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Waterborne Disease Threat Overwhelming Medical Workers in Pakistan

August 26, 2010 at 12:00 AM EDT
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Medical personnel in Pakistan are working to control the spread of flood-related waterborne disease, but they face a monumental task as the humanitarian crisis worsens. Special correspondent Jeffrey Kaye reports.
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JIM LEHRER: In Northern Pakistan, disease is overwhelming the local health care systems. We have a report from there by special correspondent Jeffrey Kaye.

JEFFREY KAYE: More than a month of heavy monsoon rains are continuing to trigger epic floods throughout a major swathe of Pakistan. But even in areas where floodwaters are receding, medical personnel are coping with rising numbers of waterborne diseases. And the most-feared diseases are appearing here in Khyber Pakhtunkhwa, the northern province where the vast majority of flood-related deaths occurred.

In Nowshera District, the devastation in both rural and urban areas has been widespread. The water supply has been compromised, and even people who managed to escape the flood’s initial ravages are now showing up in hospitals as the toll of its victims lingers.

DR. ASAD ULLAH, Medical Emergency Relief International: We have seen malaria. We have seen typhoid. We have seen skin allergies. We have seen scabies, infected scabies.

JEFFREY KAYE: Doctor Asad Ullah works for the British aid group MERLIN, Medical Emergency Relief International, specializing in a particularly pernicious infectious disease, AWD, acute watery diarrhea. A surge of cases has appeared in the last few days.

Six-year-old Faiza (ph) fell ill the day before her mother brought her to the hospital. Her family gets their water from a well. Her mother, Shahgul (ph), describes her symptoms.

WOMAN (through translator): She was conscious, but she was having this continuous vomiting and diarrhea.

JEFFREY KAYE: Dr. Ullah says she was in acute shock. He couldn’t find a pulse or record a blood pressure when she came in.

WOMAN (through translator): Last night, I thought she was going to die.

JEFFREY KAYE: Faiza was started on I.V. rehydration therapy and immediately improved. She’s being sent home, so another patient can take her bed. According to Dr. Ullah, contaminated drinking water in Pakistan made diarrhea the number-one killer of children under 5, even before the flooding. Acute watery diarrhea, its most virulent form, is easily transmitted and spread. It can be fatal if not caught early. But it can be easily treated.

It strikes mostly the very young and the very old. In response to the outbreak here, Dr. Ullah and MERLIN opened these two special treatment wards, one for males, ones for females. More than 200 patients have been treated in the two days since it opened and have been sent home. Dr. Ullah says that’s a lot of cases for just a small area. The wards are designed to be quickly expanded into neighboring buildings at a local government hospital that was itself devastated by the deluge. The hospital had been completely evacuated and was closed for a week. You can see the line where three feet of mud inundated the building.

DR. ASAD ULLAH: So, when we came here, it was a big mess. It was mud everywhere. It was water everywhere. It was bad smell everywhere. And we cleaned this place within one night, I would say. We spent the whole night here. We cleaned this place. We sterilized this place. You can see the white powder everywhere.

It’s basically a chlorine compound which we use to disinfect our — every place. At the first — I think, within the first hour — like, we were not even unpacked yet — we received two and four patients of severe dehydration. And we were had even completely unpacked our drugs and our whole systems. But we have to treat them. And they were so malnourished and they were so dehydrated, that we were trying to get an idea of what we were expecting in the coming few days.

JEFFREY KAYE: Acute watery diarrhea is just one of a host of waterborne diseases breaking out in flood-ravaged areas across Pakistan. Thus far, about 400,000 people have contracted such diseases, according to the United Nations. On Wednesday, Dr. Rajiv Shah, the administrator of AID, the State Department’s Agency for International Development, visited the latest areas desolated by the floods in the south, near the city of Sukkur, where more than 3.5 million more people have been affected. Shah is the highest-ranking American government official to visit the country so far.

DR. RAJIV SHAH, administrator, United States Agency for International Development: Well, the number-one concern is the spread of waterborne illness. That’s always a risk in flood situations. It’s even more so a risk in this setting. It’s particularly important because it — the risk actually goes up even floodwaters recede. So, the United States Agency for International Development has worked with the government of Pakistan to create a disease early warning system.

And it’s that system that helped us pinpoint and identify some of the early cholera cases, and then dispatch medical teams to provide support and treatment to children who have diarrhea and to those communities to make sure we’re preventing the spread of disease. But that is the top medical priority right now.

JEFFREY KAYE: The flood has demolished roads, buildings and bridges. The water reached 10 feet at this ruined auto parts market. Families are living in tents along the road with no sanitation, no toilets, and no access to clean drinking water.

DR. ASAD ULLAH: The drinking water system and the sewage water system, they have been mixed and they have been just a cocktail of — sewage water and drinking water and floodwater is everywhere.

JEFFREY KAYE: Even those still living in their ruined homes are vulnerable. Abdul Nasir (ph), whose elderly uncle is near death from acute watery diarrhea, says the tap water in their home is muddy.

MAN: The main cause of his situation is the water. The water is not clean.

JEFFREY KAYE: Stress is also taking a mental toll among a destitute population. Nurse Tehmeena Falak does her best to console patients with physical ailments.

TEHMEENA FALAK, Nurse (through translator): Becau

se of the flood, people are suffering from anxiety and depression. People have lost their relatives, old ones, young ones.

JEFFREY KAYE: The fear of waterborne epidemics following in the wake of the floods has health officials and aid organizations organizing outreach campaigns to inform people about the danger of unclean water. Relief operations are shipping bottled water to camps and are distributing purification tablets.

But providing safe water to the general population is just one of the many and massive challenges for the Pakistani government coping with the worst disaster in its history.