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Aug 17, 2014

Dalit Reality - Poverty and Health



Dalit (दलित) =  untouchable (अछुत )

Watching this video on Dalit reality, I am angry to what goes around us.

Yes, "anger" can be natural response to protect yourselves or even your family from  "outside" dangers or can be a plethora of emotional expressions that explodes out of an individual or a community !! Here, my "anger" is a symbolic representation of what is prevalent in our society as of this year 2014. I know, anger is said to be negative energy but how can you justify not to be angry, when some souls are treated less than animals !!  I am angry at this caste system, which has pushed certain segment of your community to the bottom pit of the socio - economic ladder. In this bottom pit of the social ladder, they have forgotten to even dream or even utter a word to express their pain and sufferings, because their mental process is so clouded with fear, everything seems impossible !!

Before proceeding further, let me be very clear upfront, the purpose of this 'anger" is not to point finger or muscle flex at anybody. This is simply to turn the negative energy (that boils in your psyche) to a positive outcome that benefits all of us. So, the best way is to write what comes in your mind and what you have seen in your community. This is what I am going to do. After all, writing is so powerful !!

Today, it is gloomy outside and is raining, so I have decided to write on this (un)social, unjust or even barbaric act that exist and still goes unnoticed in our South Asian society especially India and Nepal, where millions of socially marginalized people live in abject poverty to this day. To be a bit balanced or fair to all those social activists and government agencies, who are working or advocating  tirelessly in this area,  some of these practices may go noticed and treated lawfully but this is just a "centimeter" of journey, when we need to travel "kilometers" of proverbial rough road to eradicate such social practices. Therefore, I am pretty sure that i will not be overstating when I say, "The practice of untouchability is still rampant all over the country." This is what I can say of Nepal !! 

Photo - Anuj Bhattachan (verbal consent +)
As an example, let me share a story I usually come across in various parts of Nepal. Here, I would like to share an anecdote of a Dalit family (as shown in the picture above) that I had to come across in Sankhuwasabha in Eastern part of the country. This was in the year 2008, the month of rain. I had to visit one remote village since there was a report of measles like illness outbreak, so I had to travel all the way on foot for 2 whole days. Sometime, we had to walk for hours uphill and sometime, walk downhill for hours straight to river between a gorge. We had to cross the river in an old leaky boat. 

Once we reached the village and responded to the outbreak with necessary preventive measures including samples collected to confirm the diagnosis. The local office aid from the health post advised her to consult with me. The health professionals who were supposed to be serving this unfortunate people were on long leave, and the health care delivery was the mercy of the health aid. Utilizing his knowledge and experience, he did what was supposed to be done for any kind of illnesses. At least, he was there to be beside these people in their sickness. 

Photo - Anuj Bhattachan (verbal consent +)
On that day, I came across a young girl with a worried face in a dirty clothes covering her whole body (shown in above picture). From my cursory assessment, she was in a terrible situation and top of it, being a girl from a Dalit family. She was taken to local health post after everything done to cure this skin lesion failed. Her parent told me they applied all kind of herbal ointment suggested by locals. In the health post, there was not enough medication and trained health personal. The health aid was the only guy to dispense whatever medicine was there in their cubicle. When I asked them, " What is the white ointment applied in her weeping sore?" To my surprise, it was paracetamol (anti fever drug) applied in its powder form (after they grinded the tablet) !! No comment further, I carefully examined her and came in a conclusion that she was infested with scabies.  Once the disease was recognized, the girl including family members were advised what needs to be done. I knew, if i prescribe the anti scabies drug, it would be difficult for them to purchase it. So we arranged a way that she gets the drugs and all the members also gets necessary precautions.

