Community action against Dengue
In the courtyard of a health centre in Managua, Nicaragua, a mother and daughter share a supportive smile. Their expressions convey joy and confidence. They have just shared with us a story of survival and empowerment. Having had a very hard personal experience with dengue fever, both are now community volunteers in a Nicaraguan Red Cross vector control operation.
In 2019, the Central American region suffered the most extensive dengue epidemic of the decade. More than one million people have been affected by the outbreak, with the highest numbers of cases reported in Honduras and Nicaragua. The Red Cross is working in these two countries, as well as in Costa Rica, El Salvador and Guatemala, to empower local communities to cope with both the current crisis and possible future outbreaks.
With the support of the International Federation of the Red Cross and Red Crescent (IFRC), National Societies are working alongside communities in the most affected areas to equip them with the information and materials necessary to control and mitigate the effects of the current outbreak, and prevent future ones. This community-based approach is known as Community-Based Epidemiological Surveillance (CBES), and has been used in the region before with positive results in other epidemic crises, such as zika in 2016. This strategy allows community members themselves to identify risks in their environment and take action to eliminate or mitigate them, empowering them to become active agents of change.
The first step of CBES is to identify social leaders who, working together with National Societies, organize community groups. Once these groups are formed, the Red Cross provides them with information on the outbreak so that they can identify warning signs and know what referral routes to health care are available if a potential dengue case is identified, as well as what hygiene and sanitation measures should be taken to prevent and mitigate outbreaks. Based on this information, communities create risk maps and plans to implement preventive and mitigation measures. The final step of CBES is the implementation of these plans through breeding site identification and elimination campaigns, home visits in which they replicate the information learned about dengue prevention, and outreach activities in schools.
A life-changing disease
At a recent activity with community volunteers in Managua, Karen Rodriguez, a Nicaraguan Red Cross volunteer, shared her experience with dengue fever. Her daughter, Jade Gámez, had suffered from dengue three times, at the age of 11, 12 and 13. The last of those times, Jade had been diagnosed with severe dengue, and the girl suffered kidney and liver damage as well as a preinfarction.
Children under the age of 15 are a particularly vulnerable group. In August 2019, 66% of the deaths reported in Honduras as part of the current outbreak were under 15 years of age, and in Guatemala, 52% of the severe dengue cases reported were also in this age group.
Having survived such a serious illness, mother and daughter are now volunteers with the Nicaraguan Red Cross. As part of the current operation, their work consists on replicating the information received among their neighbors, as well as carrying out clean-up campaigns to eliminate breeding grounds in their community. "We both do the same thing - when one can't go to the clean-up activities, the other one goes," says Karen. For them, this is an opportunity to help their neighbors avoid going through the same experience they went through years ago. "Now that I am supporting the Red Cross and I can help people, I feel calm, I feel happy," says Karen. "More than anything, so that people don’t go through the same experience I went through," adds Jade.
Dengue fever outbreaks are cyclical and peaks occur around the world every year during rainy seasons, with extensive epidemics occurring at a frequency of every four to five years. In 2019, the World Health Organization recognized dengue as one of the top ten threats to global health, with an estimated 40% of the world’s population currently at risk. Epidemics can have a devastating effect on the most vulnerable groups, such as children. That is why it is important for National Societies to work on advocacy and capacity building to continue to empower communities in preparing for and responding to dengue and other vector-borne diseases such as zika and chikungunya.
Indonesia: Red Cross continues to support as further rains are forecast
Volunteers and staff from Palang Merah Indonesia are continuing to support flood-affected communities as the country braces for further heavy rains and storms forecast in the coming days and weeks.
Flash floods, flooding and landslides have killed 67 people and injured a further 110 since the crisis began on 28 December. Since then, more than 100,700 people have been displaced from their homes and communities in 255 sites across North Sumatra, West Java, Bengkulu and Jakarta. At the height of the crisis, some 300,000 people were displaced in the greater Jakarta metropolitan area alone.
Palang Merah Indonesia has deployed 455 volunteers and staff, 15 ambulances, 13 water tankers, 12 rubber boats and nine trucks in support of the affected communities, and has provided more than 90,000 food packages in the Central Jakarta and West Java areas.
