Chick V Chick V

Introduction

The disease Chikungunya is one spread by mosquitoes that causes fever and severe joint pains. It is spread to humans by the bite of an infected mosquito. The mosquitoes which cause this disease are called the Aedes aegypti and the Aedes albopictus mosquito. The Aedes aegypti also spreads the dengue virus.

It is said that the Chikungunya (ChickV) disease is not an easy one to endure; it will take the fittest of the fit to stand up to and overcome it. It is a mystery to a lot how this disease can be contracted, and a bigger mystery as how to cure this disease. It is therefore hoped that this case study will enlighten the darkness as to what is Chikungunya, signs and symptoms, feelings when the disease is present and even preventative measures.

Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain. It causes an illness with an acute febrile phase lasting two to five days, followed by a longer period of joint pains in the extremities; this pain may persist for years in some cases. Chikungunya is characterized by an abrupt onset of fever frequently accompanied by joint pains.

Other common signs and symptoms include muscle pain, headache, nausea, fatigue and rash. The joint pain is often very debilitating, but usually lasts for a few days or may be prolonged to weeks. Most patients recover fully, but in some cases joint pain may persist for several months, or even years. Occasional cases of eye, neurological and heart complications have been reported, as well as gastrointestinal complaints.

Serious complications are not common, but in older people, the disease can contribute to the cause of death. Often symptoms in infected individuals are mild and the infection may go unrecognized, or be misdiagnosed in areas where dengue occurs. There is no specific antiviral drug treatment for Chikungunya. Treatment is directed primarily at relieving the symptoms, including the joint. There is no commercial Chikungunya vaccine.

 The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for Chikungunya as well as for other diseases that these species transmit. Prevention and control relies heavily on reducing the number of natural and artificial water-filled container habitats that support breeding of the mosquitoes.

This requires mobilization of affected communities. During outbreaks, insecticides may be sprayed to kill flying mosquitoes, applied to surfaces in and around containers where the mosquitoes land, and used to treat water in containers to kill the immature larvae.

The differential diagnosis of CHIKV infection is broad, as fever with or without disease is a common manifestation of many diseases. In addition, persons with chikungunya fever may not have the typical manifestations, and CHIKV infection may coexist with other infectious diseases such as dengue or malaria. Diseases that should be considered in the differential diagnosis may vary on the basis of pertinent epidemiologic features, such as place of residence or travel locations and activities, and can include dengue, malaria, leptospirosis, erythema infectiosum, other alpha-virus infections and post infectious arthritis.

 

The Interviewee

A very minute quantity of knowledge has been acquired about the Chikungunya virus, and there are still rumours which have not yet been proven right or wrong. The general public does not offer much where the new disease is concerned, and so what little is known, is cherished. The symptoms are similar to other diseases, such as dengue and leptospirosis which are likely to occur in this time period.

I chose to interview and elderly lady who is a retired teacher and widow living in the Granville area. She is my neighbour, a lady in the age range of seventy to eighty (70-80). She is a mother of one (1) female child, and has recently contracted the Chikungunya disease otherwise known as ChickV. She lives quite a distance from the public hospital which makes it difficult if any illness should arise.  However, she lives approximately ten miles away from the Granville Health Centre and in case of emergency could visit there, if the emergency occurs during the daytime. Otherwise, it is up for a visit to the Cornwall Regional Hospital for her.

Being a retired teacher, she relies solely on her pension and daughter for life support where the dollars are concerned. She has been living in the Granville area for over forty (40) years. She also lives alone, and is visited by her daughter on some weekends or holidays.

  

The Interviewee’s Lifestyle and Yard

Her yard is the ideal “chill spot” for the CHIKV mosquitoes to hang out. She has a garden which you will find the first set of breeding sites for these mosquitoes.

Within her garden are flowers which hold water after she has done her watering duty, or the rain has fallen on it. She also has scattered around the yard pans and various equipment for catching rain water as she reserves the right that that is the best water for plants. In one section of the yard are two old tires used for holding plants, and located at the back of the house are large uncovered barrels used for catching water from the roof top and awnings.

The awnings seem to have been battered in and possess dents large enough to hold a small portion of water for at least half a day. A closer inspection of the back yard reveals a few old tins set upright, and with no holes bored in them. These are located under the breadfruit tree a little way from the house.

Immediately outside of the house is an old stove with its oven compartment open. A little way from this mosquito breeding laboratory is an ancient enamel bath turned up-side-down with an opening at the top, located just a few feet away from this are unused pipes laying under a mango tree. To make matters worse, there is an old clogged up sink located directly at the right side of the fence where its sole purpose is to catch and store water for mosquito births.

