Diarrhoea remains challenge in quake zone

Despite his mother’s presence, seven-month-old Umer Naseem continues to cry out loud. Admitted two days earlier to the Abbas Institute of Medical Sciences (AIMS) in Muzaffarabad, capital of quake-ravaged Pakistani-administered Kashmir, he suffers from acute watery diarrhoea and is not easily consoled.

Two beds over, the plight of 14-month-old Tybba Waheed persists as well. Admitted one month ago with severe gastrointestinal infections, including diarrhoea, fever and vomiting, she suffers from malnutrition, dehydration and a parasitic infection – and will not likely be discharged for another three weeks.

But according to attending physician Dr Naeem Ghaffar, who notes an increase in diarrhoea levels being reported amongst children coming to the centre – the only one of its kind in the city – it’s all in a day’s work.

Most children suffering from diarrhoea would be discharged after 48 hours were it not for the secondary infections that often follow, Ghaffar explained, noting the real danger was the loss of liquid and nutrients from a child's body.

“Many of the children would not have secondary infections, had their parents brought them in earlier for treatment,” he said, noting, however, as the only hospital with a children’s unit in the region, often requiring parents to travel overland for days on end, that’s not always possible.

“There has definitely been an increase in the incidence of diarrhoea over the past two months,” the 30-year-old medical practitioner maintained, citing poor hygiene, sanitation issues, unsafe water sources and particularly heavy monsoon rains this year.

Overcrowded IDP camps in the area provide a fertile breeding ground for outbreaks of diarrhoea

Yet according to health officials working on the ground, current incidence levels of diarrhoea were actually less than originally feared following concerted efforts by Pakistani health authorities and the humanitarian community.

“That I think has been a large part of why we haven’t seen a massive incidence of acute watery diarrhoea,” Sean Healy, project coordinator for Médecins Sans Frontières (MSF), told IRIN in his office Muzaffarabad.

“The incidence has increased, but that’s not so surprising because it’s the monsoon and it’s seasonal. It’s pretty much what you would expect actually,” he explained, describing the interventions made thus far as a real success story.

“The leadership of the [Pakistani] Department of Public Health has been excellent,” Healy affirmed, describing the current situation as “concerning, but not alarming”.

“While the health structure is very much stretched, there is no breaking-point in the capacity to cope,” the Australian aid worker maintained.

One month earlier, with monsoon rains proving particularly heavy this year, fears had heightened that things might worsen given the large numbers of people still living in internally displaced persons (IDP) camps without adequate water and sanitation in the area – more than 35,000 people in the Muzaffarabad area alone – as well as the capacity of area hospitals to cope.

More than 75,000 people had died and more than 3.5 million people rendered homeless by the 8 October earthquake that ripped through Pakistani-administered Kashmir and the country’s North West Frontier Province (NWFP) – a disaster that devastated the region’s water supply system, not to mention its health infrastructure.

Access to clean drinking water remains problematic throughout much of quake-affected northern Pakistan

According to Ghaffar, of the 150 children their unit sees each day – more than 30 suffer from gastrointestinal infections, including diarrhoea and vomiting – a source of concern for the fledgling unit.

“Where will I put 30 more patients a day? I simply don’t have the facilities,” he complained, noting only patients that were severely dehydrated were actually admitted.

Despite the current situation, things could have been far worse.

In the first 10 days of August, the United Nations Children’s Fund (UNICEF) reported more than 800 patients had been treated at the agency-supported Battagram District Hospital in NWFP, where doctors had been overwhelmed by the increasing number of patients suffering from acute diarrhoea, prompting two tents to be erected in the hospital’s yard to accommodate the overflow.

“It is estimated that more than 150,000 Pakistani children die every year of dehydration [resulting from diarrhoea], so this is a potentially very serious problem,” UNICEF health officer Wali Mohammad said at the time, citing issues of access to clean drinking water, compounded by heavy monsoon rains that had contaminated water flows in from the land, often containing waste and other harmful elements.

“The children then drink the river water and become seriously ill,” Mohammad said.

Yet more than one month on, the UN children’s agency is now expressing confidence that it is on top of the problem.

In addition to diarrhoea, 14-month-old Tybba Waheed suffers from malnutrition, dehydration and a parasitic infection

“More important than how common diarrhoea is, is the question of what people are doing about it,” Dr Tamur Mueenuddin, project health officer for the agency, said in the capital, Islamabad, citing information sharing as a key component to its coordinated response.

Efforts are scaling up to control diarrhoea outbreaks, he maintained, with excellent collaboration between Pakistani-health officials, the World Health Organization (WHO), UNICEF and NGO partners in response to the challenge.

“We are all part of a team in the field. We discuss what we are going to do and we have got a preparedness plan,” Mueenuddin said. This plan ranges from the distribution of Vitamin A to reduce the severity of diarrhoea, the provision of intravenous drip solutions, oral rehydration salts [a special combination of dry salts that, when properly mixed with safe water, can help rehydrate the body when a lot of fluid has been lost due to diarrhoea], chlorine tablets, to hygiene promotion activities directly to the families or caretakers of the child, including the distribution of soaps and other hygiene items.

“We’re trying to make sure when diarrhoea occurs, when it is severe and is being referred, everybody is on alert,” Mueenuddin said, explaining that information was now getting to them much quicker than before, allowing them to respond better.

DS/AT/JL/DS