Beating Ebola Means Drinking, Last Thing Patient Wants to Do

Bloomberg, Jason Gale, Nov 17, 2014

Dr. Fadipe Akinniyi Emmanuel, Ebola survivor, shows the daily dose of oral

 rehydration salts, or ORS, he and other survivors took to survive in Nigeria. 

(Photographer: Andrew Esiebo/World Health Organization via Bloomberg)

The best medical advice for surviving Ebola right now might fit in one word: drink.

With targeted drugs and vaccines at least months away, doctors and public health experts are learning from Ebola survivors what simple steps helped them beat the infection. Turns out drinking 4 liters (1 gallon) or more of rehydration solution a day -- a challenge for anyone and especially those wracked by relentless bouts of vomiting -- is crucial.

Related Slideshow: Liberia: Ebola's Ground Zero

“When people are infected, they get dry as a crisp really quickly,” said Simon Mardel, an emergency room doctor advising the World Health Organization on Ebola in Sierra Leone. “Then the tragedy is that they don’t want to drink.”

Aggressive fluid replacement was deemed critical in saving two American health-care workers with Ebola at the Emory University Hospital in Atlanta, according to a study published in the New England Journal of Medicine last week. Interviews Mardel and WHO colleagues conducted with six of the dozen patients who survived Ebola in Nigeria, where the fatality ratio was much lower, also point to the importance of drinking. Ada Igonoh, a doctor who caught Ebola in late July while working at the First Consultants Hospital in Lagos, said she took oral rehydration salts, or ORS, mixed in water as soon her gastrointestinal symptoms started -- even before her Ebola diagnosis. Once hospitalized, she trawled the Internet on her iPad for insights from survivors.

Ada Igonoh, a doctor who caught Ebola in late July while

 working at the First Consultants Hospital in Lagos, said

 she took oral rehydration salts, or ORS, mixed in water

 as soon her gastrointestinal symptoms started -- even

 before her Ebola diagnosis.  (Photographer: Andrew

Esiebo/World Health Organization via Bloomberg)

Studying in Seclusion

“I knew that in diarrheal diseases, shock from dehydration is the number one cause of death,” Igonoh said in an e-mail. “From my research on Ebola while in isolation, I found that to be true.”

The WHO shared transcripts of interviews with Igonoh and five other Ebola survivors with the patients’ permission to provide insight into clinical experiences and management. Igonoh also answered follow-up questions in a direct e-mail.

Patients in Liberia lost 5 liters of fluid a day from diarrhea alone, doctors treating cases there wrote in a Nov. 5 paper in the New England Journal of Medicine.

Severe fluid loss can cause a type of shock that prevents the heart from pumping enough blood to the body, eventually leading to multiple organ failure.

“As I took the ORS and treated dehydration, it provided me with energy, and my immune system was able to battle the virus,” 29-year-old Igonoh said.

Simple Message

Patients become “stunningly dehydrated” because they don’t feel like eating or drinking in the early stages of the illness, and then later they lose liters of fluid from profuse sweating, vomiting and diarrhea, according to Mardel. 

 

Source: WHO (Updated Nov. 14, 2014)

“You don’t want to drink, then you’re too weak,” he said in a telephone interview from Freetown. “In the last stage, you’re in shock and your gut has shut down.”

Mardel has worked on medical aid and emergency relief operations for 30 years, including responding to outbreaks of Lassa fever in Sierra Leone, Ebola in Uganda and Marburg virus disease in the Democratic Republic of Congo.

Mortality could be reduced by delivering a simple message about the importance of taking fluids and picking the right painkillers, he said. Paracetamol, the active ingredient in Panadol, is the preferred medication for pain and fever, and picking others such as aspirin and ibuprofen can worsen bleeding, he said.

“We will halve the mortality by firstly just stopping anti-inflammatories and giving hydration, and really pushing it,” Mardel said. “I want every man and woman in Sierra Leone to know this. I want sports personalities to be talking about it. I want everybody to be talking about it.”

Ebola Blueprint

In Nigeria, 40 percent of those known to have been infected died. Across the rest of West Africa, the fatality rate is about 70 percent.

Nigeria’s success in stopping Ebola shows how the virus can be stamped out and is a blueprint for other developing countries at risk of the disease, the WHO said after declaring Africa’s most-populous nation Ebola-free last month.

Related:

• Ebola Vaccine Challenge: Motorbikes and Kerosene Fridges
• Doctor Dies in Nebraska After Ebola Infection in Sierra Leone

Liberian-American Patrick Sawyer introduced Ebola to Nigeria in July when he arrived on a flight to Lagos, a city with an estimated 21 million people, according to the WHO. In addition to Sawyer, five health workers and the protocol officer who received him at the airport died of Ebola, according to Nigeria’s health ministry. Twelve survived.

Learning from their experience and putting those lessons to use in other West African countries is key, because too many patients arrive at treatment centers severely parched and difficult to salvage, Mardel said.

Spurning Care

Patients typically seek medical aid after five days of illness, according to a study of Ebola cases in Conakry also published Nov. 5 in the New England Journal of Medicine.

“Over eight to 10 days of illness, you will need possibly 40 liters of fluid,” Mardel said. “Day after day, if you’re not getting that, we can’t suddenly give you 20 liters to catch up.”

