Interview with Dr. Md. Asaduzzaman Miah
Associate Professor
Department of Entomology
Patuakhali Science and Technology University, Bangladesh

I first heard about dengue in 2008. I am an Associate Professor in the Department of Entomology, Patuakhali Science and Technology University, Bangladesh. I have been performing research work on vector mosquitos, vector borne disease etc. I completed my MSc on Entomology and PhD, Post-Doc on vector biology and their control.

“I am presently engaged in teaching and research, with Teaching (30%) and Research (70%).”
“Personally, I believe, effective mosquito control is one of the best tool/strategies for dengue management. As there is a lot of problem in other strategies like no effective vaccine, climatic change, resistant Aedes population etc.”

“I have faced some issues like dengue data specially in Asian countries that are not updated. We have not a single platform from where we can share our news and views on dengue to solve the problem. As our dengue problem is almost same, we should work on dengue together.”
“Other than research and teaching job, I like to do editorial work on articles, books etc. My hobby is writing articles/ opinion on different national/international issues.”

I first learned about dengue as a graduate student studying virology.  It became more than just another virus to me when my first job out of grad school was working on a recombinant subunit dengue vaccine at Hawaii Biotech.”

“I was trained as a molecular virologist with a medical technology background. Following my graduate work I made the decision to join industry rather than following an academic route as my interests were always more focused on translational rather than basic research and so have spent the last 25+ years working in industry on vaccine development. I have transitioned back and forth between the small biotech (Hawaii Biotech) and large pharma (GSK Biologicals and MSD) environments and actually really enjoy both, although they are very different.”

“Over the last decades I have focused on vaccines for infectious diseases, primarily on viral vaccines but have occasionally supported vaccines for bacterial targets as well.  Dengue vaccine development has been one constant in my career – while I have worked on many other targets, I have been involved in dengue vaccine development non-stop since 1993.  I do hope to eventually contribute to the licensure of a safe and effective dengue vaccine and to help make a difference for so many people impacted by dengue every year.

“I joined MSD in 2010 when MSD acquired the Hawaii Biotech recombinant subunit dengue vaccine candidate.  I joined MSD initially to support the evaluation of that vaccine candidate and ultimately transitioned to the role of Product Development Team Leader for the dengue and Ebola vaccines at MSD.”

“I lead cross-functional, cross-divisional teams that are responsible for product development.  That includes responsibility for defining the strategy and tactics to develop a product, and then executing the plan from early development through licensure and the post-licensure space.  My teams include experts in their respective fields (e.g. manufacturing, regulatory affairs, clinical development, safety, etc.) who work together to advance products that aim to help to protect people from devastating diseases such as dengue and Ebola.  It is both people and product oriented and always driven by the science – the perfect mix from my perspective.”

“The huge impact that vaccines can have on global public health is tremendously appealing.  If you look at history and the assessment of the impact that vaccines have had in terms of lives saved it is mind boggling.  Joining MSD in 2010 and learning more about the amazing work done by Dr. Maurice Hilleman has further inspired me, as it highlights the impact that a single person can have on the world.  His example and the example of so many pioneers in the vaccine field inspires me on a daily basis.  Recently I have had the privilege to be part of a global collaboration to develop an Ebola vaccine and seeing the incredible sacrifices made by so many to respond to Ebola outbreaks, and the critical way in which a vaccine can make a difference in that response, has driven home how important the work that we do to develop vaccines truly is.”

“I am lucky enough to never have experienced dengue myself, but working in the field of tropical medicine for decades I have seen the impact on so many people.  With my home in Hawaii I have seen the fear that even a small outbreak can bring to a community.  I can only imagine what it feels like to live in a highly endemic area during a major epidemic, but imaging that provides me with a sense of urgency around vaccine development.”

