ConCerenceObjectives ORT COMMITMENTS Seventy participants from Bangladesh, Tanzania, -We the participants commit ourselves to Pakistan and Brazil attended the "ORT achieving the goal of 80 percent use by end- Mobilization and Media" Conference held in 1995. Dhaka, Bangladesh from August 30 - September -We are all determined to contribute to the 3, 1994. They represented governments, media, reduction of mortality and morbidity NGOs, Scouts, Oral Rehydration Salt (ORS) caused by the diarrhoeal diseases, which now producers and the medical profession and health kill 3 million children every year around the world. workers. Their aim: to create a global movement to reach the goal of 80 pkrcent use of Oral -We, the medical and health professionals commit ourselves to achieving a 100 percent Rehydration Therapy (ORT) in the treatment of rate of prescription of ORS in all cases of diarrhoea1 diseases by the end of 1995. diarrhoea. Over a period of four days, participants listened to -We, the producers of ORS commit ourselves presentations on national Control of Diarrhoeal to achieving a 10 percent increase of ORS pro- Diseases (CDD) Programmes, NGO initiatives, duction and availability in the next 450 days. medical association and private sector activities, -We, the members of the media here commit and media contributions to the promotion of ORT; ourselves to the design, production and participated in working groups and panel dissemination, at every opportunity, of ORT promotional messages. discussions and witnessed ORT in action on field visits to rural areas and to the International Centre -WHO and UNICEF commit themselves to supporting national efforts by Governments, for Diarrhoeal Disease Research, Bangladesh NGOs, media, communities and individuals. (ICDDR,B) - the birthplace of ORS twenty-five -We, the Governments, NGOs, media, years ago. They emerged from the Conference medical and health professionals and staff, having forged new alliances and with pledged pharmaceutical industries and community commitments to actively work in their respective representatives commit to meet on a quarterly fields towards reaching the goal of 80 percent basis to review progress on achieving 80 ORT use by the end of 1995. percent use by 1 995.

ORT Mobilization and Media Conference: Dhaka, 30 August3 September, 1994 m The Conference Agenda 86% Use 06 QRT: 30 August '94 : Openiny Ceremony Why a Movement is Needed 31 August '94 : What arc we doing wrong when Field visits to Manikganj The power of ORT to save lives has been known for centuries, but in the last political leaders and national 1 September '94 : 25 years the world's awareness of its governments are not effectively Visit to ICCDR,B Hospital existence has grown dramatically. But advocating the use of ORT as part of Conference : the problem remains that actual use of their national plans of action for hcalth? ! 0 Social Mobilization in Bangladesh ORT is still too low. In Bangladesh, for 0 Promotion through the Media instance, awareness is 93 percent, while 0 Government initiatives in Brazil Ingredients for and Pakistan use is around just above 60 percent. In Pakistan, awareness is 77 percent, use Building and Sustaining 2 September '94 : less than 28 percent. Conierence : a Movement

