Day: January 3, 2018

At Balukhali refugee camp in Bangladesh, unclean water, cramped living quarters and squalid conditions create a prime environment for outbreaks of preventable diseases among the estimated 650,000 Rohingya Muslims who have fled strife in neighboring Myanmar.

While 900,000 doses of oral cholera vaccine already have been delivered by more than 200 mobile vaccination teams, another contagious bacterial infection, diphtheria, has emerged.

“Diphtheria is a vaccine preventable disease. It’s an illustration of how the Rohingya population that are living in the makeshift settlements here had very little access to health care in their place of origin in Myanmar,” said Kate Nolan, emergency coordinator with international aid group Medecins Sans Frontieres, or Doctors Without Borders.

Diphtheria often causes the buildup of a sticky grey-white membrane in the throat or nose. The infection causes airway obstruction and damage to the heart and nervous system. The fatality rate increases without the diphtheria antitoxin.

“This is an extremely vulnerable population with low vaccination coverage, living in conditions that could be a breeding ground for infectious diseases like cholera, measles, rubella and diphtheria,” said Dr. Navaratnasamy Paranietharan, the World Health Organization representative to Bangladesh.

Myanmar’s health sector is rated among the worst in the world, particularly in the ethnic regions where conflict and poverty have delayed medical development.

The Rohingya refugees fled Myanmar’s northern Rakhine state after insurgents attacked security forces in late August, prompting a military crackdown that has since been described as ethnic cleansing.

‘Appalling’ health care

Myanmar’s government denies it has engaged in ethnic cleansing, and it insists that a majority of the violence and burning of Rohingya villages was done by the Rohingya militants who attacked the Myanmar security forces.

“The health care facilities for the Rohingya in Rakhine state are appalling and just a small amount of the needs were being met, even before the attacks in August,” said Rohingya expert Chris Lewa of the Arakan Project, a human rights organization that monitors and documents the situation.

According to Lewa, the impoverished Rohingya population in northern Rakhine say they are treated with discrimination by Myanmar medical staff at government hospitals and face severe movement restrictions when traveling to health care facilities.

Lewa points to Myanmar’s Maungdaw District, where the army conducted so-called “clearance operations” following deadly insurgent attacks last year.

“Health facilities set up by INGOs [international nongovernmental organizations] in Maungdaw have been burned to the ground, which will make it even more difficult for them if and when they are allowed to return,” Lewa added.

Currently, INGOs are not allowed in the areas outside Maungdaw.

Doctors Without Borders has responded to the rapid spread of diphtheria in neighboring Bangladesh by converting one of its mother and child inpatient facilities at the Balukhali makeshift settlement, and at another inpatient site, into treatment centers.

“The emergence of this disease is a concern because it contributes to an existing precarious public health situation that we have in the makeshift settlements,” Nolan said.

Tracking down carriers

Now, potential carriers must get antitoxins and antibiotics to prevent the further spread of the bacterium and kill it.

“We need to find all the suspected cases in the camps and get them all here to start the antibiotic treatment and keep them isolated for 48 hours,” said on-duty doctor Thomas Hansen.

Because the disease spreads easily through water droplets from sneezing and coughing, medical teams are tasked with following up on initial quarantine with visits to a patient’s family to trace and treat people who might have come in contact with the disease in the community.

Doctors Without Borders and health partners like the International Federation of Red Cross and Red Crescent Societies are working together to isolate suspected cases.

One of the biggest challenges for health workers, however, is getting to remote locations where potential outbreaks can occur.

With the sudden influx of the 650,000 refugees, new land clearance has led to huts being constructed well beyond the main roadways.

“They live in areas that are difficult to reach. You cannot reach them by cars or Tom Toms [three-wheeled taxis] because of no roads, so they will have to carry their patients to where they can get treatment,” said Dagne Hordvei, team leader with the Norwegian Red Cross.

“We have an agreement with [Doctors Without Borders] that we take the measles patients from them, and they take the diphtheria patients, with lots of activity going out to the communities to try to reduce the speed of the spreading of diphtheria.”

Vaccination campaign

As Bangladesh’s Ministry of Health and Family Welfare — working with the World Health Organization, UNICEF and other health partners — implements a vaccination campaign to prevent future outbreaks of diphtheria, it appears that at least some of the next generation of Rohingya will have protection from preventable diseases.

“We are working with partners to ensure that clinical guidance is available to health workers, and that there are enough beds and medicines for those who get sick. But the only way to control this outbreak is to protect people, particularly children, through vaccination,” said the WHO’s Paranietharan.

As of December 21, Doctors Without Borders has seen more than 2,000 suspected diphtheria cases in its health facilities, and the number is rising daily. Most of the patients are between the ages of 5 and 14 years old.

