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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: [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

Jul 15, 2014

I got INVITE to write !!

Now, I am back from 3 weeks of home leave. As always, I reached office early in the morning and checked e - mails. Hundreds of mails !! I patiently scrolled through all and responded to those urgent and organized the rest in files. Today, I am particularly interested in one mail sent by Linkedin .This is an invitation to write. Wah...For me this is so important that I am excited but whenever, i think of writing I go through a kind of "uneasiness" how to start and what to write? Nonetheless, I am getting a dominant positive thought that this must be the beginning and I should act on it. After all, each of us improve and start doing well only after continuous practice. There is no shortcut !!

To begin, I have to be honest, I am not a professional writer. However, one thing is common to everybody and that is, everybody has something to say - that is STORY of their own. Also, we have to start somewhere early in your career or late. It does not matter, how good or bad you write. My only intention here is to write, write and write. Nothing more, nothing less !! So let me start by saying that i am going to write whatever comes through my mind. After all, it will not be any worthless irrational thoughts.
Story begins. This time, I planned my leave in different in a way. I planned about it a month back. As always, early planning makes everything better in terms efficiency and it saves lot of time & of course, your money. Above all, one important feeling has taken over me and realized after returning back to Seoul that this trip is in a way spiritual journey. Seeing the dire situation of our country and all the cacophony that your hear has made me in thinking mode. What next?
To forget those noises and begin the journey of hope, let me briefly walk you through short reminiscence of my childhood and professional career that started from Nepal and now in Seoul. I come from a rural mountainous part of Nepal. Like any child, I had many dreams like joining British Gurkha army or be a trekking guide. As time progressed, I completed high school and lucky enough to enter a university in Kathmandu, where I got inspired to study science and dreamed of becoming a doctor. I studied hard day and night. Somebody rightly said that "luck favors those prepared mind". I was lucky because I prepared hard and entered a government medical college. It was here that I understood the value of health research in order to expand our limited knowledge.
On completion of med school, I worked in a hospital in eastern part of the country for a couple of years. Here, I come across face to face with various infectious diseases as a result of poor drinking water, sanitation and poverty like acute diarrhea, pneumonia, malaria, measles like illness, poliomyelitis, tetanus, rabies. During this period, I would say, I partially understood the nature of diseases of the impoverished, so I took up a jot at WHO – Program for Immunization Preventable Diseases, Nepal. As a surveillance medical officer, this job required application of core public health competencies, which is a combination of social skills and knowledge based on evidence. I had to manage Vaccine Preventable Diseases (VPDs) surveillance, conduct mass vaccination and investigate disease outbreaks & reports of adverse events following immunization. During this job, I realized, I need to develop myself further in the field of health research.
Fortunately, I got an opportunity to work for International Vaccine Institute (IVI) that requires skills and knowledge in clinical development of vaccines for fighting diseases that mostly affects children in the developing countries. To further my career, I have cherished a dream that I am able to master health research skills, so I can train more health professionals able to conduct quality health research in Nepal.

In tweetosphere

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Jul 12, 2014

On Viral Hepatitis

The World Hepatitis Day  is celebrated worldwide on 28th July, 2014. This day is organized by World Hepatitis Alliance.  I would like to take part and contribute in whatsoever capacity I can in order to make this day meaningful. For me, this day is personal because I know what does it mean to suffer from viral hepatitis. Like me, millions of people even today suffers or have suffered from this preventable disease due to various reasons.


First let me take you through my personal suffering as a result of viral hepatitis in early 1990s. At that time, I was studying in Kathmandu University, which was then located in Hadi Gaun in the valley. In the university, I was studying science (biology, chemistry and physics) aiming to be a doctor. It was in the second year, I caught jaundice and got confined to bed for almost 3 weeks. I was profusely vomiting and white of my both eyes became yellowish including skin. Commonly, people also call it as "Jaundice", where your white part of eye and even to some extent your skin turns yellow due to increase in "bilirubin" pigment in your body. I felt so weak and my appetite was so poor that I could not even tolerate the smell of food and walk few steps. During this illness, I took care of myself with pure restriction of those foods that were said  not to be eaten or avoided, instead had to rely on boiled vegetables and glucose reach sugarcane juice or papaya fruit. Slowly, day by day, I recovered from this illness and regained my strength and started to visit university class again. Looking back, now I realize, what it means to suffer from this preventable illness. I also came to know that I did suffer from viral hepatitis, which may have been be either type A or E [ Note - Here, I have  omitted anything about type B and C - this was not the type I contracted. However, I acknowledge that type B and C are even more notorious in its nature]. At that time, I was taken to local Vaidya (medicine man), who prescribed me herbal remedy. I took those remedy regularly with food supplementation. Now, I know that this viral illness is self limiting infection as a result of compromised water and sanitation. Somewhere in the chain of event, I must have got infected with this water borne illness. May be somewhere in the restaurant - where food hygiene must have been compromised. 