0 Government initiatives in Bangladesh Globally, ORT is known to already save "Movements are not started by govern- and Tanzania the lives of one million children a year ments, they are started by people. A 0 "Creating a Movement" (group work) suffering from diarrhoea1 diseases but it movement must be human rights orien- 0 The Role of the Medical Associations is only being used in 38 percent of all ted, aprotest against something and plu- 3 September '94 : cases. Three million children under the ralistic. Nobody can be neutral, one is Conference : age of five are still dying annually. An either for or against a movement. A 80 percent use of ORT would save 2 0 Role of ORS ~roducers movement must work against myths million of them. 0 Recommendations and Conclusions and use our young people in the front line." Mobilization Dr. Urban Jonsson, Regional Director, UNICEF in to Action Why a Movement is Needed 2 Dr. Jonsson was discussing how to The ORT Mobilization and Med~a The Opening of the Conference 3 create n movement during the final . - Conference provided an historic Government Interventions session of the Conference in Uhaka. opportunity for representatives from Media Mobilization Previously, Kul Gautam, Programme groups able to create a global Director, UNICEF, had outlined the The Participants Speak movement to meet for the first time. - On Media essential ingredients for thc swtained The agenda reflected the crucial success of an ORT movement: - On Mobilization problems that faced the participants in NGOs of Bangladesh trying to nieet the Mid-Decade Goal of an alliance between knowledgeable Mobilize 80 percent ORT use: activists and communications media; The Role of the Medical the commitment of political What are we doing wrong that we leadership: Profession and ORS Producers cannot convince families to have the support of thc medical profession Using ORT confidence to use ORT. and continued and ORS producers: and The Development of ORS feeding, as regular family practice? Concluding Session strengthcned rrronitoring and What are we doing wrong when the acceptability. media does not consider as newsworthy Increasing ORT usc to 80 percent in the Writers: Jeanette Rive and the fact that a solution has been found treatment of diarrhoea1 diseases is an Carolyn Eberle to save the lives of three million of our Photographs: Shehzad Noorani essential first step towards lowering the children every year? Design: Nazmul Ameen incidence of childhood deaths. As Kul For Further Information: What are we doing wrong that we Gautam said, "All of us in this room, Section Chief, cannot convince medical practitioners whether we are government officials, Health G Section, to prescribe ORS and other home-based NGO activists, representatives of UNICEF Bangladesh rehydration remedies for diarrhoea and international aid agencies. doctors or House 73, Road 5A, Dhanmondi RIA, to prescribe antibiotics only when news media, can a role in Dhaka, Bangladesh. necessary? popularizing ORT".

--. - .. . pll ORT Mobilization and Media Conference: Dhaka, 30 August-3 September, 1994 "Where is the social responsibility of the media towards the poor, the illiterate, the marginalized? How can the media bring a fraction of its power to influence social and cultural norms to bear on perhaps the single most important issue of our times: saving the lives of millions of children?" H.E. Barrister Nozmul Huda, Minister of Information, B:~ngladesh

"Twentyfive years ago this message was given a scientific underpinning and proven beyond any doubt; it is time to The Mit~i.sterqJ'Healtlr atirl I.'(ltnily Weifme Batlgladr.~h,H. E. Chowdhlol): Kcitnal Ihn~YML,~' make it work, to carry this revolution to speaking at the oprtlitlfi session. Seoted ji.otn left to right, H. E. Borristrr Nuanul Hrrdo, ~l/lit~i.stvrof ltlf0nnutiot~,Projessor M. Ni~rimiVubi, Dir~ctorGener.01, Health Services, its fulfillrnent. to become a past of Ministry oj'Health crnd Family Wdfare, Kill G~mturn,Progrumtne Director, UIVICEF and Dr. culture. Only when it is integrated into Jot1 Rohde, Int~rnationalExpert on ORT. the culture of the poorest families will we see the full promise of this scientific revolution." The Opening of the Conference Dr. Jon Rohde, International Expert on ORT "The Government alone cannot reach "ORT is a life-saving treatment. This the goal of 80 percent ORT use. We Conference is an opportunity to both must have the participation of the peo- explain the excellence of ORT to the "The world community has now set plc In the villages. We need to build an health workers and medical communi- itself the challenge of reaching the goal alllance wlth every sector involved in ties and convince them to work towards of 80 percent use of ORT by the end of reaching this goal. Only then can we finally putting an end to needless death 1995. The biggest challenge in making hope to see the end of unnecessary due to diarrhoea. I myself commit to ... ORT universally practised is not deaths of our children from diarrhoea1 coordinating and mobilizing the scientific OS technical - the real chal- diseases." alliance on ORT promotion and use." lenge in popularizing ORT.... is a H.E. (howdury Komal lbne Yusuf, Professor M.Nurun Nabi, COMMUNICATIONS CHALLENGE.'' Mmster of Health and Family Welfare, Director General, Health Services, Ministry Kul Goutom, Bangladesh of Health and Family Welfare, Bangladesh Programme Director, UNICEF

ORT Mobilization and Media Conference: Dhaka, 30 August-3 September, 1994 m closely with the media, the CDD Government ln~erven~ions programme has promoted ORT through information campaigns and on-going Initiatives for the Control of Diarrhoeal training, as well as regular evaluation of ORS and home-made sugarlsalt Diseases (CDD) solution usage.

