Posted by Shefali Oza
A diarrhea epidemic is spreading through Nepal, particularly in the Mid- and Far-Western regions. Recent news stories have reported that the district of Jajarkot, two removed from Achham, is the current epicenter of this outbreak. Many believe this is a cholera epidemic, though this theory is unlikely to be tested in the immediate future due to limited lab capacity in the country.
In the last several days, we have started seeing severe diarrhea cases coming to Bayalpata Hospital. The first cases were three young children from the same family. Each child stayed in the hospital for 3-4 days in life-threatening condition. Fortunately, all three children recovered after receiving regular doses of medicine and IV fluids. However, the youngest daughter was carried back to our hospital two days after being discharged. Though she no longer had diarrhea, she was now unable to move her limbs due to the sudden and extreme loss of electrolytes from her system. Fortunately, our health providers were able to treat this side effect of severe diarrhea and she made a full recovery.
The youngest of the three children with severe diarrhea. Her parents brought her outside for fresh air after she appeared to be recovering at Bayalpata Hospital.
While we have successfully treated most diarrhea cases thus far, we have had one death at the hospital from this outbreak. A woman in her 60s was carried over a distance of three hours to reach our hospital in the evening. She was one of our first diarrhea patients from this outbreak, alongside the three children mentioned above. Her symptoms (severe diarrhea and vomiting) began twelve hours prior to her arrival at Bayalpata. At the hospital, she was unable to keep IV fluids in her system and kept having continuous diarrhea and vomiting. By the third day, lab tests indicated that her kidneys were beginning to fail. In the US, a dialysis machine would have saved her life. But instead, she died on the fourth day, unable to retain any fluid. This preventable death and the scores of near-deaths that have occurred due to this recent outbreak underscore the vast inequities that underlie the living conditions in Achham. This patient died because she did not have access to clean water and because her family members had to carry her on their backs for hours to reach our hospital.
The dangers of a widespread cholera epidemic are frightening. If left untreated, patients can die within as few as three hours. In areas like Achham, this is particularly concerning as many people live hours from their nearest health facility. Initial treatment is as simple as adding oral rehydration solution (ORS) to water. However, with continuing diarrhea but no ORS, patients can quickly dehydrate and need IV solution at a health facility. Daily we are witnessing a rise of patients coming to Bayalpata Hospital with severe diarrhea. And daily our staff are saving numerous lives through the simple interventions that can stop severe diarrhea/cholera in its tracks. And yet the question remains: how many people are dying because they cannot reach medical care quickly enough? We suspect that in the coming days and weeks, we may witness the unfortunate answer to this question.