A fluid deficit and “profound electrolyte derangement” appears to increase the risk of death, the WHO said in a Nov. 6 statement. In that document, the Geneva-based agency recommended intravenous rehydration. Not everyone agrees that that delivery route is the best way to go. Oral rehydration, which is taken up in the gut, seems to help patients maintain a better balance of electrolytes, according to Mardel.

Don’t Gulp

Most intravenous rehydration fluids also don’t have much potassium, calcium, or magnesium, doctors at Emory University Hospital wrote in their journal article last week. They recommend supplementing oral rehydration with all three, especially in patients with large-volume diarrhea.

Still, drinking has its challenges. Patients must overcome recurring nausea, as well as debilitating joint pain that can make gripping and movement difficult.

Ebola survivor Fadipe Akinniyi Emmanuel, another doctor at the First Consultants Hospital where Igonoh works, said gulping down the rehydration solution made him sick.

“Each time I attempted to take the ORS, I vomited,” he told the WHO, according to the transcript. Eventually, Emmanuel found he could keep down 4 liters of fluids a day by taking frequent, small sips between bouts of nausea.

‘Most Important Thing’

Rehydration is “the single most important thing” in the management of Ebola, Emmanuel said in an e-mailed response to questions.

“It really helped restore what I was losing when I was stooling and vomiting relentlessly,” said the 29-year-old doctor, who still suffers occasional joint pain and stiffness as a result of his past Ebola infection.

Flavoring the liquid also helps. The granules that Emmanuel’s colleague Igonoh took at home were orange-flavored and much more pleasant than the flavorless kind she was given in the hospital, she said.

“I had to mentally force myself,” she said, according to the transcript.

Igonoh used less of the rehydration salts per liter of water than recommended because a more diluted brew was easier to stomach, helping her to increase her intake, she said.

“You don’t want to drink anything,” Igonoh said. “You are too weak.” That’s when morale is key, said the doctor, who now sports a shaved head after the viral illness caused most of her hair to fall out. “You should be able to tell yourself, no matter how many people die, you are going to survive. And you will survive.”

To contact the reporter on this story: Jason Gale in Melbourne at j.gale@bloomberg.net

To contact the editors responsible for this story: Elyse Tanouye at etanouye@bloomberg.net Marthe Fourcade, Terje Langeland

Related Article:

"Revelations of Darkness" - Oct 1, 2014 (Kryon Channelling by Lee Carroll) - (Text version)

“ .. The Role of Gaia in Human Consciousness

One of those times might be frightening for you to know about, since it was a full cooperation with Gaia for your termination, and a pandemic almost wiped humanity off the map. A pandemic! Now, you say, "What has that got to do with Human consciousness, Kryon?" Pay attention, dear ones, because this is the day where the teaching was given by my partner, and he put together the Nine Human Attributes. One of the attribute sets included three Gaia attributes and one of them was the consciousness of the planet. Gaia is related to Human consciousness!

Are you starting to connect the dots? You are connected to this planet in a profound and spiritual way. As goes humanity goes the planet's consciousness. Gaia, Mother Nature, whatever you want to call it, cooperates with Human consciousness. If you spend 1,000 years killing each other, then Gaia will do its best to cooperate with your desires! Gaia will look at Human consciousness and try to help with what you have shown you like to do! Did you know this role of Gaia with you? It's a partner with you, fast tracking what you give to it. You may wish to review what the indigenous of the planet still understand. Gaia is a partner!

Pandemic: Don't you find it odd that in the last 50 years, when you have a population of seven billion Human Beings, with up to 2,000 airplanes in the air at any given moment, going between almost every conceivable place, that there has not been a pandemic in your lifetime? There have been five starts of potential pandemics over the last 20 years, yet none became serious. Did any of you put this together? Dear ones, when the world was far less populated a few hundred years ago, with no mass travel to spread a virus, there were still millions wiped out by a pandemic. With the increased population and mass travel, there is far more danger today than before. It doesn't make sense, does it? What happened to stop it?

When you know humanity's relationship to Gaia, it makes sense. Gaia is a life-force that is your partner, watching you change the balance of light and dark and reflecting what Humans want. It has polarity, too! Perhaps it's time to start your meditations with thanking your planet Earth for supporting you in the spirituality of your Akash, for always being with you, a life-force that is always present. The ancients started their ceremonies in that way. Have you forgotten?

Ebola

Now, I've just set the stage for the next subject, haven't I? Ebola. Are you afraid yet? Gaia is a life-force that is a part of Human consciousness. My partner put it on the screen today so you could see the connections [during the lecture series]. Now it's time to connect the dots. Dear one, Gaia is in the battle, too, for here comes something scary that you haven't had in your lifetime and you're afraid of it - the potential of a pandemic on the planet.

There's a very famous film that has some dialogue that my partner will quote. Some of you will know it and some of you won't, but here it is: "Have a little fire, scarecrow?" What are you afraid of? Darkness? Gaia is in the battle with you and is actively pursuing solutions through light. The energy of the planet is with you in this fight! The ebola virus is a shock and a surprise. It is propelled by ignorance and fear, so it can flourish. Look at where it started and look at how it gets its ability to continue. It expands its fear and power easily with those who believe it's a curse instead of those who understand the science.

