Running head: GLOBAL HEALTH
1
A Vector Born Global Health Issue
Laura L. Jimenez
California State University, Stanislaus
April 14, 2014
2
GLOBAL HEALTH
A Vector-Born Threat
Over the winter break of my senior year of nursing school, I had the grand opportunity to
travel to the island of Hispanola, which is subsequently divided into the nations of Haiti and The
Dominican Republic on a global health medical mission. Although these two nations share a
geographical locale, they are very distinct from one another in culture, language, and social
structure. They do however have one thing in common: Dengue Fever.
Because the virus, of the Flavivirus genus, has four different serotypes, an individual
living in a Dengue-endemic area could potentially fall prey to the disease up to four times in the
course of a lifetime (Gubler & Clark, 1995). Transmitted through the bite of a mosquito, Dengue
is a febrile illness that can cause an array of symptoms ranging from mild flu to life-threatening
hemorrhagic fever (World Health Organization [WHO], 2014). Because the voracious vector,
Aedes aegypti, breeds in standing water, its proximity to human life proves beneficial to the
species (Gorman, 2013). Swimming pools, bird-baths, horse troughs, ponds, even old tires or
buckets filled with water, provide an ideal breeding ground.
Today there are three billion people living in Dengue-endemic areas on almost every
continent of the world, with an estimated 50-100 million cases of the disease annually (WHO,
2014). This defines Dengue Fever as a global health issue, with humankind itself as a
stakeholder. In fact, the tropical mosquito known to carry not only Dengue Fever, but Malaria
and Yellow Fever as well, has recently been identified in Fresno, Madera, and San Mateo
Counties (Gorman, 2013). Being that the vector needs an infected individual to obtain and
transmit the disease, there have been no documented cases yet in California (Gorman, 2013). But
3
GLOBAL HEALTH
with international travel being a commonplace concept in our modern age, the threat is always
impending.
Because of the lack of quality medical care for many populations of developing nations
like Haiti and The Dominican Republic, the lethality of Dengue Fever is a daily threat to life. To
the group of women I traveled to the Caribbean with (all either existing or prospective RNs), the
effect of Dengue Fever on nursing and healthcare were apparent. Most of our time was
consumed with triaging and treating patients who manifested symptoms of the disease: infants
with skyrocketing fevers, severe abdominal cramping, painful systemic rashes. We depleted our
mobile pharmacy in a matter of days just trying to stave off symptoms, and every family we saw
could recall the name of a loved one taken by the disease.
The days were long, hot, and sometimes felt defeating. After several days, there was a
frustration that erupted among us. We felt defenseless in the face of this tiny vector, defeated by
a tiny insect. All of our resources seemed to be spent, wasted, obliterate on treating symptoms
that were out there multiplying exponentially. The antipyretics, topical antibacterials and steroid
creams, the vitamins and re-hydration solutions thinly distributed were a weak and unsustainable
way to combat the disease. Of course, it is not in the nurse’s nature to lie down and accept defeat.
We realized that, collectively, we had over 100 years of education and experience under our
belts. How could a tiny, brainless, water-breeding vector compete with that?
One night after another day of clinic, we crowded onto a cot and discussed how we
would combat this bug. We discussed patterns in infection distribution; the more rural areas of
Haiti were much worse off than the urban areas of the Dominican Republic. What was different
between the two? First, in the urban city of Santo Domingo (the capital of The Dominican
Republic) and its surrounding slums, there were public health advertisements on billboards,
4
GLOBAL HEALTH
buses, and taxicabs. They prompted citizens to empty or cover any free standing water, to sleep
with mosquito netting, to close windows and doors at dusk, to apply bug repellent.
The most important method of staving off the disease is prevention. And this is the
conclusion we arrived at that night: we would leave our mark through teaching. Currently there
is no vaccine for the prevention of Dengue Fever. Whether a country is industrialized or
developing, it is essential that the nurse is able to effectively influence change at local, national,
regional and international levels (Benton, 2012). Our little group traveling through the Caribbean
decided that night that we would try to teach this bug a little farther away from the populations
we were serving by teaching them methods of vector control.
Effective and sustainable prevention of dengue outbreaks are dependent on community
participation (Rigau-Perez, Clark, Gubler, Reiter, Sanders & Vorndam, 1998). We collaborated
and mobilized and taught each and every patient that came to our clinic how to prevent mosquito
bites. Not only did we teach standing water elimination, use of mosquito netting over beds, cribs,
and strollers, but we collaborated with community leaders (most often women) in an attempt to
inflict lasting change long after we had returned home to the States.
By opening communication lines with community leaders, we could better understand the
resources available to the community and the willingness of the community to collaborate and
cooperate, among other influential factors. After a focused assessment of the community, we
were then able to formulate a nursing plan of action based on this assessment. We found
ourselves meeting with community leaders for a couple hours each day after clinic. Tired,
exhausted and sweaty, we crammed into the lean-to family room of the “grandmother” of the
Haitian community we were working with. Despite the thumb of poverty under which this
woman lived, she fed each and every one of them as we crammed onto random plastic chairs, the
GLOBAL HEALTH
rest of us settling in cross-legged on the packed (and immaculate) dirt floor. We talked long
5
into the night. Not only about Dengue, that was just the tip of the ice-burg. In the end, we each
learned how similar we are to one another, despite cultural and language barriers. Not only did
we teach them about vector prevention, but gained a wealth of knowledge from them. As my
plane gained elevation over Santo Domingo, I felt a certain satisfaction that the work I did
thousands of miles from home may possibly, somehow, have a lasting impact. Perhaps even save
a life.
6
GLOBAL HEALTH
Resources
Benton, D. (2012). Advocating globally to shape policy and strengthen nursing’s influence. The
Online Journal of Issues in Nursing, 17;1. Retrieved from
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/
OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocating-Globally-to-ShapePolicy.html
Gorman, S. (2013). California mosquitoes with dengue, yellow fever worry public health
officials. Huffington Post Los Angeles. Retrieved from
http://www.huffingtonpost.com/2013/10/30/california-mosquitoes-dengue-yellowfever_n_4179250.html
Gubler & Clark. (1995). Dengue:dengue hemorrhagic fever: the emergence of a global health
problem. Emerging Infectious Diseases. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626838/
Rigau-Perez, J., Clark, G.G., Gubler, D., Reiter, P., Sanders, E.J. & Vorndam, V. (1998) Dengue
and dengue haemorrhagic fever. The Lancet, 352; 971-977.
World Health Organization. (2014). Dengue control. Retrieved from
http://www.who.int/denguecontrol/faq/en/