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May 17, 2015

A short report of suspected Enteric Perforation with localized peritonitis - Post Earthquake (April - May 2015)

On 9th May, 2015 - we went to inspect the temporary settlements in Kamal Binayak, Bhaktapur. We volunteered for few hours to soothe various ailments that local people living there in settlement had to go through. Among various complaints, some had diarrheal illnesses (some acute onset while some suggestive of dysentery), while some senior citizens complaints of joint pain aggravated by cold exposure. I think, there were around 100 to 150 people living there at the time, when we visited the settlement. During that period, we were a bit more concerned with two person who came to the temporary health center established there through District Public Health Office (DPHO), Bhaktapur. One was a middle aged women who was bitten by a local dog. We advised her to visit Sukra Raj Tropical Hospital and informed Dr. Sher Bahadur Pun, who is, I think, one of few passionate doctor in Kathmandu valley. Dr. Pun can be said without doubt one of  a leading infectious disease expert in Nepal. However, we found that she was not taken to Teku hospital for needful further. We know, sometime, local people have other priorities thought to be more important than to get vaccinated. But, we may land into an unfortunate event sometime - rabies is a deadly disease with 100 % fatality. This we know loud and clear! Hope she will be safe and healthy !! 

A child treated for enteric perforation, Bhaktapur (May 2015)
Photo Courtesy:Dr. Bhim Dhoubadel
Other visitor to the temporary clinic in the settlement was a female child of around 10 to 12 years of age. She was brought to the clinic by her parents. On seeing her, I immediately felt "a dead person walking" since she was profusely sweating with her face looking bland and i guess, she was in extreme agony. But she did not express it !! Now, i can realize how much suffering she must have faced hopping from one clinic to another with prescriptions that did not work. Fortunately, Dr, Bhim (Assocaite Professor at Nagasaki University, Japan and also a technical adviser in Sidhi Memorial Hospital in Bhaktapur) examined the child, then immediately diagnosed "intestinal perforation with localized peritonitis" and referred to Sidhi Hospital for surgical exploration. She was provided free care by the hospital and was surgically explored with Intensive Surgical Care. Later we came to know that the child had enteric perforation most probably due to typhoid fever with peritonitis with impending septic shock. She was given pints of blood transfusion. As of now, Dr. Bhim is waiting for reports of blood culture and sensitivity and also biopsy report for the final diagnosis. 

In retrospect, I can think the urgency of this public health problem of typhoid fever in Bhaktapur. We also know and we have been hearing in international forum that Kathmandu valley is considered and reported as "Capital of Typhoid fever". In order to say that there are enough studies to supplement the statement. The only contention that I have to be clear is whether this is exaggeration !! Nonetheless, it is right time that all those involved in the prevention and control of typhoid fever has an excellent opportunity to work in concerted effort to showcase an exemplary public health campaign so we could prevent this enteric illness through vaccination. In this effort to address possible typhoid fever outbreaks that may arise post Earthquake due to compromised water sanitation and hygiene, the Coalition Against Typhoid (CAT) local and international chapters have to act now. Never before has there come this opportunity to advocate typhoid and paratyphoid agenda to the international  fora as an global public health agenda !! I think and i believe, this is immense opportunity that we should not miss and erase once and for all from all literatures and even word of mouth the stigma of "Capital of Typhoid Fever" said for Kathmandu Valley, which is the national headquarter of Nepal. 
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Anuj in Himalayas

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