Christians Help Stem Cholera Outbreak in Cambodia

Wed, Jul. 21 2010
By Nathanael Ng
Christian Post Correspondent

Two churches and a non-governmental organization working with the authorities have effectively stemmed a cholera outbreak in a district of Cambodia. The outbreak was part of a wider epidemic in the North-eastern Ratanakiri province that has resulted in at least 36 deaths since April.

Taveng district’s health center was overwhelmed with patients by early July. The health center expressed its need for help from volunteers to provide basic health education to prevent the spread of the disease. This was the evening of the first Sunday of the month.

As soon as churches in Ban Lung district and Ta Aung heard the plea, they mobilized their young people and trained them Monday morning. By the afternoon, volunteers were conducting a community education course with 300 people in attendance.

After the meeting, the team trained 14 health volunteers from Phaw and a neighboring village. Each volunteer received a set of materials to facilitate cholera education in outlying fields and hamlets.

In one instance, a woman living in a distant hamlet was about to die. However, local taboos prevented villagers from lending a motorized canoe to take her to the health center. The village head appealed to his Christian villagers and one of them lent his boat and the woman was saved.

Within three days, the team covered seven villages, all of them hotspots, in Taveng district. As a result of the cooperation between the Ban Lung Church, Christian development NGO ICC and district health authorities, the Taveng outbreak was brought under control.

According to official statistics, there were 96 cases and four deaths reported in Taveng during the one-week period of outbreak.

Cholera, a highly contagious disease, causes violent vomiting, diarrhea and possibly death from dehydration within four hours. More than 1,700 cases of cholera have been recorded in Ratanakiri province from April to early July.

The Cambodian province saw its last serious cholera outbreak in 1999 when 275 people died. At that time, Christians were involved in developing cholera education materials, such as pictures and catchy songs, suitable for use with illiterate tribal villagers. Multiple copies of the materials were made for health center staff and village health volunteers.

Pleased with the cooperation, the provincial health department invited the Ban Lung Church to address an official government cholera meeting held July 7.

During the meeting, the church distributed cholera education materials to staff of 29 health centers and health posts throughout the province.

The church even used creative arts in its efforts to promote health education within village communities. Young volunteers were trained to conduct educational skits and community theater. On invitation, they performed at the provincial hospital for relatives of cholera patients.

At the hospital, volunteers noticed that there were too many patients living in unsanitary conditions. Many people who came to care for their sick relatives ended up contracting the disease due to a lack of knowledge concerning hygiene. Meeting the need, the team set out to disinfect the wards with clorox.

After a successful debut in the hospital, the community drama troupe was invited to provide cholera education in the villages around Ta Aung commune, where outbreaks were still happening. The church also cooperated with officials from Kon Mum district to educate its villagers.

Villagers loved the slapstick performances in their own language. One lady, rolling over with laughter, exclaimed, “This is too real!” The performances showed how cholera is transmitted at funerals and through lack of personal hygiene.

The cooperation between Christians and the local authorities encouraged other Christian groups elsewhere. One group, inactive due to persecution, was emboldened after seeing the troupe working with authorities. Its members immediately resumed worship meetings.

Christians in the village of Sek were encouraged to see that they are part of a wider, caring community of faith. The close cooperation between Christians and authorities left a good impression on community leaders and parents of young Christians in that village.

As a result of the community service, non-Christians in the predominantly Buddhist country were drawn to learn more about Christianity. A staff from one of the health centers, who worked with the Christians, turned up for a worship service at Ban Lung Church. At that meeting, the church prayed for him and other public servants and organizations engaged in fighting cholera.

The team continues to cooperate with officials in Ta Aung and Toeum communes. It is currently visiting other hotspots in Taveng district.

Hanoi reports 18 cholera patients

7/5/2010
Source: Thanh Nien, Tuoi Tre (Hanoi)

The Hanoi-based Central Hospital for Tropical Diseases said Sunday they have admitted 18 patients that tested positive for cholera among 36 with acute diarrhea over the past week.

Most of the cholera patients are from the center of Hanoi, which has recorded no cholera cases over the past four months, according to the hospital.

Tests showed that most of them had eaten food that was not safe nor hygienic, namely dog meat and raw vegetables, before falling sick.

