VIJAYAWADA: Krishna district, which has a population of about 45 lakhs, has only two hospitals where ELISA test facility is available. Sadly, one of them at District Headquarters Hospital, Machilipatnam has been dysfunctional for almost three years. As a result, all blood samples of fever patients across the district are sent to the Government General Hospital, Vijayawada for dengue determination. These two hospitals have been designated as Sentinel Surveillance Hospitals.
According to the World Health Organisation (WHO), a sentinel surveillance system is used when high-quality data is needed for determining certain disease that cannot be obtained through a passive system. It has medical staff specialised in diagnosing and treating cases of the disease under surveillance. Across the country, there are 646 SSH for dengue and chikungunya and Andhra Pradesh has 19 such hospitals to determine and monitor dengue and chikungunya cases.
Speaking to TNIE, a senior official of the district health department on condition of anonymity said, “There is hardly any impact on dengue testing due to the non-functioning of ELISA facility at the Machilipatnam hospital. Patients are being treated in the normal way and the samples are being sent to Vijayawada, which is just an hour away. While it takes six to seven hours to get test reports in Vijayawada, it takes two hours more in Machilipatnam if journey time is taken into account. We have written to the Centre about the need for urgent repairs to the equipment.”
Meanwhile, district health department officials said private hospitals are not keeping the government informed of dengue cases and fleecing patients by creating a scare. Only 18 of 572 samples sent by private hospitals to the GGH, Vijayawada since January this year tested positive for dengue.Till September 30 last year, the laboratory tested 1,243 samples for dengue, swine flu, hepatitis A, E, C and B. Of them, 271 tested positive for various viral diseases. As many as 4,065 samples were tested from January to December in 2017 for dengue. Of them, 300 tested positive for dengue. Of the total samples tested, 3,088 samples were sent by GGH, 908 by private hospitals and 69 came from primary health centres (PHC).
This year since January, 1, 992 samples for suspected dengue were tested in the district. Of them 42 samples from GGH and 18 from private hospitals tested for dengue. A majority of the private hospitals in the district are conducting NS1 rapid test and diagnosing every fever case as dengue to make a fast buck. As much as Rs one lakh is being charged from each patient. The NS1 test gives positive result for viral fevers like malaria, chikungunya, etc. Without ELISA test, dengue cannot be determined.
District Medical and Health Officer I Ramesh said, “There are many kinds of viral fevers and malaria and dengue are a bit tricky. Private hospitals are looting people in the name of dengue. Hospitals are cashing in on the fear of patients. Some private hospitals are not informing us about the number of fever cases they are treating.”
Recently, a private hospital collected Rs35,000 for transfusion of platelets from a patient after his test report showed that his platelet count dropped to 12,000. Suspecting something fishy, his family got his blood sample tested at other laboratory. To their surprise, the report showed that the platelet count was over 75,000. When confronted, the doctors denied any wrongdoing and asked the patient to leave the hospital. The hospital even refused to refund the money. “The patients are not coming forward to give us a written complaint. They only call us on phone and complain. Without proper evidence, we cannot take action against them,” asserted Ramesh.
Blood banks are also taking advantage of the situation and creating artificial shortage of platelets. Most of the private blood banks in the city are charging over Rs6,000-Rs10,000 for a unit of platelet as against usual cost that is not more than Rs3000-Rs5,000. Due to lack of compound separator at the GGH, people depend on private blood banks. Though government doctors say that transfusion of even fresh blood or whole blood to a dengue patient is enough, in case of fall in platelet count, the doctors at private hospitals insist on platelet.
Dr M Madhavi, a general physician, Andhra Hospitals, says, “If the platelet count falls to 10,000 then we recommend platelet transfusion. But in some cases it is also done when the count is around 30,000-40,000. The platelet count in whole blood is very less, and will not help the patient fight dengue. So we recommend transfusion of platelets. The single donor platelets cost more but the reactions will be very less, when compared to multiple donor platelets.”
Currently, the demand for fresh blood in GGH is around 40-50 units. However, the blood bank is able to supply only up to 35 units a day. Patients who are in need of platelets are also being given fresh blood, as platelets being sold by private blood banks is beyond the reach of poor patients. Dr PB Manasseh, in-charge of blood bank at GGH said, “We received almost Rs87 lakh worth machinery but still small equipment that is necessary for setting up blood compound separation unit hasn’t arrived. Once we get the separation unit, everything will be alright.”