Eighty percent use of ORT has been Government's focus there has been on adopted as one of the primary targets of training. Literacy rates are very high in A National Pact for Children the national Control of Diarrhoeal Tanzania and con~municationis well- The "National Pact for Children" was Diseases (CDD) Programmes of developed. There is already widespread crcated in Brazil in 1991, uniting more Bangladesh, Brazil, Pakistan and community involvement. Now the aim than 100 governmental and non- Tanzania. is to further increase NGO participation governmental organizations around a In Bangladesh, Government medical and to emphasise the need for people in single special objective: to mobilize colleges have established training units the rural areas to change their hygiene organized sectors of Brazilian society to specializing in tliarrhoeal diseases and and health practices. improve the possibility of survival, intensified the training of medical staff. The CDD programme in Pakistan is protection and development of The Government is providing ORS aimed at effecting a change in the atti- Brazilian children and adolescents. This packets, IV fluids and drugs when tude of policy makers and the practices action has proven to be unique, uniting necessary in thelr health facilities. A of implementers, health-care givers and groups normally opposed to one further focus of the programme now is . The Government plans to work another to improve the conditions for KI ensure national coverage through a with the private sector, NGOs and the Brazil's children. coordinated effort of Government and Pakistan Medical Association and NGOs, village doctors anti school through this improve the health and teachers. nutritional status of children. The media has been pivotal in Twelve years of aggressive promotion contributing to the current ORT use rate of ORT in Brazil has resulted in an of S3 percent in Tanzania. The ORT use rate of 62 percent. Working

-P- m ORT Mobilization and Media Conference: Dhaka, 30 August-3 September, 1994 Media Mobi!ka~ion

"Unless the media and other societal Meena series are being used partners take on o ncw social to reach large segments of responsibility to propagate the life- the population and are saving know-how of ORT. this highly influential. knowledge will rcmain confined to the People must be convinced to medicai establishment and the death use ORT as a regular family toll will remain high for much longer practice. The product must than is necessary." be sold, the same way a Rolf C. Carriere, commer-cial product such as UNICEF Represcntar~ve,Bangladcsh a soft drink must be sold. The media in turn needs to On the third day of the Conl'erence. be convinced ancl educated media represcntntives from Erazil, in order to run a story. Australia, Bangladesh and thc United Media such as com-mcrcial Kingdom discussed ancl reported on the television must have a promotion of ORT through the media. reason for covering a story Iticdia can cause a product to succeed Radio has the potential of reaching a On Bangladesh Television (BTV), 25 or faii. Oniy through massive and wide section of the population. The minutes a day are dedicated to human effect~vemedia campaigns supported Urdu and Hintfi Services of the BBC development issues. 6 percent of total by foilow-up door-to-door campaigns, World Service broadcasting to Pakistan! broadcast time. In 1993, 67 mobile such as that carried out by the Bangladesh, Northern India and the units of the Deportment of Mass Bangladesh Rural Advancement Gulf Iiegion with approximately 42 Communication reached some I5 Committee (HRAC), will the message n~illionlisteners has committed to million people with key development of OKT be communicated. Radio broadcast several programmes on OKT messages. Two to three thousand peo- campaigns. advertising. television, during 1995. ple at a time come to watch the films in drama and songs such as the Baul the rural areas. Radio has broadcast singers. traditional village singers in Thc National Advertisins Council of over 2,000 hours of health and popu- Bangladcsh, and l'ilms such as the Brazil has been working with UNICEF lation messages on six radio stations. and NGOs since 1981 in promoting children's health and rights. Television advertisements have been supported by posters, radio spots and leaflets. Well- known artists cooperate voluntarily and social and health causes are given free air time. In the last 12 years, $100 million worth of free time and space Au ma klu sana Hall au kunywa vkurl have been given by the media. In Tanzania, the radio has played an important role in the transn~issionof @ health messages. There is a radio in +3i2 00 dmost every house and a message Au klniaiiklna damu Au aMharlsha sana transmitted over the radio is considered reliable. Radio spots are targeted for the evening and especially at the beginning of the rainy season when cases of diarrhoea1 diseases increase. These messages are reinforced by graphic posters and leaflets. T-shirts are given as incentive to those who practise ORT.

