In the past few days, Sri Lanka has experienced the mother of all monsoons. Torrential rains beat mercilessly across the island leaving in their wake flash floods, river floods, and burst bunds. Entire roads, , buildings, schools , hospitals and even police stations (23 at the last count according to Police Media spokesman Prishantha Jayakoddy) disappeared in the twinkling of an eye, buried under swirling waters and landslides.
Although the rains are now beginning to recede , the threat of landslides continues with landslide warnings issued by the Met Department and Disaster Management Unit in at least eight districts, in the Southern and Sabaragamuwa Provinces, Galle, Matara, Hambantota, Colombo, Kalutara, Ratnapura and Kegalle. The landslide warning continues to stay at the time of writing this article, in seven districts, the most number of fatalities being in the Ratnapura district, followed by Kalutara, Matara and Galle.
Infectious disease spread
Traumatic impacts apart, health officials are also concerned about the likelihood of infectious diseases spread from exposure to contaminated flood water.
A circular issued by the Acting Epidemiology Chief Dr. Samitha Ginige to all relevant authorities in the affected districts which was posted on the Epidemiology official website and endorsed by Deputy Director General, Public Health Services , Dr. Sarath Amunugama who we contacted for comments since Dr. Ginige was unavailable, is worth quoting in this respect. In it Dr. Ginige comments on the likelihood of the spread of communicable disease from contaminated flood water and says, three main areas: safe water, safe food and sanitary facilities within and around the temporary shelters need to be identified and prioritised.
With regard to ensuring safe water, Dr. Ginige says the first step should be to identify the sources of water – i.e wells, pipe borne water, tube wells, and external supply.
Thereafter, the Divisional Secretary should coordinate with local government authorities to ensure continuous and adequate supply of safe drinking water. Adequate water storage tanks should be supplied for proper storage of water. If facilities are available make arrangements to boil and properly store water at least for children. He further suggests that advice be given to the public on proper methods of storage and usage of water for different purposes without wastage.
What if the water is contaminated?
“If there is no pipe borne water, water must be collected in barrels or tanks and chlorinated adequately. Chlorinated water should be monitored regularly with the PHI’s involvement in supervising the chlorination activities of wells, tanks etc., he stated, adding that group leaders be trained in water sanitation.
Safe food
Safe food being an equally important area, he stresses the need to provide safe, adequate and nutritious food. In the circular he states, PHIs should coordinate with the Divisional Secretary of the area to ensure that food supply by local authorities and other sources are hygienically prepared before distribution- ideally within two hours of preparation. Food handlers should adhere to hygienic practices in preparation and packing of food. PHIs should regularly supervise food preparation within the camps.
Sanitary facilities
Here, Ginige emphasizes the need to identify the existing sanitary facilities in each temporary camp. Where necessary, he suggests, arrangements should be made to construct an adequate number of temporary latrines. PHIs of the area should assess the adequacy of toilets – shallow or deep trench latrines or temporary pit latrines should be prepared according to the existing situation.
Commenting on how far these pits or trenches should be sited from the camps, he says, “At least thirty metres from any water source. “ He emphasizes the maintenance of clean toilets at all times, with proper disposal of excreta of infants , babies and the disabled, and distribution of underwear for children . He also calls on mothers to empty potties into latrine pits at the same time reminding PHIs to maintain an adequate supply of water for washing with soap, after using the latrines.
To prevent flies and other insects in the vicinity he stresses on proper waste disposal and cleanliness all around the camps.
Wading in water
Consultant Community Physician, Health Education Bureau, Dr Ranjith Batuwantudawe, while rejecting rumours of the spread of infectious diseases, nevertheless, cautioned the public to be careful as we were still in the acute phase of the flood situation. He warned people against wading in collections of water of unknown depths and to stay indoors as far as possible.
“They should not go to houses that are submerged, as they could be swept away or cut their legs on pieces of glass, stones, boulders. Those who are diabetic must be especially careful not to injure their feet, legs, arms, as the wounds will not heal easily. Those with hypertension or any other ailments must immediately report to the nearest camp MOH and obtain the necessary drugs”.
He said there was no shortage of drugs as the Health Ministry immediately released any drugs for which there had been a request from any temporary shelter in any part of the island.
