Dengue…

Rain, at least in Metro Manila and in other parts of the country, pours almost uninterruptedly for the last 7 days causing not only the perennial problem of flooding but the dengue scare. The Department of Health has been warning the public that H1N1 epidemic aside, dengue has to be taken with equal seriousness as a public health concern. Many died of dengue this year compared with the casualties of H1N1. Part of the problem is behavioral, that is, residents both in urban and rural areas, are often less alarmed-into-action for example with regard to how stagnant water can turn into a danger dwelling-zone for mosquitoes responsible for the transmission of the virus to human beings. Another part of the problem, or at least the solution to the problem is social, that is, the kind of specific remedy or medication often embedded within a larger social playgrounds inhabited by government agencies, climate of research, pharmaceutical companies, medical establishments, or indigenous attitudes towards local resources such as medicinal plants to say the least.

Let’s deal with some facts for a while. Here’s what the World Health Organization (WHO) had declared about dengue:

“Dengue is the most important emerging tropical viral disease of humans in the world today. It is estimated that there are between 50 and 100 million cases of dengue fever (DF) and about 500,000 cases of dengue haemorrhagic fever (DHF) each year which require hospitalization. Over the last 10-15 years, DF/DHF has become a leading cause of hospitalization and death among children in the South-East Asia Region of WHO, following diarrhoeal diseases and acute respiratory infections.”

Secretary Francisco Duque III of the Department of Health was quoted for this last week’s news:

“Duque said that in 2007, the country had more than 45,300 dengue cases and 416 deaths. It was also the third straight year that the country had been trying to push back an alarming rise in reported dengue cases, he added.

The health secretary described the pattern as unusual because they were reporting dengue cases even at the start of the year, which was outside the peak season of the ailment.”

I wish to tackle a bit of the social embeddednes of the dengue cure (or the search for it) and set aside the behavioral factor I curtly mentioned because it deserves a separate closer take. My facts are not that exhaustive as I rely entirely on online data available and stitch those through my personal perspective and exposure in social science and health.

I think we can agree on this: no one must die out of a mosquito bite. But given the circumstances of morbidity and mortality in the face of mosquito attacks, people living in tropical countries still grapple in the dark for an easement from the burden of the disease. Why? For the simple reason that no “scientific cure” in the form of vaccine or some potent drug are available. The WHO could only recommend this far as easement from the fatal blow of dengue:

Bed rest
– Keep the body temperature below 390
– Paracetamol-Yes**
– Aspirin-No
– Brufen-No
– Oral fluids and electrolyte therapy
– Follow-up for any change in platelet/haematocrit

Very fine enough and understandable for a non-diagnostician. But for further diagnosis of dengue, the WHO guideline, standard as it is, is actually more pro-diagnostician than pro-ordinary patients, especially when it comes to laboratory analyses for example of platelet levels, determining the plasma leakage, or the febrile from the afebrile state of the patient. There is always that part of the medical world that remains strange to ordinary patients regardless of the very personal experience of illness. When things get worse, said the WHO, visit your nearest hospital, but don’t expect too much beyond those temporary balm mentioned above:

“Patients and households should be informed that severe abdominal pain, passage of black stools, bleeding into the skin or from the nose or gums, sweating, and cold skin are danger signs. If any of these signs is noticed, the patient should be taken to the hospital.”

Even in the caring hands of diagnosticians and doctors, patients and their families still will grapple in the constricting rooms of confinement or perhaps financial grip. That’s the truth! How many times have we heard families of dengue patients being informed by diagnosticians of the end of the medical rope that hospital dismissal would be the more humane recourse over dengue’s incurability. You bet what are patients’ and their families last recourse outside the medical parameters – a whisper of a prayer? some miracle? a visit to the Baclaran Church? It’s equally important, even if it borders on turning God into an instant magician from time to time more than a Faithful Companion in life and death.