Villages are filled with those who refuse to leave their family members because they believe the disease is a curse! FEAR! Instead of understanding that they should be in isolation from the virus, the family dies together through ignorance and fear. This represents how darkness works. Are you going to become afraid also? Dear ones, ebola will be conquered. Know this and be at peace. Pray for light for those in the villages who are afraid, that they can know more about how to keep the spread of this disease and live to see their families. .”

India Unveils Vaccine for Deadly Diarrhea Virus

JakartaGlobe, Agence France-Presse, May 14, 2013

A diarrhea-suffering Bangladeshi child receives treatment at the International
 Center for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) in Dhaka
on April 11, 2010. (AFP Photo/Munir uz Zaman)

New Delhi. Scientists unveiled Tuesday an affordable vaccine against a deadly diarrhea-causing virus that kills some 100,000 children in India every year.

Rotavirus, which causes dehydration and severe diarrhea, is globally responsible for some 453,000 deaths annually and is particularly threatening in Africa and Asia, where access to urgent healthcare is often out of reach.

K. Vijaraghavan, secretary of India’s Department of Biotechnology which steered the hunt for an affordable rotavirus vaccine, said it was a product of international cooperation, although it has yet to be approved by New Delhi.

“The result is a world-class vaccine for India’s children,” he told a press conference in New Delhi.

“For the first time we have taken a vaccine from the earliest discovery to every stage of development and that is a very remarkable thing for India,” he said, adding that the dollar–a–dose oral vaccine was ready for production.

The vaccine named Rotavac will be manufactured by Hyderabad–based Bharat Biotech pharmaceutical firm which has said it has the capacity to mass produce 60 million doses after clearance is given. Each vaccination consists of three doses.

Rotavirus is blamed for causing up to 884,000 hospitalizations in India a year, at a cost to the country of 3.4 billion rupees ($72 million), scientists say.

“We have (now) added to our know-how and capacity in ways which will pay dividends for development of future solutions,” said Vijaraghavan.

Each dose of licensed vaccines from GlaxoSmithKline and Merc cost around 1,000 rupees ($18), said Sushmita Malaviya of PATH, an international healthcare organization which is also part of the Rotavac program.

M.K. Bhan, who pioneered the project after local scientists discovered a localized rotavirus 23 years ago in a New Delhi hospital, said the development was a boon for India’s creaky public health service.

“Total 25 percent of all diarrhea admissions would be prevented by this and that means you will have 25 percent less diarrhea illnesses of severe nature in India which is a very substantial public health gain,” he said.

“We have a good vaccine which will be useful and we will do post–marketing surveillance and keep accumulating more experience.”

More than 300,000 babies die within 24 hours of being born in India each year from infections and other preventable causes, according to a report last week by Save the Children.

Agence France-Presse

Related Article:

300,000 Day-Old Babies Die Each Year in India: Report

Worms detected by converted iPhone microscope

BBC News, 13 March 2013

Related Stories

• Smartphone app tests users' urine
• Device to fight anaemia in India
• Scottish health app surprise hit

Slides were stuck to the lens with
 double sided tape and lit with a cheap
torch

Scientists used an iPhone 4S to diagnose intestinal worm infections in schoolchildren in rural Tanzania.

They attached an $8 (£5) ball lens to the handset camera lens, and used a cheap torch and double-sided tape to create an improvised microscope.

Pictures were then taken of stool samples placed on lab slides, wrapped in cellophane and taped to the phone.

They were studied for the presence of eggs, the main sign of the presence of the parasites.

When the results were double-checked with a laboratory light microscope, the device had managed to pick up 70% of the samples with infections present - and 90% of the heavier infections.

The study has been published this week in the American Journal of Tropical Medicine and Hygiene.

Researcher Dr Isaac Bogoch, who specialises in internal medicine and infectious diseases at Toronto General Hospital, told the BBC he had read about smartphone microscopes being trialled in a laboratory and decided to "recreate it in a real world setting".

"Ultimately we'd like something like this to be a useful diagnostic test. We want to put it in the hands of someone who might be able to use it," he said.

"70% (accuracy) isn't really good enough, we want to be above 80% and we're not quite there yet," he added.

"The technology is out there. We want to use materials that are affordable and easy to procure."

Camera key

Dr Bogoch and his team, which included experts from Massachusetts General Hospital and the Swiss Tropical and Public Health Institute, said the only reason he used an Apple iPhone was because it was his own handset.

"You need the ball lens to help with the magnification - but any mobile phone with a decent camera and a zoom function will be sufficient," he explained.

The smallest eggs visible using the smartphone were 40-60 micrometres in diameter.

"From an egg standpoint that is not tiny but it's not enormous either," said Dr Bogoch.

"The microscope was very good at diagnosing children with heavier infection intensities as there are more eggs, so they are easier to see."

Intestinal worms are estimated to affect up to two billion people around the world, mainly in poor areas.

"These parasitic infections cause malnutrition, stunted growth, and stunted mental development," added Dr Bogoch.

"It's a big deal, a big problem."

