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Prudence Hamade (Myanmar & UK): contracting dengue while working in an outbreak

Dr. Prudence Hamade is Senior Technical Advisor at Malaria Consortium. Trained as a pediatrician, she has more than 20 years’ multi-country experience on implementing and capacity building initiatives to improve quality of care and control of infectious diseases, malnutrition and child health and has provided technical oversight and management for neglected tropical diseases programmes in sub-Saharan Africa and southeast Asia. In 2001, Prudence fell ill with dengue while working with Medecins Sans Frontieres in Cambodia. Here is Prudence's story.

One morning, I woke up feeling a little off colour and very tired. I put his down to the intense workload of managing a large Medecins Sans Frontieres (MSF) project in Cambodia supporting the local authorities to run a hospital and 17 health centres. There was a big dengue outbreak in process and the hospital was full of cases - it was so busy that sometimes we had three children to a bed.

It was a significant outbreak and MSF was also running a campaign to address mosquito control: this was done by increasing input into messaging around prevention, as well as supplying covers and the insecticide Abate for water jars. They also led clean up campaigns.

I am very rarely ill so I ignored symptoms and continued with my workload given the situation, including preparations for an exchange visit between hospitals running different versions of a contracting process to improve quality of care.

This involved traveling between health centres and after a 3 hour journey along terrible roads our team arrived at the MSF house where the team were supporting another hospital. I was feeling increasingly weak and finding it difficult to walk but managed to take part in the visit and return to our own region.

The next day I again had to travel for two hours to MSF headquarters to conduct a meeting with the local NGO running an equity fund. It was very hot and humid and I remember the wonderful relief of a glass of iced tea provided during the meeting. As I was coming down the stairs I met our lab specialist who said: "You look awful"! I jokingly said that I thought I may have dengue. He arranged a few blood tests to be done in a local specialist children’s hospital which came back positive for Dengue Type 2.

By that point, I became really unable to get out of my bed. The MSF house was not equipped with air conditioning so it was very hot. I had daily blood tests and as my platelet count rocketed down but my haematocrit count remained stable, I was unable to read or do anything but sleep. The lovely house maid Pau supplied me with frequent drinks including squeezed fresh orange juice and I developed a bright red rash from head to foot. Questions were raised about evacuating me to Thailand but I only wanted to rest and let Pau take care of me. I was confined to my bed for about one week and then gradually got back on my feet to complete my mission and return to the UK.

Even in the English summer, I was unable to get warm and was very tired and generally run down for about three months. As I experienced first hand, both through my personal experience and what I witnessed during outbreaks in endemic regions, dengue can have a serious effect not only on the health and wellbeing of individuals, but also of entire nations.

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