More than 20 Rohingya in Bangladesh have died from the disease.
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Eleven years since the end of the civil war in Uganda, which pitted Lord’s Resistance Army rebels against the government, tens of thousands of people still struggle with post-traumatic stress disorder.

Mental health practitioners estimate that seven in 10 people in Northern Uganda were traumatically affected by the war.

At the age of 12, Francis Okello Oloya was blinded by a bomb blast as he dug in the family garden. In a boarding school for the blind, Okello found it difficult to ask people for help, especially in getting to the toilet at night. Now a 29-year-old community psychologist, that childhood experience led to the birth of a project involving what he calls comfort dogs.

“I had to navigate my way from the sleeping quarter to latrine and that was not easy,” he said. “And these dogs came to know that I needed help. And they began the practice of helping me from the sleeping quarters to the latrine. Being a person of visual impairment, you normally feel that you are going to burden people a lot.”

Dogs are mainly used for hunting in Uganda, with a few people warming up to the idea of owning dogs at home, mostly for security. But Okello began collecting street dogs, which were handed over to guardians with training in dog handling.

In 2015, Okello started The Comfort Dog Project to help people in Gulu town, especially those who were suffering from post-traumatic stress disorder, depression and anxiety.

Philda Akum, 35, is one of the 29 beneficiaries of the project. In 1997, she and her four brothers were abducted by the LRA and taken to Sudan.

One of her brothers tried to escape.

That brother was captured and killed, Akum says. Another brother was selected to go to the battlefront; he was shot dead. Two days later, her youngest brother contracted cholera and died. The horrors have left her traumatized, she says. She returned home and joined group therapy, which is how she got her dog, Lok Oroma.

Lucy Adok, 39, spent five years fighting in the bush.

“I was in combat and saw many people being killed,” she said. “I was destroyed. When I returned home, I experienced flashbacks and any loud sound sounded like a bullet. When I learned that I could get a dog as a friend, I took on Sadiq.

“I now spend a lot of time with Sadiq. I have dreams of our games during the day and slowly Sadiq has replaced the bad memories from the war.”

The dogs find a home, and the guardians find life companions.
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A first-of-its kind genetic treatment for blindness will cost $850,000, less than the $1 million price tag that had been expected, but it’s still among the most expensive genetic therapies in the world.

Spark Therapeutics says it decided on the lower price tag for Luxturna (Lux-turn-a) after hearing from health insurers about their ability to cover the injectable treatment.

Consternation over skyrocketing drug prices, especially in the U.S., has led to intense scrutiny from patients, Congress, insurers and hospitals.

Luxturna, approved last month, is the nation’s first gene therapy for an inherited disease. It can improve the vision of those with a rare form of blindness that affects just a few thousand people in the U.S.
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Malawi is battling a cholera outbreak that began at the start of the rainy season in November. The disease has killed four people, and more than 150 others are hospitalized.

The disease — an acute diarrheal infection caused by consuming contaminated food or water — affects children and adults, and can kill within hours if left untreated.

The hardest-hit districts are Nkhatabay and Karonga, on the shores of Lake Malawi.

“As of today, we have 137 cases which we have registered from Karonga only,” said Joshua Malango, spokesperson for the Ministry of Health. “And unlike Karonga, in Nkhatabay we have 16 cases as of today, with no deaths. While in Karonga we had three deaths.” 

The Kasungu and Dowa districts have registered one case each, while on Tuesday, medical workers confirmed two cases in the capital, Lilongwe.

The outbreak is believed to have been triggered by poor hygiene among residents, especially in Karonga.

According to Karonga-based journalist Special Absalom, more than 70 percent of people there use untreated water. 

“People who are along the lakeshore area use water directly from the lake, while others who are close to the rivers, they are using water from the rivers and some are even using wells,” Absalom said.

In neighboring Zambia, the disease has killed about 40 people in the capital, Lusaka, and affected more than 1,500 others since September.

However, Malawians bordering Zambia should not panic over the Lusaka outbreak, Malango says.

“We are not that close with Lusaka. But we are not taking it lightly. We are putting measures to ensure that people traveling in and out of the country, they must have proper surveillance, we have checked them to ensure that Malawians are safe,” he said. 

Meanwhile, Malawi’s government has embarked on a nationwide campaign to remind people to wash their hands with soap, especially after using the toilet and before eating any food.

More importantly, Malango says, the government is distributing chlorine and other chemicals to treat drinking water.

Malawi suffered its worst cholera outbreak in 2009, when 82 people died and more than 3,000 people were infected across the country.
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Anchorage, Alaska, was warmer Tuesday than Jacksonville, Florida. The weather in the U.S. is that upside down.

