It started just before Christmas with a pulsing behind the eye sockets – like an icecream headache but worse. Then intense fever, dehydration, an itchy rash on his legs and the sensation that his arms and legs were being severed from the rest of his body.
Lyle Watson, of the northern Pacific beach town Tamarindo, would have preferred a bag of coal to dengue fever – especially after community efforts to suppress the spread of the mosquito, usually Aedes aegypti, that transmits the virus.
In the past year, residents of this booming coastal community instituted a program to clean up neighborhoods and educate locals and tourists alike, in response to a near record outbreak of dengue fever the year before. They started education programs in schools, worked to eliminate the standing water and trash piles that serve as breeding grounds for the mosquitoes, and helped finance fumigation efforts.
Similar efforts took place throughout Guanacaste, where nearly 41% of dengue cases nationwide occurred last year, according to Health Ministry statistics.
It worked – at least, in places where residents remained diligent. In 2006, cases of dengue dropped 73% nationwide, but only 11% in Guanacaste (TT Dec. 22, 2006). The most recent outbreak, including Watson’s case – began in late November and has continued in force through the New Year – perhaps indicating a relaxing of these health and sanitary standards.
Residents and tourism officials throughout the region – among Costa Rica’s most popular beach destinations – are concerned; not only for themselves, but also for the effect such an outbreak might have on tourism.
“We’re worried, but we’re also a little angry,” said Watson’s wife, Stacey, who tended to her husband through his nearly three weeks of fever and sickness. “They should have been spraying for this.”
Stacey Watson says she’s one of the only people she knows in Tamarindo who hasn’t contracted the illness, which often leaves people bedridden and with high fever for three weeks or more.
She believes the situation is quickly getting out of control.
“We need some help out here.Most people I know have had dengue,” she said.
The recent dengue outbreak in Guanacaste has inundated EnriqueBaltodanoBriceñoHospital in Liberia, leaving officials scrambling to find the enough beds to accommodate new patients.
Cira Viales, the nurse in charge of the dengue ward at the hospital, said she’s seen nearly 300 cases of the virus in the past three months, but that the figure didn’t account for patients who checked into local clinics instead. “What we know for certain is that we are seeing far more hospitalized patients than the year before,” she said.
Viales said she gives the same speech to each patient admitted to the ward with dengue. She starts with an explanation of how the virus was likely contracted – by mosquito – then goes on to explain how important it is that people take this problem and its relatively straightforward solutions seriously. And she says it’s not just about wearing bug spray at dawn and dusk, when mosquitoes are most active.
“I think the government needs to take a stand to eliminate the holes in the street that collect water, to do a better job cleaning up garbage, to fumigate,” she said.
Her frustration is clear when she talks –more with the people than the government.
“People need to become more conscious of this – all of us. Not just one neighborhood, or one city, but everywhere. This mosquito doesn’t respect color, or cleanliness, at least not if there are dirty places around where it can reproduce.We live in a tropical country. It rains a lot. People need to keep their houses and the roads clean. We will
always have it until the people of Costa Rica change their habits,”Viales said.
Henry Wasserman, a doctor who works in Epidemiological Surveillance for the Ministry of Health, said there’s no reason to panic yet, though he is concerned with the rise in cases of hemorrhagic dengue, a more severe strain of the virus that causes bruising and bleeding of the nose, gums and other orifices. This strain is sometimes fatal, though the ministry denied press reports that the recent death of Juan Valdavia, a patient admitted to the hospital in Liberia with symptoms of the virus in late December, was caused by hemorrhagic dengue.
In 12 days of the New Year, Wasserman said they’d recorded 13 cases of hemorrhagic dengue – a breakneck pace considering that last year saw just 72 cases total nationwide. The reasons for the sudden spurt are unclear, but Wasserman suspects it has to do with the high number of cases of dengue fever in the country over the past few years, and particularly in 2005.
“What we do know is that when a person has had dengue in the past, he’s at an increased likelihood of getting hemorrhagic dengue in the future,” Wasserman said. “We’ve had so many cases the past few years, this may be elevating the numbers.”
Wasserman said the government is “encouraging sanitary measures,” and added it is most important to take care of garbage and not let fluid accumulate in containers.
Such measures, said Mauricio Céspedes, executive director of the Guanacaste Chamber of Tourism, will help insure that unsuspecting tourists don’t get sick, and then spread the bad word back home – a situation that could negatively effect this region, which has seen continued tourism growth even as the rest of the nation stalled last year (TT, Jan. 12, 2007).
“Realistically, you have to do something before people get infected, not after,” he said. He said the tourism chamber is ready, and willing, to help the government in any way it can.
Stacey Watson – who’s seen both friends and family in Tamarindo infected with the virus – couldn’t agree more with this philosophy.
“We need some help out here. They’re killing the golden goose that’s laying the egg of tourism,” she said.