Photo - Anuj Bhattachan (verbal consent +) 


What stands out from this story is social ills that keeps people perennially poor & illiterate. In this environment, we are bound to suffer from every kind of exploitation, so women suffers the most. If women suffer, their children also suffer. This is where every kind of diseases take root like scabies, tuberculosis, worm infestation, skin diseases, and many others - you name it and you will find it. Therefore, I am of the opinion, it is only through healthy dialogue and discourse that we can bring change in the society. The change that accommodates people's aspiration for equal opportunity and treatment. This is one of initiative to start dialogue and discourse in this area of social justice, which is root to any kind of disease dynamics. This is one of my realization over the years. Now, i think, i have matured enough to justify my graying of hair. May Wisdom Prevail !!

17 Aug, 2014



Jul 30, 2014

Let us know more of Ebola Virus Disease (EVD)

This year 2014 started with accidents or vanishing of Malaysian Airlines (no one knows where !!) and recent sinking of a ferry carrying school children heading for Jeju Island, South Korea. We were trying to forget this sad event, now we are bombarded with news about Ebola Outbreaks in some African countries, mainly Guinea, Sierra Leone and Liberia. I am particularly interested in this news because of my personal interest scanning anything that are emerging and re - emerging diseases in literature or social media.


Though we may think, these African countries are far  away from us, so we may plainly say, "Why do we have to worry about it?" On contrary, we need to get worried. First, humanity is suffering and dying from this disease. Second, we can not rule out that this disease may spread to other continent if ecology favors it circulation. I feel, therefore, the argument, " We are geographically distant so we are not at risk" no longer holds true !! To support my point, we can talk of recent cholera outbreak in Haiti that preceded a major earthquake that ravaged whole of the country in the year 2010. This was one of the worst disaster of massive scale that human kind has to face and deal with. This natural disaster affected thousands of family losing their near and dear with high death tolls.

Once Haiti was hit by cholera outbreak, the detailed epidemiological investigation(s) along with massive humanitarian relief activities was carried out by various international organizations and universities. It was reported that the bacterium was introduced into the country by those who actually came their for humanitarian assistance in the country. This brought about lots of academic as well as political debate, which is still haunting United Nations. Some academicians asserts that the organism was introduced in there from Nepal based on genotyping study.

Let us not go into dispute and argue who brought this bacterium or who did not and play political game. My main point here is - we are now living in a global village. Our travel time is much reduced, it is also said humorously that "Nowadays that we can have dinner in Asia and Toilet in Europe!!' Partly, this is a fact, we may like it or not !! Another popular saying that floats among disease detectives is that "lethal organisms do not need passport like we humans need!!" and to add some experts even say, " Some of them even evade immigration very easily" This two statements really stress that no body is out of danger. Infectious diseases can travel across continents in disguise.We have to be extra vigilant more than ever.

Ebola virus (source: commons.wikimedia.org)

Ebola Virus Disease (EVD) is caused by Ebola virus (EV). This virus is named after Ebola river in Zaire (now DRC) and first reported in 1976. There are five species of  EV and are named after their place of origin: BundiBugyo, Sudan, Reston, Ivory coast and Zaire. This disease spread through close contacts with
blood, secretions and other bodily fluids. It is said that EVD is highly contagious and fatal. This virus circulates in animals population - Bats and primates such as Chimpanzee and even deer. Human are accidental host. (Please look up at he EV Ecology below). There is no medicine or vaccines for this disease. Some experts say that this is the result of human economic activities interfering with natural habitats. So, this is unfortunate, the people have to face this deadly diseases on top of economic hardship in low economic setting. This outbreak this year has caught many international newspapers' headline, however, I am interested to understand the gravity of this disease outbreak myself.