Le Anh Tuan, director of the Hanoi Department of Health, said shrimp paste, a dipping sauce used when eating dog meat, and the meat itself are not foods that normally cause the intestinal disease.

However, the way they are prepared could make someone contract cholera bacteria.

The current hot weather is ideal for the growth of the bacteria that causes the disease infecting hundreds of people in northern Vietnam in 2008 and 2009, he said.

Meanwhile, Nguyen Van Binh, deputy chief of the health ministry’s Preventive Health Department, said the department has proposed that southern localities adjacent to Cambodia further promote preventive measures to local people, given that the disease has plagued many localities in the neighboring country.

Areas with shared water sources need to be checked and should be cordoned off if they are found to be contaminated with the bacteria, according to Binh.

He said the southern province of Binh Phuoc has recently admitted five people who contracted cholera in Cambodia.

Food-Borne Illness, Cholera Remain Concerns

A cholera victim, a 60-year-old hill tribesman is comforted by his wife while receiving treatment at Ratanakiri Provincial Hospital in Banlung, located in northeast Cambodia. (Photo: AP)

Nuch Sarita, VOA Khmer
Washington, D.C Friday, 28 May 2010

“Specific symptoms of cholera include sudden and large amounts of watery diarrhea and vomiting.”

Cambodia continues to experience a prolonged hot season, and health experts remain concerned about severe illness or fatalities resulting from diarrhea.

“Your body can lose a lot of fluids and salts when you have very loose, watery stool,” Taing Tek Hong, a Florida-based physician, told “Hello VOA” on Thursday. “And it is important to replenish them. You need to drink plenty of fluids.”

He said dehydrated people may need to drink oral rehydration solutions that contain carbohydrates and electrolytes. You can use regular soda or soft drinks to replace water, he said.

Taing Tek Hong also said the rotavirus disease is the most common cause of severe diarrhea in children worldwide and is responsible for the deaths of children in developing countries.

A lack of sanitation or access to clean water can encourage the infection in children before age five, he said.

“In young children, rotavirus disease is characterized by diarrhea, vomiting, fever, and severe dehydration,” he said. “Death is caused by dehydration, not by the virus itself. Rotavirus disease can be treated with zinc tablets. Vaccination offers the best [solution] for preventing severe rotavirus disease.”

Along with watery diarrhea, Cambodians are worried about cholera, with several outbreaks occurring this year.

“Specific symptoms of cholera include sudden and large amounts of watery diarrhea and vomiting,” Taing Tek Hong told a caller. “The stool has a characteristic ‘rice-water’ appearance—grey—and a mild fishy smell. Other symptoms can occur such as thirst, weakness, coma and death. Fever is not a symptom of cholera.”

A simple home remedy of water, salt, sugar and ground charcoal can help rehydrate people with severe diarrhea, he said, following the suggestion of another caller.

One teaspoon of salt and eight teaspoons of sugar can be added to one liter of clean water, along with ground charcoal, he said, which can absorb toxins.

Treatment can include antibiotics, IVs and the replenishment of liquids.

Causes come from germs that infect contaminated food and water, allowing infection of many people through a single source. Microbes can be found in undercooked meat or unwashed food.

Illness can be prevented through hand-washing prior to food preparation, before eating and after using the toilet. Trash should not be thrown in the river, he said.

Cholera Suspected in Six Kratie Deaths

By Chun Sakada, VOA Khmer
Original report from Phnom Penh
26 March 2010

At least six villagers have died and dozens fallen ill from severe diarrhea and vomiting in a suspected cholera outbreak in Kratie province, authorities said Friday.

The outbreak occurred in two villages of Chet Borey district, a remote area far from the provincial capital, said Choung Seang Hak, chief of Kratie provincial police.

At least 53 people were being treated at the provincial hospital while “several dozen” others were being treated in their villages, Sanday, Treap and Village 105, in Thmei commune, he said.

Ou Pilay, chief of the provincial hospital, said six people died from serious diarrhea and vomiting suspected from cholera, causing worries of an epidemic.

“The patients have the conditions of chest pressure, difficulty breathing, and have indigestion” caused by dirty drinking water, he said. A lack of hygiene and high temperatures also contributed, he said.

