Doctors declare ‘epidemic’

Photo by: Rick Valenzuela
Sok Reaka, a six-month-old suspected cholera patient from Kampong Speu province, watches a nurse tend to him at Kantha Bopha Children’s Hospital on Wednesday.



Thursday, 11 February 2010 15:04 Brooke Lewis and Tep Nimol

Hospitals confirm 14 cholera victims as officials dispute any confirmed cases

DOCTORS from two hospitals confirmed 14 new cases of cholera on Wednesday, but the Ministry of Health continued to question whether any patients had tested positive for the disease, a position that has drawn criticism from officials at a children’s hospital in Phnom Penh.

Dr Denis Laurent, head pathologist at Kantha Bopha Children’s Hospital, said six new cases had been confirmed there on Wednesday, bringing the total number of cases treated so far this month to 25. The hospital recorded 65 cases between November and January. “This is an epidemic,” he said.

Or Vanda, deputy director of the technical office at Calmette Hospital, said staff there had confirmed eight cases of cholera on Wednesday. He added that families living nearby the eight people who tested positive for cholera had not been told of the diagnoses.

“In principal, it isn’t good for the public to be informed, because people become surprised and disturbed because cholera is regarded as a serious disease in their minds,” he said.

Despite the reports from the two hospitals, Ly Sovann, deputy director of the Communicable Diseases Control Department at the Ministry of Health, said he did not believe there had been any cholera cases in Cambodia. “Doctors have a right to say their own opinions,” he added.

Nima Asgari, public health specialist at the World Health Organisation, said there was no doubt that cases of cholera had been confirmed, but that cholera is just one strain of watery diarrhoea, an affliction that is common during the dry season.

He said there was no need to distinguish between cholera and watery diarrhoea when warning people about the possibility of an outbreak.

“From the viewpoint of preventing transition and providing treatment [for cholera and other forms of watery diarrhoea], the initial steps are the same,” he said.

But Dr Visoth Mony, deputy director and head of the intensive care unit at Kantha Bopha Children’s Hospital, said seasonal diarrhoea is often caused by a virus, whereas cholera is caused by bacteria. He said cholera could very quickly lead to liver failure and death, and that the two diseases need to be treated differently, with suspected cholera patients given antibiotics immediately.

“The WHO completely disagrees with that statement,” Nima Asgari said. “To routinely give out antibiotics is not the way the WHO recommends dealing with cholera. The first step should be rehydration with fluids and electrolytes.... Cholera kills because it dehydrates people.”
Photo by: Rick Valenzuela
Dr Khieu Kolrath holds up a petri dish showing a confirmed cholera specimen at Kantha Bopha Children’s Hospital on Wednesday.

Nima Asgari said the majority of cholera cases could be treated simply by drinking plenty of fluids. “The first line of treatment for cholera is oral hydration – lots of water and supplements such as Royal D,” he said. “Those who become sicker and are still dehydrated need to be admitted to hospital for intravenous treatment, and a small amount of these patients will also need antibiotics.”

Dr Beat Richner, director of Kantha Bopha Children’s Hospital, said it was imperative that people in affected areas be informed about the threat of cholera and told how to seek immediate help because, in the worst cases, the disease can kill within hours.

“We know about a 13-year-old girl who died because her family was not informed that their neighbour had cholera,” he said. “This girl would not have died if they’d been informed.”

Visoth Mony said the Ministry of Health must know of the presence of cholera because the hospital was obliged to report all communicable diseases to the government.

“We have reported every case, and the Ministry of Health comes to the hospital to make reports, and they say that they will warn people in the villages. But when [patients] come to our hospital, they usually say nobody went to their village,” he said. “Just 40 percent of patients have received information from the Ministry of Health, and 60 percent had heard nothing.”

Nima Asgari said he believed the Ministry of Health generally informed families living in areas stricken with many cases of watery diarrhoea about the potential threats.

Laurent said he did not know why the government might be reluctant to confirm the existence of cholera, but he speculated that it could be due to fear of a potentially negative impact on foreign investors and tourism. “Our goal is not to create panic, but we have this problem now with cholera, and we have to react,” he said.