Diarrhoea
While gastro enteritis diseases could occur, he said sufficient packets of Jeevani had been issued to each camp, especially, for the use of young children who were mostly vulnerable to diarrhoea.
He further cautioned against leptispirosis which is common at this time around and warned those in high risk professions to ensure they don’t allow rat urine contaminated water to enter their bodies through cuts, eyes, mouth, toe nails. He advised parents to safeguard their children against playing barefoot in muddy water in flooded areas.
Asked whose responsibility it was to supervise the overall prevention of communicable diseases, he said, “The main responsibility of prevention of communicable diseases and disease surveillance lies with the local public health staff (MOH, Regional Directors of Health , etc) while technical guidance will be given by the Epidemic Unit. All Regional Epidemiologists are requested to communicate with the Epid. Unit on a daily basis during this emergency situation to provide an update and get additional support needed from the Unit”.
Former Poisons Information Chief, now Consultant Physician at the National Eye Hospital, Dr Waruna Gunetilleka, our next contact, gave us fresh perspectives on the disease impacts flood victims faced, highlighting several little known dangers to which they could be exposed.
Carbon dioxide poisoning
“In my opinion, one of the most fearful experiences people face in a flood situation as bad as this, is the likelihood of becoming exposed to carbon monoxide poisoning”, he told the Sunday Observer.. Explaining he said, “This is because many persons who can afford to do so, like business owners have begun using generators operated by battery power or kerosene oil, due to the breakdown of electricity lines.
To minimize this risk, they must ensure these generators are not activated inside closed rooms but in the open, outside their rooms, preferably, in a corridor with the doors wide open.” Further noting that people living in those areas were also switching to the old fashioned kerosene oil lanterns, he said, “This again could pose a danger to householders if the lamps were placed where strong winds could overturn them. To avoid serious burn accidents from alternate lighting system currently used in the flooded areas, he said, the safer option would be candles and a box of matches.
Cover bodies
He also shared with the Sunday Observer another little known nugget of information with regard to the proper procedure to be followed when handing over the bodies of landslide victims, after they have been dug out of their muddy graves.
“Cover them properly. Wrap them before handing them to the nearest hospital. Even if it is a part of a body even a finger or head, cover them before handing them over to the nearest hospital.”
Why? We asked. “It would facilitate the identification process. Laws regarding the proper procedures with regard to landslide and other natural disaster victims already exist. Adhering to them will help relatives when it comes to compensating them or sorting out any other legal matter later”.
Injuries from flooded water
He also gave the following practical advice on injuries that one could be exposed to, while wading through flooded areas.
“Ideally, people living in flooded areas should stay indoors. If they walk through flooded water they can get injured from stones, glass, heavy boulders or bitten by water snakes or crocodiles. Diabetics are especially vulnerable as any wounds sustained from wading across flooded water will not heal easily, if their sugar levels are uncontrolled. So wound care should be a priority, as such persons are most vulnerable to wounds and fungal infections from contaminated water. If someone is under long term medication for hypertension and heart ailments, and their immune systems already compromised, an exposure to bacteria and viruses from flood water will merely compound their health issues.”
On walking through vast stretches of flood water, he had this to say: “Ideally, there must be a leader if people are travelling in groups. One person must lead the way and the others must follow him in a line instead of walking in parallel. That way the leader can protect those behind him should he encounter stones, sudden dips, boulders that can maim, injure or cause sprains.” He also warned people caught up in a flood not to use makeshift boats or tyres or drive through the swirling water, as they could drown. Last week’s tragedy of a schoolboy who tried to row a boat using a tyre tube in a stream full of flooded water near the Customs premises at Uragodawatte, and drowned, and his body being found by rescue teams a few feet below ground, underlines this point.
Dr Waruna also commented on infectious diseases like chicken pox, sore eyes, etc that could spread in the present situation, and how this risk could be minimized. He said, it was important that patients be isolated and kept away from others, especially, in temporary shelters. “At least protect the children”, he said.
Food borne diseases
With regard to food borne diseases from spoilt cooked food, he noted that the safer option would be dry provisions like biscuits which flood victims on tree tops or rooftops can store as they were packeted. To minimize the high organic wastage that currently polluted the environment, he said, should be a priority of the relevant environments, as such surroundings especially, near IDP shelters could lead to the spread of diseases like dengue, etc. He recommended the use of mosquito repellents against flies and mosquitoes. We asked him who he considered most at risk in a flood situation. Who should be given priority in an emergency situation to be rushed to the nearest hospital?