Villagers were treated with anti-bacterial medication, and the conditions of some have improved, he said.

Around 20 medical officers and several dozen civil servants, police and military police are staying in the villages to investigate the cause of the outbreak, the officials said. Six ambulances were also on standby in the villages.

Authorities are searching the homes of villagers for signs of the disease and have urged anyone sick to seek out the medical teams.

Choung Seang Hak said the “cholera epidemic” was now under control and no further deaths were reported.

Cholera concerns in Cambodia

February 18, 2010
ABC Radio Australia

Cambodia has confirmed that there's been an outbreak of cholera. There's been more than 128 confirmed cases of the disease since the first cases were diagnosed in November, last year. But there's concern that the government hasn't moved fast enough to alert the public.

Presenter: David Chen
Speaker: Dr Pieter Vanmaaren, World Health Organisation, Cambodia

Click here to listen to the audio program (Windows Media)

Ministry confirms cases of cholera

A doctor holds up a petri dish containing a confirmed cholera specimen at Kantha Bopha Children’s Hospital last week. The Health Ministry said Friday that 128 Cambodians had contracted cholera. (Photo by: Rick Valenzuela)

Monday, 15 February 2010
Brooke Lewis and Khouth Sophak Chakrya
The Phnom Penh Post

THE Ministry of Health has reported that more than 100 Cambodians have tested positive for cholera since November, reversing its initial refusal to confirm the presence of the disease and simultaneously defending its handling of the outbreak.

Speaking at a joint press conference held with the World Health Organisation (WHO) on Friday, Minister of Health Mam Bunheng said there had been 128 confirmed cholera cases and one death. About 65 percent of the cases involved children under the age of 15, and the single recorded fatality was an 82-year-old man from Takeo province who died after contracting cholera in January, he said.

Dr Nima Asgari, a public health official at the WHO, on Sunday noted that the nation has only four hospitals, all in Phnom Penh, with the correct laboratory facilities required to test for cholera, adding that it would be “almost impossible to estimate the actual number of cases of cholera” nationwide.

Prior to Friday, ministry officials had not released any information about cholera cases, drawing criticism from officials at Kantha Bopha Children’s Hospital in Phnom Penh, who said they had been forwarding information on cases of cholera to the government since mid-November.

Though doctors at the hospital last week accused the government of not doing enough to publicise the outbreak, Mam Bunheng said his ministry had tried to balance the need to be forthcoming and the need to avoid sowing “panic”.

“We have not hidden any cases,” he said, pointing out that cholera cases had been reported in “three or four” Khmer-language newspapers. He said the ministry had refrained from making more publicising information about the cases so as to avoid encouraging people to seek unnecessary treatment and potentially overwhelm medical facilities.

“We may cause panic among people, and they will rush to hospitals to get treated,” he said.

He said the ministry had taken immediate action after the first case was confirmed, visiting provinces in which potential cases had been reported to educate residents about the importance of frequent hand-washing, covering toilets and boiling drinking water. He also said the ministry had distributed oral rehydration salts, intravenous fluids and chlorine for disinfecting water.

Mam Bunheng said an uptick in diarrhoea cases was common during the dry season.

“An increase in diarrhoea is not unusual at this time of year in Cambodia, when water levels are low and people may be tempted to use unprotected water sources,” Mam Bunheng said.

“I hope the press will inform people about preventions rather than making them panic.”

Dr Sok Touch, director of the Health Ministry’s Communicable Diseases Control Department, echoed that sentiment, saying: “This [press conference] is not to declare an emergency but to provide an update about cholera cases.”

Treatment
As they have throughout the past week, government and WHO officials argued that, when it comes to treatment, there is little difference between cholera and other forms of acute watery diarrhoea.

“We want to consider cholera as just another kind of diarrhoea,” Sok Touch said. He added that it was important for people to practice good hygiene to protect themselves from all forms of diarrhoea, not just cholera.

Asgari reiterated that most cholera cases can be treated with oral rehydration, and that only 10 to 20 percent of cases become severe enough to require hospitalisation.

He disputed the argument put forth by Kantha Bopha doctors last week that all suspected cases of cholera should be treated with antibiotics.

