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Medical assistance related to Dengue Fever in Indonesia

We care a lot of Dengue cases, especially in poor villages

A Covid-19 patient can also get dengue fever, which is also caused by a virus and for which there is no known cure

Vaccines are not effective against dengue fever

Extract | The COVID-19 epidemic has not slowed the onset of seasonal dengue fever across the country. The country has been battling dengue fever since early this year, at a time when state resources have been spent on curbing the COVID-19 outbreak. The similarities between dengue fever and COVID-19 symptoms have also complicated efforts to mitigate the annual spike in cases. In a recent press statement, the Meteorology, Climatology and Geophysics Agency (BMKG) said that while 51.2 percent of the country had entered the dry season, the rest of the archipelago was expected to experience prolonged rain for the next two to four months.

Beyond Corona: Dengue Fever Cases in Indonesia, how can we interact?

However, symptoms of dengue fever are different from those of Covid-19.

Dengue occurs is spread by mosquito bites and is due to the infection by a flavivirus which is transmitted by the bite of the ***Aedes aegypti mosquito. This mosquito bites during the daytime.

General information

In 2020, there were 35,315 reported cases of dengue fever and dengue hemorrhagic fever in Indonesia. This was a steep increase from the number of cases reported in 2019, which was 15,998. The reported cases do not reflect by far the real number of Dengue cases because a huge part of the population living in rural areas does not all have a birth certificate, identity card, or family record book!

Dengue fever is typically a self-limited disease with a mortality rate of less than 1% when detected early and with access to proper medical care. When treated, severe dengue has a mortality rate of 2%-5%, but, when left untreated, the mortality rate is as high as 20%. This mortality rate of 20% is that in force in the most rural and poorest regions. Those where access to care is almost inexistent, economic resources at the lowest.

Dengue fever is most common during the rainy season (November-May) as Aedes mosquitos require clean standing water to reproduce. The peak of the season is usually from March through May.

Dengue haemorrhagic fever (DHF) was first recognised in Indonesia in the cities of Jakarta and Surabaya in 1968. There is no vaccine against dengue fever, though several are in development. This mortality rate of 20% is that in force in the most rural and poorest regions. Those where access to care is almost inexistent, economic resources at the lowest.

Key facts about Dengue

  1. There is no specific treatment for dengue/severe dengue;
  2. Dengue isn’t spread from person to person;
  3. Dengue is spread by infected mosquitoes, usually the Aedes aegypti and Aedes albopictus varieties;
  4. These mosquitoes bite during the day, usually early in the morning or in the early evening before dusk. They’re often found near still water in built-up areas, such as in wells, water storage tanks or in old car tyres;
  5. The global incidence of dengue has grown dramatically in recent decades. About half of the world’s population is now at risk. There are an estimated 100-400 million infections each year;
  6. Dengue prevention and control depends on effective vector control measures. Sustained community involvement can improve vector control efforts substantially;
  7. Dengue fever can cause spontaneous bleeding, such as nosebleeds, red spots, and bleeding gums. Only around 10 to 15 percent of patients develop a cough and, unlike Covid-19 patients, they don’t experience respiratory problems;
  8. Dengue fever symptoms also include eye pain, headache, continuous vomiting, increased red blood cells, and a low platelet count (under 100,000 platelets*);
  9. The disease can infect people of all age groups, but most dengue fever patients in Indonesia this year in 2020, have been teenagers;
  10. A lot of teens suffering from dengue fever come to the hospital already in critical condition. Many of them are in hypovolemic shock or lacking fluid. They refuse drinks because it makes them vomit so they suffer from dehydration.

Dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS)

A rare complication of dengue fever, DHF occurs most often in small children and elderly adults. If DHF occurs, it will usually do so by day 3-5 of infection. The relationship between DHF and previous dengue infection has not been clearly established, but previous exposure to dengue is correlated with subsequent DHF. Uncontrolled bleeding distinguishes DHF from fever accompanying a dengue infection. Bleeding can occur from the gums, nose, intestine, or under the skin as bruises or spots of blood, especially under a tourniquet.

