Outbreak

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After a prolonged spell of incessant rains an outbreak of gastroenteritis with cholera like symptoms hit at least five districts across Kashmir and Jammu divisions in the past three weeks. However, the health authorities are yet to determine what the disease actually is.

Unofficial figures put the death toll caused by the widespread gastroenteritis at eight. Though none of these deaths occurred in a hospital, people say that these patients were suffering from gastroenteritis and “cholera”.

Health officials refuse to treat the outbreak as cholera and are treating such cases as acute gastroenteritis.

The state government had to employ almost all of its healthcare resources to meet the challenge. At places even Army and a central team had to be called in to help the ill equipped state.

Healthcare officials, however, claim that the worst was over and the cases of gastroenteritis were completely under control. “It (outbreak) has had its peak and now it is gradually decreasing,” Dr M A Wani, director health services Kashmir said.

The worst affected has been the mountainous district of Doda, where more than 3000 persons fell ill. Medical experts attribute this large scale outbreak of gastroenteritis to people using untreated contaminated water.

In Kashmir valley, the first case of gastroenteritis with cholera like symptoms was detected in Budgam and within hours many more were afflicted with the disease and had to be hospitalised. Kupwara and Bandipora districts followed.

“Budgam was our worst affected, which recorded 2400 such cases and they were admitted in different hospitals,” said Dr Wani. “Of them 2370 have been discharged and 30 patients are still undergoing treatment.”

According to official statistics, Kupwara was the second worst affected district in the valley with 440 cases and Bandipora had recorded 54 cases.

“In Kupwara we have discharged 430 patients and 10 are still under treatment,” said Dr. Wani. “Bandipora is completely under control where we have discharged all the patients.”

There has been a lot of confusion regarding the deaths due to the gastroenteritis outbreak as officials refuse to attribute any of the eight reported deaths to it.

Dr. Wani confirmed that his department has received reports of some deaths. “According to our field reports and other sources, five people have died in the affected districts. The deceased included three elderly and a pregnant woman,” said Dr. Wani. “But we can’t say with surety, what was the cause of their deaths.”

The people allege that the deaths were due to the “cholera and gastroenteritis”, but in the absence of any post-mortem, or sample having been taken before their death, nothing could be proven.

“May be it was the cause but we can’t say with surety. Besides they died in their homes and didn’t visit hospitals… Not a single death has occurred in our hospitals and medical institutions,” said Dr. Wani.

Officially there is no word or figure regarding the actual cases of cholera among these patients, but sources in the health department say that around “100 persons were being treated for cholera”. The blood samples of these persons have been sent outside the state for analysis, the results of which are yet to arrive. Officials term these cases as acute gastroenteritis.

The major cause of the gastroenteritis outbreak, medical experts say, is contaminated water.

In Jammu division the wide spread gastroenteritis broke out in the hilly districts of Doda and Ramban, with former registering bulk of the cases. Sources said around 3000 cases of gastroenteritis with cholera like symptoms were detected in Doda and more than 700 in Ramban.

Unable to cope up with the rush of patients a special team of doctors was also flown in from New Delhi on the directions of Union health minister Ghulam Nabi Azad and Army’s help was sought.

Officials said 1747 patients have been admitted in Doda and Banihal hospitals and the rest were treated in their hamlets by the teams of doctors from the army and state health department. At least 16 patients were shifted to Jammu hospitals for specialised treatment.

Government officials say that in Jammu region there has been “just one death of an elderly woman” who was admitted with symptoms of acute gastroenteritis. However, unofficial reports put the toll of the outbreak at more than three.
Health officials say the widespread gastroenteritis is caused by contaminated unsafe drinking water.

The recent cloudbursts and prolonged rainfall has killed number of animals in the far off areas particularly in mountains and meadows. Rains washed down the animal carcases and human faeces – many people defecate in the open in these areas – into the streams, waters of which people in most of the villages downstream use for drinking. Sukhnag stream which provides drinking water to many villages of Beerwah Budgam was one such polluted stream, which ultimately became the cause of the outbreak.

To make people aware of the dangers of using contaminated and untreated water, health department has embarked on a massive public outreach campaign all over the state. The campaign involves print and electronic media, door to door contact by health educators and composite health camps in affected areas.

The health department has issued directives asking people to desist from drinking untreated water. More than two lakh chlorine tablets were also distributed among the population in affected districts.

As the disease is said to be water borne the Public Health Engineering (PHE) department- responsible for supply of water to homes – has been getting most of the blame. However officials at PHE deny the charge.

“All the cases of gastroenteritis and cholera cannot be attributed to the water supplied from our sources,” said Ghulam Rasool Zargar, Chief Engineer PHE Kashmir. “We supply treated water but people also use untreated water from streams, underground sources and springs.”

Zargar attributed the pollution to heavy rains and heavy movement of people and animals in the upper reaches of the state. “There are nomads in the upper reaches along with their livestock, there is considerable security presence and the pilgrimage tourism just concluded high in the mountains,” said Zargar. “Most of the times they defecate in open and unusual heavy rains claimed a lot of livestock. The rains also washed down the pollutants into streams and water bodies.”

All these factors according to Zargar created an ideal situation for the contamination of water sources used by people. “As they also connect to our sources, so some of our supplies too didn’t remain insulated,” said Zargar. “So this created the problem where the people got gastroenteritis and Cholera.”

To tackle the situation the department has initiated a massive drive to clean its water sources. They have also doubled the usage of chlorine and bleaching powder to ensure its full safety. “I have personally visited the six most affected water sources in Budgam and we are keeping 24-hour vigil over the water quality,” said Zargar. “Now the situation is completely under control. We have also issued precautions for people to use boiled water.”

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