How poor access to information and outdated detection methods hampers dengue eradication in Guyana

– Misdiagnoses, underreporting and research limitations harm both the vulnerable population and the people trying to make a difference

Misdiagnosis

When I was admitted to Dr Balwant Singh’s Hospital in October 2009, my doctor thought that I had a stroke. The night before, my body hit its breaking point. For months, I had been living with a headache that would not go away and, as a result, I had taken a nap earlier in the evening, hoping to get some rest before doing my homework. Around 11:00 pm, though, I woke with a start because my headache had transformed into an immensely painful downward pressure, as if the world had flipped and suddenly, like the Titan Atlas, I was cursed to bear the weight of the sky on my head and shoulders.

Before that night, the headache would be a dull incessant throbbing that sometimes got worse and sometimes went away completely. None of the doctors I went to could figure out what was happening to me. I endured X-rays, MRIs and CAT-scans. I downed Paracetamol, Excedrin and Ibruprofin – pills that gave me only temporary relief if any. I changed my diet because a family friend suggested that I may be allergic to foods like corned beef or Vienna sausages with their high preservative content. In desperation, I even visited a neurologist who thought that I was simply depressed. The anti-depressants made me gain about 50 pounds in three months, and the painkillers he prescribed sent phantom creepy crawlies scuttling up and down my legs, but they never managed to take the headache away.

When at last my headache blossomed into something far more serious, I got lucky that this doctor didn’t rely solely on his original suspicion and ordered a round of blood tests to make sure that nothing else was wrong. Thankfully, one of the tests he did do was a dengue test. Within a few hours, I knew that his original suspicion was wrong. I did not have a stroke. I had something that was more immediately serious. The nurse assigned to me explained that I had dengue haemorrhagic fever caused by a dual dengue virus infection. I had to remain in the hospital for a few days. Ten years later, the gravity of all the misdiagnoses has finally hit me, and I can’t help but wonder how all my doctors got my diagnosis so wrong.

How doctors get it wrong

The answer to this question lies in both the dengue virus’s biology and the fact that in Guyana, dengue is one of the many neglected vector-borne tropical diseases whose seriousness is often downplayed because it is overshadowed by malaria and other more prominent tropical ailments.

Dengue, unlike malaria, is a viral, mosquito-borne disease that is endemic to Guyana. Only the Aedes aegypti and Aedes Albopictus mosquitoes spread dengue, and they may also carry the Chikungunya and Zika viruses as well. There are four strains of dengue found throughout Latin America and the Caribbean, but it is unclear which strains are present in Guyana. Currently, the range for the disease is Regions 2-6 along the coastal plains, but according to Dr Cassindra Alonzo, head of the Guyana Dengue Programme, there have been some reports of infected persons in Region 7, which shows that the disease’s range may be spreading inland.

Viral diseases are often deceptive with their symptoms because many of the disease’s signs resemble less dangerous ailments. If a person has an uncomplicated dengue infection, they may initially get a headache, feel fatigued and nauseous and may experience various bodily aches and pains, especially in their joints. These symptoms are frequently associated with the flu and many doctors tend to treat patients for these symptoms without running dengue tests. Doctors would give the patient a round of painkillers, send them home to rest and, if no complications arise, the patient will recover quickly and neither he nor his doctor would know that they were suffering from dengue.

Dr Alonzo therefore noted that dengue cases are only recorded in two instances. Firstly, the patient may be lucky to have a doctor who is more familiar with dengue and asks for tests to be done when they see the right symptoms. Secondly, a patient goes down on the record if they develop complications from dual-strain infections from repeated exposure to the disease, or if they lack resistance because they are foreigners or if they have some form of immunodeficiency. Even when complications arise, the possibility of dengue is often overlooked and treated as something else.  These misdiagnoses can have lethal consequences.

On February 11, 2009, the country recorded its first dengue-related death of the season. Her name was Ji Caitao, and she was a 28-year-old Chinese national who was misdiagnosed multiple times by various private hospitals and treated for flu before a final private hospital diagnosed her with dengue haemorrhagic fever just like I was. Unfortunately, by then, it was too late. She, like me, has gone down in history as one of the over 1000 people who contracted the disease that year according to the Ministry of Health’s official record. However, since the disease is woefully undiagnosed, the actual number of dengue infections during that outbreak may be far higher. This trend, Dr Alonzo notes, continues to this day.

