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JAPANESE ENCEPHALITIS AND DIARRHEA |
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JAPANESE ENCEPHALITIS AND DIARRHEA |
Poor Hygiene Easily curable diseases
like Japanese Encephalitis and Gastroenteritis are claiming hundreds of lives in Nepal
because of poor sanitation and hygiene practice By THAKUR AMGAI
To rural folks of Nepal who are
suffering the woes of losing lives to easily curable diseases like diarrhea, there are
reasons to heave a sigh of relief as the rainy/summer season is gradually on the retreat.
With the end of monsoon and summer, the chances of catching diarrhea and Japanese
Encephalitis gradually wane. So, the risk of dying of such diseases has been put off till
at least the next year for many of them. The diseases have claimed heavy toll of
lives this season. More than 400 people have died an untimely death because of these
diseases this year, according to official reports. Cases of underreporting are common in
Nepal. Considering the scores of other people who have died but have not been included in
the official statistics, the number of deaths could be significantly higher. Even the
officials agree to this fact. According to Dr. Mahendra Bahadur Bista,
Director of the Epidemiology and Disease Control Division (EDCD), this season, 22,000
cases of diarrhea were reported and 304 of them died. Likewise, 780 cases of Japanese
Encephalitis were reported from 13 districts and 102 of them died. While the number of cases of Japanese
Encephalitis is similar to the previous years, the number of gastroenteritis patients has
increased by six folds compared to the previous year. In the past few years, there used to
be about 5,000 cases of gastroenteritis out of which about 40 -50 used to die. Doctors cite heavy rainfall, contaminated
water and delay in the collection of garbage as the main reasons for the outbreak of
diarrhea in the urban reason. In the rural area, the lack of awareness, lack of good
hygiene is the main reason for the outbreak of diarrhea. Because of the contaminated water, the
outbreak of diarrhea almost took the form of epidemics in early June. Speculations on
contaminated water led to water testing in various parts of Kathmandu, which revealed that
the water of most areas in Kathmandu were contaminated with faecal coliform. Measures to
improve water quality were taken and awareness raising programs were launched. The problem
could also have been aggravated by the three day long strike followed by another two day
long strike, which caused problem in garbage collection. Probably due to good health facilities,
despite the outbreak of diarrhea, there had been only one death in the capital. Western
hilly districts were the most affected by the disease. Among the most affected districts
was Jajarkot where 45 out of 1400 patients died. In Kalikot, 25 out of 1175 patients died;
in Rasuwa 13 out of 462 patients died; in Pyuthan 20 out of 525 patients died; in Bajura
15 out of 875 patients died; in Surkhet 18 out of 465 patients died; and in Dhading 14 out
of 1250 patients died. Likewise, Jhapa, Kailali, Morang, Sunsari,
Saptari and Dhanusha were the major districts, which were affected by Japanese
Encephalitis. A total of 13 districts had been affected by the disease - most of which
were eastern terai districts. According to the statistics from the EDCD,
out of 224 cases reported in Bheri Zonal hospital, 30 had died; 12 died out of 58 cases
reported in Seti Zonal Hospital; in Dang Hospital 19 died out of 148 cases; in Koshi Zonal
hospital 6 died out of 52 cases; and in Sunsari district hospital 4 died out of 23 cases. In the past, there used to be around 1000
to 3000 cases of JE every year. While in the global scenario, only 10 percent of those
affected by the JE die, 15 percent of them die in Nepal. The major reason for the increase in the
number of cases of encephalitis is also poor hygiene. "The bred pigs and ducks play the
major roles in transferring the disease to humans," said Dr. Bista, "And
mosquitoes also easily transfer the disease." To control JE, the government of Nepal is
going to launch a vaccination program next year. According to Dr. Bista, the government is
planning to vaccinate 7,00,000 citizens with the aid of World Bank. ARSENIC
CONTAMINATION Arsenic contamination
is threatening the health of rural population in Terai district By KESHAB POUDEL Many tube-wells installed to supply safe
drinking water to the population of Nepal’s southern plain have turned into poisoned
wells due to high contamination of arsenic, a metalloid toxic element, which has a long
term effect in human life. The preliminary testing conducted by the
government agency National Arsenic Steering Committee, a government policy making body,
and non governmental agencies with the support from United Nations Children Fund (UNICEF),
World Health Organization (WHO) and other donors like Japanese International Cooperation
Agency (JICA) and Finland International Development Agency (FINIDA) in 25,000 wells
revealed that Nepal’s 700,000 population are drinking water contaminated by arsenic
level ranging from over 50 parts per billon (ppb) to 2600 ppb. Nepal’s standard of
arsenic is 50 ppb or 00.5mg/l. If it is judged as per the WHO guidelines of safe
arsenic level of 10 ppb or 00.1 mg/l, the affected number will be 1.7 million people. “Our limited number of tests of
various tube-wells have shown that arsenic concentration is alarmingly high in southern
plain,” said Abdhesh Kumar Mishra, an expert working in National Arsenic Steering
Committee, which is also coordinating different activities related to the arsenic testing.
