Though of late, such news has lessened, the frequent occurrence of diarrhea is testimony to the poor health and sanitation practices in Nepal. [break]
However, this situation is not limited to remote areas. Kathmandu, the capital, suffers no less.
Sukraraj Tropical and Infectious Disease Hospital confirmed Kathmandu’s first cholera case of this summer in April, before the onset of monsoon.
From Baisakh (April/May) till the end of Jestha (May/June), 11 cholera cases have already been identified, informed Dr Sher Bahardur Pun of the hospital. But due to lack of technology, the hospital has not been able to track down the strains for these cholera cases.
On Wednesday, June 30, Republica reported that at least a dozen patients admitted in different hospitals of the capital have tested positive for cholera and that all the all the patients are residents of Kathmandu.
The doctors also warned that the disease might have already spread making drinking water in several parts of the capital unsafe.
In this context, it is important to note that on June 27, among the 15 patients who reported at Sukraraj Hospital with waterborne diseases, one of them was Gyan Bahadur Lama, 66, who traveled from Kavre to Kathmandu to get emergency admittance at 8 pm.
On the record
A 2007 study titled “Microbiological Analysis of Drinking Water of Kathmandu Valley” which evaluated the quality of drinking water shows that most of the natural water sources are highly contaminated.
A total of 132 drinking water samples were randomly collected from 49 tube wells, 57 wells, 17 taps and nine stone spouts from different places of Kathmandu.
An earlier research carried out in 2003 in two wards of Kathmandu, No. 19 and 20 also detected high bacterial contaminations during spring and rainy periods in most water sources (over 90% of stone taps and wells).
The research, titled “Urban Ecosystems and Health in Kathmandu: Community Based Biological Assessment of Drinking Water Sources,” reveals that only about 34% of the total 78 water connections of Nepal Water Supply Corporation have either good or sufficient water flow.
Others have limited water supply, and sometimes the taps are dry for weeks.
Thus the tragedy is that the denizens of the Valley have to make do with hygienically unsafe, unprotected and untreated stone tap water and underground water resulting in seasonal waterborne diseases.
The research also indicates that people who lived in the two sample wards relied on ground and surface water, and that most of the sources were not safe for drinking. In Ward 19, of the 78 different water sources, 47% showed the presence of fecal contamination on the second day of the study.
In the case of stored tap water for drinking purposes, large numbers of pathogenic bacteria, that cause diseases, were sometimes present. Since the water supplied by the state is insufficient, most people who have connected taps store water either in reserve tanks or containers.
Reality meets record
Though the research on the above mentioned two wards could be dismissed as specific to isolated cases, the findings surely serve as a warning on the overall state of Kathmandu’s health and sanitation standards.
And if this could sound a warning bell, a report obtained by Metcalf and Eddy in 2000 from Teku Hospital in Kathmandu shows that 16.5% of all deaths were due to water-borne diseases.
Though the Clinical Research Unit of the hospital shies away from such data, the hospital does see a rise in the number of water-borne disease patients with the onset of the rainy season even today.
In his 35 years as a veteran Ayurvedic physician of Piyushabarshi Aushadhalaya in Mahabouddha, Madhu Bajra Bajracharya has seen growth in the number of waterborne disease patients in Kathmandu.
“Mostly, they are foreigners, but the number is no less when it comes to locals,” he says.
Most of Bajracharya’s patients suffer from giardiasis.
“Usually, the cases are seen among those who take street food and water,” informs the physician. A microscopic parasite that is considered one of the most common sources of waterborne illness, Giardia causes giardiasis. The result is continual diarrhea, abdominal cramps, nausea, and dehydration.
Along with giardiasis, a number of other diseases, such as dysentery, typhoid, and hepatitis also increase during this season. The root causes being contaminated water and food, according to doctors.
Dr Pun of Sukraraj notes that diarrhea in children under five are also common during winter.
“This is particular due to rotavirus, which might be found in water sources after getting contaminated with feces from infected human,” he says.
But there has been some progress in the effort to make the Valley safer.
Dr Samir Koirala of Oxford University Clinical Research Unit at Patan Hospital points out that when it comes to typhoid, there actually has been a decrease in the number of patients in Kathmandu.