How lack of data access worsens Guyana’s dengue situation

The Dengue Programme was created shortly after the 2009 outbreak to find a way to eradicate the dengue-carrying mosquitoes as well as treat cases where they occur. The Programme cannot do this independently, of course, and relies on collaboration with doctors in hospitals across the country and with the Ministry of Public Health for the data it needs to fulfil its purpose.

Unfortunately, the Dengue Programme is not getting necessary disease statistics it needs to be effective. Hospitals usually send case reports directly to the Ministry of Public Health. There, the information is usually filtered before being sent to the various governmental or non-governmental organisations and programmes that need the information.

Dr Alonzo explained that this system is ineffective and hinders the programme. What should happen, she says, it that the hospitals should send their data to the Dengue Programme first before the data is transferred to the Ministry. In that way, they would have access to raw data that would tell them the number of incidences over time, where the majority patients are coming from and the type of dengue (complicated or uncomplicated) for which they are being treated. In this way, the programme can dispatch biologists and educators to the areas with the most cases to test to see which of the two mosquito sub-species are responsible for these cases, assess the environment for risks and educate residents about how they can reduce their risk of infection.

Unfortunately, they do not always have access to this information. Often, the programme director – Dr Alonzo in this case – would have to write to the Ministry to make a formal data request, which is a long and oftentimes fruitless bureaucratic process.

Dr Alonzo has tried to find a way around this problem by developing a dengue tool for hospitals to use. This tool gives doctors various criteria to look for to assess if a patient is showing signs of a dengue infection and gives them instructions on how to proceed with treatment and reporting. They are then supposed to return to tool directly to the Dengue Programme so that its staff can get some amount of data to carry out further study to help with the eradication programme. In the two years that the tool has been created and distributed, however, no hospital has yet returned theirs.

Children are the new hope

Without access to as much data as they need, the Dengue Programme’s research is stifled. However, they are still trying to reach out to the public – especially to young people – to educate them about dengue and how they can work within their communities to prevent the disease’s spread. May 6 – 12 is Caribbean Mosquito Awareness Week and Dr Alonzo and her team plan to collaborate with various GOs and NGOs to host a range of activities. Her team plans to target primary schools with events such as an awareness walk, a community clean up and school visits. There, students can play educational games like Larvae and Ladders – a variation on the traditional Snakes and Ladders – where students must answer questions about mosquitoes, vector-borne diseases and prevention methods to advance in the game and win a prize. They also plan to make several television and radio appearances to drive the message further.

Even though they do not have enough data and resources to implement a more scientific eradication programme at present, they hope that by promoting social changes from a young age, they may be able to eradicate dengue through a more grass-roots, community-wide effort. Children are their new hope in this regard as they hope that they would educate their parents with their newfound knowledge as well.

Dengue is easily preventable and is easy to diagnose. An educated population can help to eradicate the disease through their actions and save lives by identifying the symptoms early and insisting that they get the tests and treatments they deserve. Hopefully, through these efforts, dengue will cease being one of Guyana’s neglected tropical diseases.

 


 

This article was written and submitted in partial fulfilment of the requirements for the Degree of Bachelors of Science in Communications Studies. It was specifically written as a part of the course content for the DPC3209 – Reporting and Writing: Specialised Journalism: (Science, Health, Climate Change and Environment) and was submitted to my lecturer, Carinya Sharples, on April 20th, 2019.

It was later adapted and printed in the 2019 edition of The Guyana Annual and then posted on this blog.

Image taken from Wikipedia commons.

Biology Students Stand Out in UG’s Career Day Activities

Preserving Guyana’s Biodiversity a Major Concern Among Current Students

Not even the overcast skies and occasional showers managed to dampen student enthusiasm today as thousands of secondary school students flooded the University of Guyana campus as the Career Day activities commenced. They congested booths, buildings and campus roadways as they explored the institution’s grounds and indulged in all UG had to offer.

Among the departments represented along the Main Road was the Department of Biology. Clad in their royal purple tee-shirts, the students did their best to feed, entertain and attract potential students with cakes, games and a wealth of knowledge about Guyana’s abundant flora and fauna.

Some students were eager to talk about their degree experiences.

