MONSOON OUTRAGE IN NEPAL AS FLOODS AND LANDSLIDES: ROLES OF PHARMACIST

      Apart from staying beyond the counter of the pharmacy and working over the laboratory, pharmacists are smart and aware with the knowledge of different field which can be thoroughly utilized at the time of necessity. The recent times of the series of natural disasters and the catastrophes continuously striking the hills and land of our landlocked country have shown the possibilities of the working areas. Flooding  is one of most widespread climatic hazard allover the country killing hundred or lives. The high lands are eroding and the plains are overflooded with water  at many places with monsoon rising at it’s peak. People went homeless, cultivable lands have been swept away and a state of humanity crisis percolated with each passing days. Apart from the natural and economic havoc, high chances  of epidemic outbreak and disease susceptibility is hovering around those victims.

Here in this article we are trying to summarize the health hazard that a flood victim can face and its assessment. These victims who are thriving for healthy food, clothes and shelters,are also being engulfed in the burning risk  of diseases like diarrhea, cholera, and dysentery ( due to unhygienic food  and water),skin and eye infections,upper respiratory tract infections, urinary tract infections, Hepatitis A and E along with snake bites in tropical plains and subtropical forests. Apart from those infection and diseases there is high chance of insect bites, physical injuries, parasite infestations and some other opportunistic infections which follow.

1.       Injuries: Many injury cases has been reported during and after the flood. Injuries could be relatively minor, such as cuts and abrasions, or may be more serious, e.g. fractures and punctures.There is the high chance of infection on wounds or cuts which can lead to necrosis or septicemia which can turn fatal if left untreated. Such cases have to be assessed carefully and treated with proper care. For cuts and wounds, sterilized cotton, bandage and antiseptic ointment or solution always works well.
2.         Diarrhea  and faeco-oral disease : Diarrhea  and faeco-oral diseases are the major cause of health hazard in flood victims, due to poor sanitation, lack of hygienic food and water, and contaminated water source.. We suggest for proper antidiarrhoeal medications and if necessary, antibiotics, water purifying tablets/ liquids and plenty of ORS, for the relief team to keep in list. These diseases can be caused by : diarrhoea,amoebic dysentery,bacillary dysentery, Balantidiasis Campylobacter enteritis Cholera Cryptosporidiosis E. coli diarrhoea Giardiasis Rotavirus diarrhoea Salmonellosis Shigellosis (bacillary dysentery) Yersiniosis Enteric fevers Typhoid Paratyphoid Poliomyelitis Hepatitis A
3.         Parasite infestation : Many helminthics  are endemics in subtropical country like Nepal. There are high chances of transmission of such parasite in such vulnerable population. Though the helminths have a bit longer incubation period, the health response team can carry anthelmintics along with other medication but first priority should be given to save the lives under danger. Setting priorities under the disastrous conditions also should be done proactively so that dilemma doesn’t strike you over the disaster spot.
4.       Vector born diseases: DIseases like Malaria, Dengue, encephalitis are few common diseases which need to be controlled to prevent any further transmission.
5.      Miscellaneous: Some other infection may include, skin allergy, eye infection, respiratory tract infection. Such hazards can be controlled by respective medication like eye ointments, antihistamines and antibiotics. Poisoning can be one health hazards especially in terai region of Nepal. Many people use poison for fishing, so, this hazard can’t be ignored. Poisoning may not be serious but can lead to intestinal cramps and indigestion.

HOW CAN A PHARMACIST EXTEND HELPING HANDS?

1. The first thing which we need to do for any flood affected area is  to figure out the real scenario and picture of the situation.Investigate from the reliable source and winnow it from the rumors.
2. Working alone in such condition is not that productive so that try working through volunteer organization or groups.
3. First step for any organisation, or  team is to estimate the number of victims or targeted families.The periphery of the calamity strike should be thoroughly observed and plans are to be made accordingly. Even you can confirm the local information from local reporter or social activist contact.
4. For any medical supplies,contact the District Health Officer  to find out the real scenario and availability of medical supplies and medical workers for the flood hit zone. Enquire what they are planning to do and how it has to be executed for maximum effectiveness.
5. Contact the CDO for the manpower which he is mobilising at the area. Is it health workers,army of some other  rescue teams? Find out if any health professional is available in team? If any health professional is working, find out the number of health workers who is serving and find out is the number is sufficient?
6. Find out the medical supplies( medication) availability and stock. Confirm either  from CDO or from Natural disaster relief funds being mobilised of medical supplies. Even confirmation can be obtained  from the DDC( District Development Committee).If DHO couldn’t give the information;contact the local district hospital/ nearest hospital for health status/ medical supplies status. Contact PMO, Home and Logistic management department for emergency supply of medication for affected area.
7. Inspire the professionals and friends around you to take the collective steps to provide hands to face the problems created by this nature’s wrath. Try to create an aura of companionship, responsibility and unity.
8. It’s never easy to work at such time of calamities as they highly put you outside the box of comfort zone and convenience. But it’s the best thing which we as a health professional and a responsible citizen can do.

MEDICATIONS ON DEMAND DURING CALAMITIES

Considering the health compromised in highly vulnerable population and possible diseases that can incubate in the concerned areas, we have prepared the  following list of basic medications which is recommended. Try to cover at least 10% of the medication with respect to total numbers victims. The 10% is considered on the basis of incidence in previous floods in Pakistan and India.

Required medicines: List out the necessary medicines with priority

Requirements	Indications	Priority level
Oral rehydration salts	Diarrhoea,weakness,anemia	High
Piyush ( water purifying tabs or liquids )	Water borne diseases	High
Tab metronidazole or alternatives like Tinidazole or in combination with diloxanide furoate	Diarrhoea(conventional treatment approach)	High
Syp. Metronidazole	Diarrhoea(conventional treatment approach) for paediatric patients	High
Tab cefixime  50, 100 & 200 mg or cefixime syrup	Bacterial infections	High
Tab cetrizine 10 mg	Allergies	Medium
Tab paracetamol 500 mg Or paracetamol ibuprofen combination	Inflammations, Hyperthermia, Body pains and fever	Medium
Paracetamol Or paracetamol ibuprofen combination Syrups	Fever and Body pain in children	Medium
Sanitary pads	For women	Medium
Sanitizer	For health professionals	Medium
Scrab lotion or Permethrin 5% and 1%	Itchy and highly contagious skin infestation by itch mite	Medium
Azithromycin 250 & 500 mg tablets	Complicated bacterial infections	High
Syp. Azithromycin 5 ml/100 & 5 ml/200	Complicated bacterial infections in children	Medium
Body soaps	Sanitation	Medium
Neosporin powder	Antibiotic powder for cuts and wounds	High

Add cotton, bandage and povidone ointment ( bigger size-500gm/1kg )
Note- We have estimated the priority level considering that there should be no scarcity as the victims are highly susceptible to diseases due to lack of healthy living in such cases, and please try to mobilise as much as health worker as possible.

STORAGE:

As the climate is highly humid and the medication you are carrying may get wet or dampened, special care should be taken. Damp medicaments sometimes fail to show it effect. You can protect the medicaments by double sealed polybags, of triple lined polybags. If possible try to add activated (completely dried waste cartons papers) for shock absorber and as desiccant.

CONCLUSION

Try to do maximum individual effort, as few individuals work can make lot of difference.

For any queries consult health workers or you can contact us at medicationfornepal@gmail.com.

BY- Ishwor Poudel, M.Pharm, Bharati Vidhyapeeth

-          Kabin Maleku, Consultant Pharmacist, Medication for Nepal