“Product development is all about challenges and figuring out ways to overcome them, so I view my job as primarily problem solving.  Dengue vaccines have been particularly challenging given the natural history of dengue, but all of us in the field continue to learn and innovate and look for ways to overcome the issues.  There is no guarantee that we can overcome the challenges, but that does not stop the effort.”

“I love history so if I weren’t a scientist I would probably be doing some sort of historical research.  I particularly love when history and science intersect and would love to think that I could have written books like the amazing books written by Paul Offit and others on the history of science of vaccines.”

1/“I had dengue when I was in my early twenties, just after army. So it was 1997. I was at home. I was staying with my parents in Lorong Lew Lian, Upper Serangoon area. We didn’t know there was dengue there until I got it. It happened because, if I recall correctly, there was a construction site behind it. They were leveling state land and I had that dengue during that period of time. I estimate a few months just after finishing national service (in the army).”

“I was in the middle of my audio engineering course. So I did come home every night. My room was facing some trees. I noticed numerous mosquito bites, more than 10 over a few nights. Then I put some mosquito coils in place – the traditional mosquito coil coupled with bug spray. But by the time I did that it was too late.”

“Within the week I had fever that didn’t come down, and I felt very nauseaous, miserable is the word. Then went for blood test and realized that the platelet count was low – less than 20. I was warded for one night for observation where they had to give me a drip. Since I was a young man I was maybe more resilient, but still the sense of being miserable lasted for about 10 days. Waiting for the body to fight, it was about 10 days of hell.”

2/

“I went to the hospital almost like the next day, or over the next two days after the fever started. My mum brought me in because the fever didn’t come down and the aches were maybe weird to her. And she just told me, let’s go. We went to A&E actually, not the regular GP.”

“I think I was amongst a few of the ongoing cases that happened then. They just said, oh okay Serangoon, (that’s a) Red Zone, we think its dengue. I don’t know if they did any testing for dengue – maybe they did, but they didn’t tell me, I was just miserable then. They drew a few vials of blood, I stayed for the night, and then they said, do you want to stay some more? I said no thank you so I went home.”

“I wasn’t in critical condition. My temperature was reduced from near 40 to 38+. I was clear of mind, I was functioning, so they let me go home. But the sense of nausea was quite strong.”

“They said to come back if fever goes up above 39 again, if my sense of well being dropped over the next few days please come back and look for us again. That’s what they said. It wasn’t like specific. If I feel worse, come back.”

“Came home, change of diet to nothing fried, nothing spicy, until I got better.”

“The fever went on for a week.”

3/

“Before I realized it was dengue, I suspected it was regular flu. Flu with a different kind of ache. I recall that the steps I took were slower – I just didn’t want to function.
And it’s a different sense of dread when you’re having dengue as compared to regular flu. Like there’s a weight on the chest . It feels like it takes more effort to just exist.”

“For me, I had muscle aches. Very like, I don’t know how else to describe it – sickening pain. It’s a different kind of ache, different from regular flu. I never felt it before. It was very nauseating. There was weight loss – I wasn’t fat then, my BMI probably about 24, yet I lost about 5-6 kilos, over 10 days, because I had no appetite. It could be water loss, or it could be just not eating you know.”

“Did we employ further anti mosquito measures? Yes we had to. We were all freaking out. So every room had mosquito coils, lemongrass , citronella oil, and the electric bug zapper thing. We continued that for about a month.”

“We weaned off the coils which were getting smokey and then we weaned off the citronella oils later, when the mosquito bites still didn’t come anymore. But during that period for about a week during my dengue they were doing aggressive fogging. They fogged the (construction) site, they fogged the open drains behind. The town council came by and they fogged up the place – every alternate day for a week.”

“We felt safer.”

4/

“If I could take a dengue vaccine, would I take it? Yes. Yes. I would still take it even if there is a small risk of getting a worse version of dengue. Dengue is an ongoing risk in Singapore. Regardless of age and time period. As you grow older, your body will be able to take on less and less of this suffering. So I would definitely want to take the vaccine.”

