When his 13-year-old daughter Priya developed fever, D Koilpillai first took her to the primary health care at his village. Koilpillai is a construction labourer from Poonimangadu village in Tamil Nadu’s Tiruvallur district.

“She was given a report saying that her condition was normal,” he said. “When she began vomiting and having high fever again, we took her to the Tirutani [taluk] hospital.”

From there, Priya was transferred to the Tiruvallur district hospital, and when her platelet count continued to dip, she was sent to the the Rajiv Gandhi Government General Hospital in Chennai.

Several of Koilpillai’s neighbours have taken this circuitous route to get treatment in Chennai for dengue and other viral fevers.

“Three people from my colony are also here in this same ward,” said Koilpillai.

Most patients at the 100-bed special ward for dengue and fever cases at the Rajiv Gandhi Government General Hospital had been referred there from the neighbouring district hospitals in Tiruvallur and Kanchipuram. The ward was full over the weekend. But there are seven other wards in the hospital, packed with patients with lower-grade fevers.

“Our hospital is seeing a turnover of at least 100 cases a day,” said a duty doctor at the hospital.

The hospital staff are visibly stressed by the large number of patients, and the corresponding increase paperwork. Even private hospitals have been referring serious fever cases to the government hospital.

The outbreak

Over the past few months, Tamil Nadu has seen a spurt in reported cases of dengue, as well as viral fever accompanied with low platelet cells. According to The Times of India, at least four people died of dengue in Tamil Nadu and Pondicherry on Saturday. Over the weekend, about 11,000 patients had been admitted to hospitals across Tamil Nadu for fever, of which 200 were confirmed cases of dengue. Chennai alone had about 1,500 cases.

State health officials say that they have been taking action against the spread of dengue. About 35,000 workers have been engaged across the state to clean up potential mosquito breeding sites.

“We are providing treatment according to the World Health Organisation protocol. In places where we are seeing a cluster of cases, we have a rapid response team in place,” said Director of Public Health D Kolandasamy. “If anyone is feeling feverish, we are asking them to come to a government health facility.”

The government has also asked at all serious dengue cases be transferred from district hospital’s to the Rajiv Gandhi Government General Hospital, said a hospital staff member who did not want to be identified. “But, the district general hospital should be able to treat dengue, it’s not that difficult,” he said.

According to S Raghunandan, professor of medicine at Madras Medical College, the district hospitals are referring only patients needing high-end care and blood component therapy, which includes platelet transfusion for dengue patients. “All the district hospitals have been strengthened and given adequate training to handle fever cases,” he said.

Patients are being transferred to the Government General Hospital Chennai. Credit: Vinita Govindarajan

However, many patients and their families say that they have not received adequate treatment at district hospitals.

N Sugandha complained that her daughter, 24-year-old Jenifer, had got little attention at the Tiruvallur district hospital where she had first been admitted with fever and low blood platelet count – both symptoms of dengue – a week ago and that her condition only deteriorated over four days at the hospital.

“Her platelet count dropped from 1,26,000 to 44,000 while at the [Tiruvallur district] hospital,” said Suganda. “The nurses call out asking the sick to come to a common desk for injections and medicines. How can they expect half-conscious patients to get their own treatment?”

When Jenifer did not get better, the district hospital doctors referred her the Chennai government hospital.

Overcrowded hospital

On Sunday, Sugandha sat outside the dengue and fever ward of the Chennai hospital while Jenifer rested inside the ward on a bed draped with a leaf green mosquito net. After spending three days getting treatment for dengue at the Chennai hospital, Jenifer’s fever subsided but her platelet levels were still low. “They took blood samples twice to test for dengue, but they have given us the report yet,” said Sugandha.

The hospital’s doctors have been testing all fever patients for dengue using two tests – the NS1 antigen test for rapid detection and the ELISA antibodies test that is a more conclusive test.

Two of Sugandha’s neighbours, who live on Vembuliamman koil street in Tiruvallur district, are also patients at the Chennai hospital.

“We live right next to a temple tank, which is filled to the brim with rainwater,” said P Mahalakshmi, whose son 16-year-old Abhishek was admitted in the ward. “People in our neighborhood are saying that the water is the main reason for their illness.” Stagnant water such as that in temple tanks are often a breeding ground for the Aedes mosquito that spreads dengue.

Even as doctors and hospital staff rush to treat the large number of cases, more patients with fevers arrive at the hospital. Uma Maheshwari, whose daughter Jayalakshmi had been admitted to the Chennai hospital on Saturday, recounted how they came from Chengalpet in an ambulance packed with 10 other patients.

“At Chengalpet, they told us that they cannot handle serious cases,” she said. “It took us two hours to get here. They made some people sit on other’s laps to fit more people.”