Cholera in north western Cambodia

Phnom Penh - The Pasteur Institute in Phnom Penh, Cambodia confirmed the presence of cholera in a stool sample taken from a patient in the border town of Poipet, Banteay Meanchey Province. MSF staff took the sample from Poipet to the Pasteur Institute. "MSF staff in Poipet who are running a clinic to treat Sexually Transmitted Diseases (STDs) have been hearing rumours that several people died from diarrhoea over the past two weeks", said Dr Dominique Lapierre, MSF Medical Coordinator in Cambodia. When four patients suffering from acute diarrhoea were admitted to the public health centre, one of whom died shortly thereafter, the provincial health authorities and MSF decided to prepare for a worst-case scenario. MSF started moving medical personnel and supplies to Poipet in the afternoon of 24 June. The Cambodian authorities have moved 14 additional medical staff to the refurbished health centre. They will work in shifts to ensure 24-hour service. Three MSF staff, who are training additional local nurses in how to treat cholera, back them up. MSF is also assisting the authorities with the management of the health centre as well as providing medicines and logistical support. "All the ingredients for a cholera outbreak are present. We are dealing with a weak and malnourished population of migrant workers in a densely populated slum area, people who are therefore more prone to become sick. The infrastructure is still in a shambles following years of daily bombardment from the former Khmer Rouge stronghold of Phnom Malay. The public health system was, until yesterday, made up of a health centre, with a few beds, but no running water and no latrines. This is the rainy season, so we will most probably witness a cross-contamination of the water supply," said Maurits van Pelt, MSF Country Coordinator in Cambodia. To make matters worse, the real magnitude of the problem is still 'hidden'. Due to the quasi-total absence of public health services in Poipet in the past, sick people are not coming forward to seek treatment. " The health authorities and MSF are investigating the size of the problem through an active outreach programme. It is too early for us to say whether the situation will get worse because we cannot say whether people are sick or dying in their homes," said MSF staff member Dr Verena Carrara. Health Authorities are very worried about cholera spreading to other parts of the country, as Poipet is the temporary home for large numbers of migrant workers. To date, two deaths from cholera have been recorded in Poipet. It is impossible to estimate how many cases have gone undetected. There is no functional health information system in Poipet. Cholera comes at a particularly bad moment. The public health system is grappling with an outbreak of dengue fever and the authorities are busy preparing for the elections. Cholera is endemic in Cambodia, but no case has been reported since 1993.