Respiratory diseases plague Aceh’s flood victims

The Jakarta Post, Fri, 03/18/2011

Victims of a recent flash food in Pidie, Aceh are suffering from respiratory diseases, according to a local official.

“The majority of the flash flood victims are suffering from respiratory diseases, aside from diarrhea, malaria and trauma,” Aceh Health Agency chief M Yani said on Friday as quoted by kompas.com.

Nine health posts set up by the agency in Tangse, around 170 kilometers from the province’s capital, Banda Aceh, were monitoring the situation and had provided free treatment to about 230 people, mostly children and elderly, Yani said.

High Number of Diarrhea Deaths in Kebumen

Tempo Interactive, Monday, 10 May, 2010 | 19:56 WIB

TEMPO Interactive, Kebumen: The number of deaths caused by diarrhea is high in Kebumen. Throughout 2009, 18.854 cases of diarrhea were reported, 13 of which led to deaths. The reason is that only 68.6 percent of all Kebumen residents own toilets. “Only 17 villages in Kebumen have their residents defecating and urinating in proper toilets,” said Kebumen regent Nashiruddin Al Mansyur yesterday.

Nashiruddin has called on the government to prioritize the construction of sanitation facilities. To support this program, the government will launch a sanitation awareness program this month in 86 model villages. “The government will continue to encourage investments in the sanitation sector,” he said. According to Nashiruddin, there are three important agendas in the program, namely cleaning water channels, creating healthy homes, and providing potable water.

ARIS ANDRIANTO

Bill Gates promises $10 billion for vaccines

Reuters, DAVOS, Switzerland, Fri Jan 29, 2010 1:55pm EST

DAVOS, Switzerland (Reuters) - Bill and Melinda Gates said on Friday they would spend $10 billion over the next decade to develop and deliver vaccines, an increased commitment that reflects progress in the pipeline of products for immunizing children in the developing world.

Over the past 10 years, the Microsoft co-founder's charity has committed $4.5 billion to vaccines and has been instrumental in establishing the GAVI alliance, a public-private partnership that channels money for vaccines in poor countries.

By increasing immunization coverage in developing countries to 90 percent, it should be possible to prevent the deaths of 7.6 million children under five between 2010 and 2019, Gates told reporters at the World Economic Forum.

Margaret Chan, director-general of the World Health Organization described Gates' commitment to vaccines as "unprecedented" and called on governments around the world and the private sector to match it with "unprecedented action."

Vaccination rates have already climbed remarkably in recent years, with even a poor African country like Malawi now boasting coverage rates similar to those in many Western cities.

"Over the last 10 years, the success of both increased vaccine coverage and getting new vaccines out has been phenomenal," Gates said.

More cash is now needed to make the most of new vaccines becoming available, including ones against severe diarrhea and pneumococcal disease from GlaxoSmithKline, Merck and Pfizer.

"We can take immunization to the next level, with the expanded uptake of new vaccines against major killers such as pneumonia and rotavirus diarrhea," Chan said in a statement.

She said an extra two million deaths in children under five could be prevented by 2015 by widespread use of new vaccines and a 10 percent increase in global immunization coverage.

Further off, Glaxo is also in the final phase of testing a vaccine against malaria that Gates said could slash deaths from the mosquito-borne disease.

Gates warned against the risk of governments diverting foreign aid funding for health toward climate change, arguing that health should stay a top priority -- not least because better health leads to a lower birth rate.

Curbing the globe's population growth is critical for tackling global warming.

(Reporting by Ben Hirschler, additional reporting by Kate Kelland, editing by Jon Boyle)

Rainy Season Brings Threat Of Diseases

Antara News, Thursday, January 21, 2010 11:02 WIB, Fardah

Jakarta ( ANTARA News) - As Indonesia has entered the rainy season, a number of diseases, such as chikungunya, dengue fever, diarrhea, bird flu and lymphatic filariasis, are threathening people in some areas.

Diseases like chikungunya, dengue fever, and lymphatic filariasis are spread through certain mosquito bites, while bird flu and diarrhea are usually rampant in a cold rainy season.

Rainy season has come in Indonesia since around November 2009. Over the past few months, Chikungunya cases have been reported especially in the provinces of South Sumatra, Bengkulu (Sumatra Island), South Kalimantan, Bangka Belitung, Lampung, Riau, Jambi, East Java, Central Java, and West Java,

Chikungunya (pronounced as chik`-en-GUN-yah) fever is a viral disease spread by mosquitoes - Aedes aegypti mosquito, which is also called yellow fever mosquito. The symptoms include severe and persistent joint pain and fever similar to dengue fever. It is usually not life threatening. But the joint pains can last for a long time and hence full recovery may take months.

Chikungunya disease was first detected in 1952 in Africa at a place called Makonde Plateau located in a border area between Tanzania and Mozambique. The name "chikungunya" is from the Makonde language and its meaning is "that which bends up" as Chikungunya patients walk in a stooped posture due to joint pain. Chikungunya is also known as Chicken guinea, Chicken gunaya and Chickengunya.

The Aedes mosquitoes that transmit chikungunya breed in a wide variety of man-made containers which are common around human dwellings.

