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Jul 18, 2015

In Nepal: Earthquake, Cholera and Gorkha !!

Previous 3 months, I wrote and posted 6 parts series on cholera and one more post re: our experience with risk assessment in 14 earthquake affected districts. This is my mental exercise of expressing what I think and what I do. I know, sometime what I write and express may be immature or even out of context - well - so be it !! It is only through regular writing that we can refine how and what we write - this is so simple !! Key to success would be perseverance and consistency. So, I will be writing from now onward as a record of our "real" public health experiences in Kathmandu and some of the hilly districts we will be visiting for our challenging task - that is to prepare and conduct cholera vaccination. While, I can not tell you now what lies ahead but I am pretty sure this is going to be one of the most challenging public health campaign so far we have been involved. Why? Monsoon is already in the air !!

In Nepal (what I can tell from recent Gorkha and Dhading visit !!) as of today, we are under the spell of anything that moves could be Earthquake !! And you may be right most of the times, when we are experiencing minor jolts day and night. We have come to our homeland with our heart open to support at anything where we are able to contribute, while for me, being involved with clinical development of safe, affordable and effective "vaccine" against enteric diseases like cholera, typhoid fever and HEV - what else could I do? For me working together with epidemiology division along with other key organizations like WHO, UNICEF, Rotary, Red Cross is the best option available.

After 2 month long exercise of preparatory exercises, Nepal government firmly decided to go for preventive measures against acute water diarrhea including cholera. While, there  are  measures taken to strengthen the existing Early Warning and Reporting Network (EWARN) and additional support from WHO to enhance disease surveillance activities - it has been hard to reach remote hilly areas in the affected districts. So you may ask why??

Before answering WHY? First let us ask ourselves - Is it in the interest of few professionals interested in using vaccine or is it only for our academic voracity that we want to use oral cholera vaccine ? Definitely not !! Those who have seen in his or her clinical practice must have experienced the ferocity of acute diarrheal illnesses that may spread in the community. While those people who have experienced sickening experiences of getting loose watery diarrhea and getting weak "unable to walk even few feet away" would definitely know the importance of getting vaccinated and protected especially in places like remote villages like Lapu or Lapa villages. In these villages, if you get sick say viral hepatitis or even typhoid fever, you may have few days to get treated in the district headquarter or if you have enough money, then you could charter a helicopter, however this is not the usual situation. However, all residence in the community are not well off !! Especially, those people who are affected with outbreaks of infectious diseases are those low in the socioeconomic ladder. The main concerns that we have are about access to clean drinking water, health facilities in case you get sick and in particular vulnerable population - children, women, and senior citizens.

Another question that i would like to share for our intro inspection:

To understand more of Jajarkot outbreak - I suggest you to read the blog post:

18 July, 2015

Anuj in Himalayas

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