There are water pots as well which do not have the soaking away area nor holes to release excess water. Approximately three (3) construction blocks are set aside near her deteriorated fencing, which was once a palm tree which has either been blown or cut down, leaving a deep hole for water catchment. Some old shoes which missed the garbage collector still remain; along with an old wheel borrow. Having lost its wheel, it has been exiled to the utter most part of the yard and turned faced down, proving to be an ideal protector of mosquitoes in hiding

The semi-final attraction for mosquitoes present in her yard is that of her un-serviced gutters which have leaned away only to now withhold its service as a transporter of water, and to become a holder of water. The interviewee also live just a few meters away from a pond which is surrounded by the tall grass which holds water and acts as mosquito habitat.

These are the many facilities that allow for mosquitoes to breed in this lady's yard, and is the continuous result of ignorance and neglect, which brings us to her current situation of contracting the ChickV virus.

The Interview

Upon arrival at the interviewee’s home, her daughter is on the outside watering the plants. She points me in the direction of her mother’s room where I relax in comfort while awaiting the lady of the hour as she drags herself into the bed. A few coughs are heard as she makes herself comfortable under the sheets. She looks up at me with a smile as greetings are exchanged and the college experience is related to her. (For confidential purpose, the interviewee is referred to as Lady C)

My opening question is what has happened to you? The interviewee responds by saying that she is uncertain, one day she was just fine, listening to the news and hearing of this Chikungunya, which in her view could not be possible as mosquitoes have been around for ages, and she has never heard of such a disease being affiliated with them. Mosquitoes are vectors she complained, but now they have become killers, actual human killers who. She relayed her belief that these were a plague on the Lord’s land because of the peoples’ actions and neglect of Him. She continues, stating that when she heard the news of the new disease, she took it lightly and went about her daily life thinking nothing of the new killer on the loose, little did she know that she was soon to be a victim of such attacks. She changed her tone to that of fear stricken, analysing how she could have got the disease. She was always bitten by mosquitoes and by now was used to it, but about two weeks ago (September 21, 2014) she was working in her garden when she felt something bite her, which she quickly slapped of course. It felt like a red ant (fire ant), and found out it was a mosquito of a different nature. She then realized that it was something far worse than she anticipated as she immediately felt pains starting to subdue her fragile body. Because of the intensity of the bite, she had to analyse what exactly had bitten her, and saw from what was left of the mosquito she had killed. In her analysis, it was quite larger than the average mosquito, or any mosquito she had ever seen before, containing white stripes all over. With a close look, she found that belly was reddish in colour.

She said she gave herself an analysis that same night when she actually started to see symptoms of the disease. How it began so soon, she had no idea, all she knew was that from she got the bite, life started to change. I then asked Lady C what was this disease she had, which triggered the first answer of uncertainty.  She resorts to a cough as if to change the question or reiterate that she was indeed sick, but added that according to the television, and her research, there were other disease with similar symptoms which are common to the country, and which are present in the atmosphere at this time. So she had to be certain what she had caught as it could have possible been that she contracted the dengue virus, malaria or even leptospirosis as she had a rat infestation. With that, I counteracted her answer with the question of how can you possibly be sure that it was indeed CHIKV that you had?

Her reply stated that she was not in the mood to argue, however, she first got a fever which wasn't uncommon at all, but that was followed by severe joint aches which caused her to lose balance many times, joint aches that made you stay in one area and fade away, which was not good as if you stayed in bed, or even in one place, there was a greater effect of not recovering from this chronic illness. She then started to experience constant consistent headaches which she claimed caused her eyes to desist seeing at some points. She started to worry about it at that point as she had never experienced a disease which brought on so many symptoms in such a short space of time. One minute you are well, she said, and the next you are on your way to the morgue, feeling next to death. The very next day, after her midday bath she said her skin itched, so she took another bath thinking it was her towel that needed changing. The itching continued, but she got relief after going into the sun and exposed itching areas to the sun which proved successful as the sun was the remedy. She laughed at this point, and said, "dat time wen mi go out, wen mi tun mi han to di sun, mi si seh it stop cratch mi, so mi back, mi belly, all mi buttox mi tun up fi sun bun, u wudda tink mi a tel God sumn". After the third day of the illness, she found that she was not getting better, and more symptoms were crawling onto her, her mouth she said, had become tasteless, even dry at some point and she went as far as to say even water tasted far better than the foods she ate, they were insipid and indigestible. With all these symptoms upon her, she could no longer stay at home doing nothing, her daughter brought her to the doctor and she got medications called Apo-Acetaminophem and Acepaminoph which she took with a vitamin to upgrade her immune system, this was becozinc. Another day had passed and she didn't see results she wanted. The symptoms were on and off, so she had to constantly be taking pills, which she didn’t enjoy so she called for her good-old bush remedies as a typical Jamaican would.

