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Earthquake affected Kashmir now dealing with cholera "When the first patients started coming with symptoms like watery diarrhoea and vomiting, we immediately suspected it was cholera. The rapid tests we did were positive and so we immediately set up a cholera treatment unit," says Luis Neira, medical co-ordinator for Médecins Sans Frontières (MSF) in Pakistan. Since mid July, the disease emerged in various areas in Pakistani administered Kashmir. Though the number of patients coming in with cholera is decreasing in some areas, in other areas the numbers are still increasing.
The first patients with symptoms of cholera came in the MSF district hospital in Bagh in mid July. On July 28th patients also started arriving at the MSF hospital in Hattian and mid August, the first patients with similar symptoms were admitted in the MSF hospital in Muzafarrabad. In all locations, an isolation ward was quickly established within the hospital structure, before being moved to a specialized treatment unit or centre on the hospital grounds. In total, more than 2,300 people have been treated for cholera in the medical care facilities of Médecins Sans Frontières. According to Luis Neira, there is a pattern of cholera outbreaks in the region during the monsoon season. "Cholera is transmitted by water that's infected with the cholera bacteria as well as through human carriers of the disease. People get water from natural resources like rivers and when people who have been infected travel around, they infect others." Luis continues: "An additional problem in the earthquake affected area is that roads are still in bad condition and though most of the roads have been cleared, monsoons cause new landslides. It's still difficult for our teams to reach the villages and for the patients to travel to our medical facilities." There are still thousands of people staying in displacement camps in the area. However, the majority of the people who have been coming in with the disease in Hattian and Muzafarrabad, are from the areas around the towns itself. In Bagh district, 70% of the patients were coming from rural areas. More than 2,000 patients have so far been treated in the Bagh district hospital and two cholera treatment units in Rerban and Mallot. In a special cholera treatment unit on the Hattian hospital grounds, 178 patients have being treated. MSF has set up a cholera treatment centre on the Muzafarrabad hospital grounds where 110 patients received medical care. In Muzafarrabad, the number of new patients is still rising, whereas in Bagh district and in Hattian, the amount of new admissions is on the decrease. "We now receive about 20 patients per day in our medical units, compared to close to 80 at the peak of the outbreak," says Fasil Tezera, co-ordinator for MSF programmes in Pakistan. "Thanks to the involvement of key partners, including the Ministry of Health, World Health Organisation and many other relief organizations; the case fatality rate of the current epidemic remained low - 0,29%, and the outbreak could be scaled down drastically. We hope it will continue along that trend." "It has been an impressive experience and a big challenge. We took the lead in providing treatment, co-ordinating with the Ministry of Health but also with other relief organisations and had to quickly re-organize the medical staff within the projects to assemble our cholera task teams," says Luis Neira.
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