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Health services “coping” in battle against diarrhoea

A scene inside the International Centre of Diarrhoeal Disease Research, Bangladesh (ICDDR-B) in Dhaka. More than 50,000 people are suffering from diarrhoea throughout Bangladesh after unusually heavy monsoon rains and flooding
(David Swanson/IRIN)

At first glance, the scene outside the hospital in the Bangladeshi capital, Dhaka, looks like a war zone as one patient after another is rushed in on a stretcher.   
“This one is going into shock,” the doctor shouts, as a nurse quickly inserts a needle of re-hydrating solution into his arm - his eyes drifting upward into his head.
But this is not a war in the conventional sense, nor is the enemy new: The battle lines were drawn long ago and thanks to immediate life-saving interventions such as this, this young man will survive.
Diarrhoea is a regular visitor to flood-prone Bangladesh, where one third of the country floods each year during the monsoon season.
As water levels recede, health officials in this impoverished river delta nation are well versed on what to do.
“We’re used to this”
There is always an increased incidence of water-borne diseases - particularly diarrhoea - and this year is no different.
“We’re used to this,” Dr Tahmeed Ahmed, a doctor at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR-B), said.
According to the Bangladeshi government, more than 10 million people were affected by this year’s floods, leaving hundreds of thousands homeless and more than 350 dead.
And while there had been an increased incidence this year following heavier than normal rains - up from a normal caseload of 250 patients a day to more than 1,000 - the facility, the largest of its kind in the city, is coping.

Photo: David Swanson/IRIN
Severely dehydrated, a young man begins to go into shock after arriving at the International Centre for Diarrhoeal Disease Research

“We have seen a steady increase in the number of people coming in since the beginning of August, mostly from the poorer areas in and around Dhaka. Those are the people we’re treating,” Dr Alejandro Cravioto, executive director of the centre, told IRIN. He said some came from as far away as 50 to 60km from the capital.
“Although we will need to replenish our stocks soon, we are coping. We have the beds, the staff and the medical supplies to handle this,” he said.
To deal with the overflow, hospital officials have already erected three large military-size tents in the parking lot, with sections for emergency cases, recovery, children, as well as a separate section for men and women.
“We can’t always do that,” Ahmed said. “But we try,” he said.
On 15 August, the hospital received 1,045 patients - the highest number this year. Most stay for just 24 hours while a third require an additional 24 hour recovery period. A very small group - mainly babies stay longer because of added complications - including pneumonia and septicaemia.  
But this year people were staying a bit longer. Firstly because they were arriving in a more severe state of dehydration, requiring a longer time to recover, and secondly, because many had no place to go because their homes were flooded.
“In a sense, they are trying to delay their departure and we don’t want them to go if they are not perfectly ready,” Cravioto said.
Abdul Barek - who arrived one hour earlier by rickshaw and is now on his second bag of saline solution - is already feeling better. 

Photo: David Swanson/IRIN
Suffering from severe diarrhoea, 27-year-old Shahida delayed seeking treatment because she didn't want to leave her two-month-old daughter alone

“I started feeling sick last night, but then it just got worse,” the 35-year old cook said, clearly weakened by the ordeal.
Nearby, 27-year-old Shahida who had been vomiting earlier, slowly drinks from a glass of oral rehydration solution (ORS) - a simple solution for rehydrating people using salt, sugar and water.   
“This is her first time in a hospital. We would have come earlier, but my wife didn’t want to leave our two-month old daughter behind,” her husband said.
Yet such delays in seeking treatment can be dangerous. Those that wait run the greatest risk of becoming severely dehydrated which can lead to shock - and potentially death.
Low mortality rates
Nationwide upwards of 50,000 people were suffering from diarrhoea as a result of this year’s floods, according to the government, while very few of the 370 deaths reported as of 16 August had actually died from diarrhoea - a credit to emergency preparedness efforts.
“Yes, the incidence is high, but the mortality rate is very low,” Louis-Georges Arsenault, country representative of the UN Children’s Fund (UNICEF), which has been heavily involved in the pre-positioning of rehydration solutions and medicines, told IRIN.
To date, mortality due to diarrhoea at the ICDDR-B was practically zero.
Since the beginning of August, three diarrhoea cases arrived at the hospital dead and couldn’t be revived, while one baby who also suffered from pneumonia died in the intensive care unit.
“That’s all the dead people we have had,” Cravioto emphasised. “If people arrive here alive, we can treat them.”   
Meanwhile, elsewhere in the country, the government maintains a strong public health network of hospitals - all of which are well versed in the treatment of diarrhoea and other water-borne diseases.
In each of the country’s 64 districts, as well as in each of the country’s 460 sub-districts, there is a public hospital.
“Each sub-district has a hospital that provides these types of services,” Dr Mushtaque Chowdhury, deputy executive director of BRAC (Building Resources Across Communities), one of the largest non-governmental organisations in the world based in Bangladesh, and a noted expert on ORS, said.
Added to this is a host of private facilities and medical colleges throughout the country, as well as number of makeshift facilities erected both by the government and the military over the past week.

Diseases peaking?
But with rains still battering much of the country, health experts wonder whether the worst is truly over.
“At this point in the monsoon, we’re probably looking at the peak,” Cravioto asserted.
“We hope we have seen the worst of it. We have had the floods and the receding of waters. The rivers are going down,” he explained.
The acute phase will probably last for at least three or four more days, he said, predicting a decrease, but at the same time warning of an increased incidence of enteric fevers, including typhoid, hepatitis A, and leptispirosis.
“These are the diseases that take 14 days to inoculate. In about seven days we will be seeing these types of diseases which are not yet the acute ones, but the ones that have a longer incubation period,” he warned, adding, however, if there were a second wave of heavy rains, there could also be a second surge in diarrhoeal diseases.

This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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