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Journalism of Courage
It’s one of the simplest and most well-known cures known the world over against dehydration. Three decades ago, The Lancet called the Oral Rehydration Solution ‘‘the most important medical discovery of the 20th century’’. Any remaining doubts were put to rest during the Indo-Pak war of 1971.
But Dr Dilip Mahalanabis and Dr Nathaniel F Pierce—who gave a new meaning to salt, sugar and water—have been working all this while on an ‘‘improved’’ version. Tomorrow, they will be present at the function in Nirman Bhavan when the Government finally launches this version of the ORS.
Thanks to the wonder cure whose formulation—one teaspoon of salt, eight teaspoons of sugar in one litre of water—is now household knowledge, child mortality rate due to diarrhoea has come down from 5 million per year three decades ago to 1.5 million currently.
The improved version, the doctor duo says, isn’t much different. ‘‘During the past 20 years, numerous studies have been undertaken to develop an improved ORS that would be optimally safe and effective for treating or preventing dehydration in all types of diarrhoea, and would also cause reduced stool output or have other clinical benefits. The new formulation is better in that aspect,’’ says Dr Pierce.
‘‘In layman’s language,’’ explains Dr Mahalanabis, ‘‘it is a little dilute and aids in absorption of more water and salts. In scientific language it is more about reduced osmolarity.’’
Awarded Pollin Prize by Columbia University (considered more or less the equivalent of Nobel in peadiatrics) in 2002, the scientists are visibly proud of their discovery. While more than 65 years of age, both are still very much active in the field. Dr Mahalanabis (who retired after serving the WHO at Geneva for over a decade) is back in Kolkata involved in research projects on nutrition and child health. Dr Pierce is a professor of international medicine in John Hopkins School of Public Health.
Oral rehydration therapy as treatment for severe cholera was first tried in the 1940s, and developed simultaneously in the last half of the 1960s in Dhaka, Bangladesh (then the Eastern Province of Pakistan) and Calcutta.
‘‘The idea was to develop a treatment as effective as intravenous fluid therapy, but experts were worried about leaving its administration in the hands of inexperienced health workers,’’ says Dr Pierce.
The 1971 Indo-Pak war proved all such fears wrong. Dr Mahalanabis and Dr Pierce were involved at the time in a project by John Hopkins University for cholera research in Dhaka and Kolkata.
The war broke out and, says Dr Mahalanabis: ‘‘I went with my team to just help the government in treatment of thousands of refugees who were crossing the Indo-Bangladesh border.’’ Dr Pierce had to return back due to censorship clamped on foreigners in the area.
Most of the people, according to Dr Mahalanabis, were exhausted and dehydrated after travelling miles on foot.
As he was part of the team involved in the development of ORS, he started trying it on refugees.
‘‘The hospitals didn’t have enough IV fluids to treat them. As we were sure the solution would work, we started giving it to adults as well as children (who were in not urgent need of IV fluids), and thosands of lives were saved,’’ he says.
Dr Mahalanabis also noticed something else: well-trained, experienced health workers were not administering the ORS to patients, but mothers, sisters, spouses, grandmothers and friends, who collected the solution in small cups from central drums.
Dr Malahanabis turned a small library into his laboratory and started developing the solution with glucose powder and common salt.
‘‘The overwhelmed health workers concentrated on replenishing supplies in drums and making quick visits to check on patients,’’ he recalls.
Soon the fatality rate in Mahalanabis’s camp was down to 3 per cent, compared to the 20 and 30 per cent in camps that used only intravenous fluids.
Even then the world wouldn’t have come to know of the discovery had Dr Dhiman Barua, head of the Bacterial Diseases Unit of WHO, not visited the camp managed by Dr Mahalanabis.
‘‘Dr Barua began boldly promoting the ORS for treating childhood diarrhoea as well as cholera and started pushing it in WHO and UNICEF,’’ says Dr Pierce.
Initially, the scepticism was high and a number of medical journals rejected Dr Mahalanabis’s paper describing his refugee camp experience. It would be seven years before the ORS would be accepted as a good form of treatment and UNICEF would started developing it.
‘‘At the time, almost five million children under five years of age died annually from diarrhoea, and most paediatric departments were fully occupied with rehydrating young patients with intravenous fluids. Today, the ORS is an accepted therapy, valued by health workers in developing and developed countries alike and has brought down the mortality figures to just 1.5 million per year,’’ says Dr Pierce.
