Sunday, June 21, 2009

Prevention Of Typhoid in Pakistan

As discussed in seminar on Typhoid in Pakistan. ,Typhoid is a major disease burden in Pakistan. It is almost endemic in urban densely populated slum areas of major cities like Karachi, Hyderabad, Lahore, Rawalpindi.( /National).The mechanism of safeguarding the water supply of drinking water is deficient. A new safe drinking water policy is bieng announced ( see pg 3 of Dawn newspaper/National) but let us hope this is carried in its true spirit.
The true picture is that the urban workers be they domestic servants, cooks, resturant and eatery workers are never screened for Typhoid and Hepatitis. Inspite of appearing to look modern no safety precautions, screening , vaccinations are carried out. Most are carriers of Typhoid and these bacilli are secreted in stools . As no standard operating procedures are carried for pre food handling there is abundant carraige under finger nails. The excreta contamination of drinking water supply is also massive as most pipes for fresh water supply and waste disposal are running parallel in urban areas with frequent overlapping and mixing of two streams. Also sewerage and waste is bieng disposed without treatment directly into rivers and streams. This is bieng taken directly into drinking water supply. The chlorination and some substandrd cleaning is bieng done. This is never made public and no public interest group or government agency is monitoring this. This has to be made public so that there is pressure from public for improving standards. Only doing conferences and announcements of policies by ministers will not solve the problem. Our whole attitude to safeguarding health of the people has to be more proactive with open access to cleaning procedures with more awareness of these issues. Also the affluent citizens need to take more of these issues up as causes and help the administration and the public health officials in a more problem solving way.
There is a need to take up public health issues as serious priority and increase the budgetary allocation .Also there is a dire need to be more proactive in fighting Hepatatitis and Typhoid.only a thrust on war footing will help fight theses menaces.

Saturday, June 06, 2009

Water An Expensive Commodity.

Pakistan is facing acute water shortages already. Due to climate change the precipitation will decrease in Pakistan. Already there are many areas facing a drought like situation.As each Pakistani city is teeming with millions of people and there is acute shortage of clean drinking water, the conservation measures have to be taught and taken by the municipalities as a priority task.Pakistani cities are bieng polluted by industrial and chemical wastes,all ending up in drinking water reservoirs. there are no laws and no treatment facilities. The water bieng supplied to large cities like Karachi with a population of over 16 million people is not passed through a very stringent or modern treatment plant. The piped water is also supplied to very large worker population which live in large urban slums mainly by hydrants and tanker mafia. the quality of this large water supply is very questionable. non of the tankers are owned by any companies. There is no water testing of the drinking quality of these tankers. The inner tank cleaning is neither checked or tested by any inspector or any administrative authority. The hydrants where these tankers are filled from are also not checked for the quality of water, whether fit for drinking or not. The water supplied to such a large population results in diseases of stomach and intestines both of the men workers and their families. As I work on social basis as doctor with some of these people I have seen over the last 30 years the growth both physical and mental slow down amongst the children of such areas. These children due to repeated stomach and intestinal infections,suffer from malnutrition and anemia. Malnutrition is also due to the fact that an average family size is atleast 8 persons including parents and the GDP is very low and a large number(40%)live below poverty line that is less than $1 a day.There is no food shortage as such but as Roti(bread) prices have increased the food intake is also lessening. Due to anemia and malnutrition especially protein calorie malnutrition ,these children have less resistance to infection and infestation. As the water is polluted and contains worms etc.,there is a vicious cycle of disease and diarrhoea and anemia and malnutrition. The average worker family spends about 40% on medicines and that too preferably on the earning member. The child and the female child especially remains the last priority for medical treatment.
I need to write a seperate post on the health access and services to these families. So the water shortage and its pollution impacts negatively on the these slum dwellers health. This will manifest in so many problems which I will discuss later.
There is a dire need for the city government to link up development plans with access to clean drinking water and health.For providing better water environment and clean drinking water in such communities I have few suggestions:

The idea of water board as a supplier organistaion should be changed and made an user organisation.The areas should be under control of regional communities which should form water clubs at very small areas level. In Karachi we have local bodies such as councils, which are perfectly suitable to manage their water problems. These groups will not only monitor their supply but also be able to check and standardise water quality.These should then have link with local health officer so that the incidence of diarrhoeal diseases is monitored and controlled. This kind of activity does not need a new infrastructure or money input. All these systems are in place it only needs awareness in communities and they will form their own bodies once they know the advantages in combating water pollution and maintaining water quality.
The mayor of Karachi(Nazim) should form water checking team under his direct care which checks the water tankers water quality also.On this he should not compromise anymore as the burden of disease is increasing and taking its toll on the productivity of the city. All social aspects are directly linked to water quality.
These ideas will be further elaborated in later posts.
As a commodity the value of water is not only increasing in the pricing context but as a value for decreasing or affecting other development parameters such as productivity,health index, morbidity, mortality,burden of disease etc. We need to approach this problem in a more holistic and sociological way in order to find solutions in way of human progress and harmony.