The teams are responding on several fronts: helping people to evacuate and supporting them in centres; helping people to return home when it is safe to do so; providing first aid, health services and emotional support; and distributing clean water and running public kitchens. Volunteers and staff are also helping people clean the mud and debris left behind and spraying disinfectant to reduce the risk of diseases such as dengue and leptospirosis.
The heavy rains that caused the disaster were the most intense since records began in 1966, with Indonesia’s Meteorology, Climatology and Geophysics Agency measuring 377 mm of rainfall on New Year’s Eve at an airport in East Jakarta. Rainfall above 150mm per day is considered extreme.
The flooding and landslides have caused extensive damage to buildings and infrastructure, including hundreds of homes and 20 bridges. A state of emergency is still in place in several flood-affected areas.
Kuwait Red Crescent Society
Yemen’s healthcare system on the brink of collapse
Text and photos: Julie Lorenzen, Danish Red Cross
His brown eyes look tired – almost absent – and the skin is way too pale. He speaks with a voice that is difficult to hear.
Nine-year-old Luai and his mother are visiting a primary health clinic, run by Yemen Red Crescent Society in Yemen’s capital Sanaa.
Luai has been sick for a while with a fever that shows no sign of abating.
“His body is weak. He was fine, when he was little, but then his body started to weaken. I am worried, he cannot fight diseases,” says his mother Fatima.
Doctor Anisha examines the little boy and it does not take her long to conclude that he is malnourished and has anemia. There is also a risk that Luai is suffering from internal parasites, a condition common in many Yemeni children.
Doctor Anisha prescribes iron and multivitamins. That is all she can do.
But this visit to the clinic is a short-term solution. When Luai goes home, his parents can only afford to buy rice and bread because of the sky rocketing food prices in Sanaa. Vegetables are a luxury the family can only afford once a month - like so many other Yemeni families who suffer from the impacts of the 5-year long conflict.
Lack of medicine and doctors
According to doctor Anisha who has worked in the clinic for 17 years, Luai’s story is sadly familiar.
“Five years ago, we did not see many cases of malnutrition”, she says.
“But now there are cases in all health clinics around the country. I am worried because it affects their ability to learn in school. We only see the mild cases in this clinic.”
Doctor Anisha also sees many malnourished pregnant women which can lead to complications like low birth weight and premature births.
According to UN OCHA 3,2 million women and children in Yemen are acutely malnourished - the number of children suffering from severe acute malnutrition has increased by 90% in the last three years.
And it is not only malnutrition the children suffer from.
“We see that diseases like measles, diphtheria and chicken pox have returned. They were not present before the conflict,” says doctor Anisha.
She used to vaccinate the children, but the clinic can no longer provide this vital service. The vaccinations need to be stored in a cold place, but because of the lack of electricity and fuel, this is no longer an option.
It is the same story with the X-ray machine which has not been working since the beginning of the conflict. And the ultrasound scanner has been silent for the last year, since the clinic cannot afford to pay salary to an ultrasound doctor who can operate it.
Doctor Anisha is the only doctor to help the approximately 40 patients who come to the clinic every day.
“We need more doctors and nurses in the clinic,” she says, adding:
“And we need medicine to treat patients with hypertension and diabetes. We can check their blood pressure and blood sugar, but we cannot give them medicine. Medicine is the most important.”
The clinic has a laboratory, but currently they cannot carry out liver, kidney and cholesterol tests because of lack of equipment. Today it is free for the patients to get tests done in the laboratory, but in the future, the clinic might be forced to demand payment.
It is not going to be easy for the patients.
“Our patients are poor,” says doctor Anisha.
Stay and risk your own life
Many doctors and nurses have fled from the conflict in Yemen. But not Doctor Anisha.
“The future is horrible. If you stay here, you are killing yourself. But I stay and do my best. I cannot leave my patients here. I would feel bad, if they came and asked for me, and I wasn’t there.”
“We help people the best we can.”
According to UN OCHA an estimated 19.7 million people in Yemen lack access to basic healthcare.
But only 51% of the health facilities are functioning.
The Yemen Red Crescent Society currently runs 22 health facilities around the country.
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