[This is a personal log and does not represent any organizational position]
Dr. David Sack in his May post in stopcholera blog writes "quick, efficient and reliable surveillance that is supported with robust laboratory surveillance do save lives". This is a fact that nobody can deny, however conducting a surveillance in an efficient manner do cost a lot of money and above all - an efficient coordination and collaboration is the key deciding factor. In this post, I would like to dive into the actual functioning of the surveillance activities in Kathmandu valley. Also, i hear "surveillance" as a buzz words among all stakeholders involved in the business of communicable diseases prevention and control in Nepal.
Basic first: the meaning of surveillance is data collection, analysis and its interpretation for prompt public health action. In this respect, data is power. Some people even go further in saying that power is political so data is political !! I think - there is partial truth in this statement. The main objective of disease surveillance is to rapidly identify any re-portable epidemic potential infectious diseases [acute gastroenteritis (AGE) / acute watery diarrhea (AWD) / cholera].
Currently, there are several sentinel sites established and enhanced within Earthquake affected 14 districts of Nepal. This is a syndromic surveillance. Also, there exist Early Warning Reporting System (EWARS) which started with 6 re-portable diseases in early years of 1990s. There is also Vaccine Preventable Diseases (VPDs) surveillance in parallel that runs through Program for Immunization Preventable Diseases (IPD), which is a collaborative effort of child health division (CHD) and WHO country office Nepal. As of now, there are EWARs surveillance going on in 81 sentinel sites in 75 districts, which reports and alerts on daily/weekly basis. The collection method of surveillance data are said to be conducted through informers or through mobile - text and paper form. Additional responsive activities are daily situation report and weekly bulletin and also the situation of AGE and cholera in KTM valley.
Today, Dr, Marasini, Director of EDCD started the meeting with opening remarks "Cholera is a severe waterborne illness that kills within hours not days." Also, he added historical anecdotes where people in the rural areas had to be abandoned in rivers or even their home to die because of extreme fear that was associated with this diseases and even a Nepali queen then died due to this disease. He also said that "Cholera does not spread in a straight path that can be easily predicted !!. Most importantly, Dr. Marasini referred to the first scientific paper reporting cholera outbreak in KTM valley in the year of 1886 published in British Medical Journal (BMJ). With this background, Dr. Marasini concluded by stating that "Surveillance is the heart of any public health system and further added that this plays vital role to avert public health disaster. Therefore, surveillance has to be inbuilt system that should be robust able to detect any potential outbreak early"
The core activities that have been done and planned in order to strengthen the surveillance system in Kathmandu valley are as following:
- Issue official letter from EDCD to support the surveillance activities
- Visit all important health institutions in KTM valley
- Coordination with NPHL / lab
- Identify for surveillance gaps
- Orientation & training if and when necessary
- Logistics and swift management when and where required
- Regular M & E
- Data mx and analysis
- Lab sample collection and transportation
- Response and action
Finally - I liked Dr, Marasini stressing a point very effectively saying "Cholera spread does not take straight path instead it takes zig zag path - very unpredictable, if we do not have a robust surveillance to detect early and response." Also, "Poverty is humankind's greatest injustice" said Mahatma Gandhi while we know cholera is a disease of poverty. This means very straight - detecting cholera outbreak in the community means there exist injustice but not sure who are responsible for such injustice. This remains a question for next write up !!
14th Sept 2015