“But I would probably read into the pharmaceutical literature to see if they are covering the more common strains that are in this region. If they are covering a strain that’s outside of this region then no point. It has to be localized.”

“I would also give my kids the dengue vaccine. I vaccinate my kids for anything I know that is vaccinable in Singapore.”

“Any measures to especially take care of mosquitoes now? I will probably check for stagnant water at least and I’ll open all windows to test drive the environment to see if there’s mosquitoes coming in. Typically there are none in the environments I go to. If there are I’ll start off with citronella oils first and probably a mosquito net if needed. But that’s as far as I’ll go now.”

“Once you’re cured, happy-go-lucky again, don’t care.”

“I was born and raised in Milan, but I have been living like an expat since 2007. I moved to Denmark in 2008 for my PhD studies in Nanotechnology, and since then I spent most of my professional time between Copenhagen and Taipei, where I was exchange student during the doctorate program, and where we opened our BluSense subsidiary in 2015. Before launching BluSense with my co-founders, Marco and Robert, I took various entrepreneurship courses to “learn the startup game”, which is significantly different from the life of a scientist. Writing business plans is very different than writing a scientific paper, and chasing investors is quite another game than chasing research grants. Furthermore, I had to visit regularly dengue endemic countries to visit clinics, plan clinical studies, meet users and key opinion leaders in order to truly understand the needs of better diagnostics technologies. I consider my background therefore a mixture of science, entrepreneurship and business development”

“My responsibilities tend to be cyclical as natural in my role of CEO in an evolving young company. I started in the laboratory with my co-founders before moving to nearly full-time fundraising-related tasks, to then move almost entirely to business development and market-creation. Now I am in charge of the company medium-to-long term strategies, managing investors relationships, conducting market analyses and scouting new business opportunities for our technology. I naturally act as the main point of communication between the board of directors, our shareholders, and internal operations. I’m trying to find time for hands-on activities, from designing illustrator files for marketing material, training distributors to the use of our products, writing protocols for clinical studies, to supervising the project of building a new production line.”

“We were developing technology for measuring different biomarkers, while at the same time looking for the killer application, the one which could have the highest impact and provide a true value to the users, when compared to other existing products. Because of the collaboration with the University of Queensland we investigated the field of Dengue fever diagnostics. We’ve noticed that there was a considerable market gap due to lack of innovation resulting in underperforming commercially available products. Likely, large players are less interested in such “niche” markets, and Western startups are too little exposed to tropical diseases knowledge to innovate in that space. It was in 2015 when we decided to apply our diagnostics technology to dengue fever, as at that time we were applying our prototype to more “Western” diseases, where competition was fierce (and the impact appeal low). Only later did we realize that indeed we would be able to provide among the best performing products in the market, with associated impact to the endemic region healthcare systems. That was the moment where we were like “that’s it, we have in our hands a device that could really impact millions of people’s lives!”.

“It’s great to be able to develop technologies for responses to viruses. It’s compelling for me that it’s the technology that has a strong impact on people. It’s not the greatest of all businesses in terms of profitability of the products, and that’s probably among the reasons why there is little innovation in dengue diagnostics or topical diseases in general. Bringing technological advancements to neglected sectors of healthcare feels like the right thing to do, and at BluSense we are proud of it. It is of course of great help that our investors share our passion and commitment to making an impact more than making only a large profit.”

“It was thanks to a scientific collaboration which my co-founder Marco had with the University of Queensland in Australia, that I heard about Dengue fever for the first time. It’s not easy to comprehend the incidence of dengue when you’re so far away from countries where it’s prevalent. Here, in Denmark, we hear only echoes about this disease. But once you start working in the field and travelling to countries where it’s widespread, it’s impossible not to face the force of this virus. It’s not merely a few people, it’s almost half of the human population that is in danger of being exposed to dengue. Before 2015 dengue was nearly unheard of in Taiwan, but due to climate change there are regular outbreaks across the country every year, and dengue is now among the diseases treated by national policy agenda. Only once you live in an endemic place, or when you start working in the field, you realize what a heavy burden it is to some regions of the world.”

