KARACHI: Slow response from the government to tackle a viral fever outbreak in Malir has compounded the miseries of poor patients who are neither getting free medicines nor proper medical attention at the Sindh government hospital in Saudabad, the largest public sector hospital in the area, a visit to the health facility showed on Monday.

Hundreds of patients complaining of high-grade fever and severe joint pain have been reporting daily at the hospital for over a month, though the health department is yet to identify and confirm the viral disease believed to be ‘chikungunya’ by some doctors.

During the visit, almost all the departments of the 200-bed facility, the Sindh Govt Behbehani Hospital, Saudabad, were found packed with patients having high-grade fever and severe joint pain or related health issues after recovering from fever.

Patients, most of whom were daily-wage earners, were compelled to buy medicines from a private pharmacy on the hospital premises as free medicines were not available at the government store.

“What’s the use of coming to a government hospital if the poor can’t get free medicines from here? People like us can’t afford to go to a private health facility. How can we buy a Rs500 capsule when we don’t have enough money to have three meals a day?” questioned Zeenat, an old patient waiting for her turn at the hospital.

Her husband, who lost his eyesight some months ago, suffered from the same disease at home. “I couldn’t bring him. He used to sell vegetables but now with this illness he can’t do that. I have no money to treat myself or him,” she said.

Standing near her at the medical outpatient department was Shamir, in his late 20s, who had to lose his daily earning of Rs750 in order to visit the hospital. “I have been suffering from high-grade fever for the past two days and my lower joints have become so painful that I can’t even stand,” he said, expressing his concern over the implications of his health condition on his livelihood.

There were also patients whose entire families were suffering from the disease. Among them was Yasmeen. “Our family of seven has been affected by this crippling disease for one and a half months. We all have recovered from fever but still find joints very painful. The body is too stiff in the morning and we are unable to do our daily chores,” she explained.

Conversations with patients also showed that the facility had failed to cope with an increasingly high number of patients. Absence of counselling measures had added to confusion among patients, as they couldn’t understand why they hadn’t completely recovered despite using medicines for weeks.

“I have been using the medicines recommended by a doctor for over a month but I still have pain in the joints and couldn’t resume my normal routine. I think these medicines are substandard,” said another patient.

Around 80 hospital staff members, including 20 doctors, too, have fallen victim to the disease in recent weeks. One of them was Dr Farhat Pirzada at the gynaecology section. She said: “Though I fell ill last month and took five days to recover from fever, my joints are still painful. I can imagine what patients have been going through. I am daily examining 25 patients with viral fever out of 60 in the OPD.”

Patients, she said, were being prescribed only those medicines which could alleviate fever and pain, as there was no other treatment for the viral fever. However, she believed, patients deserved some treatment for prolonged joint pain.

According to doctors, patients are coming to the hospital from all neighbouring localities. They said the outbreak of viral fever was not limited to just one health facility in Malir.

Dr Imtiaz Hussain at Atiya General Hospital at Kalaboard, Malir, said: “We have been receiving an alarming number of patients with high-grade fever along with joint pains since the beginning of this month. I have never witnessed this kind of outbreak in my 30 years of practice.”

According to him, what is making this viral fever different from dengue is drop in the total leukocytes count and no reduction in the blood platelet count (as found in the case of dengue).

Linking the viral outbreak to unhygienic conditions prevailing in the city, Dr Sayeda Rabia Najam at Al-Mustafa Welfare Society Hospital in Saudabad asked the government to initiate cleanliness drive in the city. No government official had yet visited the health centre.

“We are daily receiving around 800 patients with these complaints. I think it’s a mosquito-borne viral fever, called chikungunya,” she said.

Rejecting the impression of delayed response, director health services Dr Abdul Waheed Panhwar said the health minister, government officials and a team of experts had visited the facility.

“The medical superintendent of the Sindh government hospital has been asked to take a few patients to the Aga Khan University Hospital to test their samples. Some samples will also be sent to the National Institute of Health in Islamabad,” he explained.

No other public-sector hospital in the city had so far reported the viral fever outbreak, he claimed. The Saudabad hospital would be fully supported by the provincial government, he said, adding that additional staff had already been deputed there.

Ikram Junaidi adds from Islamabad: The Ministry of National Health Services (NHS) has issued an advisory to the health department of the Sindh government to clear up any misgivings or fears about the viral disease, Chikungunya.

“The disease does not require any treatment. A patient will automatically recover within five to six days. So a patient just has to take Paracetamol or any other similar medicine. I suggest that people should not get panicked,” said Dr Asad Hafeez, the director-general of health department, while speaking to Dawn.

Rejecting the media reports that thousands of people had been suffering from the viral disease, he said it was too early to arrive at such a conclusion as no single case of the viral disease had been confirmed so far.

“Some samples are being sent from Karachi to Islamabad [to the] National Institute of Health (NIH) and it will take almost a week to confirm the virus,” he explained.

Dr Hafeez said: “Whenever a patient is tested for dengue and it is diagnosed that the patient is suffering from Chikungunya virus, it is considered good news, because casualties can be reported in dengue but a patient never dies from Chikungunya virus.”

The DG health said Chikungunya virus was not a new disease for Pakistan, as it spread from time to time and the precautionary measures for the viral disease were the same as for dengue. People just need to take steps to avoid mosquitoes, he said.

Federal NHS Secretary Ayub Sheikh said the situation was under control. Yet the NIH had been put on alert to ensure that the process of testing the samples was started as soon as the sample would be received, he added.

According to the health advisory, there are unconfirmed reports about the presence of Chikungunya virus in Karachi, especially in the areas of Malir.

It says the ministry, World Health Organisation (WHO) in Pakistan and health departments are working closely in the wake of these unconfirmed reports and carrying out epidemiological investigations.

It explains that Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash.

Joint pain is often debilitating and can vary in duration. The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common. There is no cure for the disease. Treatment is focused on relieving the symptoms. The proximity of mosquito-breeding sites to human habitation is a significant risk factor for Chikungunya.

According to the WHO, the disease occurs in Africa, Asia and the Indian subcontinent. In recent decades, mosquito vectors of Chikungunya have spread to Europe and the Americas. In 2007, disease transmission was reported for the first time in a localised outbreak in north-eastern Italy.

Published in Dawn December 20th, 2016