BORUNGO KHOLA, Bangladesh | A pinch of salt. A fistful of sugar. A half liter of water. It’s a recipe 8-year-old Mee Akter recites easily while squeezing and scooping her tiny fingers through the air with precision, pretending to measure just the right amount of each ingredient.
“You take the salt with three fingers,” says the little girl in a pink-and-blue ruffled dress, smiling shyly. “I learned it in school last year.”
Over the past 30 years, this simple ’poor man’s Gatorade’ has become a cheap, trusted home remedy passed down to generations of Bangladeshi moms nationwide. It is bought or whipped up and sipped down at the first sign of diarrhea to stave off dehydration, which can drain a weak child of life in just hours.
Bangladesh, one of the world’s poorest countries, is a leader in the fight against diarrhea, which is the No. 2 killer of children under age 5 worldwide after pneumonia. Diarrhea claims 1.5 million kids annually - more than AIDS, malaria and measles combined - and the United Nations has projected the number of deaths will rise by 10 percent each year over the next decade.
“When I talk to people in developed countries about diarrhea, they don’t believe me when I tell them it’s killing children,” says Dr. Olivier Fontaine, a diarrhea expert at the World Health Organization (WHO) in Geneva. “We have the magic bullets, and now we need to apply them to make sure every kid has access. What we need is money to implement what we have seen in Bangladesh.”
A pinch of salt. A fistful of sugar. A half liter of water.
Rahima Begum, 45, was among the first to teach the homemade recipe to mothers 26 years ago in Borungo Khola village, a bucolic farming community down a dirt road about 40 kilometers outside the capital, where little Mee Akter is a neighbor. It was a time when parents had no idea what to do when diarrhea struck. If there was no hospital nearby, many kids simply died.
“Spreading the message is very important,” Mr. Begum says. “We didn’t know it, but now we do. Maybe people from Bangladesh can teach this to other countries.”
At first glance, the country would appear to be an unlikely instructor. Bangladesh is a young democracy plagued by corruption and natural disasters, where nearly half the population lives on less than $1 a day.
Yet the Muslim nation has vast experience beating back diarrhea tied to annual monsoon flooding, unclean drinking water and poor sanitation. Over the past two decades, its overall child death rate has dropped threefold to 5 percent today.
Bangladesh is the birthplace of ORS, the lifesaving oral rehydration salt-sugar solution. Today, the concoction is so woven into the culture that it’s not only mixed up or purchased for pennies to treat diarrhea and tummy aches, but guzzled by children and adults alike after working or playing outside in the sweltering heat.
Bangladesh is also home to the International Center for Diarrheal Disease Research, which treats more than 100,000 patients a year at its hospital filled with hundreds of brightly colored diarrhea cots with holes in the middle opening to clear buckets beneath.
Some 27,000 health workers have trained here from about 70 countries, and WHO regularly calls on its experts to assist with global outbreaks of cholera, a fast-spreading watery diarrhea.
“Almost everybody starts rehydration at home,” says Cathrine Costa, a nurse at the hospital where mothers, rich and poor, sit beside one another in open wards shoveling spoonfuls of a special rice gruel into the mouths of bare-bottomed babies, many malnourished. “If they don’t, the dehydration is much, much worse.”
Oral rehydration solution was first tested in the late 1960s in East Pakistan, which would later become Bangladesh. But the real experiment came in 1971 during a cholera outbreak in the refugee camps of West Bengal, India, which were crammed with families who had fled the war between East and West Pakistan. With a scarce supply of intravenous drips, doctors proved that by drinking the formula, the death rate could be reduced to less than 5 percent.
“These people were not getting drugs. They were not getting IVs. They were dying,” recalls Dr. Richard Cash, a Harvard University professor who conducted the first ORS clinical trials at the diarrheal research center. “We were not looking at failure. We were looking at measures of success.”
Diarrhea is caused by viruses, parasites, bacteria and toxins. Rotavirus, spread through contaminated hands and surfaces, is the most common cause of diarrhea, killing half a million children annually. A vaccine is now available in the West, where the disease is a mere irritation, but it will not reach the poor for several years. Measles is another vaccine-preventable disease that causes severe diarrheal deaths.
The ORS solution helps the gut absorb fluids and electrolytes that are rapidly being purged, bringing life back to children’s sunken eyes and dehydrated skin. The recent addition of zinc further decreases the length and severity of the attack. Breast-feeding and continuous eating also are encouraged.
The Bangladesh discovery was hailed by The Lancet medical journal three decades ago as “potentially the most important medical discovery of the 20th century.” Some 800 million ORS packets are produced worldwide today, saving more than an estimated 50 million lives.
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