Myadhe Joro, Aka, Typhoid Fever

The bulk of the problem is in “hamro” South Asia, that is India, Pakistan, Bangladesh, Sri Lanka and Nepal. We have the dubious distinction of being the typhoid capitals of the world.

April 28, 2013, 5:45 p.m. Published in Magazine Issue: Vol: 06 No. -21 Apr.26- 2013 (Baishakh 13, 2070)

Nepalis suffer so much from typhoid fever that we have a colloquial name for it, Myadhe Joro. Observant patients in the preantibiotic era found out that the fever caused by typhoid usually lasts for about 3 weeks; there was a certain time frame ( myadh). So if you could hold off not succumbing to your illness in that time frame, you made it. Typhoid or enteric fever annually affects some 27 million people in the world with at least 300, 000 deaths. The bulk of the problem is in “hamro” South Asia, that is India, Pakistan, Bangladesh, Sri Lanka and Nepal. We have the dubious distinction of being the typhoid capitals of the world.

Typhoid is basically a disease brought about by poor hygiene, that is it is caused by fecal oral transmission. Eating and drinking bacteria ( salmonealla typhi and paratyphi) contaminated food stuff is easy to do in Nepal. Intriguingly, typhoid fever is human specific. So our loyal friends the dogs are spared, thank heavens; otherwise all dogs in Nepal would be dead of typhoid.

Shah kings to Everest summiteers to Nepali prime ministers to the Nepali villager have had a taste of this illness. In fact it used to be so common that as a health professional if all you knew in terms of fever was how to effectively treat typhoid fever, your practice would be a grand success, “mala mal” !  Typhoid fever came to the limelight in the world stage some year ago because salmonella typhoid resembling DNA was extracted from some of the skeletal remains of victims of the Plague of Athens ( 450 BC) suggesting it could be a cause of that famous plague.

Because drugs are easily available over the counter,  drug resistance (  especially drugs like ciprofloxacin) is a problem. Amazingly older drugs like chloramphenicol are making an effective comeback in the treatment of typhoid.

For prevention, it is important to drink clean drinking water, wash your hands with soap and water and eat hot steaming, well cooked food, especially during the summer months, when this disease peaks. What about vaccinations? Since most of the people who suffer from this illness are school going children about 15 years old, it would be ideal if our government provided this vaccination for free to this age group, as mandated by the WHO. Ironically, the only ones using the typhoid vaccines today are tourists from yonder lands.

Buddha Basnyat.jpg

Buddha Basnyat MD

Buddha Basnyat, MD, MSc, FACP, FRCP, Director of the Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Kathmandu.

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