Nepali Times
MALLIKA ARYAL
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Confusion in the time of cholera


MALLIKA ARYAL


KALENDRA SEJUWAL
It will soon be 100 days since the cholera epidemic started in the mountains of western Nepal. This week, the death toll in Jajarkot crossed 140. The disease has spread to 17 districts where it has killed another 105. The cholera bacillus is present in some of the stool samples.

Cholera is an acute diarrhoeal illness caused by the infection of the intestine by bacteria and the patient eventually dies of acute dehydration. The disease spreads through water contaminated with fecal matter. This year, the acuteness of the disease was compounded by a long winter drought followed by pre-monsoon squalls that washed contaminants into water sources.

The disease is preventable as well as treatable. Because it is a communicable disease, the first line of defense is communications: making people aware about safe drinking water. But awareness alone is not enough for behaviour change, people need alternatives. Safe drinking water systems need to be accessible.

If the infection is already spreading, prevention is too late, and the public health authorities need to move fast on treatment. Acute-diarrhoea and cholera are treatable through oral and/or intravenous rehydration to replace the lost water in the body.

An outbreak like this was waiting to happen. The areas where the epidemic is seen are the most impoverished and remote. Boiling water and personal hygiene are not priorities in districts where people don't have enought to eat. And hunger makes them more vulnerable to infections. Two years of winter drought and a monsoon failure had physically weakened people. The areas hardest hit are so remote that no health worker wants to go there. Medicine and doctors have remained in the district headquarters, while those who have needed medical attention dehydrate and die in villages that are a few minutes away by helicopter.

The government's apathy is shameful, but sadly, not surprising. At the height of the epidemic the health minister left the country for a junket in Europe, the PM was off for a NAM summit. The media dilly-dallied with the issue, the public did not want to admit that in this day and age there are people dying of cholera in Nepal. Aid organisations, even those working on health, had other priorities and didn't have 'epidemic' listed in their area of work.

Despite the daily headlines and field reporting, the government response is still sluggish. It seems Singha Darbar just wants the problem to go away. Meanwhile, private individuals have been doing the government's job by air-lifting doctors and medicines to remote villages. Here was a chance for the government to show it cared, and it didn't do enough - at least in the public perception.

The sick are scattered across remote mountainous villages, they are difficult to identify and reach. Doctors and nurses need to move out of the district capital in helicopters, sending medicines by donkey will take too long. The best doctors need to go, not interns, and stop the token press conferences in Kathmandu about "package relief programs" when people are still dying. Translate these words into action.

The opposition pointing fingers by saying that the government is not doing enough because the affected areas are former Maoist strongholds doesn't help. Also, it doesn't help that human rights organisations divert attention from the urgently required responses with wildly incorrect statements that the WFP's food aid caused the cholera epidemic. It doesn't help that organisations with no expertise on epidemics or contagious diseases are pointing fingers at other organisations that are doing their best in these trying times. There is a danger that people will avoid or skip meals in an attempt to protect themselves from cholera, which will endanger more lives.

And it is us in the media who deserve part of the blame. We have joined the witch-hunt, bannering absurd accusations without cross-checking facts and proper research. Shallow and irresponsible reporting in the time of cholera can kill. One wonders if the government itself benefits from this attempt to distract attention from its own failures in preventing and treating the sick.

READ ALSO:
Early warning - FROM ISSUE #463 (07 AUG 2009 - 13 AUG 2009)
Less food, more mouths to feed - FROM ISSUE #463 (07 AUG 2009 - 13 AUG 2009)
"Disaster in the making" - FROM ISSUE #463 (07 AUG 2009 - 13 AUG 2009)



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