In December 2009, over 500 residents of Kayuagung and Tulung Selapan sub districts, Ogan Komering Ilir (OKI) District, South Sumatra Province, were infected with chikungunya virus.

About 50 percent of 1,100 residents or 240 families at Guci village, Ujan Mas sub district, South Sumatra, were believed to be infected with chikungunya. In Tulung Selapan, there were about 500 patients and in Kayuagung around 30.

In last November 2009, chikungunya disease has affected around 500 residents in five sub districts in Rejang Lebong District, Bengkulu Province, Sumatra Island.

The local health service immediately conducted mosquito control fogging activity and distributed abate (potent micro-granule insecticide) to kill mosquito larvae, in the five affected sub districts, he said.

In South Kalimantan, chikungunya has infected a number of residents in 11 districts and cities since late 2009. Some 3,098 people in the 11 districts and cities of South Kalimantan were infected.

In Banjar district alone, some 1,622 residents of 33 villages in four sub districts suffered from chikungunya in early 2010. The local health authorities have declared the chikungunya cases an extraordinary happening.

Almost all districts in South Kalimantan Province, except Banjarmasin and Barito Kuala, were affected by Chikungunya, Rosihan Adhani, head of the South Kalimantan provincial health service, said early January 2010. The disease was predicted to continue affecting the districts until Frebruary 2010, he added.

Another mosquito-borne disease affecting some regions is lymphatic filariasis, known as Elephantiasis. Lymphatic filariasis is infection with the filarial worms, Wuchereria bancrofti, Brugia malayi or B. timori.

These parasites are transmitted to humans through the bite of an infected mosquito and develop into adult worms in the lymphatic vessels, causing severe damage and swelling (lymphoedema).

The infection can be treated with drugs. However, chronic conditions may not be curable by anti-filarial drugs and require other measures, for example surgery for hydrocele, care of the skin and exercise to increase lymphatic drainage in lymphoedema.

Lymphatic Filariasis puts at risk more than a billion people in more than 80 countries. Over 120 million have already been affected by it, over 40 million of them are seriously incapacitated and disfigured by the disease.

In Indonesia, lymphatic filariasis disease has been reportedly endemic in 368 of the country`s 471 districts/cities. The government has launched massive medication in order to completely eradicate the disease by 2018.

In Southeast Sulawesi, for instance, filariasis or elephantiasis cases have been reported occurring in six districts, namely Konawe, Buton, Konawe Utara, Konawe Selatan, Muna, and Baubau City, Abdul Razak, the head of the Southeast Sulawesi provincial health office`s disease control unit, said last December 2009.

Dengue is a mosquito-borne infection which in recent decades has become a major international public health concern. Dengue is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.

The Health Ministry has reported that in the current rainy season, the dengue fever cases have increased in the provinces of Riau, Jakarta, West Java, West Kalimantan, Central Kalimantan, South Kalimantan, West Sulawesi, and North Maluku. Dengue cases have also been reported in Bangka Belitung, East Kalimantan, Gorontalo, and Palu.

Seven residents of Bangka Belitung (Babel) died of dengue fever late last year. Fogging had been conducted in 20 houses to prevent the further spread of the disease, Helmi Soefie, head of the Babel health service`s disease control section, said last December 2009.

In Bangkalan, East Java, the number of patients suffering from dengue fever in the current rainy season at Syarifah Ambami Rato Ebu (RSA) hospital was also on the rise, the hospital`s director said last January 11, 2010.

"Since the beginning of this year the number of dengue fever patients treated at this hospital has increased to 22 persons," RSA hospital director Teguh Basukohadi said here on Monday.

Up to November 2009, Indonesia recorded 137,600 dengue cases with 1,170 deaths, while in 2008 there were 126,600 cases with 1,084 fatalities.

"We should be on alert of dengue fever as the country has entered the rainy season,"

Health Minister Endang Rahayu Sedyaningsih said when visiting Matahari community health post (posyandu) in Cilincing, North Jakarta, last January 8, 2010.

As for bird flu or Avian Influenza (AI - H5N1) virus, Indonesia reported fewer deaths from bird flu in 2009, but health specialists warn that the risk to humans remains high.

Over the past two months, pultry deaths due to bird flu virus have been reported among other things in South Sumatra, Lampung (Southern Sumatra), Bangka Belitung,

Central Kalimantan, Riau, South Kalimantan, East Kalimantan, and Central Java.

Late December 2009, South Sumatra`s Metro city animal husbandry culled at least 39 chickens infected with the bird flu virus. Some 320 chickens were dead at South Metro sub district and 323 others in West Metro.

Last January 19, Pamekasan regency (Est Java Province) veterinary office culled 270 bird flu-infected chickens to prevent the spread of this dangerous virus.

Meanwhile, diarrhea killed four persons in Caringin sub district, Sukabumi District, West Java, since September 2009. The health service has recorded a total of 72 diarrhea cases at eight villages, at Caringin sub district so far.

Disease outbreak concerns after Indonesian quake

Reuters, by Sunanda Creagh, Mon Oct 12, 2009 7:10am EDT

JAKARTA, Oct 12 (Reuters) - Health workers in Indonesia's quake-hit Sumatra are battling to contain local outbreaks of diarrhoea and dengue fever, and require more specialist equipment, officials and a doctor said on Monday.

