Yemen: From cholera to diphtheria – shattered health system battles a new threat(HINDI)

डिफ्थीरिया जीवाणु कयनेबक्टेरियम (Corynebacterium)से पैदा होने वाला गले का एक ऐसा रोग है जिसमें नाक या गले /कंठ के पिछले भाग में एक झिल्ली राख या स्लेटी रंग जैसी ही बन जाती है  एन्टीटॉक्सिन्स  और एन्टिबायोटिक्स देने से यह रोग ठीक तो हो जाता है लेकिन रोगी को अलग थलग रखना पड़ता है। वरना यह (महा )संक्रामक रोग है आज यमन को ये अपने गले के नीचे उतार रहा है वहां दवाएं नहीं हैं गत ढ़ाई बरसों से निरंतर चल रहे युद्ध की वजह से आवाजाही निलंबित है।

It is an acute infectious bacterial disease with inflammation of a mucous membrane specially of the throat ,resulting in the formation of a false membrane causing difficulty in breathing and swallowing.

टीकाकरण इसका सीधा समाधान है।  

ज्वर और गले की दुखन सोर थ्रोट इसके आम लक्षण हैं।अलावा इसके हार्ट फेलियर ,फालिज (Paralysis )यहां तक के मृत्यु भी इसकी वजह बनते हैं। 

रोगी के छींकने ,खखारने ,coughing से उसके स्रावों secretions से यह आसपास उपस्थित लोगों को भी संक्रमित कर देता है। खतरनाक छूतहा रोग है यह।  

टीकाकरण उपलब्ध होने से पहले हर बरस इसके दो लाख मामले अमरीका में सामने आते थे। दर्ज़ होते थे। 

तकरीबन तकरीबन दुनिया भर के देशों से इसका उन्मूलन भी हो चुका है यहां तक के लोग इस रोग को भूल चुके हैं स्वास्थ्य कर्मी इसीलिए यमन में इसके लक्षण जल्दी से पहचान नहीं पाते हैं। यमन में भी इसका आखिर मामला १९९२ में मिला था पूर्व में १९८२ में इसने वहां एक व्यापक रोग का ,प्रकोप का रूप ले लिया था। 

चालीस फीसद मामलों में यह रोग घातक सिद्ध होता है लापरवाही जानलेवा साबित होती है।मरीज़ को परिवार से अलग न रख पाना एक कमरे में यवनों के परिवारों की तरह औलाद की भीड़ सबको अपने चंगुल में ले लेती है। जबकि परिवार के शेष लोगों को बचावी चिकित्सा देकर बचाये रखा जा सकता है।  

यमन में इसे मानव निर्मित रोग ही कहा जाएगा जहां चंद क्लिनिक काम तो कर रहें हैं लेकिन लोगों के पास उन तक पहुँचने के लिए न ईंधन है न अन्य साधन। कैसी विडंबना है यह इस शती की जो युद्ध उन्माद को गैर -प्रासंगिक बना देती है। 

http://www.msf.org/en/article/yemen-cholera-diphtheria-%E2%80%93-shattered-health-system-battles-new-threat

By 4 December, 318 suspected cases of diphtheria and 28 deaths had been reported in 15 of Yemen’s 20 governorates. Half the suspected cases are children between the ages of five and 14, and nearly 95 per cent of deaths are children under 15. Nearly 70 per cent of all suspected cases are in Ibb governorate.

Diphtheria is a contagious and potentially fatal bacterial infection, mainly characterised by a thick grey membrane at the back of the throat or nose, sore throat and fever. It can be prevented through vaccination.

Marc Poncin, MSF’s emergency coordinator in Ibb, said:

“Globally, diphtheria has been eradicated from most countries after systematic childhood vaccination campaigns, and it’s become something of a neglected and forgotten disease. Even in Yemen, the last diphtheria case was recorded in 1992, and the last outbreak in 1982. The ongoing war and blockade are sending Yemen’s health system decades back in time.”

Poncin adds:

“After two and a half years of violence and a blockade on supplies including medicines and vaccines, the healthcare infrastructure is in tatters. The blockade on fuel has meant that patients cannot afford to travel to the very few health centres still operating across the country. This is crucial, because if people infected are unable to access treatment regularly, diphtheria can spread in the body and be fatal in up to 40 per cent of the cases.”

Humanitarian actors are also struggling to start diphtheria treatment and prevention activities due to the ongoing logistical difficulties in bringing specialised staff and needed supplies into Yemen and to areas where they’re most needed.

“This is undeniably another human-made disease inflicted on a country that has barely recovered from a massive cholera outbreak, which is not even over yet,” says Poncin.

“Globally, the decline of diphtheria in recent years was accompanied by a concrete loss of knowledge regarding its treatment. This is making it much more difficult for health workers to quickly and correctly identify, isolate and treat cases.

Nuha Haider/MSF

The female inpatient department at MSF cholera treatment center in Khamer.

“To treat diphtheria, patients need to be isolated and receive antibiotics and antitoxins. But the global supply of the antitoxin, which is the single most important aspect of treatment, is very limited, and no antitoxins were available in Yemen until a few weeks ago.”

To tackle the outbreak, MSF, together with WHO, is acquiring most of the antitoxin that is still available worldwide, and ordering more antibiotics. MSF has also put together a rapid response team to survey and identify suspected cases in communities, and provide prophylaxis to those in contact with a diphtheria patient.

On 11 December, MSF opened a diphtheria treatment unit in Nasser Hospital in Ibb city, and is in the process of supporting two others in Yarim and Jiblah hospitals – the latter with intensive care unit capacities. An ambulance referral system will also be set up to transport suspected cases to hospital. In addition, MSF will support the transport of samples to a laboratory to better confirm cases, and carry out health promotion activities to alert communities to diphtheria. Meanwhile ,MSF is also setting up an intensive care unit in Sadaqa hospital, Aden, where 14 cases were recorded, resulting in four deaths.

“We have been visiting houses where six or more displaced people are living in very cramped conditions. In such settings there are no ways to properly isolate cases, and it creates the perfect conditions for diphtheria to spread. Isolating and treating patients, offering preventive care for affected communities and raising public awareness are therefore crucial to halt the spread of diphtheria,” says Poncin. “Yemen’s healthcare system cannot afford another outbreak.”

Pl see this link also :https://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html