Nepal - Emerging Disease

[Snowy Owl]

'Mystery' disease kills 8 in Nepal
http://news.webindia123.com/news/Articles/Health/20061015/480106.html

Kathmandu | October 15, 2006 11:15:06 AM IST
An outbreak of an unidentified "mystery" disease in a remote village claimed eight lives including four children in far west Nepal in the past two weeks, a newspaper reported Sunday.

The English language daily Kathmandu Post said that the outbreak of the disease in Belapur village in Dadeldhura district, about 525-km west of the capital, created "lots of problems" for the villagers there and in adjoining villages, as over 400 people were reported sick with the disease.

Kathmandu Post reported that there were no health workers to staff the village health post in Belapur village, and even the district hospital at the district headquarters in Dadeldhura was without a doctor.

According to the newspaper, those who died showed "strange symptoms" that included headaches and respiratory problems.

Quoting local people, the newspaper reported that the victims died "wherever they caught the deadly disease".

"Some died while working in the farms, while others fell dead while grazing cattle," the newspaper reported.

The newspaper quoted Shuvesh Raj Kayastha, chief of the Mahakali Zonal hospital in Mahendranagar, about 80-km south of Dadeldhura, as saying that the disease could be a viral infection.


He feared that the disease could be similar to severe respiratory syndrome (SARS).
--DPA

[Siam]

Re: 'Mystery' disease kills 8 in Nepal

This sounds like the stories in John Barry's book the Great Influenza of 1918, wherein the workers died at work.

Snowly Owl said

"Some died while working in the farms, while others fell dead while grazing cattle," the newspaper reported.

[Nancy]

Nepal June 2, 2006

Article from June 2, 2006

11 die of unknown disease in Achham
KOL Report

KATHMANDU, June 2 - At least 11 people have died of an unknown disease in the remote VDC of Accham district within the last three weeks. [Accham is in the far western area of Nepal]

Our Achham correspondent reports 11 people of Basti VDC died of an unknown disease while over dozen have been infected by the disease in the VDC.

According to a local man who arrived in the district headquarters, 4 people each died in ward 5 and 3, while 2 died in ward 8 and one in ward 4 of the VDC.

Of the dead, 3 are women and 8 men. There is possibility of rapid epidemic effect of the disease due to dearth of medicines and health workers, reported our correspondent. (hbt)

Posted on: 2004-06-03 12:53:10 (Server Time)

http://www.kantipuronline.com/kolnews.php?&nid=12539

[Nancy]

Nepal Aug 18, 2006

Unidentified disease kills 14
PR

NUWAKOT, Aug 18 - Unprecedented epidemic of an unidentified disease has killed at least 14 people, including seven children, in Netini VDC, a far eastern village of the district, in the past two weeks.

The disease, which was first detected in dogs and chicken in the last week of June, had started spreading to humans.

Major symptoms of the disease are high fever together with bleeding from nose and mouth at the time of death.

Posted on: 2006-08-18 20:44:59 (Server Time)

http://www.kantipuronline.com/kolnews.php?&nid=83207

[Nancy]

Nepal Oct 14, 2006

This version of the article that Snowy posted early this morning includes a couple of additional details, including the name of one victim.

8 die of ?mystery disease?, 400 sick
BY D R PANTA

DADELDHURA, Oct 14 -

An outbreak of a "mysterious disease" in a remote village in the far-western district of Dadeldhura claimed eight lives, including four minors, in the past two weeks. Some 400 others in adjoining villages are reportedly affected.

To add to the woes of the locals, the health post at Belapur village is without health workers since the last two years while the District Hospital too is without a doctor since some time back.

According to locals, those who died showed strange symptoms of headache and breathing difficulty. They died shortly after.

Among the dead, only Beludevi Khadayat, 60, of Belapur VDC was identified.

Over 400 persons in the village and other areas of Singas Siddapur and Dhungad - villages adjoining Baitadi district - have been affected by the strange disease.

The locals say that those afflicted had died wherever they were at the time they caught the "deadly disease". Some died working in the farms while others fell dead while grazing cattle in the forest.

The number of those affected and dead could be even higher, according to locals.

Dr Shuvesh Raj Kayastha, chief at Mahakali Zonal Hospital at Kanchanpur, Mahendranagar, said that the disease could be caused by viral infection.

