A few people were hurriedly extracting logs from a funeral pyre when police arrived at a remote village in Nepal’s Jajarkot district. Villagers told the police that the body belonged to a woman whose daughter was also about to die, so they were saving some of the wood for her pyre.
The police walked for two hours to find the girl struggling for life against the symptoms of cholera. They took her to the nearest health centre, a further five-hour walk. She survived with the help of 62 bottles of saline and medicine.
Nepal’s cholera and diarrhoea epidemics, largely unnoticed by the outside world, have quietly killed more than 280 poor villagers in hamlets mostly reachable only on foot or mule since the outbreak began three months ago. Medical teams hesitate to go to remote villages as there is a lack of security, weak infrastructure and shortages of food for residents, let alone for visitors.
”It’s very difficult for the government to reach individual homes to treat the sick,” said Dr. Sudha Sharma of the health ministry. “They should at least be brought to the nearest health centre. But [villagers] bring the sick only when it is too late.”
The UN organisations and other aid groups have been working through partner organisations in the field, but as Ugochi Daniels, UN Population Fund deputy representative, said, “The number one challenge in providing assistance is access to the affected areas.”
A lack of community awareness about the causes of cholera is a major mitigating factor of the epidemic. Villagers defecate in open areas, drink water straight from streams carrying waste from upriver settlements, do not wash hands before eating, and have little sense of personal hygiene or sanitation. With harvest season underway, villagers who remain healthy are focused on tending to their fields and less able to care for ailing family members.
Dr. Badri Narsingh, president of the Medical Association of Nepal, has criticised the government for not taking the cholera issue seriously and undertaking strong awareness building campaigns.
There has also been very limited coordination of supply and distribution of medicines and materials. ”There are no complete sets of equipment at health centres to treat the patients. I think the government has not done as much as it could have,” said a doctor sent to the affected area.
The problem is also being manipulated for political gain by various groups.
The Communist Party of Nepal (Maoist), which launched a bloody 10-year revolt from the districts now most affected by epidemics, has also been critical of the government, which the party led until May.
”The government should take the reins to control this epidemic. If not, they should let us take charge,” said Lokendra Bahadur Bista, a Maoist legislator from Jajarkot. He said the party has mobilised 1,300 cadres in the district to transport medicine and raise health awareness.
INSEC, a local human rights group, claimed that the UN World Food Programme caused the cholera epidemic by distributing rotten rice and lentils. The government and most observers however trace the outbreak to contaminated water and Robert Ragan, the WFP’s local representative insisted that all food the group provided was safe.
Recently the government has claimed success in slowing the spread of the epidemic. However, Raj Kumar Dangi, a Jajarkot leader, said, “As the area is experiencing a change of weather from the rainy season to fall, the temperature in the mountainous region has gone down significantly, which has helped in controlling the disease.”
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