“You learn about diverse species of animals. You learn about your own country’s biodiversity. You learn about the different policies they have in order to protect these endangered species,” Nerissa Surajpal stated. She, like many of the other fourth-year students, will soon complete her Bachelor’s degree in General Biology. She hopes that her local qualifications will ultimately launch her into an international Master’s program in Ornithology – the study of birds.

Another student, Arianne Harris, stated that she was also doing the Bachelor’s programme with aspirations of becoming a conservationist.

“I care about animals, and I want to make sure that some valuable flora and fauna species don’t go extinct,” she said as she lounged in the Assistant Dean’s office. As 3:00 drew closer and the smell of coffee wafted around the air-conditioned room, the coolness and promise of caffeine seemed to do little to revitalise the students exhausted from the day’s numerous activities.

“There is now the whispering of oil…[and] there is also the development aspect,” Harris continued, “As we become more urbanised, it begs the question: what happens to the wildlife? Where do they go?”

This concern about conservation often manifests in the courses offered by the Biology department. According to Harris, every programme manages to include some aspect of conservation and preservation within its literature.

Even the recently re-established University of Guyana Biology Club has a few conservationist slants. The current president of the club, Rovindra Lakenarine, stated that the UG Bio Club has plans to participate in every science-based event day throughout the year. Thus far, they have hosted tree re-planting activities around the Centre for Biological Diversity on campus, participated in the International Coastal Clean-Up in September 2017 and, more recently, World Wetland Day 2018 on February 2nd. Each event was focused on raising awareness about Guyana’s vulnerability to both climate change and pollution.

As Guyana continues its march toward social, infrastructural and economic changes, Harris’ question looms ominously in the background. What WILL happen to Guyana’s ecosystems, flora and fauna in the years to come? The Biology Department’s students offer a glimmer of hope. Their lecturers have already sowed the seeds of conservationism in their minds. Guyana is vulnerable, yes, but the country’s biodiversity is now in the good hands of young, locally trained, passionate scientists working diligently on behalf of our voiceless natural resources.


Feature image compliments of Shane Rampertab and the UG Biology Club and vynyll.

A Catalyst Called Jordan – A Profile

This is my final assignment for my reporting and writing class.

As I look back at the last month and a half of work, I can honestly say that I have developed a genuine appreciation of the work journalists do. I had to shift through two hours of recordings, an entire notebook full of observations and rough drafts and, lastly, find a way to compress everything into approximately 1000 words. This, of course, had to be done amid the scramble of other projects, classes, tutorials and a personal life. It really was a challenge.

Many people assume that writing is easy, but I think I now understand why Ernest Hemmingway meant when he said “There is nothing to writing. All you do is sit down at a typewriter and bleed.” My work is nothing compared to Hemmingway’s lifetime of work, but I do – in part, at least – understand the slavery involved in crafting even this minor project.

Nevertheless, as I reminisce, I feel like I have accomplished something. The stress has dissipated and the words that swirled relentlessly around my skull for weeks have finally quietened. I look at my work now with both the love and hatred of a mother. It has taken so much from me, and yet, I love it because it is mine.

It was an honour to work with my old Chemistry teacher – Miss Jordan – on this project and I thank her so much for opening her life to me. I learned a lot about her over these few weeks, and in turn, I have discovered a few things about myself.

“Hair” We Are, Naturally Rooted

– The Natural Hair Movement Adding Texture to Georgetown

The new black hair renaissance – the modern Natural Hair Movement – has its roots in America. Through social media, African-American women have been striving to re-educate themselves about their natural hair and the very essence of their blackness. They are learning to care for their hair with love and patience, embracing it and promoting it with pride. They are wearing their hair with the joy that 400 years of oppressive forgetfulness could not quell and are making a statement. They are saying: “This is us and we will not be changed.”

African-American women are no longer alone. Over the past five years, the cries from their movement have reverberated around the globe and the movement itself has grown out of its shell multiple times. Like a hermit crab, it has crossed oceans and shining seas to travel from shore to shore and take up residence in new, virgin spaces. As it wanders and grows in both size and strength, it leaves its mark on the global African Diaspora.

One can see the influences of the movement everywhere now. Women are sporting kinky twist-outs or coily flexi-rod sets. Men who are joining the movement are spicing up their fro-hawks with springy, spiky curls. Both women and men are donning sculpted afros like dark, textured halos glowing golden brown in the tropical sunshine.

