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Health Crises Hit Flooded Pakistan

Professor Paul Roepe

Paul Roepe, professor of chemistry and professor of biochemistry and cellular and molecular biology, says rampant infectious diseases will cause death and hardship in Pakistan after massive flooding this past July.

September 2, 2010 –Heavy monsoons in late July triggered massive flooding in Pakistan, where an area the size of England is under water and at least 20 million people have been affected, according to the United Nations. Deaths continue to climb from a mid-August estimate of 1,600. But the major cause of death and hardship will come from resulting and rampant infectious diseases, says Paul Roepe, professor of chemistry and professor of biochemistry and cellular and molecular biology. Roepe, who co-directs Georgetown’s Center for Infectious Disease, talks about the 'triple whammy' of diseases hitting flood victims and what the increased disease rates mean for global security.

Q. What are the primary health concerns in Pakistan right now?
A. The big three are cholera, malaria and other types of gastroenteritis caused by viruses and other bacteria. It’s a triple whammy hitting vulnerable populations, especially children.

Health issues existed before the floods, but the floods are exacerbating the situation. We’re about to enter the rainy season in Pakistan and normally they would expect 100,000 to 200,000 cases of malaria over the next couple months. They’ll have more cases and more deaths for sure, but we don’t know an exact number.

Q. Why will malaria cases increase?
A. Refugee populations are moving from areas where malaria is nonendemic to where it’s endemic. That’s going to cause increased mortality. If you get malaria as a kid and survive, you’re pre-immune, but if you never had it before and you get it and don’t get treated, the risk of death is enormously higher.

Pakistan is one of a few countries in the world that has a roughly 50/50 mix of the two most common forms of malaria. Plasmodium falciparum malaria causes about 95 percent of the malaria in Africa, and is the most lethal form. In Southeast Asian countries, Plasmodium vivax malaria is more common; this disease is less lethal but more difficult to cure and can persist in a person for years. Pakistan, being between the two areas, has both.

The initial symptoms are almost identical, but how you treat those two diseases is different. So, another general area of concern is that people come in with malaria symptoms, and there may not be enough medical care available to correctly diagnose and treat the specific type of malaria.

Q. Is malaria the top health concern from the floods?
A. Unclean water diseases are more of an immediate threat. People are drinking contaminated, virus and bacteria-filled water because they have no other choice. Diseases from unclean water lead to gastroenteritis, a spectrum of diseases that, if left untreated, lead to dysentery and severe dehydration. Untreated, most of these diseases will kill children.

Then there’s cholera. It is also caused by bacteria, but most public health experts put it in its own category. It can kill children within hours. The bacteria don’t kill you directly, but cause diarrhea-based massive dehydration.

These diseases are more of an immediate threat because peak transmission of malaria has not yet started. Also, while it can be lethal if untreated, malaria does not kill as fast as cholera.

Q. What has the medical response been like, especially from the international community?
A. More people are finally starting to pay attention, but it’s slow and much less than is needed. The U.S. has pledged money and supplies, but other countries, like France, have not given much at all.

Pakistan has immediate and dire needs for water and rehydration solution. These things can very effectively treat the dehydration that people are dying from, and prevent more spread of bacterial and viral diseases. We’re not talking about expensive treatments or prevention measures. A malaria bed net is $1; rehydration solution costs pennies. It’s tragic to watch people die when the things that could save them cost so little.

Q. Why do you think aid response has been so slow?
A. Pakistan is under a microscope in this country. There is a lot of justified apprehension of the Pakistani government, and some people have a perception that if we’re assisting Pakistan, we’re propping up the government. The message that has to get out is that if you are committed to helping innocent kids and people who have nothing to do with the government, work with the U.N., World Health Organization or Doctors Without Borders. These organizations are not part of Pakistan – they’re in Pakistan.

I have no patience for people who sit around talking about politics while hundreds of thousands of kids are dying. That’s morally reprehensible to me.

Q. When disasters like the floods happen, health concerns often seem pushed aside in favor of other needs. Can you talk about why this happens?
A. Infectious disease can cripple a region. It can put global security and economic systems at risk – it’s a huge risk in Pakistan. The health issues have security and political implications. A war is being fought on Pakistan’s border, and there is a very complicated military dynamic there. You have Pakistani military responding to the floods and passing out medications, yanking them away from fighting the Taliban. Although I’m not a military expert, I would guess that it puts our entire set of accomplishments in the region at unbelievable risk.

These diseases wreck economies and destabilize countries. When you have a country like Pakistan, you can’t afford to have that happen. But we’re watching it unfold as we speak.

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