The 7.6 magnitude quake, which struck on Sept. 30, killed at least 807 people and badly damaged health care facilities in the city of Padang and surrounding areas.

Around 10 percent of the region is still without a local health clinic, said Gde Yogadhita, the World Health Organisation's emergency field operations programme manager.

"There has been no widespread outbreak of disease yet, but we are seeing more cases of diarrhoea and dengue fever," he said, adding people were also suffering from tetanus and respiratory infections.

Matt Eckersley, an Australian doctor in Padang, said more specialists, such as burns experts, were needed to treat the victims.

"We have only two nurses per 50 people, and they are the same nurses who have been here since the beginning. They are exhausted," added, Ade Edward, head of West Sumatra's earthquake coordinating desk.

"We have enough medicine for this week but it will run out soon. We need four weeks supply in advance but now we only have enough for one week in advance."

The WHO's Gde Yogadhita said there was also a shortage of specialist equipment.

"We are trying to arrange new medical equipment, including machines that were already not working properly because of previous quakes." Padang, which lies in an extremely active seismic area, also suffered a serious quake in 2007.

The United Nations has launched a $38 million appeal to pay for shelter, restoration of water facilities, the fight against disease and other urgent humanitarian needs.

Many roads in rural areas such as Agam and Padang Pariaman are still cut off by landslides, and helicopters are making up to five food and aid drops a day to isolated survivors, Ade Edward said.

(Editing by Ed Davies and Jeremy Laurence)

Papua New Guinea hit by cholera

BBC News, by Phil Mercer, Sydney

An outbreak of cholera has reportedly killed more than 40 people in a remote area of Papua New Guinea.

Government officials said that hundreds of other villagers in Morobe Province have fallen ill.

A World Health Organisation medical team has confirmed the outbreak and PNG's health minister has ordered measures to contain its spread.

Cholera is usually spread through contaminated food or water and can be fatal if not treated.

This is the first time the disease has officially been confirmed in the country.

Mystery illness

Health Minister Sasa Zibe warned that more cases of the acute intestinal infection would put added pressure on the country's "fragile health system."

The deaths are reported to have occurred in the remote Finsch-hafen district of Morobe province on the northern coast of Papua New Guinea.

Officials said that up to 800 people have been taken ill.

Villagers with cholera's diarrhoea-like symptoms or severe dehydration have been advised to seek immediate treatment.

The region's isolation and lack of development make that difficult but the government has dispatched medical teams to the affected area.

At the end of last week the World Health Organisation sent experts to Morobe province to investigate reports that a mysterious illness was sweeping through a number of settlements.

Tests have shown the disease to be cholera.

Jember flood victims suffer from diarrhea, rashes

The Jakarta Post, Jember | Mon, 02/02/2009 8:04 PM  

Dozens of flood victims in two villages in Jember regency are suffering from diarrhea and rashes following floods that have ravaged the area over the past three days. 

According to kompas.com, the diseases are affecting residents of Paseban and Kraton villages. 

Kraton village head Edi Winoto said Sunday that at least three people in the village had contracted diarrhea, while many others were experiencing rashes. 

“We have prepared rescue teams responsible to give medical aid and treatments for those suffering from the diseases,” he said, adding that the teams also had enough medical stock to anticipate possible high numbers of flood victims. 

As of Sunday morning, he added, floodwaters had begun to recede, thus allowing some residents to return and clean up their homes. 

“But we are still on alert, because floods could return immediately if heavy rains pour down our villages,” he said. (ewd)

Flood inundates Gorontalo, residents evacuated

The Jakarta Post, Gorontalo | Mon, 12/29/2008 9:39 AM  

Limboto lake has overflowed and submerged several villages in Gorontalo regency of North Sulawesi, forcing residents to find evacute themselves, kompas.com reported on Monday. 

The water of between 50 centimeter and 1.5 meter has inundated residents' homes in Dembe and Lekobalo villages of the regency, while heavy rain has poured down the locations since Saturday. 

Meri, a resident from Lekobalo, said on Monday that she and her family had to move to neighbors home located in higher place. 

“We have expected that the water level will get high and take a long time to decline,” she said. 

Meanwhile, residents in Tabumela and Tualango have suffered from some illnesses during the flood inundating their homes in the past two months. Some of them said that they were experiencing diarrhea and itching and did not go for sails to catch fishes. 

“Due to our diseases, we find it difficult to earn money. We hope the local administration will provide aids to help us,” said resident Abdul. (ewd)

Sanitation becomes a must-learned topic

Tertiani ZB Simanjuntak, The Jakarta Post, Jakarta | Mon, 12/22/2008 11:05 AM  

Education officials in Batu municipality had had enough. The uncontrolled development of its water catchment area had reduced the Brantas River, the city's main water source, to a stream; weather in the resort town was growing warmer every day and sanitation-related diseases were on the rise. 

To encourage the involvement of local people, from a young age, in combating these sorts of problems, the city's education agency launched a sanitation and environmental curriculum in 2003. 

"At first the program was laughed at by others because it focused on what people often overlook, such as how to bathe, wash the hands...But later people took it seriously because the new curriculum made children aware of the environment and their personal hygiene," education agency head Mistin said. 

