UNICEF and partners join hands to defeat diarrhoeal diseases
MUZAFARABAD, September, 2006: It’s a humid monsoon afternoon. The air feels too heavy to breathe. Twelve-year-old Burhan perched at the edge of a bed inside a tent at a makeshift Cholera Treatment Centre fans his younger brother, keeping the flies off. His sister Adeela, still severely dehydrated, lies asleep on another bed. Burhan attends to them with the maturity and diligence one would expect of an adult.
Seven of Burhan’s twelve siblings fell ill and it is thought the cause was drinking contaminated water. “We have running water at our home but it has silt these days”, says Burhan.Muzafarabad now has a well-equipped water treatment plant rehabilitated with UNICEF’s support. However, running water stored at the household level can become contaminated (for example, hands contaminated by faeces) and cause diseases if consumed without purification.
The centre was set up in the compound of Muzafarabad’s Abbass Medical Institute after cases of acute watery diarrhoea and suspected cholera began to pour in at the already over-burdened hospital.
Merlin and Medicines Sans Frontiers (MSF) sent in doctors and paramedics, while UNICEF provided the supplies including Oral Rehydration Salts (ORS) solutions, intravenous (IVs) fluids and tents. The quick response was made possible as a result of prior planning; doctors had warned that diarrhoeal diseases could break out with the onset of rains."We’ve had thirty three admissions since Saturday evening in total and today we have twenty-two patients inside the two tents", says Dr. Dorrit Maoz, an MSF doctor in charge of the facility. Immediately before the centre was set up, patients were being treated at the Abbass Institute but it was not clear then if it was cholera. “The cases we’ve had tested positively for cholera”, says Dr. Maoz.
About one-third of the cases arriving at the centre are children, some as young as eight or nine months-old. “We had a few very dehydrated patients,” Dr. Maoz goes on to add, “one of them received thirteen litres of Ringers (lactate solution) in thirteen hours and is still on IV”. Most cholera cases can be treated successfully with oral rehydration therapy. However, the few that become severely dehydrated need intravenous fluid initially and antibiotic treatment.
Meanwhile, workers erect new tents provide space for new patients. “The plan is to have an observation unit and two treatment/recovery tents, one each for male and female patients”, says the doctor. “We expect cases to reduce markedly by the end of September, so we’re talking here in terms of weeks rather than months.”
Staff at the centre has been discussing the causes and prevention of watery diarrhoea and cholera with all outgoing patients and their attendants. “We also went to the house of the family from which we received seven cases”, says Dr. Maoz. They took simple but potentially life-saving messages to Burhan’s family: “Cook your food well, eat while your food is hot; wash your hands before you eat and after using the toilet.” In addition to the high risk of water-borne diseases this season, unhygienic conditions in camps and a lack of preventive measures in general left a large population, particularly children extremely vulnerable to diarrhoea and cholera. Precisely for this reason, UNICEF puts a very high premium on health education and behavioural change communication.
Dr. George Ameh, Programme Officer Health for UNICEF Muzafarabad says, “Behavioural change is a big challenge but we’ve had great successes”. Citing UNICEF experience in district Bagh, Azad Jammu and Kashmir (AJK), Dr. Ameh recalls people there had misgivings about water purification tablets as they gave a yellowish tinge to the water. “However, once we had demonstrated that the tinge went away when you added another tablet, people came to believe us”.
UNICEF has had its workers distribute information leaflets, soaps and water purification tablets in four Union Councils of district Muzafarabad. With UNICEF’s support, local partner Islamic Relief has held health and hygiene sessions in camps for internally displaced people across Muzafarabad.
Historically cholera has a reputation as a killer disease. Thankfully, curative and public health solutions are now available. However, conditions which enable cholera and other diarrhoeal diseases to spread i.e. lack of knowledge, poverty and poor hygiene, need to be continuously challenged on the way to recovery and rehabilitation.