Political Instability, High Crime Rates, Poverty and Dengue Fever

"In another country there would be many sick but not as many deaths."
"The cure for dengue is political."
Eduardo Ortiz, adviser, Pan American Health Organization, Honduras

"As a parent [of a child with dengue], I wasn't well prepared."
"And as doctors, they weren't well prepared [to diagnose her child's illness]."
Wendy Carcamo, resident, Choloma, Honduras

"People are thinking about other problems [in their daily lives]."
"If I'm a mother and I have three children, four children, I'm going to be thinking about what I'm going to feed them, whether my son is running with the gangs."
"They'll be thinking least of all about dengue."
Dr.Dinorah Nolasco, regional health director, Cortes, Honduras

Children being treated for dengue fever at a hospital in San Pedro Sula, Honduras.  Credit...Daniele Volpe for The New York Times

There are other epidemics roiling parts of the world we hear little of, aside from the novel coronavirus striking China, that has the rest of the world on alert over its spread and threat as a new, unknown health danger. The World Health Organization has pointed out that developed areas of the world with thriving economies are well able to absorb the scientific and economic shock of dealing with a new virus that is demonstrating its potential to spread panic and death. Its concerns are mostly focused on less developed, less stable, less well-equipped emerging economies and how they will manage.

While international news media focus on the coronavirus, not much has been published to alert the world over an old concern, dengue fever, which is ravaging Honduras where 107,000 cases emerged last year killing over 175, in one of the worst dengue epidemics on record sweeping Central America killing a total of 400 people. Precisely the type of outbreak that many scientists and public health authorities warn may become more frequent and widespread in coming years.

An MSF health promotion officer speaks to children at the school in the La Lopez neighbourhood in Choloma, about how to prevent the spread of dengue and eliminate sources of infection. Honduras, April 2019.

Over 40 percent of the dengue deaths in Central America occurred in Honduras last year. Where issues such as government dysfunction, political unrest and public apathy have all contributed to its spread. Last year's outbreak exceeded that of the year before, where in 2018 three people died from the disease and in 2019, 175 succumbed. Transmitted by the Aedes mosquito known to thrive in urban areas in the world's tropical and subtropical regions, tens of millions of cases occur yearly in over 100 countries.

Symptoms include fever, internal bleeding and shock. And given that this is such a familiar disease, the symptoms so clearly identified, it is inexplicable that seven-year-old Jostin Pineda, taken to three private clinics by his mother, Wendy Carcamo, was misdiagnosed by each, and when the last of the doctors referred her to the region's main public hospital, so much time had elapsed that medical intervention was too late, and her child died.

This is a nation that suffers from high murder rates and widespread poverty. The public health system has been gutted through budget cuts and endemic corruption. Medical facilities lack the capacity to handle normal demands, much less that of an epidemic which has been particularly acute in the north of the country, the province of Cortes, its industrial heartland. It has a large migratory population of factory workers, a circumstance helpful in spreading the disease to other regions.

A patient suspected of having contracted dengue receiving treatment at a hospital in San Pedro Sula.  Credit...Daniele Volpe for The New York Times

One of the major factors that contributed to the spread of the epidemic was the shortage of trained personnel, admitted Dr. Dinorah Nolasco who described her medical teams' difficulty in gaining access to gang-ridden neighbourhoods. In Choloma, one of the main cities of Cortes, medical teams secured access to those neighbourhoods only following a meeting with community leaders who then negotiated with gang leaders of the areas that had become dengue hot spots.

Meteorological conditions were also identified as contributing to the outbreak, when Honduras endured severe droughts alongside bouts of intense rainfall, reflecting a pattern of increased weather variability which scientists feel are related to climate change. Residents in neighbourhoods without reliable public water supplies during extreme drought tend to store water in their homes, making them potential mosquito breeding sites. Heavy rainfall with subsequent flooding also provides breeding environments.

On a visit to Lopez Arellano, Dr. Nolasco as the regional health director in Cortes, visited the home of a family that had lost a child to dengue. Inspecting a basin where water was stored, she discovered hordes of mosquito larvae swimming about in the basin. Moving to the next home, the very same situation prevailed.

Health promoters measure a water tank so they can apply the exact amount of larvicide necessary for it to be effective. Choloma, Cortes, Honduras. October 2019.  

MSF/Arlette Blanco