That’s because the Arctic’s deeply frigid weather escaped its regular atmospheric jail that traps the worst cold. It then meandered south to the central and eastern United States. 

And this has been happening more often in recent times, scientists say.

Why is it so cold?

Super cold air is normally locked up in the Arctic in the polar vortex , which is a gigantic circular weather pattern around the North Pole. A strong polar vortex keeps that cold air hemmed in.

“Then when it weakens, it causes like a dam to burst,” and the cold air heads south, said Judah Cohen, a winter storm expert for Atmospheric Environmental Research, a private firm outside Boston.

“This is not record-breaking for Canada or Alaska or northern Siberia, it’s just misplaced,” said Cohen, who had forecast a colder than normal winter for much of the U.S. 

Is this unusual?

Yes, but more for how long – about 10 days – the cold has lasted, than how cold it has been. On Tuesday, Boston tied its seven-day record for the most consecutive days at or below 20 degrees that was set exactly 100 years ago.

More than 1,600 daily records for cold were tied or broken in the last week of December, according to the National Oceanic and Atmospheric Administration. For Greg Carbin of the National Weather Service’s Weather Prediction Center, the most meaningful statistics are how last week’s average temperature was the second coldest in more than a century of record-keeping for Minneapolis, Chicago, Detroit and Kansas City, third coldest in Pittsburgh and fifth coldest in New York City. 

Is it just the U.S.?

Pretty much. While the United States has been in the deep freeze, the rest of the globe has been toastier than normal. The globe as a whole was 0.9 degrees (0.5 degrees Celsius) warmer than normal Tuesday and the Arctic was more than 6 degrees warmer than normal (3.4 degrees Celsius), according to the University of Maine Climate Change Institute’s analysis. 

What’s next?

The cold will continue and could actually worsen for much of the East Coast this weekend because of a monster storm that’s brewing in the Atlantic and Caribbean, what meteorologists are calling a “snow hurricane” or “bomb cyclone.”

But forecasters don’t think the storm will hit the East Coast, keeping most of the snow and worst winds over open ocean, although parts of the Northeast are still likely to get high winds, waves and some snow.

“For the Northeast, this weekend might be the coldest of the coldest with the storm,” said Jason Furtado, a University of Oklahoma meteorology professor. “We could be ending (the cold snap) with a big hurrah.”

What makes the polar vortex move?

This is an area of hot debate and research among scientists and probably is a mix of human-caused climate change and natural variability, said Furtado. Climate change hasn’t made the polar vortex more extreme, but it probably is making it move more, which makes the weather seem more extreme, he said.

A recent study by Potsdam Institute climate scientist Marlene Kretschmer found the polar vortex has weakened and meandered more often since 1990, but that study focused more on Europe. Ongoing research shows that there seems to be a similar connection for more frequent Arctic cold snaps like what the U.S. is now experiencing, Kretschmer said.

How can it be so cold with global warming?

Don’t confuse weather – which is a few days or weeks in one region – with climate, which is over years and decades and global. Weather is like a person’s mood, which changes frequently, while climate is like someone’s personality, which is more long-term, Furtado said.

“A few cold days doesn’t disprove climate change,” Furtado said. “That’s just silly. Just like a couple down days on the stock market doesn’t mean the economy is going into the trash.”
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After more than a decade of steady increases in the rate of children diagnosed with autism in the United States, the rate has plateaued in the past three years, researchers said Tuesday.

The findings were based on a nationwide study in which more than 30,000 parents reported whether their children had been diagnosed with autism spectrum disorder (ASD).

“The estimated ASD prevalence was 2.41 percent among US children and adolescents in 2014-2016, with no statistically significant increase over the three years,” said the research letter by experts at the University of Iowa, published in the Journal of the American Medical Association (JAMA).

The first observation of a plateau was made by a separate group in 2012, when the rate flattened out to 1.46 percent, according to the Autism and Developmental Disabilities Monitoring (ADDM) Network.

Federal health authorities say that means about one in 68 children in the United States have the neurodevelopmental disability, whose causes remain poorly understood.

The ADDM had documented a “continuous increase from 0.67 percent in 2000 to 1.47 percent in 2010.”

The 2.4 percent rate described in the JAMA report translates to one in 47 children, but researchers cautioned that the discrepancy may be explained by “differences in study design and participant characteristics.”

The JAMA report, based on the annual National Health Interview Survey, did not delve into “underlying causes for the findings and cannot make conclusions about their medical significance.”

The U.S. Centers for Disease Control and Prevention also noted a plateau in the autism rate in 2016, but said it was “too soon to know whether ASD prevalence in the United States might be starting to stabilize.”
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