That was your alternative to the doctor's prescription, I asked her when it seemed she was about to skip that aspect of the story. She said the old Jamaican remedy, the one that God ordained when He said that the herbs were for the healing of the nations (Revelation 22:2). She said she made her calls to persons in the rural area and requested a few herbal items, and was also introduced to others which she found useful. "The next day they were here with my supplies, I knew exactly what was needed. I got bizzy (cola nut), to remove the poison from my body at this is a poison itself, there was also the guinea hen weed which was perfect for diminishing fever, and aids in the production of red blood cells and regulation in blood sugar levels, bet you didn't know that teacher she grinned as she said this. In the package came fever grass for a bath, paw paw leaf to be blended with a minute amount of water and drank, leaf of life and fresh cut which both helped with aches and gave rest. I heard that these are good for fighting this chickv, and renewing your original immune system, so I was going to put them to the test."

So what did you do with all these remedies I asked her surprisingly? I was used to using the bush method, but not so much at any given time. This process of getting to better health was followed by removing the poison with her traditional bizzy, she grated half a pod and made her cup of hot beverage, shortly after she felt added strength, so she continued on her path of better health and got a large pot, which she filled with water and set to boil with her added ingredients of the guinea hen weed and fever grass. From this pot she had another cup of hot beverage and then had herself a warm bush bath. That subsequent night, she had another cup of guinea hen and fever grass beverage for supper. She accounted that the next day she was a new person, such a much better feeling that she felt that all symptoms had been eradicated so she went back to her normal life. This was a mistake, she retorted, she should have continued taking her medication (bush remedies included), her joint and muscle aches returned and so she had to repeat the entire process for at least three days before she felt back to normal. Not to make any mistakes, she continued with the bath and beverage drinking even after she was no longer ill, just to be on the safe side. What had puzzled her was that when the new symptoms returned, she was not bitten by another of the odd mosquito, or any mosquito for that matter, but was lead to believe that this virus was intensely in the atmosphere and that is how it had been circulating, and not only by mosquito bites as was stated by officials. I then added my knowledge of the disease that the virus remains in your system for up to three years before it all goes away, and this could be a possible reason of it returning when she had started taking her medication and remedies. Once you stop, it actually starts again and comes on much harder than in the first state she agreed.

The medication from the doctor were merely for the pain she was under-going but she had experienced no side effects. Nonetheless, from the bush remedies taken, the use of the guinea hen made her drowsy and brought on a wild heat. It was as if a fire had been rekindled within her she explained. At times when she was under the fan, that she would feel especially hot. This, I explained to her was an effect of the guinea hen weed as heat was its way of removing fever after the removal of anything in the body that was harmful, released by continuous sweating.

The next question was what about your daughter, did she contract the illness. She smiled and started to hum a tune, which I immediately recognized as being the new song of the chikungunya disease, her tune was matched to these words...one Panadol one Panadol, one Panadol one Panadol, mosquito one, mosquito two, mosquito jump inna hot calaloo, mosquito bite me, mosquito bite you…mek young people walk like dem ole, young people walk like dem ole. She recovered from her humming with a grin, “you should have seen her” she grinned, “in need of a walking stick like dem up a Kingston”. Her movements were slow, as if she was not moving herself, many times she was on the verge of falling, and her eyes would close and she just would sway from back to front, or from side to side. However, that was the only symptom she experienced, except from the sore throat she battled with. So that night her daughter took the guinea hen and fever grass bath, then anointed her throat with olive oil, gargled essence of peppermint in warm water, even applied an ointment called vaporizing chest rub (Vaseline) and finally wrapped it with a towel. She slept with it wrapped up and woke the following to full recovery from the sore throat and half recovery from her joint aches.

Answers were given about going to the hospital for help, the nurses are first incompetent to handle such situations, and then they are uncertain of what the disease entails so the hospital was not a choice. They are unable to treat you as there is not an official vaccine for chikungunya, so she would be spending her precious dollars and time in vain as she was sure that the only thing she would get from a visit there, would be another disease, maybe Ebola. They would have only given her Panadols which she could buy for herself. Not mentioning that the Panadol needed to be taken constantly as when they wore off, your symptoms returned. Many times she had felt as if the illness was gone after taking Panadol, but was to be shown otherwise when the Panadol was cleared from her system.

