Nepali Times
Nation
Cholera choler


SAMEER DIXIT


Last year's outbreak of cholera in Haiti shows how the perceived lack of expertise in a developing county can be wrongly exploited by experts in developed countries.

This particular outbreak led to a large number of deaths. Vibrio cholera, the known causative bacterial species in most cases of cholera, was blamed for the spread of the disease. The 'source' of the outbreak was narrowed down to an area inhabited by the UN Nepali peacekeeping battalion, leading to inevitable finger-pointing. The resulting riots fuelled further unrest and turmoil in Haiti, a country already embroiled in political crisis.

Scientists such as John Mekalanos, a prominent molecular biologist at Harvard Medical School in Boston, have suggested that the strain may have come from Nepal. But there has been no conclusive evidence to justify the claim, and the scientific community is still unsure about the origin of this strain.

The available evidence does indicate that the strain is a South Asian one, but Nepal is not the only South Asian country to have soldiers stationed in Haiti. Nepal is, however, the only country that witnessed a major cholera outbreak in 2009. This combination of factors seems to have been enough for many to conclude that Nepal is guilty as charged.
Rita Colwell, a veteran cholera scientist and former head of the US National Science Foundation, puts forward a different view. She notes that Vibrio cholera is present in coastal waters worldwide, and given the right environment (such as a rise in temperature), can turn deadly.

Colwell cites the example of the cholera outbreak in Peru in 1991, which killed over 2,000 people. At the time, suspicion first fell on ships coming in from the Asian subcontinent. However, it was soon ascertained that Peru's own coastal waters had warmed up due to El Nino, activating the cholera bacteria present. The origins of the strain were never established.

Although the Center for Disease Control (CDC) in the US has stated that the origin was most likely South Asia (without categorically mentioning Nepal), there are still questions regarding the method used to investigate the strain similarities. Crucially, no organisation has published any findings on Vibrio cholera isolated from cholera patients from the 2009 outbreak in Nepal, making it impossible to link the Nepali outbreak to Haiti.

Significantly, the samples and expertise required to establish such a link (or not) exist in Nepal itself. The governmental laboratory (NPHL) has bacterial strains from the outbreak areas in Nepal and the Center for Molecular Dynamics Nepal (CMDN) affiliated Molecular Laboratory has the DNA. Molecular biotechnology could have been used to determine whether the Nepali peacekeeping contingent in Haiti deserved the blame heaped upon it, through evidence-based findings, but it has not been.

Nepal needs to open up to the inevitable possibility of linking biotechnology to address public health concerns. In a globalised world, we cannot afford to be the weakest link as far as medical intervention is concerned.

The writer is the Senior Research Scientist and the Country Director of Centre for Molecular Dynamics Nepal.



1. Thinley, France
The human intellect is such that we need to have a clear object of understanding for everything.
Where there is a problem, we seek not a solution but a culprit. For it is much easier to point a finger than imagine an alternative. The Third Reich came to power not through the Economical and Social Solutions it proposed for the post-World War 1 problems but through the hatred of Jews. If there was a problem, Hitler would say,"it's the Jews" and all accepted it. Ultimately it led to the horrors of the Shoah. 

In the case of Cholera in Haiti the fact that we still haven't found the cause of such an outbreak is demonstrative of what I have said above. 
A French scientist, who may or may not have been in Nepal, knowing that cholera was present their, simply said," look, their's a Nepali camp of Gurkhas near the river, they might have been the cause to it".
Let me say that if the Gurkhas are Nepalis, the UN's regulation on hygiene, and more specifically for the Ghurkhas themselves is such that it is foolishness in it's most unreasonable form but to  insinuate such a thing.
 Finally, if the culprit hasn't been scientifically identified and proven by means of step by step demonstration, then why are we still talking about this? Why are we still pointing the fingers to the Nepali Army?

Does the hate generated lead to any solution to the problem in hand? No.
All it does is lead the minds and spirits of men further and further away from the Problem. And ultimately, when the problem will be resolved, all that will be left is the Hate that Haïtians feel for both the U.N and the Nepalis. These same, which have never been proven as guilty. 



2. syakar adiga

Good write up. Thanks.

Since you mention you have the DNA, why can't you do the tests and absolve the Nepali Peacekeepers through "evidence-based findings"? Or does that need some funding support?



3. Sameer M Dixit, PhD
@Syakar: Thanks. We have offered that option to WHO Nepal. The DNA is joint property of CMDN and Nepal Health Research Council (Ministry of Health and Population) and therefore, with funding support, we can go for DNA sequencing to look for evidence in collaborations with interested organizations. (We are not yet quite ready with sequencing facilities at CMDN but hope to be, soon). s.dixit@cmdn.org 

4. Kishor Bhandari

Excellent work.

We aren't and cant offord to be the weakest link.



5. Shailaja (USA)
Here's an article in the Guardia that indicates that the cholera outbreak may have been due to the weather and not from Nepali soldiers:

http://www.guardian.co.uk/environment/2010/nov/22/haiti-cholera-un-weather


6. Kalyan Pande, Ph.D.
I agree with the author that there needs to be a mechanism to monitor and rapidly identify disease-causing organisms. Such capabilities are critical in order to save lives during future epidemics and pandemics. With regard to the cholera outbreak in Haiti, I recently attended a seminar by John Mekalanos where he suggested that he had difficulty obtaining  DNA samples from the 2009 Nepalese strain. Perhaps the World Health Organization ought to have a repository with samples from important disease outbreaks in order to insure that these samples are available to researchers worldwide. That could facilitate verification of scientific results by multiple independent laboratories.


7. Benoit
Useful article!
That strain comparison is a key issue for determining the origin of cholera in Haiti. But rather than analysing the cholera samples from 2009, would it not be better, if possible, to compare the haitian cholera strains with the strains that circulated in Nepal in 2010 (outbreak reported notably by the Himalayan times, the American Embassy and an article in Science by Enserink M)? Is any sample from this 2010 outbreak available for sequencing?


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