Nepali Times
Guest Column
Learning from Jajarkot


"I am alone now, my wife died last night and my daughter died this morning. How I am going to survive?Why doesn't this killer attack me?"

These words were uttered by a villager from Jajarkot, during the deadly outbreak of diarrhoea in August of last year. By that time, over 300 people had died in 20 districts in the mid and far-western regions of Nepal. This year, as summer sets in and we begin to receive reports of diarrhoea cases again, we should consider: how can we prevent another public health disaster?

Diarrhoea is one of the leading causes of morbidity and mortality among children under five in Nepal, with 10,500 dying every year. Most of these deaths could be avoided through simple measures like safe drinking water, sanitary latrines and proper hygienic practices, including hand-washing. But due to the lack of public awareness and low government priority, the hygiene and sanitation situation of the mid and far western development regions is in a critical state.

Jajarkot is one of the poorest and remotest districts of Nepal. Access to drinking water is estimated to be 49.4 per cent, though the quality of water available needs to be further investigated. Access to sanitation is less than 22 per cent, compared to the national average of 46 per cent. Open defecation is a common phenomenon and the lack of safe drinking water and hygienic practices make communities more vulnerable. It was no surprise that Jajarkot became the epicentre of last year's epidemic of diarrhoea and cholera, exacerbated by the monsoon that followed a prolonged drought.

Sanitation and hygiene promotion are the most cost-effective public health interventions. The simple act of hand-washing with soap can reduce the risk of diarrhoeal disease by up to 45 per cent. Though the importance of Water, Sanitation and Hygiene (WASH) is recognised by the health sector in Nepal, the curative aspects of health promotion or technology- driven water and sanitation interventions often overshadow basic awareness and preventative measures.

Though outbreak response activities succeeded in controlling the diarrhoeal epidemic to some degree last year, many more deaths could have been averted if preventive activities had been intensified immediately after the outbreak. Key areas for future interventions include:

* an early warning system with proper mapping and a contingency plan to focus immediate attention on outbreaks
* availability of medical staff in duty stations with back-up resources
* coordination among government and non-government actors
* improving information management and communication channels, including through the use of security forces
* focus on logistics to transport oral rehydration solutions and other drugs in time and in adequate quantities
* social mobilisation using local volunteers, health workers, political leaders and their cadres, and teachers for water purification and promotion of hygienic sanitation practices, including setting up health camps
* providing better access to health care services: most deaths last year happened at home or on the way to health institutions.

The epidemiology of diarrhoea indicates that there will be outbreaks this summer and monsoon too. If we are to prevent the loss of human life this year and in the future, it is imperative that we learn from our recent past.

Om Prasad Gautam is a public health professional with WaterAid Nepal omprasadgautam(at)

1. Unknown
Prevention is better than cure; hence his article is an early warning for the possibility of similar diarrhea outbreak in mid and far western regions as in the  previous years. Since the author is from the developmental fraternity, this article seems more like an NGO report (nothing particularly wrong in that).
However, in a highly centralized county where the government fails to provide water (forget safe drinking water) to denizens in the capital city, the author is naive to think "most of these deaths could be avoided through simple measures like safe drinking water, sanitary latrines and proper hygienic practices, including hand-washing."
Working with the local politicians and elected officials, who are responsible to the people, may be useful in addressing the issue. It will be futile to wait for the center to respond to such crisis. Decentralization and improved local governance are important to solve such issues that are neglected by the central government.

2. Shikha Shrestha
It is definitely a tragic reality that Nepal is a country where people die from preventable diseases like diarrhoea. It is possible to save these lives and 10,000 children below 5 years who die each year due to these sanitation deprivation. We need a strong political will and action to make these death a sad history that will never ever happen again. Thanks Omjee for sharing solution based article.

3. Unknown

4. Arthur
Good clear explanation of exactly what has to be done.
But in theory these simple measures could have been done by by the Panchayatis or 1990 "loktantrik" or even the present shambles of a government.

In practice a necessary precondition should be added to the list.

First, there must be a government that actually cares.

5. Om (Writer)
Thank you all for your appreciative comments. Collective efforts certainly be helpful for the immediate respond as well as to prevent such types of "Public Health Disaster" in Nepal which are associated with lack of safe water, sanitation facilities and hygiene practices. Its a real time to intensify the efforts.

(11 JAN 2013 - 17 JAN 2013)