He further feared that it could be an illness similar to SARS (severe acute respiratory syndrome).

Absence of doctors and health workers in the district has made it difficult to diagnose the disease and consequently to provide treatment to the affected.

Posted on: 2006-10-14 21:04:22 (Server Time)

http://www.ekantipur.com/ (see headlines for Oct 15, 06)

[Jeremy]

Re: Nepal June 2, 2006

If you really want to see if this disease makes it way out of Nepal keep your eyes on Uttar Pradesh over the next 2 months.

There is basically a disease highway that runs from China to Uttar Pradesh and Nepal is stuck in the middle.

[Nancy]

Re: Nepal June 2, 2006 and following posts

I'm probably not doing this correctly (I always have trouble figuring out which forum or thread is best to add to), but I am trying to collect in one place a series of articles about outbreaks of what may be H5N1 in Nepal.

Like Siam, I too noticed the similarity in the current news article to stories from 1918. Also note the outbreak in dogs and chickens, followed by people in the August 18th article.

There is also a lot of current news about new dengue outbreaks in Nepal.

[sharon sanders]

Re: Nepal June 2, 2006

You are in the right place. Thanks.

[christian]

Re: 'Mystery' disease kills 8 in Nepal

More details

?Mystery disease? claims eight lives in Dadeldhura
Nepal News - Oct 14 06

At least eight people have died of an unknown disease in a single VDC in the far-western district of Dadeldhura.

Several dozen people in Belapur VDC have been infected with the disease over the last two weeks, reports said. The disease has symptoms like severe headache, fever and cough. Eight deaths have so far been confirmed in the VDC.

More than 500 others have been infected with the ?mystery disease? in Siddhapur, Sikash and Dhungadh VDCs of the same district. Proper health services are not available in these areas, reports added.

No medical team has yet reached the affected areas from the District Health Office.

[christian]

Re: 'Mystery' disease kills 8 in Nepal

Yet more details

?Unidentified disease claims eight lives
Kantipur Online - Oct 14 06

DADELDHURA, Oct 14 - At least eight people have died of an unidentified disease over the past two weeks in a village in Dadeldhura district.
Among the dead include four minors.

The disease, which has not yet been diagnosed, has affected the people of Belapur VDC in the district.

The victims of the disease have complained of headache among other complications.

Lack of doctors and health workers in district's only hospital has rendered more difficulty in the diagnosis of the disease.

[Thornton]

Re: 'Mystery' disease kills 8 in Nepal

ProMed is also tracking..cites same news report sent by Christian above, adds commentary.

http://www.promedmail.org/pls/promed/f?p=2400:1001:4732406729466079506::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,34823

Date: 14 Oct 2006
From: ProMED-mail
Source: Nepal News [edited]

--
ProMED-mail

[From the description of the illness, a febrile respiratory illness,
influenza is high on the list of probable diagnoses, both in Nepal as
anywhere else in the world. But that being said, clearly more information
on the outbreak is necessary before coming to any conclusions.

Borrowing from a moderator note in a prior posting on an undiagnosed
outbreak in Nepal: "As one can see from the see also list below,
ProMED-mail reports of undiagnosed illnesses and deaths in Nepal have not
been rare. Unfortunately, what has been rare is for ProMED-mail to receive
information from knowledgeable sources in Nepal on results of epidemiologic
and laboratory investigations into these reported outbreaks and clusters."
As always, we are hoping that knowledgeable sources (either Nepal-based or
organizations that have knowledgeable sources in Nepal) might shed some
light on the above mentioned fatal febrile respiratory disease.

For those interested in the geography of the area, a map showing Dadeldhura
in the western part of Nepal not far from the border with India can be
found at
. -
Mod.MPP]

[christian]

Re: 'Mystery' disease kills 8 in Nepal

ProMed is also tracking..cites same news report sent by Christian above, adds commentary.

Thanks, don't like the looks of this ... yet more details

8 die of ?mystery disease?, 400 sick
Kantipur Online - Oct 14 06

DADELDHURA, Oct 14 - An outbreak of a "mysterious disease" in a remote village in the far-western district of Dadeldhura claimed eight lives, including four minors, in the past two weeks. Some 400 others in adjoining villages are reportedly affected.

To add to the woes of the locals, the health post at Belapur village is without health workers since the last two years while the District Hospital too is without a doctor since some time back.

