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Support to Diarrhea Epidemic in Rukum and Jajarkot

Brief Report on the Support to Diarrhea Epidemic  in Rukum and Jajarkot Districts
 
Background
Upon breaking out of diarrhea and cholera in the mid west and far west regions of Nepal claiming more than 400 lives (132 in Jajarkot, 33 in Rukum), Annapurna Post of Asia Pacific Communication Association (APCA) through its campaign “Sahayogi Haatharu” has publicly announced fund collection for immediate relief and recovery.  

Development Project Service Centre (DEPROSC Nepal), a non-government organization has been supporting deprived communities in 41 districts with main goals of empowering rural people for attaining self-sustaining socio-economic uplift through a package of policy research, action research, humanitarian assistance and training. It has been constantly working in the mid west and far west region since 2002 including Rukum and Jajarkot - the most diarrhea affected districts. Even during that outbreak it has been implementing ‘Social mobilization and Hygiene promotion campaign for diarrhea control and prevention in Rukum, Jajarkot and Humla districts’ based on which Annapurna Post assigned the responsibility of mobilizing its existing human resources and network for the diarrhea relief and recovery.

Alliance and Coordination
Annapurna post, Norvic Hospital, UNICEF and DEPROSC Nepal have joined hands together to functionalize the efforts. Annapurna post raised fund, DEPROSC Nepal procured items, facilitate for transportation, identified households and distributed the materials to diarrhea affected people. UNICEF as cluster coordinator took lead at the national level in coordinating things. District Health Office (DHO), District Water Supply and Sanitation Office (DWSSO) and District Disaster Rehabilitation Committee (DDRC) led the activities at the district level identifying partners, allocation of working areas among them and overall coordination.

Support and Supply
As an immediate support and relief, some basic diarrhea and cholera controlling medicines and precautionary items such as ORS suspension, water purifying chlorine solution (Water guard and Piyush) and hand washing soap were identified as crucial ones and supported to each and every affected household of Rukum and Jajarkot districts. Support was done with better coordination of DHO, DWSSO, Local NGOs, Nepal Army, Nepal Red Cross Society and other NGOs/INGOs.

Methodology of Distribution
DEPROSC Nepal Head office Kathmandu, its Regional Office in Nepalgunj and District Offices were involved at different points. Existing staff and additional 50 Volunteers / Supervisors were involved in distributing the materials at the household level. Materials purchased and received in Kathmandu were transported to Nepalgunj using the DEPROSC Nepal and UNICEF’s delivery means. Those later transported to the respective field using tractors, mules and porters. Each and every household of the identified 21 VDCs were provided with 5 sachets of ORS, 2 pieces of lifebuoy soap and 2 bottles of Piyush.

DEPROSC Nepal hired and trained hygiene supervisors and village facilitators - previously phased-out - for this purpose. Teams comprised of one to three members depending upon the settlement and household of VDCs (one hygiene supervisor/volunteer and village facilitator and/or social mobilizer in each VDC), other field staffs were mobilized depending upon the situation of the targeted areas.

As a part of social mobilization, the entire district team was fully mobilized at the targeted VDCs and headed forward in close coordination with SHP/HP and other stakeholders while performing the assigned tasks. Existing community networks (COs, child clubs, mother groups, formed WASH community) were also mobilized as per necessity. The team at first conducted the settlement level orientation and awareness raising activities then distributed IEC materials, display of information banners, flax, flipcharts at strategic locations within the VDCs; and also demonstrated on how to purify water using chlorine product in each and every settlement of targeted VDCs. Utilization of the materials distributed were tracked down up to the household level. The distribution records are maintained using Bharpai.
Distribution
Materials received in kind from various organizations and procured from the market with the funds received from APCA have been distributed in Rukum and Jajarkot at the household level. The table below shows details of total procured, total received in kind and distributed to the households of Rukum and Jajarkot.
Table 1: Diarrhea Relief and Recovery Materials Distribution
Item Particulars Total Procure Received in Kind Total available Distributed in Rukum Distributed in Jajarkot
1 Soap (Lifebuoy) 15261 15001 16761 15761 1000
2 ORS Sachet 49600 30002 52600 24340 28260
3 Water purifier (Piyush) 27616 0 27616 27616 0
4 Medicines3 The list of medicines and the hand-over letter are included in the annex.
1 Received from Norvic International Escorts hospital in kind.
2 1000 received from APCA and 2000 received from Norvic in kind.
2 57 varieties of physician’s samples and 14 varieties of other medicines received in kind from Norvic International Escorts Hospital have been handed over to Government’s Mid-western Regional Medical Store, Nepalgunj. 
Monitoring
District team regularly coordinated with DDRC, DHO, DWSSO, DDC, VDC, SHP/HP, WASH community and other respective stakeholders, then assisted to organize/facilitate coordination meeting. Monitoring and supervision task was smoothly carried out; it helped to identify and address gaps at the community level to meet current life saving needs. Personal hygiene message, point of water use, preparation of ORS, use of Zink tabs, Brest feeding for children and its importance; all these key and important messages were given through door to door visit. It was a successful effort in supporting diarrhea affected people during that epidemic period.

