Dear Editor,
Once again the people of Region 1 – Barima-Waini or the North-West district – are battling an outbreak of gastroenteritis. The fact that this community must endure the same thing each year, with clockwork regularity and deadly consequences is unacceptable, particularly since we know so much about the nature of the disease and how to prevent it.
The Ministry of Health reported that the bacterium E coli was the pathogen involved. It is known that the origin of E coli is faecal matter and the mode of transmission is contaminated water. It is known that good sanitation is the solution to the problem. The disease is well understood by medical science and prevention and treatment regimens are established. So why, in spite of having all the information, is gastroenteritis still a recurring problem? Is it because of a lack of political will? Is it because most of the victims are poor and live in the hinterland? Are the people of the North-West not entitled to some attention from the government that asks for their votes at election time?
It has happened every year for the longest while. In 2005 there were over one hundred cases reported in Port Kaituma; every year since then gastroenteritis has been in the news. In 2009, six persons died in Moruca and another seven lost their lives in nearby Arakaka. Over seven hundred cases were reported in 2013. Infants and toddlers accounted for the vast majority of deaths with the elderly and infirm close behind.
The official statistics are bad enough, but who knows how many cases go unreported? And, note well: Region 1 has a population of only 25,000 people so the percentages involved must be high.
Editor, gastroenteritis or gastro, as caused by E coli, results in inflammation of the bowel, vomiting, uncontrollable diarrhoea, abdominal pain and cramps. Because the body loses so much liquid and salts, or electrolytes, the patient can become dehydrated, organs can fail, the heart rhythm is disrupted by salt imbalance and the patient can die. In fact, an infant can die within hours of experiencing the first symptoms. One can only imagine the pain and suffering of babies so afflicted. Zashada Bunbury, only two months old, would have experienced it first hand before she died of gastro on February 15, 2013. The same can be said of other infants, including seven month old Steve Adams who died later that year. So what are the authorities doing?
In 2010, then Minister of Health Leslie Ramsammy said that gastro is a seasonal occurrence in Region 1; apparently, this observation was the end of the matter for him. In 2013, Minister Bheri Ramsaran said that the ministry was on top of things even as hundreds of persons were affected. He said that the residents got sick because they were complacent. In other words: they were careless.
In June 2013 the parliamentary opposition voted to set up a Commission of Inquiry to investigate the problem – the PPP/C voted against – to date, nothing has been done.
Editor, it is not enough to know the cause of the problem; government officials must solve it; that is their job. Insulting the people by blaming them for getting sick is sidestepping the real issue and shirking responsibility. The people must be properly and systematically educated on proper sanitation; the importance of hand-washing; the placement of latrines far from waterways and wells; the importance of the breastfeeding of infants; the sterilisation of feeding-bottles and other relevant matters.
And, the Ministry of Health must start using internationally accepted best practices and collaborating with other agencies as required. Compliance with sanitation standards must be monitored and follow-up exercises must be ongoing to ascertain the effectiveness of implemented initiatives.
On the subject of best practices: It has been known for a long time that Oral Rehydration Therapy in infants should involve the use of complex carbohydrates (and electrolytes) instead of simple sugars such as dextrose. This is because simple sugars, if incorrectly used, can actually make diarrhoea worse by increasing the osmotic gradient across the gastrointestinal membrane and pulling solvent (water) into the bowel. I wonder if we are still using dextrose solutions.
I also wonder if the Ministry of Health is collaborating with the Ministry of Natural Resources and environment, as the residents of Region 1 report that miners in the area use the creeks and streams as toilets.
Yours faithfully,
Mark DaCosta