“After I started working in this business, I unexpectedly met many people that had contracted dengue, even in Europe. On few occasions, after explaining what we do I was given stories of infections and quarantines in local hospitals. I was surprised to discover how many travelers contract dengue during holidays, and often they told me no proper testing was done to them, leaving them for days in uncertainty.”

“But it’s during field trips where I fully grasp the burden of Dengue in some parts of the world. From Delhi to Bogota’, during post-rainy season (when mosquitos are most numerous and voracious) you can find all sort of billboards, along highways or printed on the sides of buses, reminding people how to prevent the harbouring of mosquitoes, e.g. emptying vases from water. When you see that large number of spaces usually dedicated to commercials are used for advises on how to prevent dengue, you really realize what a huge problem it is in these countries.”

“If you develop a product that doesn’t exist, it takes time to educate the market. It’s not an easy journey, but an exciting one. If you’re building a product that’s neither a laboratory test nor a rapid diagnostics test, but something that works as good as laboratory test and is as easy to use as a rapid test, it takes effort to explain that to people. Not everyone easily understands the concept of microfluidics or nanotechnology behind our products, so there’s a bit of education involved when introducing novel and innovative technologies such as ours. Of course, the vast bulk of people I meet are well educated, representing lab managers or Key Opinion Leaders, and the response is always favorable. But it’s not always like this when our distributors go out into the field. There, people that are used to working with rapid diagnostics tests and nothing else can be reluctant towards new technologies. Even though the price point is similar, and the quality is better, the novelty factor sometimes causes adoption issues. For more receptive people, it’s fascinating to hear about Immuno-Magnetic Assay, our patented technology. They see the potential and believe that it’s going to have a big positive impact on the dengue health sector.”

“Even without BluSense it’s unlikely I would have remained in Academia for long as I do not have enough patience nor probably the right personality for being a scientist. I’d probably still be involved in innovation and likely in health care, maybe from some other aspects that I can’t foresee right now. Surely, I would be doing what I like the most: finding out-of-the-box solutions for addressing problems, asking provocative questions, convincing people to join a cause or project, and finding new perspectives to identify alternative scenarios. Independently on the sector, those are useful activities for advancing innovation”.

“I lead the vaccine delivery work of Bill & Melinda Gates Foundation in India. In this role there are four primary aspects to my work. One, to prioritize areas in which Bill & Melinda Gates Foundation can effectively partner with the Ministry. With our limited resources, we can only collaborate on limited specific areas. Therefore, we have to prioritize those areas that can have maximum impact and can be sustained within existing programs. We do this by constantly generating evidence that can be translated to action. Based on the evidences generated, we help prioritize our work.”

“Two, we bring in new resources in technology. For example, we worked with partners to boost vaccine supply chain in the country with a technology called electronic vaccine intelligence network (eVIN). A pilot was conducted and now the Indian Government has found this technology so effective that it has planned to scale it up with domestic resources.”

“Three, we identify highly talented partners in forms of institutions, academia and researchers and connect them to the overall work of the Government in vaccine delivery. We build collaborations with a range of partners from UN agencies to international NGOs to research organizations to vaccine manufacturers to academic institutions at both domestic and international arena to strengthen this collaboration.”

“And fourth, we ensure that voices of leaders are rallied around vaccines. From voices of our Co-Chairs, Bill & Melinda Gates, we also look for voices within and outside the country from a range of social, cultural and scientific domain to advocate with the government on scaling up vaccines in the country.”

“My role is to ensure that BMGF can coordinate all of these functions and work with the Government effectively to reach our common goal of reaching every child in India with all the essential vaccines.”

– 1/5 of Interview with Raj Shankar Ghosh,
Deputy Director, Vaccine Delivery,
India Country Office,
Bill & Melinda Gates Foundation.

