I am writing this journal out of my own suffering at intellectual level. Now, I know - you definitely will ask me what kind of intellectual suffering? Well, this is a bit tricky - if I have to ventilate this out then I may sound caustic but on sober tone (please excuse me from being too radical!!) - I am in dilemma in all these business of cholera and other diseases inflicting impoverished community. After all, I hail from low income country and have closely observed the pain of suffering some of these easily preventable illnesses. Anyway, to bring context to what I am going to write and share with you all in this part 1 of the series on cholera, it is still my duty to explain some key technical words that I will be using more often in this write up for lay readers who are not used to these terms. I know some of us hate definition like Benjamin Disraeli (1804 - 1881) who says " I hate definitions". Well for us, it helps us provide better and clear understanding of the subject matter at basic level. Here I remember that one of our professor Ananthanarayan of Biochemistry used to say, "When your basic understanding of the subject is shaky - who will help you that I do not know !!" Now, we realize the truth of that remark almost 2 decades back. For my part, I still do not understand why Benjamin Disraeli had to hate definition? I take it may be he said so in literally meaning since he used be a free thinking writer and seasoned politician. I will refer to Leon Gordis' Epidemiology (4th Edition), and Vaccine (6th Edition) which I believe are equivalent to religious texts for those into vaccinology and epidemiology, along with other freely available online resources.
- Epidemiology: The study of the distribution and determinants of health related states or events in specified populations and the application of this study to control health problems. Ref: Leon Gordis' Epidemiology (4th Edition)
- Surveillance: Ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practices closely integrated with the timely dissemination of these data to those who need to know. Ref: CDC definition
- Vaccine: a preparation of killed microorganisms, living attenuated organisms or living freely virulent organisms that is administered to produce or artificially increase immunity to a particular disease Ref: online Marriam - Webster dictionary
So let us all go into basics before we talk more on cholera. This disease is caused by microscopic organism invisible to our eyes. You can say that this organism can be found in water that is contaminated by human fecal matter. So you can straight imagine those places where water and sanitation is in compromised state. For example we can take Kathmandu valley as an example where anytime in the future cholera outbreaks can occurs. However, there is also good signals to improve water and sanitation out of citizens active volunteerism to clean up Bagmati. Let us hope that this kind of cleaning river is not a political stunt for populism, it will be sustained and routine duty of people and government. Again back to micro - organism - this cholera causing organism is said to be of curved or comma shaped with a single flagellum at one pole. This disease is characterized by acute watery diarrhea and can lead to severe dehydration due to loss of water and electrolyte from our body. If s/he can not proper treatment with fluid replacement then s/he may also lose his or her life. This is still the case in low income countries with recent examples of Haiti (2009) and even in Jajarkot of Nepal. Also, remember this disease has potential for huge outbreaks that spread across geography facilitated by quick transportation across countries and even continent. So bottom line is that cholera is still a serious public health problem that can disrupt the socioeconomic activities and can lead to political backlashes to the government or other stakeholders.
Since this blog focus on infectious diseases rampant in Nepal, I will focus rest of 5 posts on Nepal in relation to our understanding of this diseases connecting to broad public health perspective. In addition, I will also highlight my dilemma, where i think it deserves to be vocal. First thing first, let me try to dissect to key words in particular: business and impoverishment.
Business normal sense is give and take activity in which there is an expectation of return once we invest certain figure of capital. So we think business in relation to money or capital return. However, I am using the word business in the sense of understanding what, how, when, where, why and who in the field of cholera academia. And, since cholera is related to poverty, which in turn impoverish in every aspect of community dynamics in terms of health, economy and social well being. In next post, I will touch upon the history of cholera and our understanding in Nepal.
To be continued......................