The Unit has been researching on the particular disease since 2003 in partnership with the government, Mitra Samaj, and International Vaccine Institute.
A campaign to provide typhoid vaccination to those involved in the tourism sector has begun with a nominal fee of Rs. 200 in Lalitpur.
“Our next plan is to reach out to schools of the particular area,” says Koirala.
Along with this particular campaign, the clinical unit of Sukraraj Hospital also has immunization programs against Hepatitis B and typhoid in the pipeline.
“Such frequent occurrences have been trivialized because they are more seasonal diseases. But it reflects the Capital’s tragedy of not being able to develop a mechanism to control such diseases and focus on more serious issues,” observes Dr Basu Dev Pandey, a senior at Sukraraj Hospital.
“Diarrheal patients usually get admitted in the emergency ward, which means that people don’t bother about such condition until it gets excruciating,” observes Dr Rajesh Shah of the hospital. Such cases can reach 30 to 40 per day, he further informs.
Apart from the cases who come to the hospital, there are many who directly visit pharmacies with their previous prescriptions, says Dr Pun.
Nabha Raj Aryal of UP Pharma, near Bir Hospital, informs that during rainy and summer seasons, on average, at least one patient with diarrheal symptoms visits his pharmacy every day. But he also says he has seen a decline in such patients in his five years as pharmacist. “We usually refer our patients to Sukraraj Hospital,” he says.
Nevertheless, Ayurvedic physician Bajracharya also points out that, along with the immediate causes, we should also look into long-term consequences.
“At present, the use of boring-well water, which is rich in minerals, is rampant in the form of bottled water jars and for household purposes.
Consumption of such water leads to several conditions, such as yellow teeth and diseases like gastritis, ulcer, etc,” informs Bajracharya. “If you observe these bottled jars closely, there’s formation of algae in them in a few days. This proves the presence of foreign objects in the water.”
Given this context of insufficient state of water supply and the poor quality of stored jar waters, the Valley consumes a total of 900,000 liters of bottled water each day, according to Nepal Bottled Water Industries Association.
This is predictable, given a recent statement by Kalyan Singh Thapa, the acting executive chief of KUKL (Kathmandu Upatyaka Khanepani Limited), that the demand for drinking water in Kathmandu is 320 million liters per day, but its production is just 90 million liters in the dry season and 160 million liters in the rainy season.
In 2010, four water industries were shut down as they failed to meet the standards set by the Department of Food Technology and Quality Control, informs Pramod Koirala, the spokesperson of the department.
Given concerns that boring and underground water have health hazards, Koirala points out that industries selling underground water need to meet certain technical parameters to guarantee the quality.
The spokesman, however, accepts the fact that a lot is yet to be done when it comes to quality control.
There are currently about 300 companies registered with Nepal Food Corporation and the Department of Commerce offering bottled water throughout the country.
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In an interview with Republica in April 2011, Dr Shah had said that the outbreak of cholera isn’t common during the rainy season but its detection before the onset of the season is alarming. According to him, contaminated water is the main cause of cholera infection.
Adding to this, Dr Pun observed that post-rainy period also can witness a rise in the number of patients as the rainy months, too, can be the incubation period for the bacteria.
The doctors inform that if such outbreak occurs, the age group from five to 15 years is the most vulnerable one.
Though Shah claims that he does not see the possibilities of such outbreaks here, Pun, on the other hand, informs that in a densely populated area like Kathmandu, there are more chances of such epidemics.
Nonetheless, experts and doctors emphasize on basic sanitation and hygienic practices, like washing hands properly and boiling water before consumption for the prevention.
“But again, our mentality is such that we don’t bother about such diseases unless we suffer,” says Pun.
Taken together, these factors serve as a warning that Kathmandu must be alert lest it experiences a vicious epidemic of waterborne diseases. Keeping the possible outbreak of epidemic diseases during rainy months, the Health Ministry has kept its Community Rapid Response Teams on alert in all the districts.
Couple the water contamination issues with the current water scarcity, and the metropolitan city of Kathmandu is at risk of such outbreaks that we often associate only with distant places.
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