Visiting Jakarta for a discussion held by the Environmental Services Program (ESP), funded by the United States Agency for International Development, Mistin discussed the difficulties her office faced in implementing the curriculum with some school teachers in the capital. 

She said that schools usually choose teachers who worked the least, such as physical education teachers, to teach the environmental studies classes. The teachers were changed regularly because of scheduling issues and no standard teaching material was used. 

"As a local curriculum, meaning there is no national examination, the schools didn't pay due attention to it and some of them even integrated it as part of other subjects such as science," Mistin said. 

In 2005, the ESP introduced its Clean, Green and Hygiene program to Batu, in a bid to save the forest by encouraging locals to separate their organic and non-organic waste. 

After adopting ESP's fun teaching method, school students now learn about river ecosystems, forest conservation, waste management and hygiene. 

"There are special teachers handling the class and they have routine meetings to discuss the studies. Now we have standard teaching methods and modules," Mistin said. 

ESP Health Communication coordinator Nona Utomo said the program had significantly reduced the number of diarrhea cases among children, the main target of the organization's work in Batu. 

"In three years, the number has plunged from nine to 10 cases per month on average to one or two," she said. 

Working together with ESP since 2006, Muslim organization Muhammadiyah had also adopted the Clean, Green and Hygiene program in swampy Paciran, Lamongan regency in East Java. 

"At first, many people resisted the involvement of a foreign country ... We used religious approach to make them accept the importance of clean and hygienic living," said Syafiq Mughni, chairman of Muhammadiyah in East Java. 

Muhammadiyah has 925 schools as well as 815 kindergartens in the province. Currently, 119 elementary schools and 330 Islamic boarding schools have applied the Clean, Green and Hygiene curriculum. 

"By May 2009 four model schools (based on the sanitation and environmental curriculum) will be launched in Paciran, Pare, Malang and Surabaya," Syafiq said. 

Noted environmentalist Emil Salim said that the Batu municipality and Muhammadiyah in East Java had succeeded in using a holistic approach to build the school curriculum. 

"We have to encourage the next generation to develop understanding on living in harmony with nature," he said. 

Winda, a teacher at Islamic private school Al-Kenaniyah in Pulomas, East Jakarta, said that the school was considering adopting the special curriculum. 

"We need this kind of local curriculum so children will understand why there is always flood and water-borne diseases in Jakarta. But we haven't got any response from the Jakarta administration about this matter," she said.

Five people die of malnutrion in NTT

Yemris Fointuna , The Jakarta Post , Kupang | Sat, 03/08/2008 1:27 AM

At least five people, including three aged under five, died recently from malnutrition in Rote Ndao, East Nusa Tenggara (NTT), following government "financial difficulties".

Head of the Rote Ndao health office Jonathan Lenggu said the victims suffered from complications such as diarrhea, tuberculosis and high fever that led to their deaths.

"Malnourished people are quite prone to diseases such as diarrhea, TB and dengue because they have low immunity," he said Thursday.

Lenggu said three of the victims died this week and two last week, but gave no other details.

Head of health issues at the provincial government, Maxi Taopan, said the five dead had been suffering from malnutrition for a long time, but the local government had not been able to respond immediately because of a "financial problem".

"After the central government ended financial assistance in 2007, malnutrition has become uncontrollable. Still, the province has proposed an allocation of Rp 56 billion to address the issue," he said.

He called on the coordinating minister for people's welfare to visit the regency to assess poverty and malnutrition.

"If the government accepts our request, we will use the funds to supply food to poor families and revitalize women's and children's health posts in rural areas across the province," he said.

Up to 90,000 of the 497,577 children aged under five in the province are suffering from malnutrition, and 12,400 have had complications, according to the provincial government's 2008 data.

Taopan said the highest number of malnutrition sufferers with clinical disorders was found in North Timor Tengah, with 81 patients being treated in clinics and hospitals, followed by 27 in West Sumba and 13 in Rote Ndao.

"The highest frequency is in South Timor Tengah with 12,971 sufferers, followed by more than 8,400 in Sikka, 8,300 in Manggarai, 7,200 in North Timor Tengah and 6,800 in Kupang," he said.

Riau haze blamed for rise in health woes

Rizal Harahap, The Jakarta Post, Pekanbaru

The Riau Health Office announced Monday 1,547 people were suffering from a number of afflictions from the haze caused by forest fires in the province over the past two weeks.

Residents in a number of regencies have developed respiratory infections, skin irritations, conjunctivitis and diarrhea.

"The diseases are always imminent during the recurrent haze and dry seasons," said Burhanuddin Agung, head of nutrition and medical care at the health office.

Data gathered over the weekend from Rokan Hulu, Rokan Hilir, Indragiri Hulu and Bengkalis regencies, indicated 1,095 people have already contracted respiratory infections.

The most affected area is Rokan Hulu, where there are 702 cases. As many as 150 people have reported skin irritations in the regencies, 29 of them suffering from eye irritation and 19 from conjunctivitis.

"The number affected could be higher because seven other regencies have not sent in their reports, including Dumai, which is likely to be the worst hit area," said Burhanuddin.

