Dengue; not so deadly but predictably treatable disease

Dengue; not so deadly but predictably treatable disease

Sri LankaSri Lanka
Organization type: 
government
Project Stage:
Scaling
Budget: 
$1 million - $5 million
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Dengue is not so deadly – It is a PREDICTABLY TREATABLE DISEASE – learn how to treat it perfectly!

About Project

Problem: What problem is this project trying to address?

The mortality and CFR of dengue is very high in some countries specially south asia . In 2009 in Sri Lanka there were 346 deaths in spite of both having national and international guidelines by the WHO. In 2009 I collected medical information and visited the house holds of 64 deaths in the District of Gampaha which had the highest number of deaths and realized the need to reduce this number. Thailand has had more experience with dengue than any other country in the world. The Ministry of Health nominated to go me to go Thailand due to the interest I have shown in dengue, my district having highest prevalence and also because I was adjudged as the best consultant in the government sector of the Ministry of health in all specialties in the whole of Sri Lanka in 2007.

Solution: What is the proposed solution? Please be specific!

In addition to controlling the dengue mosquito the need to understand the pathophysiology as well as the complex fluid dynamics in DHF has to be stressed. In Thailand under the guidance of Prof Suchitra Nimmannitya I understood the basics of the fluid dynamics and therapy. At this point it struck me that the deaths of a large number of children and adults were the result of improper fluid therapy specially resulting from the imperfect international and national guidelines. Since the proportion of patients with DHF differ from country to country the emphasis of fluid therapy vary. Therefore I realized the need to initiate a comprehensive guideline aimed at changing the practices stressing the key role proper fluid therapy will play in reducing deaths . I also realized and need to manage difficult dengue patients in separate unit dedicated with specially trained staff. The ‘Dengue High Dependency Unit(DHDU) was a concept I created as a solution.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Developed a comprehensive guideline. I embark on an extensive educational process of training of clinicians on the management throughout Sri Lanka and later in Pakistan. In Sri Lanka from the 21st of June 2010 I have conducted over 100 training sessions by visiting many hospitals and conferences throughout the country. In Lahore Pakistan I have trained many thousands of doctors and some of these sessions were attended personally by Punjab’s chief minister. I did training of trainers to establish a core group of local experts (DAEG). As a result of my work in Pakistan I was invited to an audience with the President and the cabinet and several leading medical experts greater Pakistan to advise on clinical strategies in combating dengue. I also initiated a 24 hour hotline on my mobile for clinicians both pediatric and adult to give advice on management to patients from any part of Sri Lanka which was later extended to Lahore Pakistan. This was done free of charge and many times at my own expense. I was also invited to the expert panel that reviewed the WHO Guideline and is a co-author to the latest WHO Guideline on Dengue. I proposed to the secretary health Sri Lanka to set up DHDUs in various parts of Sri Lanka which has now been adopted. DHDUs were also introduced to Pakistan. Central to the overall successful management of dengue patients were to have a good team of doctors nurses and paramedics and the teamwork is the key to the successful outcome. One of my strategies has been to train and create such teams on all aspects including coordination.
Sustainability

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

peers and partners both local and international doctors and the medical teams involved in patient care, medical administrators, politicians, international organizations like the WHO, Competitors- other people who claim to be dengue experts who may feel personally threatened by this new strategies and those who do not want to change their knowledge, and attitudes. This has been the most difficult though it involved my own colleagues. We have gradually taken them along to witness the truth, “Dengue is not so deadly but if there is dedication it is a predictably treatable disease.” In this still there is lot more to do
Team

Founding Story

As person who was worried about the way the disease dengue cause loss of life to other wise very healthy individuals within a few days of this infection, the exposure and the learning I had from Thailand opened my eyes about the need to take the message ‘the need to change the way we were clinically managing dengue cases’ . Dengue which was considered deadly and a disease with ‘unpredictable out come’(even described in the previous guidelines even by the WHO) was not so deadly if one knows how to treat it and was very much a “Predictably Treatable” disease. We took the message around “all patients who ‘walked in’ SHOULD ‘walk out’at the end” told others how to make it happen that way with new guidelines.
About You
Organization:
Ministry of Health Sri Lanka (currently General Hospital Negombo)
About You
First Name

LakKumar

Last Name

Fernando

About Your Organization
Organization Name

Ministry of Health Sri Lanka (currently General Hospital Negombo)

Organization Country
Country where this project is creating social impact
How long has your organization been operating?

More than 5 years

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Innovation
How long have you been in operation?

Operating for 1‐5 years

Which of the following best describes the barrier(s) your innovation addresses? Choose up to two

Quality.

Social Impact
Please describe the goal of your initiative; outline what you are trying to achieve

The aim was to reduce dengue deaths and case fatality rates(CFR).

What has been the impact of your solution to date?

In countries with dengue the mortality is proportionate to the DHF they have compared to DF. The latter(DF) is almost a self-limiting disease with almost zero mortality. DHF is the one that is causing deaths. In Sri Lanka DHF is on the rise compared to the past but despite that deaths and the CFR is gradually coming down. Before my 1st workshop on 21st June 2011 the CFR for dengue was always higher than 1 % . It started coming down soon after we disseminated the new concepts and is clearly <1% now.(refer Sri Lankan epidemiology unit’s website www. epid .lk. In Lahore Pakistan the impact was more greater!

What is your projected impact over the next five years?

To bring down dengue deaths further and to bring the CFR to as low as 0.2% within the next 5 years five to ten fold lower than the present)

What barriers might hinder the success of your project? How do you plan to overcome them?

The increasing of DHF compared to DF will result from more difficult cases . The inability of the government to increase facilities will make matters worse. However more DHDUs with dedicated staff at each hospital will be a cost effective way of improving care. It is also needed to reinforce training of doctors nurses giving them the knowledge and the message.
Attempts will be made by various groups to promote incorrect methods of treatment (eg. Using of steroids for DHF). Caregivers should be allowed to see and build confidence in treating DHF cases using the newer guidelines.

Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact

The first ever common DHDU for both adults and children will be set up Negombo within 3 months

Identify three major tasks you will have to complete to reach your six-month milestone
Task 1

find funding to set up such by showing the cost effectiveness of this

Task 2

find staff to man the unit-(doctors and nurses)

Task 3

training staff of new DHDU about newer treatment methods.

Now think bigger! Identify your 12-month impact milestone

The common DHDU of Negombo as a model international training center. More such unit should come up elsewhere.

Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1

function the common DHDU effectively as a model

Task 2

Train more doctors &nurses from other centers local and overseas using the facility

Task 3

motivate others to set up such units elsewhere in Sri Lanka and Abroad

Sustainability
Tell us about your partnerships

The partnerships are mainly the ministry of health and the epidemiology unit Sri Lanka.

Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?

Dengue is an emerging disease. 40% of the worlds population live in areas where dengue can be transmitted and there are 50 million infections every year and 500,000 severe form or dengue heaemorrhagic fever with 22000 deaths in the world due to dengue. Like the 2011 epidemic in Pakistan it can hit any new place and where help is needed in how to manage the disease one has to help

What type of operating environment and internal organizational factors make your innovation successful?

Hospital setting and any other situation specially when dengue comes as an epidemic with morbidity and mortality there will be a demand for knowledge on how to handle it

Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list