“Beyond my medical school textbooks and class lectures, I first heard about Dengue in 1990 when I treated the first case as a House-physician in the Medicine Out- Patient Department of Shambhu Nath Pandit Hospital in Kolkata, India. He was a middle-aged man who had fever that did not subside for a week. We treated him with presumptive treatment for malaria. Laboratory results were inconclusive. Our Unit Professor advised advance tests from a more sophisticated laboratory at a referral tertiary hospital. The patient was diagnosed as a case of Dengue. Fever subsequently subsided and the patient was discharged.”

“My son suffered from Dengue when he was around 13 years old. Those were anxious days for me and his mother. We regularly checked for any signs of bleeding. And the itching that he suffered in the recovery phase was very painful for him and for us to watch. Those were anxious seven days in our life.”

– 2/5 of interview with Raj Shankar Ghosh,
Deputy Director, Vaccine Delivery,
India Country Office,
Bill & Melinda Gates Foundation.

“I was born in the mid-sixties in a small district town of India called Jalpaiguri. My father was an ENT surgeon in the district hospital. Jalpaiguri is a beautiful town close to the hills, forests and surrounded by tea gardens. My father was in Government services and with each transfer I changed schools. From schools run by Jesuit priests to boarding schools run by Hindu Monks, I learned how to pray and seek blessings in many languages and cultures early in life. In 1983 I joined Medical College. My first job was within a month of my marriage in 1992. I joined a small NGO in a deep desert of Rajasthan State in India. The thrill of travelling to remote villages early morning with vaccines and medicines was a unique experience. After about a year and half, I joined Government health Service and returned to Jalpaiguri, the district where my father had begun his career and I was born. I was a Primary Health Centre Medical Officer for about four years. As a Medical Officer, I got involved in one of the key public health campaigns in India, the Pulse Polio Program in 1995. In 1997, WHO launched its National Polio Surveillance Program (NPSP) with Government of India. I joined the first batch of Surveillance Medical Officers in the NPSP program of WHO. Three years on, I was given additional charge as a Regional Coordinator managing 22 field Units of NPSP in India. After seven years of services in WHO-NPSP, I received an offer to lead the Japanese Encephalitis (JE) Program of PATH in India in 2004. A massive outbreak of JE happened in 2005 in India and PATH worked closely with the Ministry to introduce and scale up a novel vaccine from China, live attenuated SA-14-14-2 from China National Biotech Group in Chengdu, China. Eventually I led the immunization portfolio of PATH in India and Nepal.”

– 3/5 of interview with Raj Shankar Ghosh,
Deputy Director, Vaccine Delivery,
India Country Office,
Bill & Melinda Gates Foundation.

“In 2008, I joined a US based non-profit drug development organization, Institute for OneWorld Health. The company was involved in developing affordable, high quality drugs for neglected Tropical Diseases like Visceral leishmaniasis. The drug, Paromomycin was tested in India and approved for use in public health programs. I additionally managed a multi country JE Project to work with governments in 8 countries in South Asia and Western Pacific Regions of WHO for introduction and scale up of JE vaccine. In 2013, I joined Bill & Melinda Gates Foundation. I currently manage the vaccine delivery program of BMGF in India.”

“My first contact with BMGF was when I joined PATH and managed the JE Program of PATH in India. The JE project was funded by BMGF. Since 2004, I have managed Projects funded by BMGF only. Till date I have managed more than 10 projects of BMGF wearing either a grantee or a donor apron. In 2012, BMGF was slowly transitioning its flagship HIV AIDS program, Avahan in India. A new strategy was developed for its engagement in Vaccine Delivery supporting the Ministry’s efforts in scaling up immunization services in India. I joined in 2013 and have worked with partners, Ministry and an internal team across many sectors to support the Ministry’s vaccine delivery program in India.”