“Out tests have revealed the concentration of arsenic level from 200 ppb to 2,600
ppb.” Nepal’s first survey on arsenic
contamination in 1999 indicated only a few affected tube-wells. Out of 8,000 tested
tube-wells, only 4 percent were found to be affected beyond 50 ppb level. “The recent result that came out after
testing 25,000 wells showed that 8 percent of tube-wells are contaminated by arsenic level
higher than Nepalese standard of 50 ppb. If it is under the WHO standard, the affected
number of population will be 25 percent,” said Anil Pokharel, an expert with the
Nepal Water for Health (NEWAH), an NGO. "The total population affected by the arsenic
contamination when considering Nepal’s standard as safe level will be around 700,000
whereas this number will shot up to 1.7 million if the WHO safe limit is considered. Our
organization’s mathematical models, with the government’s 50 ppb as a maximum
acceptable arsenic level, translated to 20,000-40,0000 deaths annually after 10 to 20
years of time." Since most tube-wells were installed in
terai only 10 years ago, many visible signs are yet to be noticed. Symptoms of arsenic
contamination can be observed within 2 to 10 years of exposure. Arsenic contamination in the drinking water
has been a major concern in the world but it is just a new issue to Nepal, which had set
the arsenic standard level only two years ago. Various countries have their own standards
of arsenic level in drinking water. Ground water is one of the major drinking
water resources for Terai Population in Nepal where more than 40 percent of country’s
population live and about 90 percent of the people there are using the ground water though
tube-wells. According to an estimate of the Department of Drinking Water and Sanitation,
each district in terai has, on average, 30,000 tube wells and the total number of
tube-wells is estimated to be around 660,000. “The recent increase in the use of
tube wells in terai is likely to result in increased health risk for Nepalese
citizens,” said Van Williams, an American geologist working under the United States
Geological Survey, South Asia Arsenic Project. The project has collected samples of
studies. “Studies in Nepal well have broad applications because the rocks of the
Himalayan mountains are the probable sources of arsenic being released by sediments in
India, Bangladesh as well as in Nepal.” National Arsenic Steering Committee
estimates that about 11 million people living in 22 districts in the Southern Nepal
are under direct threat of arsenic poisoning. “We will have exact and extensive
data regarding the level of contamination and health effects after completing our testing
by the end of the year,” said Mishra. “The percentage of concentration may go
higher.” Arsenic is an element that is a natural
part of the earth’s crust. It is found in water flowing through arsenic-rich rocks.
