THE death of 54 people with another 11,000 taken ill by diarrhea in Rukum district in 2009 sent shockwaves across the country. People found it hard to understand how the government could have been so callous to let people die for the want of simple ORS solution. The dismal level of awareness among people in the worst-affected areas also didn´t help. For instance, many of those affected in Mid-and Far-Western regions, the hub of the 2009 epidemic, were unaware that they needed to wash their hands with soap and water after going to toilet. There was similar disbelief when it emerged a year later that a big chunk of the funds going for construction of toilets in rural areas were gobbled up by middlemen in health bureaucracy and disingenuous NGOs.
The funds were meant to improve the dismal shortage of latrines in the Mid- and Far-western regions, where just 18-25 percent of households have latrines as compared to the national average of 46 percent. Given this potent combination of dysfunctional health mechanisms and poor awareness, 672 people have died, while over 100,000 have sought treatments for diarrhea between May and July in the last five years. Thankfully, subsequent intervention seems to have borne some fruit: According to latest government data, compared to the huge toll in 2009, in 2011 the country witnessed just five deaths with just over 1,000 taking ill from diarrhea.
The authorities claim to have the situation under control this year as well as the country gears up for another monsoon season. One of the defining features of the 2009 epidemic was the near-universal failure of the local-level Rapid Response Teams (RRT) in the affected areas. As RRTs were themselves severely short on both manpower and other resources, they found themselves overwhelmed by the sheer scale of the crisis. This year, in keeping with the trend in the last couple of years, the RRTs have been significantly strengthened at all levels in the 31 most-prone districts across the country.
But loopholes might yet emerge in the event of another severe outbreak. First, the RRTs which have been recently set up are untested. Given the past record, there is also no guarantee that the RRTs at the central, regional and local levels can coordinate their action in case of such an eventuality. There have also been reports of shortages of ORS in many of the historically worst-affected areas. Lack of progress on construction and awareness on toilet facilities also suggest that it will not be easy to control the contamination of local water resources, the reason behind any water-borne epidemic. But credit must be given where it´s due.
Yes, the health authorities have been able to significantly cut down on the number of casualties and affected population. The more proactive measures in place since 2009 have clearly helped improve the situation. But that is also no reason to rest on past laurels. There is still so much that can go wrong. Round-the-clock preparedness is the only answer.
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