Source: http://www.cdc.gov/vhf/ebola/resources/virus-ecology.html

Another thought that I am playing with for these few days -" What does this outbreak means to other countries in Indian subcontinent like Nepal?" As I read in MSF blogs, EV circulates in fruit bats as its natural host and these bats are found in this continent as well. As of now, we have no report of EVD here. We should remember, there are similar kind of viral illnesses linked with fruit bats that feeds on cell sap of a tree. This are Nipah and hendra virus. These viruses have been reported from Bangladesh (to my knowledge), which is just few km away from Eastern border of Nepal. Therefore, my only concern is whether this EV can get introduced in this geographical region? I need to better understand this disease through literature. My only wishful assumption is EVD  is still geographically at distance and may be, the ecosystem here in our continent does not favors for EVD to spread. To understand more of Ebola, please visit: 

  1. WHO website - http://www.who.int/csr/don/archive/disease/ebola/en/
  2. CDC website - http://www.cdc.gov/vhf/ebola/outbreaks/guinea/
  3. PLOS Neglected Tropical dieases - http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003056



Jul 24, 2014

Jul 21, 2014

Remembering Dengue Fever

True, Dengue is a fatal disease and can fetch you to intensive care unit in few days. This viral illness is spread by the bites of Aedes mosquito, particularly A. aegypti.The infected mosquito harbors Dengue virus (DENV). It is commonly reported that DENV consists of 4 stereotypes. However, there is a recent report of fifth serotype. Text book writes that the illness starts with fever, headache, muscle ache and joint pains, which is followed by "blue patches" suggestive of decrease in platelet counts. We need to remember that platelet is important for blood clotting process in the body, so its compromised number can lead to severe bleeding problem. Notoriously, we call this situation as Dengue Hemorrhagic fever (DHF), which can even take one's life if not treated timely or properly. Another remarkable feature of this disease is said to be the intensity of its pain so people have remembered it as "Break Bone Fever" in some community. These days, we have enough pain killers available in health post or clinics, so we may alleviate ourselves from this intense pain. However, I can imagine, there are still pockets of community in low income countries, where people are devoid of access to even paracetamol !! 


Source: www.facebook.com [Yugesh Dhungana 22/July/2014


Those who have survived this disease truly know the suffering in and out - bed ridden, weak even to walk, dizziness, nausea and vomiting, bleeding from your orifices or impending fear of losing your life. For some of us, this may sound pontificating on your thoughts, but this is what a friend of mine has to say recalling his good memory intermixed with period of illness, diagnosed as suspected dengue fever. Here is how he reminisces the disease, " Today, I observed my profile picture keenly and discovered a lot of changes on me. This was the photograph of mine when I was on a first honeymoon trip to UK, India....from where I caught DENGUE (manifested, I would rather say)....a narrow escape from death with platelet count plummeting to 30,000. I look thin n young....subtle changes over four years has given a cumulative difference turning me more plethoric n wrinkled. Everyday, ageing engulfs us deducting each moment from life's tenure. That's why BHUPI ( Nepali poet) once told...HAR DIN JINDAGI CHHOTIDAICHHA YASARI NAI, TOOTH PASTE JASTAI..!!"



In Nepal, all 4 serotypes of DENV have been reported through government reports and journal publications. Therefore, Dengue is not anymore a new exotic disease in our part of the world. Yearly, we hear and read news reporting of suspected or confirmed outbreaks of Dengue fever in Terai (East to West). It is said, Dengue is related closely with urbanization and weather. So, we read that most of the outbreaks occurs in cities. Now, we also fear and already starting to hear the spread of DENV in hilly districts. Now, majority of the districts in Nepal are linked with roads, so there is easy mode of transportation within matter of hours. You can imagine, it used to take days and days to travel from hilly districts to Terai but now we can travel in a matter of hours. This expose us to importation of various diseases through person to person or through vector like mosquito. Another important global phenomenon that has contributed to the dynamic of vector borne diseases is climate changes - increasing temperature, further compounded by increasing population density and rapid urbanization. Therefore, we need to act fast reasonably and in SMART ways so we can do away with these emerging illnesses, which we can control and prevent, otherwise let me say - more of such stories where this disease will leave no one - rich or poor !! To end this short scribble on DENV, there are some encouraging news, we can hear that DENGUE Vaccine availability to the population is just few years away. There is a recent press release (11 July, 2014) that particularly says that clinical phase III trail on DENV vaccine has shown encouraging results.  


Anuj Bhattachan
22/July/2014