Print Edition - 2014-08-19  |  Development

Nipping in the bud

  • Experts say diseases can be controlled before they turn into a full-blown epidemic

Aug 18, 2014-

Disaster strikes unannounced. But epidemics do. Usually, epidemics have causes and patterns of propagation that can be discerned in advance. It is well known that water-borne diseases increase during monsoon, while dengue outbreak is likely in post-monsoon period. Similarly, influenza is common during cold season, and incidence of malaria increases during summer. Despite the known pattern and the nature of these diseases, they have been affecting many people and overwhelming the health authorities during their outbreaks. This is mainly due to lack of coordination among the main body and implementing body in ground, lack of resources and slow response.

There are 40 surveillance systems based in hospitals across the country to report diseases that have potential of being epidemic. The fact that only around 20 of these hospitals report to the Epidemiology and Disease Control Division (EDCD) shows the apathy of health care system to contain epidemics.     

In May this year, the outbreak of hepatitis in Biratnagar claimed 11 lives and affected hundreds of people. The threat of the outbreak had been detected after a patient could not be treated in Biratnagar and was admitted in Intensive Care Unit in Kathmandu Medical College, Sinamangal. The disease had taken down 10 people by the time, while the District Health Office, Morang, thinking that the disease was just a routine case of hepatitis, did not bother to instruct the public to take preventive measures. Soon, the situation got out of hands. At least 1,500 people were taken ill.

Moreover, knowing that the water main in the disease-affected areas was leaking, causing sewerage water to seep inside the pipeline for years, no one bothered to fix it, exposing a large population at risk of contamination.

Laboratory tests of samples sent from the jaundice-affected area show that more than 90 percent of the patients were suffering from hepatitis E, a liver infection caused by a virus. The test reports suggested the water-borne infection was caused by consumption of contaminated water.

One of the major epidemics in the country is the cholera outbreak in Jajarkot in 2009 that killed 340 people. The government was criticised for lax and late response then.

  Dr Laxmi Raj Pathak, former director general of Department of Health Services, says the major problem with epidemics is that the government agencies have been blaming the Ministry of Health and Population of belated response when the case is just the opposite.  The MoHP, Dr Pathak says, is not mandated to provide clean drinking water and food supplies to the citizens. “The main epidemic outbreak source lies in water, food and fecal matter. Health ministry is just there to provide essential health care.”

Cholera and hepatitis takes a feco-oral route, which means that the waste of a single person with diarrhoea or hepatitis, if channelled into a water source, could create an acute epidemic.

Nepal remains prone to many natural disasters, and threat of epidemic outbreak in areas affected by calamities is a major public health concern. This year, the epidemic threat has reared its head at Mankha VDC in Sindhupalchok.  A massive landslide on the night of August 2 killed more than 100 villagers and blocked the Sunkoshi River. Local authorities say the bodies of 123 people could not be found, and there is no official count of livestock killed in the disaster.

Dr Yubraj Pokhrel of EDCD claims the response in epidemic has markedly improved compared to the past.

Apart from the local epidemic,  spread of imported diseases is another threat to the country. As the threat of spreading Ebola Virus Disease rises, health experts say, our health system is not capable of handling this deadly disease.  

Lack of Intensive Care and treatment protocol on Ebola cases worldwide have further impeded the government’s capacity to deal with the disease.

The World Health Organization has recommended keeping Ebola  patients in an isolated ICU. There are no isolated ICUs in Nepal. Among 700 ICU beds available, 70 percent are in private hospitals. The government has decided to refer EVD patients to Bir Hospital and Teku-based Shukraraj Tropical and Infectious Diseases Hospital (STIDH). Bir Hospital has a few ICU beds which are often occupied. Among 20 functioning ICU beds at Bir Hospital, six are used by neurology ward, two are used by the cardiology department, and 12 by the general ward. Meanwhile, STIDH has no ICU facility.

Dr Baburam Marasini, director of EDCD says Nepal could do its best to contain the spread of the disease by detecting the patients at the main entry points to the country, and referring them for isolated treatment.

“Our health systems are slowly adopting changes. In case of Ebola we have support from global community to fight against the disease,” Dr Marasini assures. As for combating epidemic outbreak originating from within the country, he says, every government agencies should work together and stop blaming the health ministry. “It’s a consolidated process. Every concerned agencies should be proactive and perform their duties.”

Published: 19-08-2014 09:11

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