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Nepal: Diarrhoea outbreak kills hundreds

Posted by Ramesh Khati on July 30, 2009

By Indra Adhikari, Kathmandu

A deadly outbreak of acute diarrhoea is sweeping remote districts of mid and western Nepal, killing around 200 people. Thousands more are receiving treatment in health posts and emergency camps set up by the government.

The tragic story of 25-year-old Bhagawati – a young mother from Jajarkot, in Nepal’s mid-west, who lost her two-year-old son to the disease – typifies the crisis.

Bhagawati was too ill to carry her child for treatment to the nearest health post, some three hours away. The next day she barely made it to the health post herself, arriving traumatised and dehydrated with the same symptoms that killed her son.

Dead and affected

Jajarkot lies 375 kilometres from the country’s capital, Kathmandu, but is a four-hour trek from closest airport. Many of the men from the area have migrated to other towns in search of work, and consequently most of the dead and affected in Jajarkot are women and children. Tests carried out on three out of seven samples received in the government labs in Kathmandu reveal that the diarrhoea was caused by the cholera-causing bacterium, vibrio cholarae.

Jajarkot is not alone. The disease has spread out to other districts, in particular neighbouring Rukum. So far, more than 134 persons have died in Jajarkot and 39 in Rukum – and more than 15,000 cases have been reported in these two districts alone.

The outbreak, which began in May, is being attributed to contaminated water due to a combination of factors including poor sanitation and water scarcity. Open defecation and lack of knowledge about good hygiene practises have contributed to the spread.

Endemic poverty

With endemic poverty, a bar of soap is a luxury people cannot afford. Safe drinking water is difficult to access as most people live far above the river and the high demand upstream for rice paddy transplanting has led to water scarcity for downstream populations. The health situation has been further exacerbated by food insecurity in the region which has been suffering from drought.

“As this situation has developed we have mobilized more than 200 volunteers to respond. Promoting awareness about safe drinking water and sanitation amongst these remote communities is vital,” said Mr Sudarshan Nepal, acting secretary general of the Nepal Red Cross Society.

The volunteers have been dispatched into the countryside to distribute posters that explain the symptoms of diarrhoea with accompanying messages on prevention and treatment. As the volunteers travel between remote settlements, they carry oral rehydration sachets and chlorine tablets to distribute in communities to ensure that people have access to safe drinking water.

The Nepal Red Cross Society is working closely with the government and non-governmental organizations to stem the outbreak, and has been distributing tents, blankets and tarpaulins and providing support to patients and their families in the health centres.

Epidemic spreading

With the epidemic now spreading to Rolpa, Dolpa, Jumla, Dang, Surkhet, Dadeldhura districts, Red Cross Red Crescent volunteers remain the closest providers of support to affected communities. But communication and logistics are proving difficult in the remote villages where walking between individual houses perched high on hillsides can take a full day.

Shiva Ram Khatri, secretary of the Rukum chapter of the Nepal Red Cross Society, says: “Everyday around 20 patients visit 41 health posts of the districts. The district public health office reports that two to three persons are dying in these remote villages daily.

“The double tragedy is that the signs of diarrhoea now carry a stigma that is resulting in unpredicted discrimination. People are scared of carrying even their own family members or friends to the health post for treatment.”


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