It all started with two neuropediatricians in Brazil who noticed that they were seeing more babies born with small heads than normal. From one case every two months, these doctors, a mother and daughter team, were seeing dozens at a given period of time in 2015.
In 70 percent of these cases, the mothers reported having rashes during their pregnancies. By the end of 2015, there were about 4,000 cases of microcephaly seen in Brazil compared to only about 367 in 2014.
When the same phenomenon was reported in other Latin American countries like Venezuela and Colombia, and after investigations were conducted, they have established that the condition, called Microcephaly, is linked to the Zika virus. Its mode of transmission is through the Aedes Egypti, the same mosquito strain which causes dengue and chinkunguya infections.
Zika now is called a worldwide “medical emergency”, having spread to 20 countries, including Europe and the USA.
Its symptoms are relatively mild when compared to dengue: red itchy eyes, fever, rash outbreak, muscle or joint pain and general weakness. Trangkaso, hilanat, luya sa lawas, mga butoy butoy — all of which a lot of us go through every once in a while in our lives. It does not really have any dangerous implications, except, that is, when it affects pregnant women.
Zika is strongly believed to cause Microcephaly, a birth defect characterized by abnormally small head and failure of the brain to develop thereby causing developmental delay, which may range from mild to severe. Although some children grow up without any problems, a greater number have difficulty or are unable to talk, walk hear or see; a large percentage have cognitive difficulties.
The virus is also believed to cause Guillain Barre Syndrome (GBS), a disease that causes paralysis of the muscles in the body.
Although it is self-limiting (it heals by itself), it is a potentially fatal condition once the paralysis reaches the muscles that are responsible for breathing.
Brazil was able to quickly detect the massive increase in the incidence of microcephaly in the country because of the country’s existing birth defects surveillance system. The country monitors these congenital anomalies and includes this information in birth certificates. Such a system has created awareness in the medical community about such conditions and makes it easy for early detection and early intervention.
The Philippines had a total of almost 150,000 dengue cases in 2015. Again, dengue is caused by the Aedes Egypti mosquito, a strain that is commonly found in the Philippines.
Interestingly, the Philippines ranked 5th in the ranking for highest number of dengue cases. Brazil was 4th.
If Zika and dengue have the same transmission agent, the Aedes mosquito, would it have been possible for a number of cases of microcephaly in the country to have been caused by the Zika virus even without a reported outbreak? We will never know because, for one, the level of responsiveness, to cases of birth defects in this country is low, even among health professionals, 2) routine investigation into the probable cause of a birth defect is almost nil, and 3) in all honesty, the truth is that, aside from the parents and maybe some members of the family, no one really cares. The defects are there; the child has a disability, so bear the scourge. Hard truth but still the truth.
I remember sometime last year, a friend from a local politician’s office told me: “Daghan laging nagkasakit karon ug GBS karong mga panahona. Mga napulo na nangayo namo ug assistance.” Could it have been an outbreak of a viral infection? We will never know. No investigations were conducted.
This recent phenomenon gives another reason to why there should be increased disability awareness among our health workers and health professionals. Birth defects, childhood disabilities, developmental delay, causes of disability, all these should be taught to all our health workers, from nurses to midwives to barangay health workers, doctors, even medical specialists.
Reminds me of the statement of one young doctor, while we were talking about early detection: “Wa man gyod na gi-emphasize sa among training. Nindot gyod nga hasta kami ma-aware pod anang disability aron mahatagan dayon ug tabang ang mga bata, labi na nang sa mga barangay.”
Statistics point out that around eight million babies are born with serious birth defects and at least 3.3 million under-fives die from these conditions. More than 90 per cent of these births are in low- and middle-income countries.
In the Philippines, 4,775 babies are born every day. How many of these have visible birth defects? How many may have defects that are manifested as the child grows up? New born screening does not detect disability nor congenital anomalies.
Rather, it identifies certain metabolic conditions that cause disabilities, most of which are intellectual in nature. Although it has its advantages, it does not have wide-range coverage.
Which is why I could not understand some government doctors who, when broached about a simplified process of early detection, say “Oh, we have the newborn screening.” For newborn screening has severe limitations as a method for disability detection.
Zika and its relation to dengue and chinkunguya only highlights the fact that disability is also a public health issue; this has to be realized and accepted by everyone in the public and private health system (Case in point: when presented, again with early detection to be a program in the government’s public health system, one doctor-politician said: Ah, disabled. Sa DSWD man na nga programa.)
There is a causative relationship between infectious disease and disability, nutrition and disability, smoking and disability. If society keeps on denying these links, we might miss out on a number of vital health issues and events that affect our people, especially our children.
And then it may be too late.
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Author’s email: [email protected]