Business is listening. Every few months, a new product line tailored for black hair is hitting the shelves in America, Nigeria, the United Kingdom, Barbados; natural hair has successfully infiltrated New York Fashion week and day-time talk shows like The View are dedicating segments of their programs to this new, influential trend.

Now, Guyana’s own natural hair movement is gaining momentum and growing fast. Over the past five years, both women and men in Georgetown and the surrounding areas have been learning to embrace their natural hair and are following in the footsteps of the African-Americans.

“When you walk around town, you see an afro here and an afro there.” Denisha Victor explained, her eyes shining with gleeful excitement. Victor is the founder of Koko – a small beauty-supply store located in the Robb Street Mini-Mall. She herself recently went through her own natural hair journey and, through her experiences, was inspired to open her own business to cater to the vacant niche she noticed on the Guyanese market.

In August 2015, Victor and one of her co-workers decided to go on a joint natural hair journey. “I think curiosity is what caused me to return to natural,” she said, “For months and months, I was just like ‘I wonder what my natural hair texture looks like?’”

She, like many other young Guyanese women, had been relaxed since she was six years old. The chemicals damaged and eventually broke her hair, so she cut it then, only to relax it again to avoid the shame of having natural hair in high school. She is a young woman now, and her curiosity and support from her sister-friend encouraged her to grow out her relaxer and cut off the straight ends in January 2016.

Then, she hit a wall. At some point during her transition, she used YouTube to learn about the many natural products available on the international market. There was only one problem.

“I wasn’t finding products,” she reminisced, “Or, you would go to some stores and they can’t explain what the product is. Like, I saw this thing called ‘co-wash’ and I was like ‘What the hell is this?’ and the person there couldn’t give me that information. They didn’t know what it was.”

But newbie-naturalista Denisha was determined to find a way to gain access the products she really wanted so that she, too, could pamper her new, textured hair. She took initiative, importing her first batch of products (a curl sponge and some Shea Moisture and As I Am products) and then the idea just dawned on her: “Why not do this as a business?” she asked herself. After all, business was always an interest for her and, between her daytime job and her business, she could make a few extra dollars while supporting and uplifting other black women in the movement.

So, in early June, Victor got to work. She made her own Facebook page and started promoting her business idea. She posted product info, inspirational videos of black women and men with long natural hair, and styling videos and pictures. She posted a picture with various product lines and asked the Guyanese internet community “Hey! What do you guys want to see?” But the reception seemed lukewarm. Her initial posts only garnered a few likes and a handful of comments. As as the weeks went by, however, a handful of people showed a distinct interest in her initiative and thus, she decided to open her store.

She found a tiny rental in the new Robb Street Mini-Mall, put up a sign board outside, made her logo, brought in four shelves and a make-shift reception desk and stocked her shelves high with over ten natural hair-care lines that catered to both relaxed and natural women.

“My anticipation was that it wasn’t going to be a lot of people,” she said with a laugh, “Originally, Koko was only supposed to focus on natural hair, but I thought the market wasn’t big enough, so we catered to both.”

When at last her opening day came, nothing prepared Victor and lone employee – Donnett Barnwell – for what they saw that bright Saturday morning. Before they even opened, women started lining up in front of the store, anxiously waiting for the shopping green light.

“And people just kept coming and coming!” Denisha said as she and Barnwell shared a hearty laugh at the recollection, “We were working from 9 to 1!” It was like the women of Georgetown had been waiting – impatiently and eagerly – for someone to cater to the movement. In those few hours, Denisha and Donnett discovered that their message was heard much louder and clearer than they had expected. Women with full afros or afro puffs, head-wraps and lace-front wigs descended upon their tiny store and picked some of their shelves completely clean. The demand for products was so intense that, less than a year into their business, Victor and Barnwell have had move to a bigger rental.

The new rental looks the same, except it has a small air-conditioning unit and a sliding window opening toward the hallway that leads to what seems to be the administrative part of the building. The walls are still the same shade of pink; the furry, grey carpet still spread across the concrete floor. The shelves still tower to ceiling with a new batch of various products, but she’s added two pairs of bargain bins at the bottom of the shelves where people can get old stock at a discount. There is even a small section set aside for local products like Granddad JAK Virgin Coconut Oil and Radiante’s Whipped Shea Butter Mix.