------.-pp -- ORT Mobilization and Media Conference: Dhaka, 30 August-3 September, 1994 m "When researching for the Meeno film On Media on diarrhoea to f~ndout why ORT was not being practised, I I'ound out that "Make me interested, then I'll do the didn't know WHY they should story. The audience needs to hear the give ORT. They did not know that ORS pain so that they will react and ask why wouldn't CURE diarrhoea. The people don't use ORT. For every second message must be reinforced to 1 speak on TV, i need a v~sual,give me maximize impact." a family, tell me what is new about Miro Aghi, ORT. If you want to mobilize media. Media Conhulkmt. UNICEF you need to give us the angle." Kothy Bowlen, Asia Focus Presenter. "Convincing parents and caretakers that Australian Broadcasting Corporation "I have been most impressed by the ORT is the best and most appropriate participation of NGOs and private treatment for diarrhoea is onc thing. groups in the mobilization of people But far more important is how to here in Bangladesh. Even though there convince them to bc confidcnt in the is a lot of training and community use of ORT. Knowledge alone is not participation and awareness in my sufficicnt. Thcy must practise what they country, we can involve these groups know and have learnt." stiII more as well as use the media to Dr. Witiaksono Hardiotanojo, pass the right message on to different WHO Rcprexntntivc, Bangladesh groups to encourage people to change." Dr. A.Makimbo, Asst.Chief ~uedicalOfficer. Training, Ministry of Health, Tanzania

"People have to be convinced hy the media and then maybe they'll believe." Pervoiz Alam, Senior Producer, Hindi Service. BBC World Service

"Advertising is the process of "Targeting a media campaign must be mobilizing public opinion. In done through the traditional culture. mobilizing the media. you must The rural people cannot identify with consider whom you are speaking to and western marketing techniques. To reach speak their language. You must hove a the remote areas, you must first "If there is to be a societal change, you working methodology; you must have a approach the village elders and local must have a true national alliance strategy, a style. Your message has to leaders who are very influential. around the needs of children ... talk to people's minds, people's eyes Nothing will succeed without their (because) children dying of diarrhoea is and people's hearts. It must not over agreemefit." not only the responsibility of the promise but be simple, only one idea at Syed Shujauddin Ahmed, government, but of the entire country." a time. It must speak their language." Director-General, Dept. of Mass Agop Koyan, Hiron (ostello Bronco, Communication, Bangladesh Representative, UNICEF. Brazil National Advcrtis~ngCouncil, Brazil

.--. .. .-.--p -.-- - .---pp m ORT Mobilization and Media Conference: Dhaka, 30 August-3 September, 1994 "We are coming to a point where we On Mobilization are mobilizing ourselves for social change focusing on our precious "This is the fht time in health service children who are our future. Having the that there is a grand mobilization on participation of the professional ORT. Education has been included in medical associations is really the crux the " and Chiid Survival of the matter." Fortnight" where under the CDDP we Agnes Aidoo, have been reaching out at the Representative, IJNICEF. Tanzani:~ Divisional, District and Thana level primarily through the schools. Primary school children and mothers have been taught about health, hygiene, iodized "The goal we are aiming for is salt, ORT, CDD and . As achievable, provided we can convince reinforcement, these "fortnights" will the medical profession. The village be held once n year." women have been given the knowledge Dr. S.M.Nosim, but they will only implement it with the Project Director, CDDP, support of the doctors." Ciovernnient of Bnnglxlesh Dr. Zafarullah (howdhury, Project Coortlinator, Gonoshasthaya Kentlra, B:~nglatlesh

"We have educated thousands of families on how to prepare a home- based ORT formula using a three-finger pinch of salt, a fist of moiasses and a pitcher of water. We have shown that o programme can be carried out on n national scale. Small is beautiful but big is necessary. Now we need the "Using ORT hasn't become a people's support of the medical profession for movement; it's remained more a health- our ORT Extension Programme." worker and medicine-based technology. Dr. Salehuddin Ahrned, We need to takc it out to society. Director of Progmnirnes, BRAC, Medical technology should be Bangladesh "In Pakistan, doctors are not explaining demystified for common problems so the purpose of ORT nor the dangers of that people can take care of themselves. anti-diarrhoea1 drugs and inappropriate We don't have large-scale pso,jects that antibiotic use. When mothers fincl no have been sustained long enough to decrease in stool output when using make that behavioural change. ORT, they discourage other mothers Behavioural change isn't a prqject that from using it. Unless we tackle the you can implement over a few years; issue of doctors' practices and the it's got to be sustained over a long control of anti-diarrhoea1 dru,:,"5 we are period of time." not going to improve ORS use." Dr. Monico Sharrna, Dr. Sareer Ara, Senior Advisor, CDDIARI, UNICEF UNICEF, Pakistan

