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Battered by tsunami they now fear disease
By Marisa de Silva and N. Dilshath Banu
In the midst of the loss and trauma, panic and chaos in the wake of last Sunday's devastating tsunami that shattered much of Sri Lanka's coastline, those who survived the killer wave are now facing another deadly threat, that of infectious disease. With thousands concentrated in refugee camps, medical experts warn that the spread of infectious diseases is inevitable. The problem is aggravated as many hospitals have either been completely destroyed or damaged by the huge waves.

Ten hospitals were completely washed off by the tsunami in districts including Trincomalee and Ampara, Health Ministry spokesperson Viraj Abeysinghe told The Sunday Times. Many other hospitals too had been partially destroyed, he added. "Forty doctors have been reported dead, whilst 10 doctors are reported to be missing so far."

However, Mr. Abeysinghe dismissed rumours of a virus named 'Zulican' being spread through seafood. "There is no impending threat from the consumption of seafood as yet," he said. Dr. Paba Palihawadana, Deputy Epidemiologist, Epidemiology Unit, Ministry of Health, explained that the sea water was not contaminated as the bodies of the dead were generally washed back ashore. Only stagnant waters inland like open wells, lagoons and canals are likely to be contaminated.

As a preventive measure against the spread of disease, Mr. Abeysinghe said the Health Ministry was chlorinating water in the vicinity of the refugee camps and was building temporary toilets near the shelters. Dr. Denham Pole, Acting Representative of the World Health Organisation, Sri Lanka said diarrhoea and malaria were the most likely diseases to break out during the post-tsunami period.

Diarrhoea will be seen especially in children. The Malarial mosquito may breed rapidly in contaminated stagnant water. Respiratory diseases such as bronchitis, measles, mumps or influenza could also occur, but so far there have been no reports about influenza in the affected areas, he said.

According to CNN reports, the WHO has warned that the diseases spreading during the aftermath of the tsunami could kill as many as the disaster itself. "Those in refugee camps could be vulnerable to communicable diseases. Most of them are very young children, newborn infants below the age of one, elderly people and pregnant mothers. These diseases are spread through contact," Dr. Pole said.

"Those affected need clean drinking water and we are in the process of distributing chlorine tablets to purify the water. We are providing antibiotics as well to cure infected wounds. Faeces could pose a bigger threat than decomposing corpses," he added.

The WHO was working with the Health Ministry, said Dr.. Pole. At present, however, no outbreaks of disease had been reported in the affected areas, he added. Meanwhile, reports of various degrees of damage to hospitals around the country's coast were filtering in. At the General Hospital, Matara, Director Dr. K.I. Padmathilaka, said that the hospital had not been very badly damaged. "The hospital's laundry is out of order and two wards have been slightly damaged. Our main problem is the lack of clean water for contaminated water causes many diseases. Our Epidemiology Unit is very active now to reduce the spread of communicable diseases."

In Jaffna, Acting Director, Dr. S.S. Raviraja said the Mullaitivu Hospital is not in operation currently and many injured people in the area were seeking treatment at the Kilinochchi Hospital.

"The biggest problem is that both the hospitals and the refugee camps are overcrowded. Steps should be taken immediately to provide sanitary facilities and to settle the displaced people in some permanent residence," said Dr. Raviraja.

Ampara Medical Superintendent, Dr. P.K.C.C. Jayasinghe said that there had been no damage to the Ampara hospital, but the Palamuna Hospital, Nintavur District Hospital Karaitivu Peripheral Unit, Saithamarudu District Hospital and Marudhamunai had been affected.

"Foreign doctors are assisting us in combating the outbreak of infectious diseases, but the problem mostly exists in refugee camps, " Dr. Jayasinghe said. Deputy Director, General Hospital, Kalutara, Dr. (Mrs) M.P. Ekanayake said that since the hospital was situated away from the coastal area it had not been damaged. However, one doctor from the Kalutara Hospital had been killed due to the tsunami.

There are no reports on the spread of infectious disease, but there are some cases of wound infection and chest related diseases. There are many women and girls in the hospital more than male patients and we are still lacking necessary undergarments and other forms of sanitary facilities for them, she said.

Dr. Priyanee Senadeera, Director, Mahamodara Teaching Hospital, said that the hospital had been affected quite badly as its 10 ft parapet wall had come crashing down and many of the ground floor wards had been completely damaged. The three gynaecological wards, the neonatal ward, a maternity ward, the labour room, the blood bank and the hospital kitchen had been badly damaged.

The hospital has temporarily been relocated at the Karapitiya Hospital premises, said Dr. Senadeera. Only 25% of the hospital's staff had reported for duty by Thursday, with some five to six hospital staff believed to be missing. Many are still searching for their relatives, some are faced with transport problems and others are either homeless or displaced, resulting in about 75% being absent from work, she said.

Dr. P.L. Gunawardena, Deputy Provincial Director, Health Services, Galle District, said that except for sporadic cases of conjunctivitis (eye infection) in the Hikkaduwa area, there was nothing on an epidemic level as yet.

Dr. K.E. Karunakaran (VOG), Acting Director, of the Batticaloa General Hospital, said that as the hospital was situated inland, it had not been too badly affected. Except for a few cases of respiratory tract infections and diarrhoea, there was no apparent outbreak of any disease, said Dr. Karunakaran. More than 10 foreign medical teams were working in the field, to combat the spread of infection and disease, he said.

Medical Superintendent, Dr. Champika Wickramasinghe of the Negombo Base Hospital said that there were only a few cases of diarrhoea evident in the refugee camps in the vicinity. Dr. Kanchana Munasingha, District Medical Officer, Beruwela District Hospital, said that although currently there was no evidence of disease, there was a strong possibility of its emergence in the weeks to come. Children will most probably be the most vulnerable group, she said. Unclean drinking water was the biggest cause of disease at the moment, added Dr. Munasingha.

Medical Superintendent, Dr. K. Muruganandan, Kalmunai Base Hospital, said that though there was no damage to the hospital, it was terribly overcrowded. Communicable diseases too are on the rise, he said. There have also been a few complaints of lung infection. Measures have been taken to caution people of the area against using open well water, he said.

No spread of Influenza B
Dr. Paba Palihawadana, Deputy Epidemiologist of the Health Ministry's Epidemiology Unit, allayed fears of the rapid spread of 'Influenza-B' as a result of the tsunami. The mild outbreak had virtually subsided before the disaster, she said.

Only two of the nine deaths could be attributed to the 'mystery virus'. Investigations showed that the remainder were due to various other reasons, she said adding that people had panicked needlessly.

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