The Natural Hair movement isn’t just lingering in Georgetown, however. Victor noted that it is growing exponentially eastward along the coastline toward Berbice and down inland toward Linden. “The movement is probably slower in other parts of Guyana, but it’s getting there.” She said as she nodded with excitement, her own twist-out bouncing slightly as she moved. “I think a lot of women want to go natural, but they don’t have the encouragement,” she continued, “On a weekly basis, you might come across someone who wants to do the ‘big chop’ or ‘transition’. Because more women are [going natural], [other] women are being encouraged to do it as well. A lot of women just need a friend or relative to go natural so they have somebody to sorta have company to do it with.”

Through her page, Denisha seems to be creating a growing sisterhood of natural-haired women who provide company for new members of the movement. Amid posts about products and promotions, she occasionally posts inspirational videos, pictures, and quotes to encourage her clients to embrace their blackness, enjoy their natural beauty and be who they are. “The movement is all about encouraging self-acceptance and self-love,” she said, seconding the American Natural Hair activists. For her, the movement is much more than just embracing natural hair. It’s about reclaiming one’s blackness.

Her opinions on the movement are not unique, however. Adjacent to her new store, a fellow natural hair promoter and businesswoman,  Marcell Allen – owner of Angels Cloud Cosmetics and Body Shop – mentioned that her favourite part of the movement is helping new people join in. “Bottom line, I think everyone wants to go back to their roots,” she said with a wide smile, “It feels good…when people would ask questions in terms of ‘You know what? I want to go natural. What do you think I should do? You think is a good thing or not?’ and I would give them advice because I know it’s a good thing.”

Even women in the first-year communications studies class, many of whom have natural hair themselves, agree with this sentiment. These academic naturalistas, even the ones who are still relaxed, agree that the movement is beautiful, liberating, cute and a symbol of the struggle for blackness and natural beauty.

However, they were a bit more critical of some aspects of the movement.

“I wish [business] people would let people know that natural hair is expensive. [Business] people don’t show the negatives. [They] just want to see products sell,” Lawanda McAllister complained. Lawanda further explained that if she couldn’t steal her mother’s products, maintaining her natural hair would be so much harder because of the expense.

“[Natural hair] is hard to manage,” Nateshia – another student – said, “but it’s totally worth it.” Nateshia and her friend, Finidi, are displeased about the bias they see in the community.

“No one has the same hair texture,” Finidi said amid a few giggles before her mood and tone became more solemn, “Like me. I have true black-man hair. I do a style today and tomorrow, it’s frizzy. And people laugh at me for it.”

“It’s like people don’t appreciate kinky hair.” Nateshia continued, “Like, everyone is trying products to go curly. What about texture appreciation. It’s like people trying to go dougla, not natural,” she elaborated as she gestured to her own head of large, frizzy flat twists.

Alana Lewis, a student who has been natural longer than all of her companions, believes that the natural hair movement is just a phase, doomed to die like any other trend, “You gun ketch laugh when relaxer come back,” she said, much to the amusement of the women around her, “When natural hair go out of style, you gun see.”

But Denisha disagrees and she quoted the natural hair stylist, Vincenzo, who came to Guyana a few weeks ago for a natural hair event. “He was like, ‘How could something that is coming out of your head naturally be a trend?’. And that really stuck with me. Because your skin colour isn’t a trend. Your breasts isn’t a trend. I mean, you can change that if you want to, but naturally, that’s what it is. So, I don’t think it’s going to fade.”

Maybe she’s right. Maybe the natural hair movement is permanent. Maybe Alana is right. Maybe relaxer will make a come-back and or maybe something different will take its place. But one thing that is certain is that, at least for now, the movement is growing.

At the end of the interview, I thanked Denisha for her time and made my way toward the exit. On my way out, two young girls scrambled into the mall. “Excuse me? Where’s Koko?” one of them panted at a man at the entrance as her companion tried to regain her bearings. The man pointed inward and showed them the large, golden “KOKO” on the distant wall. They hustled in, racing to get to the store before closing time. No matter who says what, the movement has taken root and it’s probably here to stay.


Author: Nikita Blair

Copyright of: Nikita Blair

Special thanks to Marcell Allen, Nateshia Issacs, Alana Lewis, Lawanda McAllister, Denisha Victor and Finidi Williams for allowing me to tap into, and publish, their stories.

Photo Credit: PBS