Two deaths and a denial: The Dengue outbreak in Anantapur and ‘negligent’ hospitals

Sanitation workers in Anantapur district in Andhra Pradesh are working twice as long these days. Not because of a new work-schedule, but because of extensive media coverage about the deaths of two siblings who lived in an area with poor sanitation.

Twelve-year-old S MD Idrees and nine-year-old S MD Junaid had died after being treated for dengue for over five days, across several hospitals, the last one being in Bengaluru where they died.

The preemptive measures, which should have been taken before the monsoon, were only initiated after the outrage over the deaths of two children.

(In Vinayak Nagar, where the two siblings lived, the drains remain uncovered and the sanitary measures will provide only a temporary relief. Image: Ayesha Minhaz)

The deaths also resulted in the suspension of the sanitation supervisor, and temporary shut-down of over 500 registered medical practitioners (RMP) across the district. Despite all this, the district administration maintains that the siblings didn’t die of dengue.

“The two siblings didn’t die of dengue. It was a case of negligence by a registered medical practitioner (RMP),” said Dr Venkata Ramana, district medical and health officer, Anantapur.

The two children were treated at five private hospitals in five days before Idress (the 12-year-old) succumbed, with a platelet count lower than 30,000, multiple organ dysfunction and pulmonary hemorrhage, among other medical complications.

“After Idrees died at Rainbow Hospital in Bengaluru, we didn’t want Junaid to die too. He was on the ventilator and died before we even left Bengaluru on our way back to Ananthapur,” said Shaik Khalander, the father.

The family spent around Rs. 3 lakh for the treatment of two children, across five private hospitals in five days.

“At every private hospital, the doctors said that our sons were being treated for dengue and that it is a rare case. Without investigation, the officials announced that it is not dengue and called it a case of neglect,” Khalander added, wiping his tears.  

(Such large open drainage collegection points are a common sight in Anantapur. Image: Ayesha Minhaz)

As part of the investigation, officials from the district administration allegedly took away one of the initial medical reports of the children, and never returned it to the family.

“An official claiming to be from the Collectorate took a report of Chinnari Hospital (Anantapur) stating that his superiors wanted to check it. We had to approach the hospital for a duplicate,” Khalander said.

What appears to have interested the district officials is that the report contained details of children being tested for dengue using the rapid method, and not ELISA.

“There are two tests used to diagnose dengue: The rapid test and the ELISA (enzyme-linked immunosorbent assay). The first one can throw a false positive. The ELISA, however, is confirmatory. Thus, unless patients have been tested using ELISA method, they won’t be considered as confirmed cases of dengue,” said Dr Ramana.

While ELISA is used to rule out the false positive, the implementation of a rule that requires that the blood samples of the suspected dengue patients be sent to government hospitals for confirmation has been lax.

In the case of the death of the siblings, the samples weren’t sent to any government hospital, neither in Anantapur, nor in Bengaluru.

“We have recently set up the hospital and applied for the credentials with the Bengaluru authorities. Also, the government notified labs don’t work around the clock and at times results take as long as a week,” said Dr M Sridhar, a consultant pediatrician at Rainbow Hospitals, Bengaluru.

In cases like that of the siblings’, the focus is more on the rapidly deteriorating health condition, he added.

On being asked if the children were being treated for dengue, Dr Sridhar responded in the affirmative. However, the records will show “suspected dengue”, as only government authorities can announce a case of dengue.

Besides these two deaths, the regional media has carried reports of at least eight dengue-related deaths in Anantapur district--a claim that the administration has refuted.

(Sanitation workers burning the garbage has become a common occurence after the dengue scare. Image: Ayesha Minhaz)

“There has been only one confirmed dengue death. Another death is under investigation. There were 90 confirmed dengue cases in the district in September,” said Dr Ramana.

Fourteen-year-old Srija, a resident of Dharmavaram, is the other case which Dr. Ramana is referring to. She had developed fever and was shifted to Bengaluru after symptoms worsened.

“In Anantapur, anyone who can afford or arrange to raise debt to go to Bengaluru will never get treated at the Government General Hospital,” said Khalander.

Terming the facilities at government hospitals appalling, M Geyanand, the member of legislative council (Kadapa, Anantapur and Kurnool), sat on indefinite fast on September 19. He was forced to break the fast after three days.

“We have been requesting the government to improve the infrastructure since 2010. A super-specialty government hospital was sanctioned, but work hasn’t started. How do we know that the quality of treatment at private hospitals is good? They aren’t even accountable,” rued Geyanand.

The dengue ward for children has seven patients currently and only four beds, forcing the children to share beds. The children being treated for other diseases are separated by just a door.

A risk of dengue affecting other patients can’t be ruled out, because, as WHO states, “The mosquito becomes infected when it takes the blood of a person infected with the virus. After about one week, the mosquito can then transmit the virus while biting a healthy person.”

“The government hospital has excellent pediatricians. However, three nurses and 60 beds can’t handle 200 patients; it is humanly impossible,” he added.

“At any given time, there are at least 1,000 inpatients while the hospital has infrastructure only for 350. There are around 1,500-2,000 outpatients on busy days, but there is a 60% shortage (510 employees) of paramedical staff and fourth-grade employees,” said Dr A Jagannath, superintendent of the Government General Hospital, Anantapur, adding that they aren’t well-equipped to handle the rush during seasonal illnesses.

For now, the hospital administration has loaned beds on a temporary basis.