Arsenic - which has slow effect depending on the exposure to the contaminated water and
dietary system - is metalloid toxic element also known as secret poison. According to experts, rocks rich in arsenic
were eroded from the Himalayas and other lying areas through flood and soil erosion. There
are two kinds of arsenic poisoning: acute and chronic. Acute poisoning occurs in
industrial locations, mines and factories. In countries with lower levels of
industrialization such as Nepal, chronic poisoning is more common as symptoms appear as
darkening of arsenic contamination in drinking water. “Along with sand, gravel, silts and
clays, arsenic got deposited in low-laying active floodplain area which now make up land
in Nepal’s southern plain, plain in Bangladesh and plain in West Bengal in
India,” said Dr. Roshan Raj Shrestha, executive director of Environment and Public
Health Organization (ENPHO), an NGO working in the area of safe drinking water. With the support from the United Nations
Children Fund (UNICEF), the National Arsenics Steering Committee is now doing a blanket
testing (extensive testing) in 8 districts of terai. This is the first such extensive
study conducted in Nepal. The early studies have shown that that
people are drinking water from wells with concentration of high level of arsenic without
knowing its harmful effects to their health. In wells of Debdaha village of
Rupandehi district, 300 miles south-west of capital, people are using the drinking water
with 2,600 ppb of arsenic. Nawalparasi district, 250 miles south-west of capital, have
more than 300 wells that have concentration of arsenic over 200 ppb. These are not two
isolated cases. The arsenic concentration in 200 wells in Parsa and Bara districts is
higher than 200 ppb. In districts like Nawalparasi, Rupandehi,
Parsa and Bara, with the support from JICA, Nepal Red Cross Society has already provided
local population preventive technology including iron-arsenic removal plants, and has
engaged in the distribution of household filters to reduce the arsenic level from drinking
water. Although many people reportedly visit
district hospitals in Nawalparasi, Bara and Parsa with skin diseases, the link is yet to
be established. Unlike other bacterial disease, the symptoms of arsenic toxicity can be
observed within 2 to 10 years of exposure and the arsenic poisoning can have a long term
effect. “Most common sights of long term, low
level arsenic exposure from drinking water are dermal changes, it needs extensive study to
establish the link,” said Mishra. High concentration of arsenic in drinking
water affects gastro intestinal, circulatory system, skin, liver, kidney, nerve system and
heart. For decades, the government promoted the
tube wells as a means to provide safe drinking water to the people and encouraged
exploitation of ground water in the region during eighties as a low cost, easy and
affordable technology. Nepal’s hope to provide the safe drinking water through
tube-wells, however, lie shattered following the revelation of high concentration of
arsenic in tube wells. The first test of arsenic began in 1999
when the Department of Water Supply and Sanitation and the World Health Organization (WHO)
tested 268 samples from three eastern districts Jhapa, Morang and Sunsari. This sample
study indicated the possibility of arsenic contamination in Terai’s ground water. “The studies have shown that
Nepal’s southern districts have high concentration of arsenic and United Nations
Children Fund is (UNICEF) supporting National Arsenic Steering Committee for extensive
study to prepare a report on the level of arsenic in different districts,” said Ms.
Suomi Sakai, UNICEF representative to Nepal. Despite health threats and hazards of
arsenic, many people in terai do not have any other alternatives other than to use the
contaminated water. “Since water containing high amounts
of arsenic has adverse affects on human health including increased risks for cancer,
diabetes and heart disease, the WHO is providing technical and other support to prevent
health catastrophe from the use of arsenic,” said Dr. Klaus Wagner, WHO
representative to Nepal. Yagya Raj-Renuka Memorial scholarships The Yagyaraj-Renuka Memorial Trust has been
established with the objective of providing scholarship for masters' level medical
students from far-western development region. According to the will of Dr Yagya Raj Joshi,
the first specialized Nepali doctor from abroad and the fifth president of Nepal Medical
Association, the trust has been founded, using the Joshi's resources, by his daughters
Manju Upadhyay, Indira Rimal and Rita Rawal, in memory of their late parents – Dr.
Joshi and his wife Renuka Devi Joshi. The Trust has built a hall on the upper
floor of the building of the Nepal Medical Association (NMC) at the cost of Rs.1.2
million, which will be rented out, and the money thus received will be used to provide
scholarships. At a program organized at the NMC on September 11, Minister for Law, Justice
and Parliamentary Affairs Tek Bahadur Chokhyal declared open Dr. Yagyaraj-Renuka Joshi
Scholarship Hall. It was also announced that the scholarship
would be of at least Rs 5,000 per person per month. Dr Kiran Shrestha, general secretary
of the association, said the amount about Rs. 250,000 per annum, generated from leasing
the meeting hall of the association would be the major source for the scholarship. A
memorandum of understanding between the Trustees and the NMC was signed to this effect. Dr Joshi, who had made significant
contribution in the medical field, especially in the areas related to chest ailment,
hailed from Doti district. Born in Doti district in the Far Western Region in 1972 B.S.
Dr. Joshi also had a stint as the president of Nepal Medical association and the Director
General of the Department of Health Services. He passed away in 2046 B.S. Former ministers
Narayan Dutta Bhatta and Bhakta Bahadur Balayar, governor of the Nepal Rastra Bank Dr.
Tilak Rawal, president of Nepal Ayurveda Association Dr. Manohar Gupta and a host of other
speakers stressed on following this kind of noble endeavor. It may be recalled that after demise of Dr.
Joshi, Mrs. Renuka Joshi had contributed Rs. 150,000 for providing scholarship to the
outstanding S.L.C graduates from Doti High School. 15 students including four girls have
so far benefited from this scheme. Rs. 52,250 has also been spent in improving physical
infrastructure of the High School. |
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