Wednesday, November 28, 2007

Diarrhea and Rang De Basanti

Today was the final evaluation of a bilateral initiative – the Project for Control of Diarrheal Diseases. The collaborative project had been launched in 1997 between the National Insitute of Cholera and Entreric Diseases (NICED) Kolkata and the International Medical Centre of Japan.

Now, ten years down the line, it was time to take a hard look at how the project had fared. An external evaluation team had completed its work and a presentation was organized at ICMR Delhi. The results were interesting – a two-hour session packed with data, PDMs, LogFrames, and somber speeches... interrupted every now and then by a peppy Rang-De-Basanti ringtone from the chairperson’s mobile phone.

The ringtone was irksome; completely out of place but it did not dilute the seriousness of the problem at hand.

Diarrhoeal diseases kill millions children in India every year – 35.4/1000 live births (Apr.2007) . It is the single largest cause of “infant mortality and morbidity in Third World Countries”. Since its victims are mostly brown and black kids living in third-world hovels, it naturally gets only a fraction of the money that goes for medical research.

WHO requires all countries to report data for only three diseases – cholera, plague and yellow-fever. Few actually do. But, of the three, it is cholera (and allied diarrheal diseases), that can easily be controlled through hygiene and sanitation. This is an embarrassing, inconvenient fact.

So embarrassing that many countries refuse to divulge data. Bangladesh perhaps loses more kids to cholera and enteric diseases than any other country but its officials like to pretend otherwise. Even Thailand too does not disclose data on diarrhea mortality fearing, perhaps, a negative impact on its booming tourism industry.

In India the data is patchy but it is there. More importantly, it is willing to do something about the problem and share whatever it learns. It is an open-mindedness that is born from the friendship of two researchers who met 40 years ago in Osaka, Japan.

Dr. Y. Takeda and Dr. N.K. Ganguly, met on an exchange programme and both grew to be formidable administrators and researchers in their respective countries. Persuading governments is a lot easier when you’re at the top, and that is exactly what Takeda and Ganguly as heads of IMC and ICMR respectively.

It has been a very productive friendship. Apart from sending scores of leading scientists, training hundreds of Indian counterparts and building an International Diarrheal Disease Research Centre at NICED (Rs.85 Cr., 1996), it has persuaded a large number of talented Indian researchers to stay back and seek solutions to a local.

But how to you measure success of a project like this?

A common symptom of diarrhea is “loosies” which, if left unattended, quickly dehydrates and kills children. But the causes are many –


* Bacteria (Vibrio cholerae, shigella, E.coli, aeromonas…over 2500 species)
* Viruses (Noro-virus, sapo, astro, rota, adeno, pico…over 400 types)
* Parasites (hookworm, ascaris, E.hystolytica, etc.,)

So the first step is to identify the buggers, and then to be ready with trained personnel and cures before a pandemic strikes again. This is exactly what NICED has been trying to do – identifying hundreds of strains (Etiology), producing anti-sera for each of them, archiving strains, and training hundreds of scientists.

The training helps create a surveillance network and producing the antisera locally helps save a lot of money – in the world market, 1ml costs about $200! Another measure is the impact of path-breaking medical research – over a 100 papers has been published since 1997.

On the whole, things seem to be on track. Now, if only the chairperson would switch the mobile into silent-mode...

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