– 4/5 of interview with Raj Shankar Ghosh, Deputy Director, Vaccine Delivery, India Country Office, Bill & Melinda Gates Foundation.

“Vaccines save lives. They help wipe out dreadful diseases from the world. Smallpox. Polio is on its way out. These are such bright examples. I have seen children and adults die from complications of diseases like measles, diphtheria, Japanese Encephalitis. And I think this is unacceptable because these are preventable with vaccines that are available. Therefore, I am committed to vaccines. Because vaccines work and vaccines prevent deaths and disabilities from preventable diseases.  Every case of Polio I see today reminds me that theses men and women could have lived a much better life had they been born a few decades later.

“The general public believes in vaccines at large. We just need to continue to have their trust with truthful messages. With the current political commitment in the country, there is a focused drive on vaccines in India. One issue that we are currently working on is in integrating vaccine delivery in the larger public health program. That is an area that will require much collaboration and patient wait for integration. We are preparing for that with evidence and tools.”

“If I weren’t involved in healthcare? I have always desired to be a Chef. I do not cook much. But that is a dream that I have. I truly cherish the satisfaction of a good meal. I love to watch the expressions on a face after a first bite of a tasty food. May be one day. I will cook a dish that will bring smile to faces. Yes, I do want to be a Chef too.”

– Raj Shankar Ghosh,
Deputy Director,
Vaccine Delivery, India Country Office,
Bill & Melinda Gates Foundation (https://www.facebook.com/gatesfoundation/).
Follow him on Twitter at twitter.com/lovingvaccines

1/
So basically, on the 3rd day of CNY, what happened was, her lymph nodes were swollen. She complained pain she said mummy my neck is painful oh maybe lou zhen I was thinking okay lar maybe rub some bu piao la. I was so ignoreant, I said I also lou zhen , mummy also don’t sleep well so we both went to bed.

But then I felt she looked very listless and tired. Then I touched her and she said it was very painful. I asked how painful? She had fever. I touched her lymph nodes and it was painful to the touch. So I thought there was something wrong. Lou zhen is not like that. Something is wrong. The lymph nodes were swollen and she had fever.,

Okay lah I said quickly cannot wait, lets go see doctor

So the doctor gave antibiotics , Augmentin. And of course paracetemol. Augmentin brought down the swell the swell was okay, vry fast went down with 2 dose of Augmentin. But her fever did not go away. So we continued with the paracetemol two or three times a days . the augmentin was a 5 days course.

However, though her neck swell stopped hurting , the fever continued and so did her lethargy. She was very lethargic. Day 2 and day 3 the fever continued. Then she started complaining of giddiness. I wondered why the fever would not go down. The doctor then suspected it was dengue, because after the lympth nodes swelling went down were not swollen but fever persisted, something must be wrong. So we went to check for dengue markers. We went to the polyclinic for a blood test but the results were negative, all her stats were normal. We got the results within an hour.

That moment when I said lets go back to the doctor I don’t think this is right she said she felt giddy and saw purple yellow colours . how come will see colour one I said. At first we thought maybe it was puberty because she is turning 12. But we’ve never heard of menses being like that. I mean when womens’ menses come we might feel a bit faint or have pregnancy-like symptoms.

I thought this was all very unusual because my daughter is not normall like this. So I told her since you are giddy, go brush your teeth, we’ll have breakfast and go to the doctors for a second visitation.

The moment she brushed her teeth, she came out bumping into things all over – she probably lost her vision in a way . she fell but I caught her . it was almost like fits . she was very stiff. I told her “cannot faint cannot faint” and asked my mum to bring oil . she regained her consciousness and asked what happened , where is this place mummy,. But she could recognise me. She said “I see yellow . why am I like this, what did I do?”I told her you almost fainted . Can you walk? Cannot walk mummy carry you. We have to go down and see doctor. We sat her down slowly gained back drink hot water , vision come back everything stable liao . she had got a cut .