“Antibiotics should be used for only severe cases of acute watery diarrhea,” Asgari said, adding that indiscriminate use of antibiotics could eventually render them less effective.

Diarrhea deaths lead to hygiene campaign in Cambodia

PHNOM PENH, Feb. 8 (Xinhua) -- The Ministry of Health has launched a nationwide sanitation and hygiene awareness campaign following a series of deaths across the country caused by diarrhea, local media reported on Monday.

Ly Sovann, deputy director of the ministry's Communicable Diseases Control Department, said that as part of the campaign, which began on Saturday, officials had been stationed on the ground in every province to treat cases of diarrhea.

He said that diarrhea is of particular concern during the dry season because people are driven to drink unsanitary water.

"We are concerned about diarrhea this month, and for this campaign we have scattered expert officers to all 24 provinces in Cambodia," he was quoted by the Phnom Penh Post as saying.

A 11-year-old boy in Ratanakkiri province died after a bout of diarrhea last Thursday, and another person died of diarrhea the following day, said Pon Pun, the chief of Lonk Khon commune in Borkeo district, where the deaths occurred.

A series of reports of diarrhea and suspected cholera cases have recently sprung up in Prey Veng, Takeo and Kandal provinces, the newspaper reported.

Ly Sovann said authorities were also concerned about a potential cholera outbreak, but he said he could not confirm whether any cases had been detected, and he also could not provide specific information on the number of diarrhea cases reported nationwide.

The World Health Organization country representative Pieter Van Maaren said he also did not have data on the total number of diarrhea cases, but he said that outbreaks during the dry season were common.

Seven people found with cholera in Mekong Delta province

Tuesday, February 2, 2010
Thanh Nien News (Hanoi)

Seven of 45 people with acute diarrhea who were admitted to local hospitals in the Mekong Delta province of An Giang between January 19 and 28, were found to have cholera, a health ministry agency reported on Sunday.

All seven cholera patients came from Cambodia’s Takeo and Kandal provinces to An Giang for treatment, according to the Department of Preventive Health and Environment.

The department did not clarify whether all the patients were Vietnamese or not.

The Ministry of Health has warned of an outbreak of cholera, an acute intestinal infection transmitted through water or food contaminated with the bacteria vibrio, causing diarrhea and dehydration that can lead to kidney failure and death if not treated promptly.

The disease has ravaged northern Vietnam two times, in 2008 and 2009, infecting hundreds of people.

Meanwhile, in the central province of Ha Tinh, which has been hit by outbreaks of the avian flu H5N1, reported that seven people had fallen sick with fever and flu symptoms after coming in contact with sick poultry.

However, tests at the Hanoi-based National Institute of Hygiene and Epidemiology showed they did not have the avian flu virus.

Also on Sunday, the Nam Tra My General Hospital in the central province of Quang Nam said they had admitted 25 people with malaria over the past week from Tra Tap Commune.

The local health agency found nearly 100 people affected with the mosquito-borne infectious disease, but they had not approached the hospital for treatment. Hospital staff said they had also found patients in Nam Tra My District’s other communes.

Northern Vietnam struck by acute diarrhoea [-A religious persecution curse?!?]

8 Nov 2007
AFP

HANOI: More than 1,000 people in Vietnam's north have become sick with acute diarrhoea, including about 160 cases of cholera bacteria, health officials said on Thursday.

No deaths have been recorded. The disease has affected 1,051 people in 11 cities and provinces, including Hanoi, said health ministry spokesman Nguyen Quang Thuan.

Some 157 people have tested positive for the bacteria that causes cholera, he added.

"Although patients are infected with the cholera bacteria, it's not yet enough to say they suffer from cholera," he said.

The American embassy in Hanoi issued a warning earlier this week against "a growing outbreak of acute diarrhoea in the northern part of the nation," saying "some of he cases have been confirmed as cholera."

State-run media in Vietnam has urged health officials to acknowledge the problem to help limit spread of the disease, which was initially reported in late October.

"It's difficult to control the situation as there have been conditions for the boom of the epidemic" Tuoi Tre or Youth newspaper quoted Deputy Health Minister Trinh Quan Huan as saying.

Infection sources include shrimp products, water, salads and street food, the minister said.