Gastro cases very erratic – Chief Medical Officer

Jan 15, 2016 News

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– importance of collaboration to tackle challenge emphasised
The Ministry of Public Health has recorded a spike in the cases of gastroenteritis in Baramita, Region

One. Last week the Ministry made public that it was battling to contain an outbreak. But although a dip in cases was observed last week, a few days ago the number of cases seen by health workers increased.
This state of affairs was acknowledged by Chief Medical Officer (CMO), Dr. Shamdeo Persaud, who during an interview with this publication yesterday intimated that this development is not at all surprising.
Last week Minister of Public Health, Dr. George Norton, spoke of a decline in cases. At the time the Ministry had recorded just over 60 cases, with one resulting death. The recorded death is that of an 11-month old child.
But earlier this week, Minister within the very Ministry, Dr Karen Cummings, disclosed that the number of cases had increased to 80.
“That is the trick with epidemiology, sometimes you think things are getting better…but we hadn’t reached to all of the areas. It’s like a spike, some days down, some days up. I have seen the graph and since I saw it, I said this is not healthy…it is very erratic in the way that the cases occur,” Dr. Persaud revealed.
He has attributed the delay in the presentation of some cases to the Region’s geographic layout, and the fact that some infected people must travel long distances to access health care service.
“There might be places with cases even on the days when we reported zero, but they never got to the health worker; maybe they got there the next day…some of them are walking, coming by boats or ATVs and so on,” the CMO explained.
He noted that while the regional health team has been doing a laudable job to combat the outbreak, a team from Central Ministry is slated to be soon dispatched to Region One to render assistance.
TREATMENT
Gastroenteritis is classified as inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection resulting in vomiting and diarrhoea.
Those infected are treated with Oral Rehydration Salts (ORS), but according to Dr. Persaud, while rehydration is the main course of treatment, antibiotics can also be administered.
He disclosed that if persons are found to have a bacterial infection with blood present in their faeces, antibiotics are administered in either liquid or capsule form. The treatment regimen, according to the CMO, is given appropriately to the various age groups affected.
And there is currently no shortage of medical supplies in the Region, Dr. Persaud assured.
“Our health workers are managing the cases well once they come, because one of the first and foremost goals is to avoid any deaths, and they have done that since the one death recorded. They have been working really hard. They had some serious cases a few days back, and they were able to keep them alive. They (patients) are happy and healthy now,” the CMO informed.
CONDUCIVE CONDITIONS
The contamination of water sources utilised by the residents of the affected Region is believed to be origin of the outbreak. Dr. Persaud noted that addressing the situation is one that will require keen focus on the provision of safe water.
“That’s actually a goal…a Sustainable Development Goal; that people should have access to safe water and safe ways of disposing their waste, particularly human waste, and that is the big crux when it comes to these gastroenteritis cases,” the CMO noted.
And according to him, “the Ministry of Health is sometimes a victim of this whole catastrophe that comes up, and unfortunately people in communities are too. These provisions (such as safe water) are not usually extended throughout the country.”
So you might look at some statistics and you might say ‘oh 88 per cent of the population has access to safe water’, but it is that small group of people who don’t have that who are always vulnerable,” Dr. Persaud asserted.
He disclosed that following a previous outbreak in Region One (Port Kaituma), the Ministry had tested all of the regular water sources in the affected area. Ninety per cent of the samples taken from creeks and rivers were found to be severely contaminated with faecal coliform bacteria.
“That means that stool (faeces) is getting into people’s drinking water. If they are not aware of how to make that water safe, they will ingest those germs and they will get diarrhoea and all these symptoms,” Dr. Persaud said.
It has been ascertained that the current outbreak was due to similar contaminants.
COLLECTIVE EFFORT
But according to Dr. Persaud, the detected contaminants could in fact be resisted to some extent with the rotavirus vaccine which is administered to young children. Rotavirus is said to be the leading cause of severe acute gastroenteritis – that is, vomiting and severe diarrhoea, among children worldwide.
However, a troubling observation highlighted by Dr. Persaud is that the vaccine coverage rates in some areas of Region One are not very impressive.  In fact, he disclosed that some areas recorded vaccination rates as low as 33 per cent.
“This is not good…and there are always those issues that we have to keep on addressing. I am really working hard with the RHOs (Regional Health Officers) and the regional health team and the district medical officers to address this.”
He also related that the Ministry has been making strides to improve the delivery of health care which is evident by doctors being stationed throughout Region One, including at Baramita, Matthew’s Ridge, Port Kaituma and Mabaruma. And these doctors, according to Dr. Persaud, can respond to people who become ill, and also educate them.
Dr. Persaud however reiterated that in addition to offering good health care, the provision of other services such as safe water requires additional support.
“This has to be a collective effort, and I think the Ministry of Communities, under whose purview the Guyana Water Incorporated falls, has taken up the challenge in the sense that it has started to assess the wells that were placed in these communities in the past to see how effective these wells are in providing safe water. Some of them were not so properly placed…there is definitely work that needs to be done.”
A similar gastroenteritis outbreak in Port Kaituma in 2013 saw hundreds of cases resulting and the deaths of at least three children.

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