Flooded Kerala is pulling out all stops to tackle health problems and prevent disease outbreaks

Rescue operations are still underway and the floodwaters have not receded in many parts of Kerala, but the health department has already swung into action to provide medical relief to the affected people.

The Directorate of Health Services has issued advisories for the public and medical workers in relief camps regarding measures to be taken during the floods and after. They cover treatment of injuries as well as control of communicable diseases, which is a major threat in the aftermath of a flood.

The department has advised the people to take these precautions:

• Consume only safe drinking water, preferably boiled.
• Wash hands frequently with soap and water to prevent infection.
• Do not consume food soaked with the floodwaters. 
• Anyone developing fever or diarrhoea should seek treatment at government health facilities, including medical camps, and refrain from self-treatment. If clustering of diarrhea cases – more than three cases in one locality – is found, a nearby health facility should be informed.

Doctors have also advised the people against wading through the floodwaters as far as possible as this could expose them to leptospirosis, a bacterial infection passed on to humans through contact with urine of animals such as dogs, rodents and livestock.

The health department has also issued guidelines for local authorities on handling the clean-up after the floodwaters recede, including on dumping of waste, disinfecting flooded areas, cleaning sources of drinking water, chlorinating water, ensuring oral rehydration of those who require it, and preventing food poisoning, mosquito-borne diseases and snake bites.

The guidelines point out that flood-affected people are likely to suffer psychological problems and ask the local authorities to conduct special camps for them wherever necessary.

Risk of malaria, diarrhoea

The health risks from a flood are of two kinds – the acute and immediate like injury, trauma, dehydration from lack of drinking water, and those that can manifest later like outbreaks of infection.

Dr Mala Ramanathan at the Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, said Kerala is likely to be vulnerable to malaria and diarrhoea in particular in the coming weeks. “While the state has had to handle more exotic diseases like Nipah, more common things like malaria and diarrhoea could be a problem,” she said. “We are used to handling dengue, chikungunya and leptospirosis, but not cholera and diarrhoea which can particularly affect children because these diseases have been eliminated in the state and so have not been on the health authorities’ radar for primary healthcare systems.”

Ramanathan added that the people are unlikely to drink contaminated water unless they are in situations where it is the last resort. This is because literacy is quite high and almost everyone is aware of the risks. By way of example, she said residents of the Thiruvananthapuram suburb of Thirumala who do not have drinking water have been been catching rain water directly in clean buckets and using this safe water for drinking and cooking.

“Leptospirosis is definitely the bigger risk because everyone is wading through water and they don’t have much of a choice,” said Ramanathan.

In Palakkad, where the floodwaters receded on Saturday, more than 10,000 people have been evacuated to 90 relief camps. The local parliamentarian MB Rajesh said the “health situation” is under control so far and there is no need for panic. “Medical teams are working at all relief camps round the clock,” he said. “As of now there is no outbreak. There have minor infections and doctors are treating those. We have sufficient medicines.”

He added that the district administration has already begun a massive campaign to clean houses and water sources.

Another big threat is that of injury. “In flood situations there is a lot of flowing water and there tend to be sharp objects like broken wood and glass that cause injuries and accidents,” said Vijayprasad Gopichandran, assistant professor of community medicine at ESIC Medical College and Post Graduate Institute of Medical Science and Research in Chennai who witnessed several such cases when the city was flooded in December 2015.

Lessons from the Chennai floods

Chennai and other parts of Tamil Nadu faced devastating floods in November and December of 2015. The state was lauded for preventing outbreak of infections in the weeks and months after the disaster through a number of preventive measures and coordinated action.

The state’s health authorities conducted medical camps and preventive screening at all relief camps. They set up mobile medical camps to reach interior areas hit by the floods and referred necessary cases to government hospitals. The state stocked up on three and a half months’ worth of medicines and procured oxygen on an emergency basis from Karnataka.

Chennai’s water authority doubled the amount of chlorination of water sources while the city corporation liberally spread bleaching powder, a disinfectant, in the affected areas. Moreover, every household was provided half a kilogram of bleaching powder and 20 chlorine tablets.

The authorities issued public health advisories, distributed free sanitary napkins to women and girls, and deployed health inspectors in villages. Relief workers and the people exposed to injuries were given tetanus vaccination as well as protective gloves and masks. Surveillance teams were formed to watch out for possible outbreaks of diseases.

As disastrous as the 2015 floods were, Tamil Nadu was able to pull in resources from districts which were unaffected. In Kerala, however, almost all districts have suffered widespread devastation and it may have to depend on support from its neighbours and from the Centre.

Specialised healthcare services

Leena Joshi, former director of the non-profit Apnalaya, remembers the psychological damage people suffered when Mumbai flooded in July 2005. “The people, particularly women, suffer quite a lot,” she said. “They are anxious about their families members who have been stranded or with whom they do not have contact for a long time. Even children suffer from traumatic experiences. They may also have physical symptoms because these are psychosomatic.”

Joshi said medical relief teams can and do offer psychological support through their volunteers who are not necessarily doctors or health workers but who are willing to hear people out.

Gopichandran pointed out that in times of disaster, routine healthcare services take a beating. “In December 2015, I would go to relief camps where people would come for their diabetes medicines because they could not access their regular supply,” he said.

It is crucial, Gopichandran said, to ensure there is no inordinate interruption in critical healthcare programmes such as for tuberculosis and HIV. “One thing that needs to be kept in mind is it is not enough if we mobilise doctors,” he explained. “The actual work is done by nurses, sanitation workers and so on. Kerala will have to mobilise these kinds of people in large numbers.”

Ramanathan already feels the need for one kind of specialised health workers in Thiruvananthapuram. “Right now, at hospitals we are looking for pharmacists to volunteer to help,” she said. “We have huge supplies of medicines that have been donated but these are all mixed up. We need people with medical knowledge to sort these out.”