She went on to state that she doubted that how and where she lived was a problem. Despite the fact that she had so many mosquito attractions in and around her yard, she was adamant that these were not contributing factors to her newly acquired disease. She had lived there for over forty (40) years with that pond there, even experienced floods, and has never before gotten a disease from it. Then her garden, she went on defending her surroundings, never had been an influence on mosquito outbreaks, using supporting evidence that from a child she grew gardens wherever she lived, and these had never in any instance brought about diseases. The contractions in her yard she was overwhelmed by and states that they have sentimental value to her and she could not just get rid of them like that, even went as far as to say that she would clean them once per week just to be able to keep them. I asked her if she was not concerned enough over her health that could over power her sentiments and cause her to dismiss the plethora of mosquito attractions. She seem to be in deep thoughts for a few seconds, then retorted by saying that the disease was completely eradicated from her system and she was going to prevent it from returning, also that the items found in her yard were not so much the problem, but the government who had stopped fogging the area.

When asked how she would do this, she pointed at her windows which were all decorated with mesh, her doors had screens which would keep the mosquitoes on the outside. Located under a bedside table were cans of the "piro" spray  which she used to spray her house once per week or whenever she saw signs of mosquito movement. She also said she now wore long-sleeved shirts and long pants during the daytime as the authorities say that the mosquito which passes on CHIKV bites during the daytime. She recently started sleeping under a mosquito net and used mosquito repellents containing DEET.

Concerning the outside, she emptied flower pots containing excess water after showers of rain or her watering. I was elated when she promised she would consider removing the old sink, stove, enamel bath and other irrelevant equipment located in her yard. The old tires would be soon on their way home she stated. About a week ago she was seen adding oil to the water containers (barrels and drums) located immediately outside of the house. She also made a call to her friend who was to come and have a look at the awnings and gutters on her house. She said that years ago, men would come on early Saturday mornings to fog the area, but this had not been done for over three years and in the following week she was going to the St. James parish council to query the matter and find out when this process would begin.

The effects the disease had had on her life were more than she accounted for. The foods she ate had to be put through excessive washing and overcooking to remove all CHIKV carriers. She has also acquired various vitamin in liquid and solid to boost her immune system and bring it up to a standard where it can ward off all fights from diseases. She has also stated living a life of a prisoner behind mosquito preventing measures. She has bought window meshes, door screens, mosquito nets and even sprays. She will allow for no other mosquitoes to bite her, neither the regular nor the irregular. Because of the virus, she has limited areas where she will go, functions she will attend because of location, and even over dress at times to prevent too much of her body being exposed to bites from the deadly insects. " Mi all pick choose an refuse who cum a mi yaad now a days, caan bi too careful, an a nuh proud mi proud, mi jus a tek precautionary measures cuz mi no waah dis ya fi ketch mi again."

Lady C would also like to tell persons who have not yet contracted the disease to be very careful. Avoid mosquito bites by properly covering themselves and avoid travelling to countries severly infected. Also, be aware that the mosquito bites in the daytime, so be on the alert during these times, and use mosquito repellents containing DEET. Persons who have symptoms of the chikungunya disease to seek medical advice or draw for the “good-ole” Jamaican herb and get well soon.

She said also that according to her research, the differential diagnosis of CHIKV infection is broad, as fever with or without disease is a common manifestation of many diseases. In addition, persons with chikungunya fever may not have the typical manifestations, and CHIKV infection may coexist with other infectious diseases such as dengue or malaria. Diseases that should be considered in the differential diagnosis may vary on the basis of pertinent features; place of residence, travel locations and activities, and can include dengue, malaria, leptospirosis and post infectious arthritis.

 


So now I have first-hand experience with Chick V. I came down with the virus a week ago. Went to school and noticed my right sole was very sore. Couldn't recall hitting it or wearing tight shoes but I Didn't think I was the virus because I wasn't educated about the real symptoms. By the next day Theresa was pain, dizziness, weakness, loss of appetite and a day later, there were red rashes. That went away in a day but all my other symptoms lingered. Fever also set in next but just for a day. I think we need more information about this virus. I don't think the government knows enough. The local Parish Council has fogged my area twice. In both instances the mosquitos were not deterred. I noticed too that my repellant containing diet does not keep them away...Overall I'm happy my 6 yr old is still virus free. My husband at present seems to be coming down with a flu. Can’t say if it's chick v because I don't know enough. Such a pity.

Prevention

1.       Use mosquito repellant with DEET.

2.       Close your windows and doors during the day.

3.        Use mosquito net.

4.        Get rid of containers that catches water.