I had encountered a few dengue cases even in my current job and casual time outside it, often with a sense of panic to find those desperate measures for dengue. And I dare to recommend one thing outside the medical commonsense of prescribing only from the authority of a professional template: TRY TAWA TAWA. They listen and they came back with some good news of being cured from dengue. So what’s stopping the medical establishment from turning it into an essential part of the treatment modality? The answer: scientific dogmatism. If a particular medicinal plant has not gone through the rigor of clinical trials to prove its value, which by the way has 4 tedious phases, then it should not be prescribed to patients. We understand where science operates from – method and proof, logic and evidence-based literature. Fine enough. But how often do we hear of science’s humble admission of its social conditioning, that is, its attitude towards methods and proofs being influenced by the larger social entities it subscribe to for a number of reasons?

Let’s take tawa-tawa, with a scientific name euphorbia hirta L., as a case in point.

I scoured the net for a couple of days in search of any scientific studies of its pharmacological values on this ordinary plant. PubMed, a database based in the National Institute of Health of the US, and perhaps the most generous and extensive health research database on the net, provided 41 scientific clinical research on euphorbia hirta but none relates to dengue. For local studies, I did the same thing and google gave me a troika of data on tawa-tawa and dengue research. As reported last year, the news from Sun Davao says:

“THE health department has still not concluded its study on the feasibility of the tawa-tawa plant (Euphorbia pilulifera) as herbal remedy for dengue.”

In the news, there is no mention on who specifically conducts or sponsors the research. I am curious so I contacted first the Philippine Council on Health Research and Development (PCHRD), an arm of the Department of Science and Technology who is “responsible for coordinating and monitoring health research activities in the country.” I was directed to their online health research database Herdin, only to admit that the said research is not within their purview. Next, I contacted the Department of Health, and spoke to their chief librarian but nowhere could he find in their file the research on dengue I was looking for. Instead, I was directed to another arm of the Department of Health, the PITAHC or the Philippine Institute of Alternative and Traditional Health Care mandated by Congress under the Republic Act No. 8423 of 1997, and whose one main task is “to encourage scientific research on and develop traditional and alternative health care systems that have direct impact on public health care”. There is no way entering their site. But if the DOH database has no record of it, could it possibly be held by its arm without the head knowing about it? Just asking. Anyway, one thing is sure – PITAHC, who now has 4 large herbal plantations and pharmaceutical processing plants in Tacloban (36 hectares), Cagayan Valley, Davao and Cotabato could not simply manufacture medicinal plants for public use without the approval of the DOH. For example – out of the 13,000 species of Philippine herbs, only 500 have been properly identified and only 10 have been studied and promoted by DOH. Of these 10, only four (lagundi, sambong, tsaang gubat, yerba buena) have validated therapeutic value.

And here’s one interesting piece Google had served me: a prize-winning research done by high school students from Xavier University of Cagayan de Oro City, an investigatory study on “The Effectivity of Euphorbia hirta L. (Tawa-tawa), Prepared in Teabag Form, on Increasing Platelet Levels in Mus musculus (White Mice)”.

I remain curious because so far, there has been no announcement by the media of the scientific results of the said research. What’s the drag all about? Lack of support from pharmaceutical companies around? Bureaucracy? Shortage of clinical experts? Within this seemingly silence of the scientific community, there are also some implicit messages hanging around. I give you one: Tawa tawa is a very ordinary plant one can pick up along the street. They can grow up anywhere; we have those here in our ground. Perhaps, they really are ordinary enough, familiar enough it could drive away the exotic shoot for unmitigated profits for pharmaceutical companies.

Here’s the third thing Google has served me – clinical experts in India have actually unlocked the phytochemistry and pharmacological values of tawa tawa and had published it in a peer-reviewed journal The Journal of Pharmaceutical Research and Health Care. So what’s the drag on the Philippine health research on dengue all about? Power and profit struggle buffered by scientific dogmatism?

I can only remain curious, but pretty much hanging on to my personal belief that tawa tawa is as efficacious as a God-given resource!

24 thoughts on “Dengue…

  1. Dengue is very scary. I know of a few people who lost their kids to this dreaded disease. We all would try anything as a last resort to save someone.

