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ASIA-PACIFIC feature story for Nepal

© UNICEF Nepal/2009/Sadhikari

A volunteer demonstrates the proper use of a water purifying solution to residents in Jajarkot District. UNICEF, WHO, the Ministry of Health and other partners helped contain a severe diarrhoea outbreak that affected 50,000 people, killing 330.

SITA’S HEALTH LESSON: HOW SAFE WATER AND HYGIENE PRACTICES ARE REACHING REMOTE COMMUNITIES IN NEPAL

JAJARKOT DISTRICT, Nepal, 4 September 2009 – It took the loss of a life for the B.K. family to realize that a little extra awareness about hygiene practices could have saved the life of their 10-year-old daughter, Sita.

“All I know is that at night we went to bed together,” recounts Sita’s still distraught mother. “But in the morning I could not wake her up.  She was still … she had died.”

In July 2009, Sita had been visiting her sister’s house for the day when she began to suffer bouts of diarrhoea.  Her sister took her to the local health clinic.  Sita received several saline water transfusions and was discharged once her condition improved.
 
“If only we had known enough about the connection between defecation and the contamination, my niece would still be alive,” mourns Sita’s uncle. 
Sita was a victim of a diarrhoea epidemic that began in April 2009 in western Nepal.  Her village comprised one of 30 that suffered from the diarrhoea outbreak in Jajarkot District, the epicentre.  In Sita’s village of Jagatipur alone, more than 103 households suffered from the outbreak, which also spread to 15 neighboring districts. In total, 50,000 residents have been afflicted with severe diarrhoea, with 330 deaths directly attributed to the epidemic.  Several cases of cholera have also been reported.

Diarrhoea and cholera are similar in nature – both are easily preventable and highly transmittable diseases.  They are caused by poor sanitation, lack of adequate clean water and a limited knowledge about preventing dehydration.  They can easily lead to death without immediate treatment and follow-up care.

In response to this public health crisis, UNICEF, in coordination with the Ministry of Health and Population, the World Health Organization and other partners, has been working to bring the outbreak under control. 

With the World Health Organization coordinating the national-level response to the diarrhoea epidemic, UNICEF leads other United Nations agencies and international and national NGOs in all water, sanitation and hygiene interventions and public information campaigns.  Campaign activities have included designing and developing standard messages on sanitation and hygiene promotion and related nutrition issues. These messages reach the public through a variety of channels, such as information booklets, loudspeakers, local FM radio stations as well as television channels. 

Together with the government’s water supply and sanitation department, UNICEF also trained hundreds of volunteers and youth groups. Despite the steep and narrow paths, scattered houses and limited services in the remote location of the diarrhoea epicentre, these trained volunteers supported by UNICEF have reached the majority of affected villages.  Volunteers come equipped with water treatment options, such as cleaning of water sources and chlorination of water systems, as well as hygiene promotion messages. Volunteers also distribute chlorine tablets and oral rehydration salts packets.

To date, UNICEF has provided 85 per cent of the required water, sanitation and treatment supplies – like zinc tablets, oral rehydration salts, water purifiers and soap - to partner agencies and district-level health outposts that also operate outreach health camps for rapid treatment services. 

The control of the epidemic remains a challenge.  There are still shortages of safe drinking water and poor hygiene practices in a number of villages.  Residents in these areas will be even more at risk for diarrhoea and cholera oubreaks when the seasonal monsoon rains begin.

Further, not all the affected areas are easily accessible.   Some are as much as a one or two-day walk in difficult terrain. An unreliable communication network and poor road access also are hindering relief efforts and the ability to reach every family.

Back in Jagatipur village, Sita’s uncles are using the tragic lesson of the death of their niece to teach others.  They are busy spreading awareness about ways to prevent diarrhoea in their remote community and explain to people to stop defecating near water sources and construct and use toilets, and to only drink treated water.

“Thanks to the volunteers who came to our homes and made us understand the importance of safe hygiene practices, distribution and correct use of water treatment products, oral rehydration salts and soap, we will now have no more deaths in our village,” says Sita’s uncle. “If only we would have known about this earlier, Sita would probably still be with us.”