Nyaya Health

Posted by Aram Harrow, as told to him by Dr. Aditya Sharma

Wherever water treatment and sewer systems are inadequate, people live with the constant risk of diarrhea, typically from bacterial infection. Diarrhea is most dangerous to young children, and (after pneumonia) is the second most common cause of infant death worldwide. For adults, even lifelong exposure to unsafe water does not provide immunity, and diarrhea can change very quickly from an annoyance to a life-threatening condition.

Recently, a 50-year old woman came to the Nyaya Health clinic after being sick for a week with diarrhea. During that week, her diarrhea had been slowly worsening along with her abdominal pain until finally, on the morning she made the 2.5-hour walk to the clinic, she had 15 bloody diarrhea episodes. She came on a public holiday, when our clinic was closed for all but emergency and maternal services. Indeed, she had waited until then to come in because she had been too busy earlier in the week to leave her work.

By the time she arrived at the clinic, she was extremely tired, unable to keep down water, and had difficulty communicating. She was first seen by our health aide Rambha Kamal, who immediately called our doctor. Her symptoms were consistent with Shigellosis, a common cause of diarrhea worldwide that is responsible for over one million deaths per year. She was first treated conservatively, with oral rehydration solution (ORS) and antibiotics. However, she was unable to drink water without vomiting by this point. She also had started showing signs of shock and tachycardia (abnormally rapid heart rate), suggesting that her condition had become dangerous. At this point, we gave the patient an IV both to rehydrate her and to deliver drugs to stop the nausea and vomiting.

The patient is treated with intravenous fluid and medication.

Within a few hours, she was feeling much better and was able to keep down the ORS and antibiotics. From this point, she rapidly recovered. And fortunately, no one else in her home village had contracted diarrhea around the same time, implying that a localized outbreak was unlikely.

This case illustrates how, despite being a “self-limiting” condition, diarrhea can still put people in urgent need of medical care. Of course, the longer-term, and in principle better, solution to diarrhea is to make clean drinking water available. But until this happens everywhere, it will fall to rural primary health-care providers, such as Nyaya Health, to stop the easily preventable deaths that occur due to diarrhea.