According to locals, those who died showed strange symptoms of headache and breathing difficulty. They died shortly after.

Among the dead, only Beludevi Khadayat, 60, of Belapur VDC was identified.

Over 400 persons in the village and other areas of Singas Siddapur and Dhungad - villages adjoining Baitadi district - have been affected by the strange disease.

The locals say that those afflicted had died wherever they were at the time they caught the "deadly disease". Some died working in the farms while others fell dead while grazing cattle in the forest.

The number of those affected and dead could be even higher, according to locals.

Dr Shuvesh Raj Kayastha, chief at Mahakali Zonal Hospital at Kanchanpur, Mahendranagar, said that the disease could be caused by viral infection.

He further feared that it could be an illness similar to SARS (severe acute respiratory syndrome).

Absence of doctors and health workers in the district has made it difficult to diagnose the disease and consequently to provide treatment to the affected.

[Nancy]

Nepal 2003 editorial

Anil Bhattarai is/was Director of the Nepal South Asia Centre, Kathmandu. He is an academic, not a medical doctor. His editorial provides some earlier context for Nepal.

OPINION
Mysterious afflictions
Why have some unidentified ailments begun to take a toll in rural Nepal?
by Anil Bhattarai

It is the season of distress yet again. News reports filter in partial images from different locales: heat strokes in and mass exodus from Andhra Pradesh, malaria and encephalitis deaths in Assam, and ?monsoon-induced? diarrhoea, influenza epidemics and measles outbreaks in many of Nepal?s districts.

The list of ?medical? afflictions for this calendar year was long already, and now with the arrival of the monsoon it seems to be unending. Cough, cold, headache, high fever, jaundice, dysentery, diarrhoea, vomiting, flu, heat, dehydration, measles, typhoid, and acute respiratory infection are here, and presumably there is more to come. The Kathmandu Post on 5 March 2003, reported that jaundice, detected in a few persons sometime earlier, had broken out on an epidemic scale in Manthali, headquarters of Ramechaap district of Nepal.

News coming in [this is in 2003] from the so-called ?remote? districts has been grim. There have been several reports of children, women and the elderly falling prey to some ?mystery? disease or the other. Such is the regularity with which this kind of news has appeared that the death of large numbers of people is no longer scandalous. We have been seeing them year after year in the same form and magnitude, with occasional variations in detail and presentation, sometimes on the front page or, more often, tucked away in the corner of the ?region? page. The irony is that this spate of reports only partially represents what is really happening in Nepal, and that is voluminous enough to inure the reader to the repetitive daily rituals of death, often attributed to various unspecified diseases.

In the first week of February 2003, for example, six people, four of them children from the Chepang community, died of measles in Makwanpur district?s interior villages, south of Kathmandu valley. Several hundreds, mainly children, were taken ill but eventually recovered. In the same village, reports say, almost all of the children have severely low body weight. According to a report published by a Kathmandu-based NGO working among the Chepang community for several years, in some villages members of this community have among the lowest life expectancies in Nepal ? less than 30 years, which is half the national average. Of course, the same reports also tell us, tangentially though, that the people so affected by disease and death have been living in a state of chronic hunger for years in this area. It is a different matter that journalists blame ?lack of health services and inadequate drug supply? for the deaths.

News of pretty much the same kind continued unabated in the months following the February reports. Between March and June 2003, 38 of Nepal?s 75 districts had continuous bouts of epidemics of different varieties and proportions. This much can be gleaned from a cursory survey of the reports published in two national dailies. There is no reason to assume that the rest of the districts have been spared such calamity. Anybody even remotely familiar with the terrain in Nepal can immediately see that if an epidemic has arrived, say, in Jumla, then the adjacent districts of Mugu, Kalikot, Dolpa, Jajarkot and Dailekh will also be affected. Therefore, if they have not figured in the news, the most that must have happened was that the reports from these other districts either did not reach the editor?s desk or these reports were found to be just too repetitive to be published regularly.

On 17 March, The Kathmandu Post published another news report. This time 21 people had died of yet another ?mystery disease?in Kalikot, a mountainous district in Nepal?s Far Western region (?far to the west? from Kathmandu). The disease had apparently been prevalent in the area for the previous two months. The numbers ran to several hundreds in villages spread over a wide and rugged terrain. What were the symptoms? ?In the beginning, people suffer from severe fever and feel dizzy?, an assistant health worker and chief of the district public health office, was quoted as saying. In January, in Gela village of the same district, seven people had succumbed to this disease. In the months that followed, 14 more died of this ?mystery?ailment. By 18 March, the number of reported deaths had climbed to 26. What happened to those remaining hundreds who were taken ill? We do not know.

