ministerial committee on dengue to set aside part of its $30-million budget to build special quarantine units instead, next to the main premises.
Rather than just asking those with symptoms to go home, rest and apply insect repellent, 'I would advocate sheltering, isolating, ring-fencing all these patients'.
In fact, get the 'army chaps' to man the isolation units and doctors to monitor them daily, he added.
An over-reaction? Former patient Ho Lian-Kuang, 22, feels forced quarantine is 'too serious' a measure, and should only be reserved for the 'irresponsible' ones or those who truly need medical attention, like the elderly.
Like many others, Mr Ho, 22, had also been sent home on his first visit to SGH last month, but was admitted the next day after his platelet count dropped to 76.
But overall, he said: 'I'd much rather take my own precautions and spend time with my family at home.'
Dr Tan doesn't think that's a good idea.
Why? Because although he now spends just three hours a day at his clinic, he already sees an average of one dengue patient daily. And with islandwide numbers climbing to over 600 infections a week, the 'reservoir' is growing bigger.
'We send them to hospital. Hospital says no need to admit, go back. But he's still feverish. Next day, he comes back to me. We have to do another blood test. His platelet count falls to 50. Then we send him back to hospital.'
SAYING IT STRAIGHT
Add to this the cost of transport, the inconvenience of getting a loved one to take leave to accompany you, the need to fork out cash at the hospital instead of upfront Medisave payments, and you get the picture, the MP explained.
'I've been in practice for 30-plus years. I've seen dengue as a medical student... Previously, when dengue patients went to hospital, they didn't come out until they were well. So there was no chance of community spread.'
This, coming from a community doctor clearly frustrated at the re-emergence of dengue.
'I hope I haven't frightened people,' Dr Tan said. '(But) I'm just going to say it straight. I'm not going to pretend.
'In fighting any infectious disease, isolation is very important. Any leakage, we must stop it.'
His parting shot to hospitals? If you say you have no choice but to turn away patients because of lack of beds and other resources, you haven't planned enough.
'Let this be a lesson for hospital authorities. Dengue is already a national problem. Lurking around the corner is the Avian flu.'

Decision on isolation units: Leave it to the experts

WILL we soon see the return of isolation units on hospital premises?
Senior Minister of State for Health, Dr Balaji Sadasivan, believes it's a decision best left to the government-appointed panel of experts studying the sudden upsurge.
'We need some science in dealing with this problem,' he said.
So far, the panel has recommended that patients simply 'cover themselves with insect repellent'.
As to whether hospitals should admit all dengue patients, Dr Balaji says he'll defer to the World Health Organisation's 'clinical criteria'.
For now, 'the majority of patients can actually be treated as outpatients,' he said.
Between May and August alone, the percentage of beds taken up by dengue patients had gone up from 0.8 per to 3 per cent at the National University Hospital, and from 2.7 to 6 per cent at Tan Tock Seng Hospital.
Dr Balaji also said there's 'no necessity' for self-quarantine.
'Because this is not an infection that spreads directly from one person to another. So any amount of human contact is safe,' he said.
Likewise, it's safe to go to nature parks even though there are 'large mosquitoes flying around and they're the noisy variety'.
Dr Balaji explained that these are not dengue-carrying Aedes mosquitoes which usually breed in 'urban' areas and in buildings.
Earlier, Environment and Water Resources Minister Yaacob Ibrahim, who heads the inter-ministerial committee on dengue, urged all patients to heed their doctors' advice.
'They can apply mosquito repellent on themselves, wear long-sleeved clothing, sleep under mosquito nets and keep their rooms mosquito-free,' he said.
Last weekend's anti-dengue blitz across four estates, the minister revealed, had uncovered 172 breeding sites, with flower pots and litter making up more than half of the cases.
As of last Saturday, overall dengue infections this year had reached an all-time high of 10,237.

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