28 September 2000
There are no effective vaccines against any of the micro-organisms causing diarrhoea. The only way to prevent its spread is to interrupt the faecal-oral cycle of contagion. The ways MSF teams do this include:
providing health education to a population on how to prevent diarrhoeal disease. The messages include hand-washing, disposal of faeces and protection of household water stocks; provision of soap to refugees;
working with the community to ensure they have pit latrines. The minimum number required in an emergency situation is 1 latrine per 20 head of population;
setting up adequate supplies of safe water. The minimum quantity required in an emergency population is 10 litres per person per day.
In all of these preventive activities MSF water and sanitation engineers and logisticians have a vital role to play - just as important as the role of doctors and nurses.
An example - teaching nomads to save their children
The nomads of the Ogaden region of Ethiopia and Somalia do not usually have access to safe drinking water. Mostly they take their water from shallow dams called birkas which they have dug to catch rain water. The water is shared with the goats and camels that are such an important part of the culture and economy. Because this is surface water (rather than ground water, such as from a spring or a well) it is almost always polluted.
The children often get diarrhoea, and as the families do not have frequent contact with health facilities or even markets where the mothers could buy ORS, it is important to find simple ways of preventing and treating dehydration. The strategy used by MSF teams is to teach the mothers to make their own rehydration solution.
The recipe is the following:
take one litre of water, which is about half the contents of a small sized gourd that is commonly owned by the women;
add a pinch of salt;
add a scoop of sugar, which means the amount that can be held easily in the cupped palm of the hand;
mix together, and give to the child liberally until the diarrhoea has passed.
This home-made rehydration solution contains sucrose (which helps the water to be absorbed from the intestine) as well as sodium and chloride. This is by no means an ideal composition but it is far better than nothing at all... And in the arid vastness of the Ogaden it has saved thousands of lives.