Structure of Hepatitis E virus

Now, let me walk you through  a public sphere and understand what happens when this same disease spreads in a community, where water and sanitation is compromised that is common in low income settings. In my last blog post May 2014, I wrote a briefly on "Increasing Reports of Enteric Diseases in Nepal". In that post, I stressed more on acute viral hepatitis outbreak that created news headline in national media. This outbreak was reported directly from Biratnagar, a city in Eastern part of Nepal. This outbreak created fear in the center of the city and caused huge toll of morbidity and some deaths. Some people said that whole town was frenzy due to this outbreak and everybody both rich and poor vulnerable to this illness. The sample tested were found to be hepatitis e virus. As per World Health Organization (WHO), this disease affects globally 20 millions of  people every year, around 3 millions get acute hepatitis and - 56,600 hepatitis e related deaths. Apart from its morbid nature, this virus can sometime lead to acute fulminant hepatic failure, which can even take someone's life. It is reported that hepatitis e infection during pregnancy is the gravest danger posing threat to the mother's life. This illness is, as I already mentioned, more prevalent in low income setting like in South Asia or Sub Saharan countries. I therefore say that this is public health problem that we can do away with clean water, proper sanitation and health education. However, I see such improvement in providing clean water and improved sanitation takes time, given the current socio - economic landscape.

A child with jaundice

Nonetheless, the best health policy is to impart people with health education on importance of hand washing, boiling water and visiting health professional if we get infected with this preventable illness. WHO also report that there is availability of vaccine against Hepatitis E & Hepatitis A. Vaccine against A is available. It is recommended to use in outbreak prevention in conjunction with improvement in water and sanitation. Regarding Hep E, China has produced and licensed the vaccine, but it is not widely available globally. There must be various reasons why this vaccine is not available in other countries. Finally, I feel, it is the common right of people living impoverished get safe, effective and affordable Hep E vaccine and this is what whole world is waiting for !! 

Anuj Bhattachan
12 July 2014

Jul 8, 2014

Random thought - Global Health and Diseases of impoverished

We are living in 21st century, the age of supercomputers. Or you may call it - the age of big data. So, for some of us, diseases related with poor water / food supply and sanitation may sound as a story of medieval period. You may also say, "I read only in a book !!" However, it is a fact that millions of people are still living with abject poverty and millions of children have to lose their life before fifth birthday. Even if we go through pages of our history, we have faced global pandemics that created havoc across Europe to Asia. Millions of people lost their invaluable life to cholera, flu pandemics, smallpox, tuberculosis, and thousands of children got handicapped & live crippled life due to paralytic poliomyelitis. On positive note, to be fair, we have also successfully controlled, eliminated or even eradicated many of these infectious diseases with the use of vaccine and public health measures since science took its foothold in the society from early 1900s. As an example, the greatest achievement in the human history is the eradication of small pox so far. The last case of this disease was detected in Ethiopia in 1980s. Now, we are almost nearing poliomyelitis eradication from the globe. In the backdrop of this success story, however, people in developing countries are still fighting death and illnesses caused by waterborne, airborne and vector borne diseases (in whatever capacity they can!!) through local and modern remedies available. But, the only challenge, this is further compounded by increasing population density, deforestation, climate changes, increasing numbers of multi – drug resistance bacteria, urbanization and poverty. It is reported that millions of children still miss regular vaccination either zero dose or incomplete dose. The reasons are simply related with a big gap in access and utilization of vaccines that are available through government health care delivery services. This means that all these missed children are "at increased risk" of vaccine preventable diseases and thus, outbreaks in the community. These unfortunate missed children are usually from poor family, especially tribal community or millions of so called "untouchables", who are pushed to the corner of social ladder always "under – privileged" and illiteracy rampant. So, we have a mission to reach these "High Risk" populations and provide them access to safe, effective and affordable vaccine against diseases of impoverished using science as its means. Our ultimate goal therefore should be to transcend vaccine science research from laboratory to the reach of community in high risk areas of developing countries.

Anuj Bhattachan
9th July, 2014