Water-borne diseases, including jaundice, are making people, especially children, ill in the earthquake-affected settlements of Darma Rural Municipality in Salyan district.

Recently, a jaundice outbreak has made many children in the quake-displaced people ill in Darma. Health workers say, extreme hot weather and consumption of polluted water are contributing to the increasing incidence of jaundice among children.

The magnitude 6.4 earthquake, with epicentre at Ramidanda in Jajarkot, affected around 50,000 households in Jajarkot, Rukum West, and Salyan districts of the Karnali Province.

Darma Rural Municipality in Salyan was hugely affected by the earthquake that struck western Nepal on November 3 last year. There are a total of eight health facilities in the six wards of Darma and all of them are either health posts or primary health centres. There is no hospital in the rural municipality.

After the outbreak of jaundice, all health institutions in the rural municipality were overwhelmed with children under the age of five. Since it is not possible to test for jaundice in the health facilities of the rural municipality, the locals are forced to travel to the District Hospital Salyan or the Mission Hospital in Chaurjahari of Rukum West for blood tests and treatment of their children. They have to take 4-5 hours of journey by motor vehicle to reach Chaurjahari.

Due to the lack of health awareness and the economic damage caused by the earthquake, the parents are struggling to provide nutritious food and proper accommodation to their children. The poor living conditions have led to frequent outbreaks of various diseases, particularly affecting children, and put parents in difficult situations.

Yagya Bahadur Basnet, head of the health unit at Darma Rural Municipality, said that there are around 1,700 children under the age of five, and among them, more than 100 have tested positive for jaundice.

All jaundice-positive children are initially checked at the health facilities of the rural municipality, and if serious symptoms are found, they are referred to better health facilities elsewhere.

Jaundice is a condition where the infected person’s skin, the whites of the eyes, and mucous membranes turn yellow. It is a communicable disease. While there are many causes of jaundice, including pancreatic cancer, the ongoing jaundice outbreak is a viral infection of the liver, mainly caused by hepatitis E virus. The hepatitis E virus is transmitted through contaminated water.

According to the World Health Organisation, hepatitis E is usually a self-limiting infection and resolves within 4-6 weeks. Occasionally, a severe form of hepatitis causes acute liver failure, which can lead to death.

According to the data at the Darma Rural Municipality, at least 4,000 houses in the rural municipality were damaged by the earthquake, out of which 1,700 were completely destroyed. Similarly, some 1,700 families are still living under tarpaulin tents.

Locals complained that more than 2,000 earthquake-displaced people in the rural municipality have not received the first installment of the relief grant provided by the government.

“The residents of the rural municipality are struggling with the financial burden caused by the earthquake, due to which they have not been able to provide quality of living and proper care to the children,” said Basnet. “The jaundice outbreak among children started a week ago after two days of continuous rains. Health officials believe it might be due to drinking contaminated water, combined with the heat wave and rising temperatures,” Basnet added.

It is common for water to become contaminated during the rainy season, as potholes and hidden spots fill with water, creating breeding ground for insects, bacteria, and germs, among other things. Previously, the locals of Darma were able to manage them, but now, due to poor economic conditions, they are vulnerable.

According to Prem Bahadur Oli, information officer at Darma Rural Municipality, the current average temperature of the rural municipality is around 36 degrees Celsius, but a few days ago, the daytime temperature had risen to 41 degrees

Three days ago, some 40 children had been brought to various health facilities in the rural municipality and they were later referred to the hospital, and among them, 25 tested positive for jaundice, said Oli.

“The rural municipality has deployed health workers and volunteers in every ward to conduct awareness programmes regarding jaundice and other health issues that could be caused by drinking polluted water and extreme heat,” Oli added.

Jaundice can turn into an epidemic because everybody in the rural municipality is vulnerable at this time.

Yagya Bahadur Khadka, a medical worker at the Dankadam Community Health Centre of the rural municipality, said that more than 20 people have been visiting the centre daily with symptoms similar to jaundice for the last four days.

“Due to a lack of skilled manpower and a lab to conduct blood tests, which are required to verify jaundice, we refer everybody to hospitals. Apart from that, several children and adults in the rural municipality are also suffering from diarrhoea, dysentery, dehydration, fever, and skin rash, among other things,” said Khadka.

Lila Khatri, a 35-year-old woman from ward 2 of Darma whose house was completely destroyed in the earthquake, said that she is struggling to manage funds for the treatment of her five-year-old son, who is showing symptoms of jaundice.

Despite the clear instructions of the health workers, Khatri has not been able to take her son to a hospital.

“I took a loan of Rs600,000 to build a house, and I am still struggling to pay it back. All my earnings go into repaying the loan, and after my son got sick, my whole world turned upside down,” said Khatri. “I spend whatever is left on daily essentials, which are hardly enough. Due to a lack of money, I have not been able to take my son to a hospital for treatment,” Khatri added.