    This is the first time I heard of tawa tawa… I hope to get hold of this weed soon.

    I tried another alternative when my son was suspected to have dengue sometime last year…….. boiled kamote tops(which have been circulated in the net). His platelets were decreasing and it was a bad sign. My son wouldn’t take any veggies but I forced him to drink the concoction. He was also taking the meds prescribed by the doctor. The next time his blood was tested, the platelet count increased slightly. He was getting better too. He continued to take the boiled camote tops. The platelet count continued to increase until his full recovery.

    I would not attribute my son’s recovery entirely to the camote top as medications were continously given. However, the increase in platelet count was detected after he started taking the concoction. Whatever the reason is, I am just thankful my son recovered.

    I also heard about extract from papaya leaves….

    Dfish, you’ve been a very judicious practitioner. I would not mind getting your sound judgment on these alternative treatments.

    btw, an idea is cooking in my head. How could I reach you? Please email me at amorflahoz@yahoo.com

    • Hi Amor, thank you for sharing this personal account of dengue illness. Vaccine is still being developed.

      “I would not attribute my son’s recovery entirely to the camote top as medications were continously given.”

      In the American setting, the medical establishment calls it complementary, to complement Western medicine. In the Philippine setting, we still use the terms “traditional” or “alternative,” as if in contest against Western meds. Doctors don’t like being overruled of course, and so ongoing conflict between the Philippine Medical Association and orgs on traditional meds. So i guess eventually, Philippine medicine will come to a compromise with the word “complementary”.

  2. wow! para akong nagbabasa ng health magazine.. thank u for posting this!

    i remember when i was in grade 5, me and my sister had hemorrhagic fever too that almost kill her.. kakatakot..

  3. oh my goodniz anong klaseng lagnat yan… samantalang ako tipus lang… hahaha… ang haba ng post very informative… hindi pa naman ako nagkukulambo pag gabi… hai…

    dfish im back… so c’mon letz party… woooohhhh….

    • Alvin, nabasa ko sa blog, sumakit lang tiyan, hinala mo, baka may cancer ka hehe. Hypochondriac ang tawag daw sa mga ganung tipong nerbyoso sa health status haha.

      Ano giveaways mo?

  4. sabi ng kaisa-isang doctor namin dito sa isla ng olutanga island, zamboanga sibugay di daw tayo dapat ma-scare sa ah1n1. mas dapat daw katakutan ang dengue kasi mas deadly…

    during the last medical mission dito sa isla last week, napag-alaman ng mga visiting doctors na uso ang tv, eheste, tb dito…

    • Human nature yata natin Pads, mahilig tayo sa anything “exotic” – food, places, disease, etc. and then we sensationalize those to attract attention. I guess there’s an overhype over H1N1.
      Yang TB na yan, matagal na natin burden yan but in fairness, we’re making strong progress in this area…

  5. I also had dengue some years ago, my platelet count dropped to 40 to the point that fellow employees who have similar blood type to mine were alerted to become possible donors.

    One of the resident doctors actually asked me if I took the tawa-tawa extract. I told her I did after 3 days of on-off fever. I stopped when the company doctor after seeing my platelet count advised that I have to be admitted, on the fifth day….🙂 I was hospitalized for 4 days…

    She then smiled and told me that she honestly believes tawa-tawa saved me, that it may have dampen the steady decrease of my platelet count, as 3 days of on-off dengue fever is already critical…

    • Welcome back kapatid….🙂 Hehehe… Very fruitful effect of your silence…

      Well written, inquisitive and pragmatic… Very popular ang tawa-tawa dito sa company grounds namin… Hindi sila pinakikialaman ng mga gardeners kasi gamit na gamit ng mga employees…🙂

  6. I was about to tell you about tawa-tawa. I recommend it to some friends and family members even if I don’t have enough “scientific proof” about its effects but I do know people who got well.

    • Hi ifm, yes, the idea of “scientific proof” is slavishly Western but once confronted with a country like ours so rich in herbal plants, i guess there’s got to be rooms for bending the dogma hehe…

  7. Very informative igsoon. Dili lang diay langitnon ang mind ni Dfish…

    May medicinal/herbal/farmacoloji/clinical/health insurance sa lawasnong katawang laman.