In children, the progression of the disease is not always characteristic. A relatively mild first phase with an abrupt onset of fever, malaise, vomiting, headache anorexia, and cough is succeeded 2-5 days later by weakness and, sometimes, physical collapse. Frequently, spots appear on the forehead, arms, and legs, along with spontaneous bruises and bleeding from punctures where blood was taken. A seriously ill child may breathe rapidly and with considerable effort; the pulse may be weak, rapid, and thready.

The criteria for DHF are a platelet* count of less than 100,000 and a **hematocrit 20% greater than normal. Children with similar blood indicators should be hospitalised immediately and managed for potential DSS. The syndrome can be lethal and requires rapid in-hospital management with assiduous correction and replacement of fluid, electrolytes, plasma, and sometimes fresh blood/platelet transfusions. Mortality due to DHF and DSS ranges from 5-30% in the untreated Indonesian population, with the highest risk category being infants under one year of age.

Symptoms of dengue – Usually develop suddenly, about 5 to 8 days after you become infected

  • A high temperature, or feeling hot or shivery
  • A severe headache
  • Pain behind the eyes
  • Muscle and joint pain
  • Feeling or being sick
  • A widespread red rash
  • Tummy pain and loss of appetite
  • The symptoms normally pass after about 1 week, although you may feel tired and slightly unwell for several weeks afterwards.

Treatment

  • There is no preventative treatment for the dengue virus. Its symptoms can and should be treated, but there is no medicine or commercially available vaccine for the virus. Vaccine candidates are going through clinical trials in many countries, but a safe vaccination protocol is not expected for some time.
  • It has been suggested that DHF is more likely if the patient has previously been infected by dengue fever within the last 8-12 months and that the likelihood of DHF relates to this previous “sensitization”.
  • To avoid getting dengue fever or DHF, you must avoid getting bitten by day-biting mosquitos.
  • Convalescence can take weeks, and bed rest and antipyretics and analgesics are required. An attack produces immunity for a year or more, but only to one of the four flavivirus strains responsible for the initial illness.
  • In an epidemic, the emergency control measure is mosquito insecticide applied outside by vehicle-mounted or portable ultra-low-volume generators a minimum of twice a day at ten-day intervals;
  • Take paracetamol to relieve pain and fever. Do not take aspirin or ibuprofen, as these can cause bleeding problems in people with dengue;
  • Drink plenty of fluids to prevent dehydration – if you’re currently abroad, only drink bottled water from a bottle that was properly sealed;
  • Get plenty of rest

Prevention

  • There are currently no vaccines;
  • The best method of prevention is to avoid mosquito bites;
  • Use insect repellent – products containing 50% DEET are most effective, but a lower strength (15 to 30% ****DEET) should be used on children, and alternatives to DEET should be used on children younger than 2 months;
  • Treatment is possible if diagnosis occurs before the patient develops DSS or DHF;
  • If you live in Indonesia, have your home sprayed. If you’re visiting Indonesia, hati-hati (be careful);
  • Common sense precautions can protect you from this day-biting mosquito;
  • Be aware of your environment – Mosquitoes that spread dengue breed in still water in urban areas;

Fair Future and its teams make a lot of prevention. Give explanations to communities in order to avoid illness, especially for young children.

DHF: Dengue Hemorrhagic Fever – DSS: Dengue Shock Syndrom;
*Platelets, or thrombocytes, are small, colorless cell fragments in our blood that form clots and stop or prevent bleeding. Platelets are made in our bone marrow, the sponge-like tissue inside our bones. Bone marrow contains stem cells that develop into red blood cells, white blood cells, and platelets;
**Hematocrit is the percentage by volume of red cells in your blood. Blood is made up of red blood cells, white blood cells and platelets, suspended in plasma. Together, those included about 45% of the volume of our blood, but the specific percentages of each can vary;
***Aedes Aegypti is a genus of mosquitoes originally found in tropical and subtropical zones but now found on all continents except Antarctica. Can spread dengue fever, chikungunya, Zika fever, Mayaro, and yellow fever viruses.
****DEET: N, N-Diethyl-meta-toluamide, also called DEET or diethyltoluamide, is the most common active ingredient in insect repellents. It is a slightly yellow oil intended to be applied to the skin or to clothing and provides protection against mosquitoes, ticks, fleas, chiggers, leeches and many biting insects.
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Donate to programs initiated by Fair Future and Kawan Baik Indonesia, and be on the ground with us. We are committed to ensuring that as many people as possible have access to a better and healthier life. We are focusing on creating solutions for sanitation and access to drinking water and clean water, sanitationaccess to energy sources, access to school and knowledge, access to medical care (basic and emergency care), especially for children, healthy food, women's rights, and minorities living in rural and ultra peripheral areas.