The doctor recommended a blood test. So we went to polyclinic take blood test . The results came back and my doctor was glad it was not dengue. Luckily the markers for dengue were normal. But felt strange about the persistent fever because she is already on Augmentin a very strong antibiotic. The thing is, either you go hospital because the fever has persisted for 3 days (despite antibiotics) and it seems like you don’t have dengue . maybe drip her . Or allow me to give her another brand of antibiotic but only 2 days, to go together. I asked if its too much but he said its fine. So Friday and Saturday , but Saturday you come back again. I said im okay. So long as there’s no side effects

The fever went down on Saturday . So I asked if she can go for tuition . so she went for tuition, everything else went already. Sunday morning, fever again!

2/
I was worried – how come fever again? We can’t be eating medicine forever. I told her, okay tell you what today no tuition, no chinese tuition. So she stayed at home and the whole day she was quite listless and tired . I made nourishing soup but she was still very tired. I asked “tomorrow can you go to school or not? She said ok. So we started the week, Monday.

But she started complaining her joints pain . Wait, joint pain is dengue symptom right? Aching right ? She didn’t have it before. Before was fever, giddiness, headache, now joint pain is something new already. Wrist knuckle, ankle knee cap, . something’s not right.

When she reached school her teacher took her temperature and she almost failed the check but was allowed to go to class. She persereved through the whole day. By now it has been almost 10 days.

Monday Tues Wed, I told her no, She covered herself with blankets window closed, but complained that she was cold. Fever. We went back to the doctor. She had a temperature of 38.1. The doctor asked, why is she having a fever? In this case, I think cannot, we need to go, we need to ask your girl to go hospital. I said I thought that time blood test there was nothing. The doctor said she can go for further blood test . But we can’t do that here, you have to go to the A&E for advanced blood tests. I don’t know what the difference is.

3/
So we went. Admit A&E. The triage doctors were also thinking about dengue. I said we had checked for dengue , for so called blood biomarkers , last week. They said the test was not valid anymore since it has been a week already. The doctors made her lie down and examined her joints for pain. Suddenly, we found a rash on her sole. We didn’t see it before. It made it more likely to be dengue – a rash , joint pain. A paediatrician came and checked everything was good. But the senior doctor said admission was warranted to do advanced blood tests. So we admitted her.

Throat swabs were taken , urine tests, activated the bone specialists just to make her bones have no major problems , in case it was due to bone or something.

In the end we stayed for 2 nights. Everything was okay, all her tests passed , so peace of mind. After that, nothing happened. So that’s it.

4/
But the thing is… there was still some joint problem. So I’ve been thinking… is it a problem with her joints? She just has aches here and there. And during the stay in the hospital, the doctor did say that sometimes that can be due to inflammation. So he gave her anti-inflammation medication. While she was in the hospital, she recovered.

Not mostly in the hand area – other joint involved – all the joints. wrist, knuckle,

While she was there she was not on any antibiotics. Though they were ready with the drip.

I did hear that there was a case of Dengue at Dairy Farm.

She lost about 5 days. But the whole course of the illness was about 10 days. Which spontaneously resolved while she was in the hospital.

We do have followups arranged with the bone specialist .

She also had conjunctivitis – when we revisited the doctor before referral to hospital we found that she had pinkeye . During those days when she had pinkeye she had been very listless. Why are you always so tired after you came back from school? One of the eyewash we gave her for pinkeye would relieve the redness temporarily but she would complain of pain but not itchiness. So this was inflammation as well

Antibiotics only until Saturday , Sunday she was fine, Monday she went to school but came back especially tired . On Wednesday or so she had conjunctivitis and found that the redness kept returning. So she had a bone specialist and then a eye specialist see her – and made appointments to see her again.

The doctor said it could have been dengue but blood tests showed nothing. And since the fever has gone away, that meant it has stabilised. She still has a bit of joint pain but not like before when it was 10/10, now its like 2 out of 10.