And then there is influenza. It is everywhere. From east to west and north to south, the flu has forced the closure of schools and affected what is often loosely called ?normal life?. In some places it obliged health personnel to scurry around, medical kits in hand, ?to bring the runaway disease under control?. District after district and village after village came down with high fever, cough, cold and running noses. Some unfortunates never recovered, as has happened many times in the past.

Those denied adequate nutrition have a habit of dying when a heat wave or influenza strikes. It killed people in Udayapur to the east, Dadeldhura in the west and Dolakha of the central region. Tens of thousands fell ill all over Nepal. Who did it kill? Prise open the can of worms and some clues are to be found there. In some of Dadeldhura?s far-flung villages, of those who died, many were dalits [oppressed people/untouchables/outcastes]. Though the Kalikot deaths were blamed on a ?mystery disease?, the symptoms sound identical to those of influenza.

There is no slack in the ?discovery? of new tuberculosis cases either. And this despite claims of a more than 95 percent success rate in the Department of Health?s much acclaimed Directly Observed Treatment Short Course (DOTS) programme. Malaria is also not to be forgotten. In fact, it is unlikely to let itself be forgotten. Malaria is back with a vengeance, even in the middle hills, from where it was once mistakenly thought to have been banished forever. And the fact that these are reports coming from villages distant from Kathmandu (and therefore deemed ?remote?) is an indication that the sick are also those excluded from the socio-economic mainstream.

Naturally culpable
If the news reports are taken at face value then nature is of course the invariable culprit. There is a tendency to blame every calamity that overtakes people on the seasonal vagaries of nature. The temperature is temperamental. The precipitation is too precipitate. Clouds burst, rivers flood and lands slide of their own accord. It is a world of chaos.

The ?monsoon?, ?change of weather?, ?floods?, ?rise in temperature?, ?drop in temperature? are among the many causes ritually invoked to explain away society?s own role in the diseases and the deaths. But epidemics talk. They speak quite bluntly about how society functions: who lives and who dies in which society, where and when.

They also tell us about the faith that reporters and their informants have in the miraculous power of medicines, health services and health personnel to set things right ? an unquestioned, self-evident truth propagated for several decades of development in Nepal. Why else would the affected residents and locally stationed paramedics both blame inadequate supply of drugs and medical personnel for the epidemic running out of control?

Why did the disease strike in the first place? The assistant health worker of Kalikot sees it as an ?ordinary common cold? resulting from seasonal change. One does not need to be an expert, however, to stop and ponder how this ordinary common cold could have killed so many people in Kalikot when it is just a few days of nuisance for people in the capital city. Something much more serious than some passing mystery of nature must have been involved here.

Journalists are occasionally perceptive. So, these news reports, by telling us about where people live, the water they drink, the food they eat (or did not get to eat), and their distance from emergency health services, also tell us why certain people ? like the dalits of Dadeldhura ? die of a ?common cold?, while so many others who contract it escape unscathed. Lack of medicines or medical personnel does not tell the entire story.

These deaths occur year after year because they are not amenable to prevention by health ministry intervention.

So we piece together the picture from other reports that tell us, to cite one instance, that Kalikot, among many other districts, has been perennially suffering from food scarcity, out-migration, lack of clean drinking water and lack of access to basic health services for most of its population. Kalikot district, according to the Nepal Human Development Report 1998, is also the third from the bottom in human development progress. This in a country that is 30th from the bottom in global human development. Little wonder that average life expectancy there in 1996 was just 42 years, that is to say, two-thirds of the national average.

Measles struck hundreds of small kids in remote villages of Bajhang district. Three died. But measles does not kill anybody and everybody so routinely and randomly. And then we learn, again from other unconnected reports, that just incidentally Bajhang also happens to be one of several western districts reeling under famine-like conditions for the last several months, and is among the two districts at the bottom of the human development index. It then comes as a surprise that only three children died. Those killed were dalits. ?Dalits are not aware of the danger of this disease?, says the reporter of a Kathmandu newspaper. Back in February, Mohan Mainali of the Centre for Investigative Journalism did a report on famine in Bajhang. From it we can deduce with reasonable certainty that it was not lack of awareness about the disease that killed people. It was just a lack of food.