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Fair Future works every day to improve the living conditions of rural communities in eastern Indonesia.

One of the Foundation's tasks is to ensure equitable access to water in quantity and quality, in order to prevent diseases such as cholera, diarrhea, dysentery, hepatitis A, typhoid, and poliomyelitis. With, for children and vulnerable people, a high mortality rate., and maintain lives and livelihoods. This is to reduce environmental risks to health, by managing sanitation safely and with dignity. Still, the foundation seeks to involve women and men in the management of water resources, in sanitation by the implementation of safe hygiene practices in order to maximize the benefits for their communities.

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After building a new school, bigger, stronger, with materials resistant to storms, bad weather, earthquakes, Fair Future and Kawan Baik, as part of the program, we named “Rebuild MbinuDita “, continue to provide basic things for the lives of thousands of people there.

The program “Rebuild MbinuDita” is to give access to clean water to all the inhabitants of the community, but also to medical care, to healthy food through the creation of organic gardens. These activities have no other objectives than to increase the quality of their life, to provide better health to people (especially children, vulnerable people, pregnant women), access to health and medical care, and for people to be able to increase their income.

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Massive pest attacks that destroy all crops and starve the people

In East Sumba, for several days now, grasshoppers have been destroying all crops, vegetable gardens, soybeans, and corn. For three years, it has come back regularly. During high population years, they feed and severely damage almost all crops, trees, shrubs, and vegetable gardens. We are in contact with the most affected populations who tell us how the fruit of their work, their fields But also their garden, are totally destroyed in a few minutes. The impact is enormous for these poor families since their income is not enough to buy food. Rice in particular is expensive, therefore corn harvests are very important and vital for families. A new trade is in the process of being born: The sale of grasshoppers by the kilo; this is in order to eat and be nourished. The price is IDR. 5,000,000.- per kilo, i.e. less than 50 cents.

Fair Future and Kawan Baik change the nature of water

Clean water is life, health, food, leisure, energy… Water covers more than 70% of the Earth’s surface. It is in water that life on Earth began, so it is not surprising that all living things on our blue planet need water. Water is indeed many things: it is a vital need, a home, a local and global resource, a transport corridor, a climate regulator. And, over the past two centuries, it has become the end of the journey for many pollutants released into nature and a newly discovered mine rich in minerals to exploit. To continue enjoying the benefits of clean water and healthy oceans and rivers, we must fundamentally change the way we use and treat water.

There will always be people who live too far away, we are here to help them!

There are no toilets here, everyone practices open defecation. Furthermore, no one has direct access to water of any kind, and no access to a source of clean, drinkable water. Fair Future and Kawan Baik Foundations are changing that with the #waterconnections program, but there will always be people who live even further than far. We meet those people, all those families that we don’t forget. Thanks to all of you and our teams who are there, on the ground at the time of writing this line, they will also have access to one of our solutions, a borehole, a reservoir connected to the network…

Water is when we don’t have it that we realise how important it is!

Water we do not realize how important it is when we have access to it like that, by opening a simple tap and sometimes forgetting to close it. Water is when we don’t have it that we realize how important it is, how vital it is for our everyday life. So for a moment, let’s try to imagine what our life could be like without water. And if we have access to it, that this water is not consumable! This is what the families experience here, the children of all these villages in which Fair Future works almost 24 hours a day. The health of people, the prevention of diseases, the reduction of infant mortality, offering a better quality of life, food every day, a shower every day and for everyone are just a few aspects that oblige us to work and develop. innovative and sustainable solutions, relating to access to water in quantity and quality for families in the poorest and rural regions.

Magic works, construction continues, people are happy, there is water!

