Emergency and humanitarian action

WHO’s disease investigation and rapid response system in post-quake Nepal

WHO/A. Khan

In post-quake Nepal, investigating and verifying rumors of disease outbreaks is the mainstay of Usha Kiran’s work.

The WHO Surveillance Medical Officer (SMO) is stationed in Gorkha District, the epicenter of the 25 April quake and one of the 14 most affected districts in Nepal. Kiran says the possibility of a disease outbreak among its 271 000 residents remains a core concern.

“Since the initial days following the quake disease outbreaks have been something we have all been cognizant of and active in regards to – especially the public. The prospect that endemic diseases could gain greater traction than usual as a result of the quake’s impact on water and sanitation has been of concern.”

On 7 July, rumor spread in Gorkha Bazaar, the headquarters of the western region district, that deaths had occurred as a result of an outbreak of diarrheal disease in Kerauja, a village development committee in the district’s north-east.

Contingency plans were executed immediately, says Kiran. “The District Public Health Office (DPHO) dispatched a health worker within hours to investigate and report back to the DPHO where it’s Rapid Response Team was waiting.”

After speaking with officials at the local health post as well as villagers in the area, Bijay Kumar Shrestha, the health worker conducting the investigation, concluded that no outbreak had occurred. Rather, it was found that the deaths were caused by a landslide.

The news came as a relief. However, procedures are in place to act swiftly in the event of a confirmed outbreak, says Kiran.

Dr Nani Babu Daani, the focal point for Gorkha DPHO’s Rapid Response Team (RRT), says that the role of the unit he leads is clear. “In the event of an outbreak the RRT will mobilize resources and personnel to the affected area to treat patients and prevent further spread of the disease,” he says. RRTs are present in each of the 14 most affected districts and comprise of members from key areas of public health concern, including immunization, nutrition, reproductive health, as well as logistics. RRTs are equipped with inter-agency diarrheal disease kits for treatment and preventative support to 500 people, and contain a range of drugs and supplies, including doxycycline, erythromycin and zinc tablets.

According to Daani, there is no shortage of medical supplies. The greatest concern is Gorkha District’s terrain and accessibility.

“Mobilizing a helicopter in the event of an outbreak is the best option, as reaching the affected area by foot could take up to ten days if it occurs in the northernmost areas. In many parts of the district there are no motor-able roads. Weather, suitable landing points and availability of helicopters are the other challenges,” he says.

WHO SMO Usha Kiran maintains that though the systems and resources are currently in place to deal with a disease outbreak if and when it occurs, it is best to ensure preventative action.

To this end, Water, Sanitation and Hygiene (WASH) cluster partners are working diligently.

Henk Veerdig, Gorkha WASH Cluster co-lead and team leader of CARE Nepal WASH team, says that there has been steady progress in providing access to drinking water and sanitation facilities in the district.

“In the beginning the emphasis was on provision of hygiene kits and implementing the needs assessment. More recently, focal agencies have focused on providing access to sanitation and water supplies by supporting the construction of emergency toilets (which serve 4-5 families, or about 20 people), replacing damaged pipes and providing reservoir tanks,” he says, adding that these initiatives are extremely important in diminishing the risk of water-borne diseases.

According to Veerdig, who has spent the past twelve years in Nepal and speaks fluent Nepali, much of the progress made is a result of the strong working relationship between WASH Cluster partners and local officials.

“The WASH Cluster has been working closely with the Gorkha District government,” he says, adding, “There is a bridge of trust and confidence between the international agencies and government.”

As WASH sector progress continues, Usha Kiran and 11 other WHO SMOs across the country will continue to monitor potential disease outbreaks while coordinating with each of the 14 RRTs to ensure rapid and, effective response is delivered if required. In post-quake Nepal, preparedness is key to achieving public health outcomes.