Water contaminated by sub-standard sanitation root cause of yellow peril

All purpose water in 'Jaundice Puri'"Feeling sick? Come to the window; let me see if your eyes are looking yellow." Time and again, doctors called to examine a case of fever and nausea get suspicious that it might be hepatitis. Time and again - all over India, and throughout the year - it is.And in virtually every case, the root cause of the yellow peril is water contaminated by sub-standard sanitation and slapdash public health engineering. The result of this wide spread bad water is nearly 100,000 people stricken around the country every year, with the total for 1971-75 coming to about 450,000 reported cases. Sufficient cause for a sober appraisal of the problem, say health authorities, "because the whole country is an endemic zone."This is not an unduly jaundiced view of the situation. Although the actual villain is the still-imperfectly known Infectious Hepatitis virus Type A, the hepatitis problem does stem from the completely preventable human carelessness, that encourages the virus along its sinister way.People contaminate water by sullying it with excrement. People use water without worrying about its purity. And people plan water and sewage systems with a similarly impressive lack of foresight. These are the people, big and small, who cause hepatitis outbreaks; doctors can do little more than treat those who fall prey to the virus.They can also provide short-term preventive protection to those who can afford the expensive Gamma Globulin injection. But they are quick to point out that the real preventive is clean water. This is what needs the most urgent and serious attention.Attention from whom? First of all, from urban planners and civil engineers. The recent major hepatitis outbreak in the huge Delhi colon) of Janakpuri has been traced to foolish blunders in the laying of water and sewage pipelines, and pollution of sub-soil water by unchecked accumulation of sewage wastes.Local authorities responsible for the planning and development of the colony's essential civic services are now digging about for plausible excuses for this mess. Meanwhile, Janakpuri - which enjoys the dubious privilege of being called "Asia's largest urban colony" - has chalked up another record by having 1,044 of its residents fall sick with infectious hepatitis over a two-month period.This equals the total number of hepatitis cases recorded in the city-wide sampling checks carried out by the National Institute of Communicable Diseases during the whole of 1972. It is little wonder that local wags have nicknamed their colony "Jaundice Puri".But Delhi's real dirty water headache is not a localized one: it stems from the brilliant planning decision that placed the city's main sewage outlet into the Jamuna river upstream of the main water-supply off take point. Sewage cast out from the city regularly flows back into the city through the water pipes. It passes through filtration and chlorination processes - but these do not kill the hepatitis virus.Delhi is not the only Indian city saddled with a chronically sick water supply. The allegedly ultra-modern planning of Chandigarh has provided another example: there, the entire network of water mains is said to have been laid below the network of sewage lines.The new capital's early settlers used to boast of the area's health-giving pure water as worthy of a spa. The gradual corrosion of parts of the sewage system, along with sundry leaks at joints here and there, has put paid to that claim. Chandigarh's water is now as bad as that of any town in the country.What does kill the hepatitis virus? Boiling the water does. But this is not something that the authorities can do. So the hepatitis preventive lies in the hands of the man in the street who actually uses the water. Unhappily, boiling of water for domestic use is not a national habit. More unhappily, the careless use of community water sources for washing after defecation is very common.And this is how the virus gets into the water, and thence into someone who drinks water from the same source. If people who are dependent on such suspect water supply could learn to boil it as a routine precaution - there might be no more infectious hepatitis outbreaks either in our congested cities or in our uncared-for villages.It is ironic that the preventive for the disease should be such a homespun one as boiling. Little else about hepatitis is simple. The bane of most places in the world where public health has been defeated by overstrained services plus official and public neglect, it is known to be a viral infection.But the virus has not been conclusively isolated, even though virus-like particles are currently the subject of much excited hepatitis research. The life span of the virus is not known, and the theory that it might be airborne as well as water-borne is still no more than a theory under study. The development of a vaccine must await the success of such research.The Gamma Globulin now used as a preventive offers about two to four months of reasonably effective protection, but with a disease that can strike at any time of the year, this kind of protection is very temporary. Besides, each dose costs about Rs. 40, whereas cleaner domestic habits cost next to nothing, except in extra fuel for boiling.The boiling solution is not taken seriously until an acute case occurs in a family or community. This is partly because people in general - including many public health authorities - are largely unaware of the secondary effects of the infection. Yet one of the four hepatitis deaths in Janakpuri - that of a 21-year-old pregnant woman - has underlined an unsung truth that should be more widely known.An expectant mother who catches infectious hepatitis during the latter half of her pregnancy is at high risk - and so is her unborn baby. If she lives, the baby is in danger of being stillborn, or of dying soon after birth - or of surviving with a badly damaged, enlarged liver.Vulnerable even in the mother's womb, children continue to be at risk during early childhood. Although most hepatitis cases fall in the 15-45 age range, and the 1-4 age group account for only around 20 per cent of cases, this percentage is proportionately a good deal more than the 13 per cent that this age group constitutes of the total population.Fatal in seven to eight per cent of hospitalized cases, and perhaps one per cent of diagnosed unhospitalized cases, infectious hepatitis may not - on paper - look like much of a killer. Its cousin, serum hepatitis - caused by infected blood transfusion or dirty injection needles - is much less common but appears to be more deadly. But health authorities currently feel it is a challenge that must be taken in hand.Only 15 states and union territories currently rate it as a "notifiable" disease. In others - including Delhi and West Bengal - doctors are not obliged to report even clearly diagnosed incidence. This should change, if curative measures are to be as rapid as they need to be. Until someone takes steps to solve the basic water threat, the question of preventing episodes like "Jaundice Puri" remains a public health poser.Published By: AtMigration Published On: Aug 2, 2014 11:34 IST--- ENDS ---

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Water contaminated by sub-standard sanitation root cause of yellow peril

Although the actual villain is the still-imperfectly known Infectious Hepatitis virus Type A, the hepatitis problem does stem from the completely preventable human carelessness, that encourages the virus along its sinister way.

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