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May 2, 2015

Open talk on cholera, Dr. Sack's question and Nepal - Part 2 of 6 parts series

This year also, we are hearing  reports of cholera outbreaks in Sub Saharan countries like Malawi, Mozambique and so on. I have been following these outbreaks closely through promedmail updates, however the only limitation that I personally feel is that I do not know first hand information of its seriousness in the local community. I love to hear those who have been engaged in its control and prevention especially those closely involved in Malawi vaccination. Reason after all, "seeing is believing" and this is true !! In this light, once I read an experience of a Nepali young doctor - Mr. Partha Bhurtel, who volunteered and served to care people in remote villages of Jajarkot during the tragedy called Jajarkot as a result of cholera outbreak that took lives of many unfortunates. When I read his real field experience as an opinion piece. Oh, it was heart touching. Once I read it - I have begun to question what is my purpose as a health professional? Nonetheless, we have to be objective and do our best from our part what we can do. Sometime we can do nothing but just pray. That is what it would be reasonable. You can read opinion piece : Dissecting the cholera outbreak in western Nepal  I take this story as a real public health endeavor at personal level very passionate. 

While getting shocked with real public health crisis of Jajarkot, I had a chance to read a recent blog post by Dr. David Sack in STOP CHOLERA JHU website: He ask a very important question: "How to handle the mismatch between actual needs and the practical use of current tools for cholera surveillance, prevention, and control?" Dr. Sack is asking a very practical question, which is the same question I also have in my mind. This is important when we go back in our memory line of Haiti and Jajarkot outbreaks. Well I have to be honest, I do not have a concrete answer but let us exercise our mind by asking: What is the real issue here? 

This real issue can be summarized in one question after it is several questions in long procession," Have we been successful in addressing this deadly disease called cholera in Africa, Asia and some Pacific islands especially during disasters?" Well I am not the right person to answer this "loaded" and "heavy" question, instead I would like to put forward opinions so let me link this question in a way that would make sense to Earthquake in Nepal. We faced an sudden and unexpected natural calamity of such magnitude that we are struggling with it. We are so far being tested so far of what nature Nepali people are built with be it physical and of course - social and moral integrity at this time of such despair. Anyway, we are fortunate that we are coping and dealing with the situation as it comes. However, it is one bitter truth that our disaster preparedness should be robust and now onward we have to hard work on it. This means this preparation must spreads across all faculties. People have started to question the government's very core of functioning. This is high time we act quick and adapt to the situation. Sure, the political landscape has to change. You may also say, we are talking about cholera and what in the world, we are talking about socio - political "connotations". Well, my understanding is that for any public health program including vaccine and vaccination - it has to convince the political and bureaucratic establishment, since they are the key decision body. This means - coming back to Dr. Sack's question - have we done better in this area of advocacy with those government, who need these vaccine. My opinion therefore is that we need to work hard to address the gaps in advocating OCV vaccine and its vaccination in a coordinated fashion, especially WHO, UNICEF, GAVI and other stakeholders like IVI, JHU - DOVE, We have to therefore act in unison rather than in a fragmented way. Here we can discuss more but i will halt here at this time.

However, we all also realize that Nepalese government has to remain vigilant and put its public health structure in order so we do not repeat the same situation that happened in Haiti some years ago. This is the key activity that should be put in place first, therefore disease surveillance utilizing the current system in place is the most important task. Should there arise the need for vaccination any threat of cholera, then we should think of vaccinating high risk population especially children. Importantly, we need to work with WHO to prepare for STOCKPILE mobilization from now on. For now, i would leave this post here. I think I would be in a better position to answer this question in next post based on "real field" experience like a somebody who has the same passion as Dr. Sack.

2nd May 2015 

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Anuj in Himalayas

Hi i am connecting disqus with my blog for healthy interaction and open dialogue