Such news is not peculiar to Nepal. What are the ?starvation deaths? in Andhra Pradesh if not a variant of what is happening in these districts of Nepal? At least, there a spade is called a spade. The deaths are not attributed to killer diseases, but to starvation. Those denied adequate nutrition for extended periods of time have a habit of dying when a heat wave or influenza strikes. While the elderly and the children are left to eke out whatever living they can, the more able-bodied head out to the nearest metropolis in search of wages. It is the same old drama, with a script that is improvised now and then to suit the context in different parts of South Asia.

These deaths in Nepal are not peculiar to this season or to this year. They appear in the news every year, as events caused by each season, mechanically recorded as deaths due to natural factors. Occasionally there is a recognition that these are preventable deaths, but typically the solutions are way off the mark. On 7 August 2001, in a letter to the editor of The Kathmandu Post, one correspondent from Kathmandu implored the health ministry to wake up and deal with the potential death of people from ?preventable diseases?. ?Due to inadequate medical supply, and negligence of health workers, the death toll could rise? and ?our government is hardly doing anything to contain the epidemic?. It went on to say that ?the Ministry of Health cannot turn a blind eye to this health hazard?. What was missed in the letter was that the these deaths occur year after year because they are not amenable to prevention by health ministry intervention. At its fundamental core this is not a health ministry issue.

Asking different questions
Instead of looking to the health ministry to solve the problem, more purpose will be served by asking some uncomfortable questions about the economy, the polity and the development apparatus that thrives on poverty. What is it about the Kathmandu-centric resource- guzzling state that districts like Kalikot, Bhajhang or Bajura must be arrested in a perpetual peripheral existence? Why are people in many districts not getting enough to eat and why is nobody doing anything about it? The answer to these questions will provide the explanation for why ?killer diseases? and ?behavioural inadequacies? always come to the rescue when such deaths become a rural routine.

Come next monsoon, we will again see a repeat of this year?s morning news ? of people dying of the same mystery diseases, with the seasonal patterns replicated in all their fine detail. The health personnel will be kept on alert to deal with reports coming in from all the remote corners. Experts will trot out the prescribed seasonal cause and the reporters will again discover to their utter disgust that drugs and medical personnel are in short supply. Those who live in unfortunate places die in unfortunate ways and all the institutions of good governance have not been able to work out the specifics of their life and death.

http://www.himalmag.com/2003/july/opinion.htm

[Nancy]

Background article on health issues in Nepal

This paper by Barbara Deslich was prepared as part of a study guide on Nepal for high school students. It provides a decent overview for people (like me) unfamiliar with the general health situation in Nepal.

http://www.isp.msu.edu/nepal/Nepal%20Study%20Guide/Unit10.pdf

[Nancy]

Nepal January 17, 2006

More historical context:

Malaria, typhoid and viral influenza epidemic in far-west Nepal
January 17, 2006

More than 1000 people are suffering [this is January 2006] from various diseases including malaria, typhoid and viral influenza at remote Jogbudha village of Dadeldhura district in far-west Nepal, local media reported on Thursday.

"Above 1000 people are suffering from these diseases at a dozen areas including Sadani, Bhaurkunda, Karali, Tatapani, Lamigada and Jamerani of the village, some 700 km west of Kathmandu," Nepal Samarchar Patra, a Nepali language daily reported.

"The condition of most of the patients is upsetting," the daily quoted a health worker Hikmat Bahadur Dhami, as saying. "We also don't have adequate medicines for treatment," he added.

"As many as eight people of single family are suffering from the diseases," Dhami said, adding the number of patients has increased due to lack of timely medical intervention.

Mandhir Singh Bhandari, former village chief of Jogbudha said that nobody remained there to help the patients in some cases when the entire family members turned sick.

People also failed to go to neighboring Indian cities including Tanakpur, Poligunj and Pilbhit for treatment due to rising water level in the Mahakali river that separate the two countries.

District Health Office of Dadeldhura said that it had already sent additional medical team to the village with medicines.

Source: Xinhua

http://english.people.com.cn/200609/14/eng20060914_302837.html

(People's Daily Online)