Forward
It has been obvious that such epidemics are broken out in the rural areas where awareness level is quite low, personal health and hygiene is severely poor and the community is embedded with various superstition and taboos. Therefore, we need to put focus on raising awareness on personal health and hygiene, use of safe drinking water and preparedness for such outbreak in the future which would definitely minimize the risk of claiming life. 

Annexes:
Photographs:

 
 District level Orientation to Supervisors, Rukum    Distribution of support materials with orientation to the community, Rukum
 District level Orientation to Supervisors, Rukum   Distribution of support materials
with orientation to the community, Rukum
     
 Materials distribution with receipt, Rukum    
 Materials distribution with receipt, Rukum    
 
 Picture of materials distribution with orientation, Rukum
Picture of materials distribution with orientation, Rukum


Annex II: List of Medicines
57 varieties of physician’s samples and 14 varieties of other medicines received in kind from Norvic International Escorts Hospital have been handed over to Government’s Mid-western Regional Medical Store, Nepalgunj:

Physician’s Samples:
 
S.N Name of Medicine Unit Total Quantity
1 Ambroxol Hydrochloride Syrup (AMIBRODIL) Pcs 4
2 Amoxycillin & Dicloxacillin Capsule Capsule 200
3 Amoxycillin for oral suspension IP (ARISTOMOX) Pcs 4
4 APET Bottle 43
5 Bismuth subalicylate Suspenoion (170) (Pepto Norm) (170ml) Pcs 20
6 Cifran 250 Pcs 97
7 Cifran 500 Pcs 99
8 Ciproffaxcion tab (ALCIPRO 500) Tablets 40
9 Cledomox (Amoxycilli & potassium clavulanate Pcs 50
10 Cyclo mps Bottle 2
11 DJ-Citral Bottle 10
12 DROSTAT 80 Tablets 20
13 Entazyle Bottle 1
14 Entazyle AF Bottle 7
15 FAM-O 20 Pcs 18
16 Fenceta Ibuproten & paracetamol Tablets 600
17 Flontin 500 Pkt 35
18 Fluconazole Tab. (Fungilasm 150) Pcs 50
19 Foltab Pkt 5
20 Fortiplex Pkt 12
21 Fortiplex-m Pkt 8
22 Fortivit Vitamin B Complex Pkt 15
23 HISTAC 150 Tablets 1800
24 Injection of vitamin Bcomplex with vitamin B12(polybion) Pcs 300
25 kethin Pcs 25
26 Lysovit Drops (15ml) Bottle 10
27 Lysovit Vitamin B Bottle 10
28 Medicath Pcs 18
29 Mediflon plus Pcs 60
30 MEDIKIT Pc 1
31 Medikit Set 24
32 Moxyrex plus Pkt 8
33 Neocan plus Pcs 33
34 Nepoten-k Pkt 10
35 Norflaxacion Suspension Bottle 4
36 Oflontin Bottle 10
37 Oflontin 200 Pkt 30
38 Ofloxacin suspension 50 Pcs 36
39 Ofloxacin tablets IP Pkt 44
40 Paracetamol & Chlorzoxazone Tab Tablets 100
41 Pepto Norm Bottle 15
42 Peptozyme 100ml Bottle 7
43 Peptozyme 200ml Bottle 6
44 Peptozyme Drops Bottle 13
45 Peptozyme fungal Diastaset pessin Pkt 14
46 Protogyl DF Pkt 9
47 Protozgyl Bottle 32
48 Protozgyl DF Bottle 22
49 Protyzyl DF Bottle 10
50 Safecan Pcs 25
51 Sporidex 125 Pcs 60
52 Sporidex AF-375 Pcs 5
53 Tinidazole GAT 500 Pcs 80
54 Trimethoprime salphame thoxazole tab (Tabrol- DS) Tablets 100
55 Vitamin B- complex with c (Omniplex) Pcs 16
56 Zinc DT -20 Tablets 200
57 Zulid 250 Capsule 144

Non-Physician’s Samples:
 
S.N Name of Medicine Unit Total Quantity
1 Albendazole chewable tab Pcs 200
2 Aqua tab (water purifier) Pcs 38
3 Cipromax Injection Bottle 20
4 Cirofloxacin injection IP (0.2%wv) (Nircip) Pcs 60
5 Cirofloxacin injection IP (NIRCIP) Pcs 60
6 Cirofloxacin injection IP (NIRCIP) Pcs 120
7 Compound Sodium lactate INJ IP (Nirlite) Pcs 125
8 Compound Sodium lactate Intravenous Infusion BP 1000Ml (Claris) Pcs 60
  Dexoride (DNS INJ 1Ltr) Pcs 25
9 Dizithro 250 Pcs 18
10 Intravenous Infusion BP (Lactoride) Pcs 102
11 Metriz 400 (Metronidazole tab) Pcs 680
12 Metronidazole INJ IP ( NIRMET) Pcs 240
13 Metronidazole INJ IP ( NIRMET) Pcs 60
14 Oyster Infusion set-vented Pcs 100
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