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Last Updated: Thursday, 6 January, 2005, 11:42 GMT
Checking the spread of disease
By Jane Elliott
BBC News website health staff

Tsunami victims queue to receive relief materials at Devanahpattinam, the southern Indian state of Tamil Nadu
Dr van den Broek will travel to Tamil Nadu, India to help medical workers
Aid workers from across the world are heading to Asia in the wake of the tsunami.

Among them are epidemiologists - specialists who study how diseases spread among populations.

There are fears diseases such as typhoid, cholera and malaria will spread among survivors of the Boxing Day disaster.

The kind of basic information provided by epidemiologists such as Ingrid van den Broek, from the aid agency Medecins Sans Frontieres (MSF), will track the incidence of these diseases and help medics act quickly to limit their impact.

Malaria fears

In the areas hit by the wave, homes have been destroyed and wells contaminated with salt water, leaving survivors without shelter, food or access to clean water supplies.

Where people are living crowded together in one building or camp we have to make sure that the disease can not spread too quickly
Dr Ingrid van den Broek, Medecins sans Frontieres
Survivors are living and sleeping in makeshift shelters, temples and schools - and there are worries that diseases will spread rapidly in the cramped and unsanitary conditions.

Dr van den Broek is set to fly out to Kanniyakumari, near Trivandrum, in the Indian province of Tamil Nadu, where an estimated 6,000 people were killed by the tsunami.

She will help set up a system that will allow herself and locals specialists monitor the diseases and any sudden changes.

She said: "I am going to set up a simple data surveillance. I will compile a weekly form so that we can follow-up if there is a rise in diseases such as diarrhoea or malaria."

Dr van den Broek, whose specialist area is in malarial research, said that in the aftermath of the tsunami it could be all to easy for diseases to flourish.

"Wells have filled up with salty water and, because of the destruction of the houses, there is rubbish left around."

She said that she was expecting to find problems with cholera, diarrhoea and typhoid, but that monitoring them would help them to contain them.

There are also worries that over the next few weeks the conditions could provide a breeding ground for mosquitoes, which could spread diseases like malaria, dengue fever, encephalitis and filariasis (a blood spread disease similar to malaria).

"We expect this because of the bad living conditions because people are not sleeping in proper beds and do not have bed nets to protect them from mosquitoes", said Dr van den Broek.

Homes destroyed

Medics will also be warned to look out for respiratory problems, pneumonia, hepatitis and skin conditions as well as the spread of infections such as measles among the children of the camps, many of whom will not have been inoculated in the more rural areas.

We are not going here to give medical care but to fill in the gaps.
Ingrid van den Broek
Dr van den Broek added: "Where people are living crowded together in one building or camp we have to make sure that the disease can not spread too quickly and if we find one or two cases of measles we will have to make sure that the children are vaccinated."

The specialist stresses, however, that she and her colleagues will be complementing, not replacing, existing health services in the affected regions of India, most of which have survived the tsunami.

Before flying to Tamil Nadu on Sunday, she will travel to the MSF headquarters in Paris where she, along with other epidemiologists travelling to the region, will be briefed about what to expect and what they need to do.

She will then link up with a colleague who is already working in the area to find out more about what is needed on the ground.

"I have seen some basic reports and what I have heard is that the whole costal region is affected", said Dr van den Broek .

"The first 500 metres along the coast were hit by the tsunami so the people who live there are now based in camps.

"I am just going to set up the system and give them some advice.

"We will have to work very closely with the local health authorities and we will train people who will then train other people, to ensure that the monitoring system works.

"It should be implemented in all the small rural areas. We will make sure all the health centres get the forms and know how to fill them in.

"In the region I will be in most of the health centres are still functioning and still intact so we are not going here to give medical care but to fill in the gaps."

And one of the tasks where there is a gap is in disease surveillance.

Already, medical teams in southern India have started vaccinating survivors against cholera, hepatitis and dysentery, to stop the spread of the diseases.

MSF will also be sending water and sanitation experts to the region and psychologists to help deal with the psychological and post-traumatic stress people have suffered in the aftermath of the disaster.

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