ORT Mobilization and Media Conference: Dhaka, 30 August-3 September, 1994 m Pioneering Scouts

"If' wc use young people such as the Scouts, our task would be ~nucheasier." Monzoor ul Karim, Chief Nationid Commissioncr. Bangladesh Scouts

The Boy Scouts of Bangladesh were the pioneers of Scout involvement in the promotion of ORT. Thcy have recently developed an ORT action manual "Actions for Scouts and Guides on : A Manual toward Saving Lives" and generated involvement at cvcry lcvcl in a 15 village ORT-education cumpoign, supported by infomational pamphlets Il!it~:;lritl~~.\lr(;lridr\ t.(il/~i~rg,/Or OK1 1r.w ~III-~II~1Irc1 'iLloilrcr. and C.'lrild Survivd E'or/rrig111' l1clti in Ar.rgm1, 1994. Tlw E'orttligh~,~vlzich coit~cidrrl willr /he OR?' Co~+~renc.e.wcu [hefirsst for parents and carc-givcrs. This litrle IIIN~11lc Governttren~of But~glode.sh I~trtlhrltl n ~~clliotwitlePvenr ,fi~crrsi~rgoti these Confcrcnce brought together I.S,Sll~'S. representatives of the Scout ivlovenient from Pakistnr,, Sri Lanka, Ncpal and the regional office in the Philippines. NGOs of Bangladesh Mobilixe Inspired by thc activities of the Bangladesh Scouts, the Scout leaders Many NGOs in Bangladesh have used economic status, are highly motivated at the Conference recommended innovative methods in the areas of and have close relationships with other ORT training for the two nlillion Scouts education, marketing and mobilization women in their area. They are given in the Asia-Pacific region and to increase ORT usage especially in thc information on diarrhoea man''1 g ernent publication of a manual on ORT in four rural areas. and instructions on how to prepare ORS languages. Between 1980 and 1990, the and maintain records. During the first month of the Bangladesh Rural Advancement Create an ORT Irw! Committee (BRAC) trained over 1,000 pilot project they sold 50 rural women workers to educate 13 percent of their stock. million households all over rural The Project and Bangladesh on how to prepare a home- Youth Ending Hunger has based formula using a three-finger used volunteers to orient pinch of salt, a fist of molasses and a 40,000 people on ORT and pitcher of safe water (the lobon-gur trained 94 ORT animators solution). who hold workshops in the In rural areas, there is a problem of rural areas to encourage access and availability of OlZS. people to use ORT. They Pharmacies are far away and health carry a simple three-point workers cannot carry a large enough message: replenish fluids, supply. In a pilot project launched in feed frequently and recog- July 1994 to market ORS packets at the nize sympton~sthat may community level, using its own existing require professional atten- national network, the Gra~neenBank is tion. They have also carried using 225 of its 54,363 centres as out interviews and sent out locations where ORS can be bought. questionnaires to find out Women who head the Grameen Bank why ORT is not being centres, although of low socio- practised.

