PRADEEP KAFLE

Typhoid fever is so common in Nepal that we have a colloquial name for it, Myadhe joro. Observant patients in the pre-antibiotic era discovered that the fever caused by typhoid usually lasts for about three weeks, that is, the illness came with a certain time frame (myadh). So if you could hold off not succumbing within that time, you'd made it.
Typhoid, or enteric fever, annually affects some 27 million people in the world and causes at least 300,000 deaths. The bulk of the problem is in 'hamro' South Asia, that is India, Pakistan, Bangladesh, Sri Lanka, and Nepal. We have the dubious distinction of being the typhoid capitals of the world.

Typhoid is basically a disease brought about by poor hygiene; it is caused by faecal oral transmission. Eating and drinking bacteria (salmonella typhi and paratyphi) through contaminated food is, unfortunately easy to do in Nepal. Intriguingly, typhoid fever is human specific. So our loyal friends the dogs are spared, thank heavens; otherwise they would all be dead of typhoid.

Everyone, it seems, from Shah kings to Everest summiteers to Nepali prime ministers and Nepali villagers, have had a taste of this illness. In fact it used to be so common that as a health professional, if all you knew was how to effectively treat typhoid fever, your practice would be a grand success, you'd be 'mala mal'! Typhoid fever has even earned a little celebrity with the recent finding that some DNA extracted from the skeletal remains of victims of the Plague of Athens (450 BC) resembled salmonella typhi, suggesting it may even have been the cause of that notorious plague.

Because drugs are easily available over the counter, drug resistance (especially to drugs such as ciprofloxacin) is a problem. Amazingly, older drugs like chloramphenicol are making an effective comeback for typhoid treatment.

For prevention, it is important to drink clean water, wash your hands with soap and water and eat hot, steaming, well-cooked food, especially during the summer months, when this disease peaks. What about vaccinations? Since most people who suffer from this illness are school-going children aged about 15, it would be ideal if our government provided this vaccination for free to this age group, as mandated by the WHO. Ironically, the only people using typhoid vaccines these days seem to be tourists.

Author's note: In Vedic mythology, Dhanvantari is the great physician of the gods. This author makes no claim to be following in his footsteps. He simply thought Dhanvantari would be a better name for this column than 'Health Column'.