Surging numbers of people seeking treatment in Pekanbaru's hospitals and community health centers show that respiratory disease has doubled in the area.

At the Arifin Achmad General Hospital, for instance, the number of respiratory disease patients seeking treatment reached 25 each day compared to around 10 before the fires.

"The conditions are like this every haze season. Patients not only come from Pekanbaru but also from outside the city. Their conditions are generally not too chronic and they can still be treated as outpatients. Only six patients are currently receiving in-patient treatment," said hospital spokesman Nuzeli.

Besides those being treated for respiratory diseases and irritation, the number of diarrhea patients is also on the rise. In the past week, the number of patients in the four regencies has reached 254.

"Based on our experience, the number of diarrhea patients usually goes up during each haze season. There is no correlation between diarrhea and forest fires. It's actually the rainfall because rural residents still depend on rain for their source of drinking water. During minimum rain, they are forced to seek other means of water, even if it is unsafe. This is believed to have triggered the rise in the number of diarrhea patients," said Burhanuddin.

The Riau Health Office has set up health posts in 11 regencies and cities across the province in a bid to monitor and overcome the impacts of forest fires.

It has distributed 30,000 masks in Siak, Bengkalis, Dumai and Rokan Hilir; areas it predicts will face the worst impacts of the haze.

The health office has also distributed 2,000 free masks in Pekanbaru. The provincial administration has also requested the central government provide an additional 100,000 masks to replenish its stock.

"Other logistics, such as medicine, are still adequate," said Burhanuddin.

217 killed by dengue in C. Java: Official

Suherdjoko, The Jakarta Post, Semarang

A series of dengue outbreaks in Central Java have led to the deaths of 217 people this year, while diarrhea has claimed the lives of 17, an official said Wednesday.

In the period between January and mid-December, at least 11,636 people in 35 regencies of Central Java were infected with dengue, said head of the Central Java Health Office, Hartanto.

"I warn the public to be always on alert. The dengue outbreak can appear any time, especially during rainy season," Hartanto said.

In 2006 the number of people infected with the disease reached 10,826, resulting in 220 deaths, he said.

Hartanto said up to 339,502 people had taken ill with diarrhea in the period between January and September. The outbreak, which killed 16 people, was mostly caused by E. coli bacteria, he said.

"So far this year we've distributed 50,503 packs of 'oralit' medicine to treat diarrhea patients."

In anticipation of the spread of both dengue fever and diarrhea during the rainy season, Hartanto said he had ordered all health offices in the cities and regencies throughout the province to be prepared.

"They must report to the nearest health offices as soon as they detect any outbreak of (dengue or E. coli). Coordinating like this, we hope to be able to contain the spread of the diseases, especially in areas where sanitation is poor," he said.

Poor sanitation worsens urban, health problems

The Jakarta Post, Jakarta

As a city riddled with sanitation-related diseases such as diarrhea and dengue fever, the Jakarta administration needs to start working with the public, private companies and non-governmental organizations to build a better sanitation system, an expert has said.

According to Basah Hernowo, head of community housing at the National Development Planning Board (Bappenas), Jakarta has the money and can afford the technology to provide proper sanitation to its residents by 2015 as targeted in the UN's Millennium Development Goals.

"What lacking is the will," he said.

"What they should do is fund NGOs so they can help educate the public about sanitation and then work with the private sector to build proper sanitation systems, like a sewerage system."

With virtually no sewerage system or waste treatment plants, most of Jakarta's liquid waste is left to flow downriver to the sea or is kept in septic tanks.

There are more than a million septic tanks in Jakarta, which has a population of almost 10 million people.

"And if they still say that they can't (put a sanitation system in place), then what reasons left are there?" he asked during the recent National Sanitation Conference.

The conference brought together more than a hundred experts and officials from all over Indonesia and the world to discuss possible solutions to the country's sanitation problems in anticipation of 2008, which has been declared the Year of Sanitation by the United Nations.

One of the UN's related resolutions is to reach 73 percent public access to sanitation by 2015.

Basah said the people who showed up to the conference were concerned about the environment and those who didn't were indifferent to the problem.

"What the city needs to realize is that sanitation is one of the main causes of poverty. Sick people, especially those with a daily income, can not make money to get themselves out of their situation. It's no wonder there are so many poor people in Jakarta," he added.

According to the 2004 National Social Economic Survey, 12 percent of the population in Indonesia's bigger cities does not have access to toilets. A third of those who have access use facilities that are not connected to septic tanks or equipped with water faucets, located instead on rivers.

Around 70 percent of the water in Indonesia's cities is contaminated with domestic waste, with 78 percent of Jakarta's river deemed polluted as of 2006, according to data provided by the administration.

The water is contaminated with E. coli bacteria and other harmful organisms that can cause diarrhea, dengue fever and typhoid.

Diarrhea kills more than 100,000 children every year in Indonesia. As of July, more than 11,000 diarrhea cases have been recorded, attributed to the prevailing unhealthy lifestyle and poor sanitation. In some areas, the disease is so common that it is classified as an "extraordinary occurrence".

Dengue fever is also an ongoing problem in Jakarta with more 29,000 cases and 81 deaths reported this year. April has been the worst month so far, with 5,133 cases reported.(anw)