--p--- P- ---- ORT Mobilization and Media Conference: Dhaka, 30 August-3 September, 1994 The Roled the Medical Annual deaths of children under 5 from diarrhoeal diseases: Bangladesh 260,000 Profession and ORS Producers Pakistan 250,000 Brazil 30,000 Tanzania 45,000 In many countries, including The Medical Bangiadesh, doctors have been accused From the national CDD Programmes of Bangladesh, Pakistan, Brazil and of prescribing antibiotics andlor anti- Community Tanzania; 1993 figures. diarrhoeals instead of ORT. The first Reaches Out motive is often identified as greed; doctors' profits are higher if they "It is the doctors who ~nakcparents The Story of Ranjit prescribe drugs. Another motive may confident in ORT use. If they prescribe Ranjit, a young doctor in Dhaka was be a desire to "give the patients what ORS and antibiotics but don't finding it a problem to prescribe they want". Some doctors perceive that emphasize the importance of ORT, they ORT in his private practice. "If we people want to be given a drug that will miss an important opportunity to only prescribe ORT and no other make them feel better and not told that demonstrate ORS's life-giving medicine, the mothers will be medicine is unnecessary. In practice, it potential." disappointed and they will go to has been shown that patients will Dr. Hans Troedssen, somebody else for drugs". Ranjit respond to the request to use ORT if Medical Officer, WHO was afraid of economic loss but time is taken to explain why they agreed to carry out an experiment In Brazil, the medical community should do so. for three months to prescribe only closely coordinates its efforts with ORT and continued feeding, and Similarly, producers are also often those of NGOs, network media and take one to two minutes to explain accused of promoting anti-diarrhoea1 national and local government. to parents why they should practise medicines and other drugs Brazilian medical associations keep ORT. After a few months, Ranjit inappropriate for diarrhoeal care. The members regularly informed so they discovered that, not only did he not same profit motive is cited as the can support and stimulate local and lose any income, but parents had been so appreciative of the time he reason. national ORS awareness campaigns had taken with them, that he had sponsored by other agencies. The Dhaka Conference was attended by gained a reputation as a caring many representatives of both the The Bangladesh Medical Association doctor.ln fact, he was gaining medical profession and ORS producers. with its 65 branches and 12,000 additional patients! Presenting their activities in promoting members countrywide can play an Told by Dr. Hans Troedsson, WHO ORT and their commitments to increase essential role in convincing doctors and the production and availability of ORS, health practitioners to promote and use Governments have supported they left other participants in no doubt ORSIORT by carrying out training standardizing packaging of ORS that they are committed to promoting programmes for doctors and health although, inappropriately designed, the use of ORT. workers. standardization policies can discourage private sector involvement and hinder "We are committed to achieving 100% availability. ORS prescription rate for all cases of The Producers of ORS diarrhoea by the end of 1995." Producers and distributors of ORS play Other obstacles to wider usage include problems of measurement, confusing Professor Sirajul Islam a decisive role in determining ORS instructions and availability. Vice President, availability and affordability. Producers Bangladesh Medical Association have developed different types of Marketing techniques intluence usage. packaging to reach a broader audience, ORS has been creatively marketed by "We are not lobbying for the existing marketing a more expensively packaged Social Marketing Conlpany (SMC), a ban on anti-diarrhoea1 drugs to be lifted product to the middle class at a higher distributor of ORS in Bangladesh in this country", price. The revenues from the more which has conducted rnuiti-media Salmon Rohman, expensive ORS products can then campaigns using radio and television President, Bangladesh Association of be used to subsidize additional and advertising on the back of Pharmaceutic'll Manufi~cturers marketing costs. rickshaws.

ORT Mobilization and Media Conference: Dhaka, 30 August-3 September, 1994 m only be prescribed when Bangladesh was one of the first necessary. Under no circum- countries to ban the sale of anti- stances should anti-diarrhoea1 diarrhoea1 drugs in 1982. In spite of drugs be prescribed to children. Professor Tariq Bhutta of Pakistan in 1990 bringing global i~ttentionto the fact that wcrc dying Irom bowel What is the paralysis caused by Imodiuni, there arc difference between still 500 brantl-name anti-tliarrhoenl drugs for sale in Pakistan. ORS and ORT? ORT is Oral Rehydration Therapy, which should always be Health workers used during diarrhoea. It means, are convinced "increased fluids along with continued normal feeding "In n refugee camp in Tanzania I was including ". When training health care workers on ORS body fluids are lost, they need to use. A mother camc in with a child on be replaced quickly. GRT can be the verge of death. She was listless and given using, for instance. ORS, uninterested in her surroundings, her skin resembled the contours of a dried From "Actionsjor Scoirrs (~titlGiricles on ORT" LGS, rice water, rice-based fluids or green coconut water, if prune, drooping from her body as if its nothing else is available, even clean spirit had already left. I put in an 1V Using QRT water can be given providing feeding is and began giving the child OKS. When continued. the IV solution was finished I continued "ORT is a brew that celebrates simplic- ity, traditional wisdom. modern science, ORS is Oral Rehydration Salts. It cost-effectiveness, and the democratic usually comes in commercially pre- impulse of ordinary people having thc pared packets to be mixed wlth water. knowledge and the means to take care ORS helps the body remain strong, of their own health and that of their even though there is a great loss of babies." fluids. A solution of Oral Rehydration James P. Grant Salts (ORS) is the best way to quickly Executive Director, UNICEF treat dehydration due to diarrhoea.