He replied, “Everybody is at risk. But, pregnant women in their third trimester will be given priority to be admitted to a nearby hospital.”
The current rains followed by short bursts of sunshine are ideal breeding sites for the spread of dengue? Did he agree?
He did. “The risk is there for breeding sites for mosquito larvae to proliferate. If everyone keeps their gardens and lanes clean and free of small collections of rainwater, it will definitely reduce this risk”, he said.
Nutritional needs of flood victims
Food Technologist, Visaka Thilekeratne drew from her vast nutritional background to share some innovative guidelines regarding the nutritional needs of flood victims.
“While they need their usual protein and energy requirements, these people also need protective food like, fruit and vegetables,” she said. On how to serve healthy meals that won’t get spoilt quickly, she suggested fried rice with vegetables which will give them the vegetables they need and won’t spoil quickly.
With regard to fruits, she said, “Due to the present situation , it is better to give them cut fruits which have been washed thoroughly in clean water and served one hour after they have been prepared. A banana is safe and contains all the vitamins and can be served without being sliced. Giving them imported fruits like apples, grapes and oranges should be discouraged, as far as possible serve them our local fruits.”
She also stressed the importance of giving them plenty of safe drinking water to be hydrated. “Ideally, the water should be boiled, cooled water from taps, but due to their present situation bottled water is recommended, although they should get back to boiled water when the situation returns to normal.” She too cautioned that those living in temporary shelters be given plenty of water and soap to wash their hands after defecating and to wear rubber slippers because worm infestation could enter their bodies from toe nails.
Breast milk, best for babies even in flood situations
Meanwhile, Consultant doctors attached to the Family Health Bureau, Ministry of Health, have urged mothers in temporary shelters to breast feed their babies, requesting the public not to collect or distribute milk powder for the use of infants.
At a media discussion at the FHB last week, Consultant Community Physician, FHB, Dr. Hiranya Jayawickrama was reported as saying that no milk substitutes like milk powder should be given to children as it could lead to serious health complications like diarrhoea etc. Some of these diseases could kill infants, she warned, stressing the importance of giving only breast milk to babies for six months and even thereafter when complementary feeding starts.
Department of Paediatrics, Faculty of Medicine, Colombo University, Professor Pujitha Wickramasinghe rejecting the myth that some mothers don’t have enough milk said, mothers always have breast milk and should feed infants and young children with breast milk to strengthen their immune systems which are still developing .
The speakers also appealed to the public not to collect and distribute milk powder for the use of flood victim infants and children as it did them more harm than good for their health.
They also said, health authorities in relevant welfare camps would make arrangements for infants and children who lost their mothers due to the disaster. Echoing these sentiments, Consultant Neonatologist, University Neonatal Unit, De Soyza Hospital for Women, Borella, Dr. Nishani Lucas told the Sunday Observer, in an exclusive interview, “All donations of milk powder to welfare camps should be stopped, because when such foods are freely available, mothers stop feeding their babies with breast milk and switch to bottle feeding.
Feeding babies in bottles that are not properly washed or washed with contaminated water can lead to all sorts of bowel diseases like diarrhoea. The result? A second disaster, this time man made! “
So what kind of food donations should be sent hereafter to these welfare centres?
“A hygienically cooked balanced meals for the mothers who are still breast feeding, so that they can exclusively breast feed their babies up to six months, will be welcome.”
What about babies who have started on complementary feeding? We asked.
“For them, ideally, there should be a clean place for mothers to cook their meals. If not, mothers can share a balanced healthy meal sent by a reliable food vendor as soon as it is cooked, with their babies on complementary feeding.
If the child can share a meal of a mashed potato, soft rice, a boiled egg and dhal with some cooked well boiled carrots it should cover his nutritional needs for the time being”. Dr. Lucas also warned against feeding children with sugary biscuits.
“Sugar coated biscuits are the worst food a baby can have as he or she will acquire a taste for sugar early in life. Instead, give the child a cup of yoghurt; which if hygienically safe and not expired will meet its nutrition needs”.