Having clean water close to home is a real challenge that Fair Future and Kawan Baik have taken on, so that the more than 2,200 villagers of Mbinudita can have clean water in their homes for the first time in their lives. This is so that everyone’s life is healthier, happier on all fronts, clearly more harmonious. Even if it is very hard physically, sometimes morally because we are isolated from everything and everyone, there is not a day during which we are not happy to be able to work within the framework of this immense project, one of the largest ever conducted by the Swiss foundation and its Indonesian twin sister, Kawan Baik Indonesia foundation.

Without or with very little water and food, it is very difficult to go to school!

Go to school, learn, concentrate, walk… All this with little water and food! This is the challenge faced by thousands of kids, their teachers and families. Not having enough water when you are a child, sometimes having to walk several kilometres to get to school. Not having enough to eat, not being able to wash. The difficulties of the teachers, their testimonies are revealing of the food, economic and access to water crisis which the children and their families have to face every day of their lives. Fair Future and Kawan Baik try to respond in the best possible way to these vital problems. Avoid malnutrition, improve health, provide access to a source of clean water so that children can go to school and learn in the best possible conditions.

Lifestyle habits: “-Because we’ve been doing it for a long time”

Pollution of streams and natural springs and everywhere. It is rare to find still pure sources whose water is not dangerous for health. Fair Future, within the framework of its prevention programs and access to better health, meets people from the most rural and poor regions of this immense country, offers affordable, simple and understandable solutions for all. At the same time, we are building clean water networks, we are drilling deep wells to provide access to quality water, in quantity, to families, children and vulnerable people.

The Water Crisis in Indonesia – Focus in Napu, Wunga, Sumba Timur

Drinking contaminated water can lead to serious health problems. Cholera, diarrhoea, dysentery, hepatitis A, typhoid, scabies, onchocerciasis, schistosomiasis, trachoma, typhoid and paratyphoid fevers, hepatitis, malnutrition and poliomyelitis, significant metabolic fatigue causing disorders of all vital systems, to death.
In the long term, consumption of water loaded with heavy metals, pesticides, nitrates and other chemical components such as arsenic are likely to cause serious congenital malformations in newborns: Limb deformation, hydro-encephalitis and other physical or mental disabilities.

Water Connections, the ongoing project on the MbinuDita Site

Where are we with MbinuDita’s Water Connections project? What are the funds that we have already collected, those that we have already invested in this vital project like never before for more than 2000 people without access to clean water? We present to you via a small infographic what we have already done, what remains to be done and the schedule for the next steps.

For the #WaterConnections Program, we have raised 42% of the budget!

We want to thank all those who help us in this project and are proud to announce that we received in donations, approximately 42% of the total budget. We encourage you all to do even more to carry out this vital project for more than 200 families, more than 2000 people, women, and children who do not have access to clean water. Without water in quantity and quality, living conditions cannot improve and people become sick and die. Without water, there is no green, no blue, no life. Without water, there are no plants, no trees, no fruits, no vegetables, no food.

Common diseases we work on

Tuberculosis in Indonesia: A social disease affects the poorest communities, those living in difficult conditions. There are hundreds of thousands of new cases in Indonesia, such as HIV, which is not often mentioned here!

Dengue virus infection: DENV is a real major cause of acute febrile illness here. In the most affected regions, mortality is very high & affects the most vulnerable. Especially for those who do not have access to medical care.

Malaria and the vulnerable: Every year, malaria kills thousands of people in Indonesia, in all regions, even the richest. 70% of all deaths are children under five, and affect people and families who cannot access medical care.

Antimicrobial resistances. In here, this is a real health emergency, almost all drugs are available over the counter! This scourge turns simple wounds and easily treatable diseases into causes of death.

Air pollution and health: Plastic that burns, everywhere! Air pollution is responsible for almost 50% of mortality here. Dioxins, furans, mercury, and polychlorinated biphenyls are highly toxic!

Malnutrition and famine: Malnutrition causes serious illnesses where we are! The phenomenon, creating a vicious cycle of starvation & disease. This is a major problem in which we deal with!

Medical care for children: Far too many children still die from easily preventable problems, especially in their first few days/weeks of life, as well as from diarrhea and pneumonia. Access to clean water and good sanitation solutions is one of the future goals to help them get better.

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