Dehydration kills and kills quickly. When a child has diarrhoea, fluids are A US $1 billion waste flushed from the body and dehydration Even though WHO has determined that sets in. A child suffering from diarrhoea anti-diarrhoea1 drugs are ineffective and can die within six hours unless given can be dangerous, it is estimated that ORT. more than US$I billion is spent every with ORS alone. Within two hours the To prevent dehydration. any form of year on anti-diarrhoea1 drugs in child had revived. She began looking ORT can be given at the onset of developing and industrialized countries. around smiling at her mother and diarrhoea. If the child is slightly In a child, the side-effects can be lethal. commenced brenstfeeding. No longer dehydrated, ORS should be given if Although they can slow down the were the health care workers or the available since it contains the best diarrhoea, they neither prevent nor stop mother "sceptical about the benefits of physiological balance to correct dehy- dehydration and they affect the central ORS. My colleagues and I then started dration, otherwise any form of ORT nervous system and the cardio- distributing ORS to the other afflicted should be given. If the child is severely respiratory system. Using these drugs children in the refugee camp and they dehydrated, she should be treated intra- detracts attention from the problem of too responded positively and began venously but ORT should be continued. dehydration. It would be disastrous and reaching out and crying out for morc." ORT does not stop diarrhoea. It regressive if the ban on anti-diarrhoea1 Dr. Saidi Egwaga, prevents dehydration and can drugs were lifted in any of the countries CDDIARI Programme Manager, rehydrate. Antibiotic drugs should that have banned them. Government of Tanzania

ORT Mobilization and Media Conference: Dhaka, 30 August-3 September, 1994 Reasearch at ICDDR,B has shown that ORS can rehydrate 90 percent of patients with dehydration. It can also reduce hospital admission rates by at !CDBR,B: the This "simple solution", effective regardless of the patient's age or the least 50 percent. Every year 1CDDR.B birthplace of ORS cause of diarrhoea, revolutionized treats over 70,000 people with diarrhoea and other dlseases in its Attempts to solve the problem of to the health care practices for diarrhoea1 centres in Dhaka and Matlab, about 55 deaths of so many children from diseases. No longer was sophisticated km. from Dhaka. diarrhoea have been sought for niedlcal attention needed. The chance for life could now be placed in the centuries. In India long ago as 3,000 An Akernative to years, Sushtttra, a pioneer in the hands of parents as well as medical traditional Ayurvedic medicine, professionals. Glucose-based QRS recommended that diarrhoea patients ORT has saved lives not only at the Researchers at ICDDR,B have drink large amounts of tepid water with domestic level but also in large-scale developed a rice-based ORS in an dissoived rock salt and molasses. He cholera epidemics. as in 1971 in the instant, ready-to-use form. Two kinds had discovered the formula for oral refuge camp of former East Pakistan, have been developed: a cooked rice rehydration although the precise now Bangladesh. More recently in Peru powder and a puffed rice (chira) measurement were not known. in 1991, more than a quarter of a powder, both of which can be mixed It was not until 1969, that researchers million people came down with acute with water. Studies conducted in 1992 at the Cholera Research Laboratory diarrhoea during a cholera epidemic indicate that stool out-put could be in Dhaka, now ICDDR,B, discovered that swept across the nation. Less than reduced by as much as 36 per cent in the correct proportions of glucose, one percent died because 3 million adults and 32 per cent in children. sali and water to make up the packets of ORS were distributed by a Rice-based ORS has been used on a scientifically balanced oral rehydration group of community workers with trial basis in certain African and soiution. The high glucose content of knowledge of OUT who trained others S.E.Asian countries. Only at ICDDR,B ORS replaces the fluids, salts, on the spots. Most recently, in Zaire, is it a standard form of ORS in the electrolytes and potassium flushed out following the war in Rwanda in July management of large numbers of by diarrhoea. ORS is the most effective 1994. a team from ICDDR,B helped set patients in a specialized centre. There is and successful treatment for up massive rehydration units in refugee potential for producing rice based ORS replenishing fluids lost through camps and train health workers in using commercially. ORS nianufacturers in diarrhoea. O RT. Bangladesh havc shown an interest in large-scale production.

