By Francis Markus, IFRC

The radiologist opens the bamboo gate to the X-ray tent and four year old Nur Kolima heads gingerly in to lie down on the bed for his image to be taken. His mother, Fatima, is taking no chances with his cough symptoms.

“I had three children, but my little boy, aged 10 months died of fever,” she says with a blank expression.

The family, who arrived three months ago, fleeing violence in Myanmar’s Rakhine state, had taken the child to a traditional community healer, but he was not able to offer any effective treatment for the baby’s condition.

Nur Kolima is diagnosed with bronchitis and slight pneumonia and given a course of antibiotics.

He’s among the first of today’s patients at a Japanese Red Cross Emergency clinic which opened two weeks ago in the Balukhali camp. The facility, in a cluster of tents and bamboo structures on a hill top, is now seeing about 100 people a day. Many of them are presenting with coughs and colds, but there is also an increasing flow of people who are worried they might have diphtheria.

There have been more than 1,700 suspected cases of the disease so far with 22 deaths as of December 18.

Late signs

Among the key tests doctors carry out to screen patients for late signs of the disease is to look for a white spot in the throat. It’s a relatively unfamiliar procedure for the Japanese doctors, “because diphtheria was practically eradicated in Japan by around the year 2000,” says Dr Mineo Nakatsuka. It has also not been widespread in Bangladesh in recent years, but many of the population from Myanmar have not been vaccinated against it.

Doctors here are referring between one and three people daily as likely cases to a hospital run by the humanitarian organization Medecins Sans Frontieres (Doctors Without Borders). The larger Red Cross Red Crescent field hospital is also offering an on-call service to the MSF hospital when it needs extra support with patients, especially overnight. Meanwhile Japanese Red Cross and Iranian Red Crescent teams have been planning to set up an isolation unit for Diphtheria case management.

The Japanese Red Cross emergency clinic is already geared up with a 24-bed treatment and isolation unit for potential disease outbreaks. A section of the clinic is concrete-floored and has drainage channels running around it.

Well crucial to contingency planning

Crucial to the contingency planning at the clinic is the work on drilling a deep tube well right next door. This will provide 50,000 liters of water daily for use by the clinic and the displaced people living nearby.

“Although there are many deep bore wells in operation in the camp, most of them use vacuum pumps which need to be primed every day and the water being used for this pump-priming is often contaminated,” says the hydrogeologist Tjaard van Ellen, working for the Swedish Red Cross, who is  responsible for managing the team drilling the well.

To get round that potential issue, engineers will install a solar powered pump.

Red Cross Red Crescent teams plan to drill several dozen deep tube wells in total and work continues to find a solution to the problem of disposing of faecal sludge from the camps’ growing number of overflowing latrines.