    Morag wala nako makita ang tut-ho, yam-yam, haplas… orasyones de la payat… pang albularyo…milagro ug uban pang panambal nga makita ug dili makita.

    Dili ko na lang pasubrahan kay basin og ma-over ra pud ta. Seryoso giod baya ni nga hisgutanan.

    Sagot ng iyong comment doon sa exodians blog ay ito…

    matud mo pa,

    Kumusta naman ang ubang mga Exodians…

    Sa tinoud?
    ang uban morag mikupos na giod ang ilang mga itlog. ang uban nangabuak na. hahaha!

    pipila, tua manggiulawon na giod kaayo hangtud e-mail lang giod ang kayang himoon.

    tua sad uban nga morag mitago sa ilang mga parokya kay basin maangin ug kasuk-an ni Papa.

    ang uban morag tua nagtago sa saya sa ilang mga asawa.

    Kung may kabit basin sa saya sa ilang mga kabit… hahahaha!

    tua sad pipila nga miingon ikaw na lamay bahala dinha. (dala tulod sa akong likod) kay kuno human na daw sila ining mga butanga.

    nagkadaiya nga kinaiyahan pero naa ra giod na sila dinha gapahipi kay sa giingon ko na dili gustong mapagan.

    may nahimamat ka dinha sa yuta?

    welcome bak igsoong dfish.

    By the way, ang picture nga imong gibutang kung ikaw na sya… may kahitsura ka sa usa sa mga eksodyanos. hahaha!

    • Darbs, pareng darbs, igsoong darbs, kalakbay kong darbs – unsa gani akong isulat.

      Aw, 2 theses from your comments: first, buhay albularyo sa Pinas, and second, buhay Exodiano. Unsay connexion? Milagro, o dala sa huthot sa tambalon makaingon ko ang pagpadayag sa pagtoo sa blogospiriyo…

  8. Hmmm, that tawa-tawa plant will surely bring joy to the people who have dengue… ^_^

    As for me, I take vitamins and do preventive measures so sana hindi ako tablan ng sakit na yan.

  9. Hi, I’m working in a hospital here in Davao City. Every Tuesday since I worked here, I would go to the City Health Office to submit our weekly Notifiable Disease Report. Sadly, dengue stands tall that as I am writing this very moment, we had 23 for the week ending June 27, 2010 and only 1 for typhoid fever. To be honest, even among us hospital workers, (except for me so far, I have not been to the ER – I actually have low temp fever since Thursday). My co-workers used tawa-tawa at early stage to prevent drastic drop of platelet. In my assessment, Tawa-tawa works well at platelet levels not reaching below 80. Otherwise, transfusion is indispensable, or there’s no other way.

  10. I together with my friend Riza Genialope is planning to conduct a study about Euphorbia pilulifera or tawatawa i its effect on the said dengue case. Can any one there give us some reliable references for our study?

  11. and do you have any idea on how it works?
    any way, we are Biological Students in WEST VISAYAS STATE UNIVERSITY-iloilo and we decided that it would be a good thesis. Can you help us?

  12. I know it’s no where near as good as you interesting posts here but let me at least give you a smile as a form of thanks for your hard work writing this stuff?

    When you have nothing to say, say nothing.🙂

  13. hmmp!can you help for my project in science investigatory?i have an idea for my project,but i’m not sure for this…!I decided to make a camote tops tea for dengue fever,but i’m not xure for this,it is because the only thing that i xurely can heal the dengue is the tawa-tawa or euphorbia hirta,.According to my research, when dengue strikes, the platelet count of the victim plunges down to a dangerous and critical level that becomes fatal. Research shows that the nutritional content of camote tops or sweet potato greens can counter attack the downfall of the platelet count of anyone hit by dengue fever.it is okey mixing tawa-tawa and camote tops,can be safe to the patient who suffering dengue nowadays????

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