Visit to ICDDR,B: Participants at the Conference had the opportunity to witness ORT in use as they toured the intensive care wards of the ICDDR,B hospital. They saw rows of sick people on cots with only a spoon and a cup containing rice-based ORS. Children were being fed by mothers and fathers, wives were spooning the solution into their husbands. friends were helping friends. Volunteer workers were sitting with the caregivers, teaching basic nutrition, health and hygiene. Mothers could be seen breastfeeding their children. The participants even sampled the rice- based ORS from the enormous vats of ORS used every day.

ORT Mobilization and Media Conference: Dhaka, 30 August3 September, 1994 m Diarrhoea tends to hit children at the time of great neurological gro\vth. If' a child is well-fed and gcts diarrhoea, the VlPP Working Groups Recommendations from thc other two effects on thc child are not significant. groups included: Howcvcr, if n child is already "Why do I want to be involved?", Improving planning and coordination malnourished, suffcrs from diarrhoea "What can I do?", "How could I do of ORT activities for 15 percent of his or her peak growth it?". These were the questions when the Working with all involved partners period, the in~plicationsare enormous, participants were divided into groups especially at the community level The children gain one kilo less than and were asked to formulatc action Increasing the involvement of they should thcir first year and by age 3 plans to create a global movement for national medical associations universal ORT use. Increasing training to students and Three groups were formed representing NGOs the Scouu, Bangladesh and Tanzania, Increasing awareness in the media and Pakistan and Brazil. Using the Creating innovative media such as methodology of' Visualization in posters, games, advertisement on . , Participatory Programming (VIPP), a~rl~nes,colouring books which facilitates full participation antl Increasing ORT accessibility ensurcs a final goal-oriented resolution, Ensuring that ORT, nutrition antl the grot~psdeveloped concrete plans to hygiene are part of school curriculam involvc mcdia. organizations, the Creating specific ORT campaigns private sector and governments in Developing ORT action plans nation-wide coordinate,d movements to promote ORT. Conclusion

Thc Scout Movcmcnt with represen- Diarrhoea is one of the major killcr can have lost between 1.8 kilos of tatives from Pakistan, Nepal, Sri Lanka, diseases for children under five. It is a weight gain resulting in stunted growth, Bangladesh and the regional office in scourge that leaves its survivors, the and deficits in intelligence and stamina. the Philippines, recommended training children who manage to live through for at least two million scouts in the the 3-5 bouts of diarrhoea they may Studics have shown that ORT use Asia-Pacific region. They also planned suffer every year, so weakened and during diarrhoea results in 50 percent to publish a manual on ORT in four lan- leached of nutrients that their chances more weight gain after the sickness. guages and to disseminate OIiT mate- of dying within months of other causes Continued feeding stops diarrhoea rial at the regional and national Icvels. arc increased five-fold. earlier and allows continued growth antl more catch-up growth. Rolf Carriere, UNICEF Representative. Dhaka, had earlicr challenged the conference participants to give reasons why they did not think it possible to reach the goal of 80 percent use. By the end of the four day Conference, all the participants committed to achieve the goal of 80 percent use. Sustained success requires social mobilization and partnership with a great variety of' societal grourps. As Rolf Carricrc said: "Who do you think is going to achieve this goal if WE don't do it ? IS WE do not take this knowlcdge and insight and act upon it. then wc will have njillions more Ali Ymeen Qrrr-oshi, P(1kistr~r1BOJ Scorrts i\.s.sociatiotl, prc~s~.t~ritrgtlw fit~1it~g.sof Iris 1/IP12 children dying from diarrhoea1 diseases ivotkrtrg g,nl~p. beforc the probicm is addressed".

W ORT Mobilization and Media Conference: Dhaka, 30 August-3 September, 1994