Cholera, Acute Diarrhea Battle Is Drawn Out in Ratanakkiri

The Ratanakkiri provincial health department, provincial authorities and health NGOs rallied this week to confront rising cases of acute watery diarrhea and cholera in the province. Outbreaks have now spread to a seventh district, Andong Meas, with 1,358 patients and 32 deaths recorded since April.

Nationwide this year there have been at least 449 positive tests for cholera plus about 4,000 suspected cases, resulting in 50 to 60 deaths. Many deaths were in Ratanakkiri province’s remote villages, which are a long journey by river or dirt road from life-saving treatment.

Health officials and NGO workers met on Monday with provincial authorities to ask for help in containing outbreaks that started flaring up three months ago, provincial health department director Sim Khanlai said.

“We invited the governor to preside over the meeting to seek support from him to strengthen measures to prevent watery diarrhea,” Mr Khanlai said.

The provincial authority lacks the money to send health workers to affected villages, but the governor tries to combat outbreaks though education and signing budget requests from the health department, Mr Khanlai said.

Ratanakkiri governor Pao Ham Phan said that his authority pays close attention to outbreaks by burying the dead and educating people about hygiene and the importance of clean water.

“The health department and provincial authority work hard to prevent outbreaks reoccurring,” Mr Phan said.

However, Hoh Sochanda, the Ratanakkiri maternal health team leader at NGO Health Unlimited, said that so far provincial authorities have been slow to react to the ongoing situation.

“Since cholera outbreaks started in April, still the provincial governor has not responded. It is not a big concern for the provincial authority,” Dr Sochanda said, noting that the health department continues to face budget shortfalls for transport, communications and staff living expenses.

The efforts of provincial authorities to combat acute diarrhea outbreaks vary nationwide, with some including Kratie actively responding while others have been slower, said Ly Sovann, deputy director of the communicable disease control department at the Health Ministry, at a conference last week.

“[S]ome provinces have been rather slow…. For example in Ratanakkiri maybe the situation has happened for too long,” Dr Sovann said.

“The fatality rate [from diarrhea and cholera] is more increased than in other provinces…. Acute watery diarrhea jumps from one place to another,” provincial director of the communicable disease department Hoy Vannara said, noting that for the moment the situation is under control.

Even if health officials and NGOs manage to reach scattered villages, rural dwellers in Ratanakkiri often ignore advice about hygiene, Dr Vannara said.

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