Cape-based doctor tells of desperation in Rohingya camps
Cape Town-based infectious diseases specialist says regional issues need to be resolved before more get sick
Dr Rosie Burton knows all too well the devastation faced by Rohingya refugees who have been forced to live in camps southeast Bangladesh.
The Cape Town-based Doctors Without Borders infectious diseases specialist has just returned from a month-long stint in Bangladesh treating some of the more than 688,000 Rohingya who have fled the Rakhine province in Myanmar since mid-2017 – a persecution the United Nations called “a trademark example of ethnic cleansing”.
Burton works for Doctors Without Borders (MSF) largely treated diphtheria patients at a facility during her time there. Diphtheria, a deadly disease long forgotten thanks to vaccinations, is now re-emerging in Bangladesh among refugees.MSF has treated more than 4,371 cases of diphtheria in its health facilities, and the number continues to rise. Most patients are aged between five and 14. The refugees are living in sprawling, overcrowded camps with inadequate access to shelter, water, food and medical care – conditions prime for the spread of infectious diseases, especially one as contagious as diphtheria.
“I arrived at the end of December to work in the diphtheria centre that MSF opened to relieve pressure on other health centres. It’s important that patients with diphtheria are cared for separately, otherwise all other patients in a health facility are at risk of catching the disease.
“When I arrived, there were about 100 patients in the centre’s orange zone, which is for patients who are not critical, but who need antibiotic treatment to recover,” she added.
The problem was that many of the ill would come into the centre with a parent or caregiver, and even with other non-infected children because there was nobody else to look after them. This puts everyone at risk.
It was vital, Burton said, that a “red zone” for more serious patients who need extra treatment to recover was established. This was done within the first week of her arriving.
Everyone – those confirmed to be infected and those who came into contact with infection patients – were given antibiotics. But phase two was way more complicated, and involves horse blood.“The second part of the treatment is to give these patients an antitoxin. There can also be complications with this treatment, which is manufactured in horse blood. Because outbreaks of diphtheria are so rare, no pharmaceutical company thinks there will be a market for an antitoxin that has been developed in a laboratory, so it is still manufactured in this antiquated way.
“However, products made in horse blood have a high rate of allergens in humans – they can cause people to collapse or to go into anaphylactic shock, so patients need access to emergency treatment when it is administered. Allergic reactions can happen very quickly, so you need one nurse per patient, which means having sufficient numbers of well-trained health workers is incredibly important,” said Burton.
But while she and other doctors are doing amazing work, they know that everything they do could be mere futility. The refugees’ living conditions – which are overcrowded, with inadequate water and sanitation and many other problems – create an environment in which the risk of people falling ill is high.
Unless the broader regional issues are resolved and the Rhoingya can safely go back home, more people will get sick, some of them fatally so.
“When patients leave the facility, you are aware you are sending them out to a camp that is seriously overcrowded, where there are water and sanitation problems. We may have cured them of diphtheria, but we are sending them back to a place where they could be at risk of further outbreaks.
“The question remains: what is next for these people? There is a great concern that if they move back to Rakhine they could be in danger once again and have little access to assistance. So there was a feeling that you were making a difference to individuals at that moment of treatment, but that the overall the picture is far bigger,” she said.What is diphtheria?
Diphtheria is a contagious bacterial infection that often forms a thick covering of the throat, which can be dislodged, obstruct the airway and cause swelling of the neck and can block a person’s airways. This often happens to children and can cause them to die. Most diphtheria patients have a fever, sore throat and difficulty swallowing. For some people it can be very serious; they can have difficulty breathing, their tonsils can become inflamed. Diphtheria makes a toxin, basically a poison, which can spread around the body. This can cause complications, including with the heart, making it beat too slowly, too fast, or even cause it to stop. It can also cause paralysis, including of the muscles used for breathing, so people suffocate.