Bulletin of the World Health Organization

Miracle cure for an old scourge. An interview with Dr Dilip Mahalanabis.

Dr Dilip Mahalanabis
Courtesy of D Mahalanabis
Dr Dilip Mahalanabis

Dr Dilip Mahalanabis studied cholera and other diarrhoeal diseases at the Johns Hopkins International Center for Medical Research and Training in the Indian city of Kolkata. His work at a refugee camp in Bangaon, in India near the border with Bangladesh, during a cholera epidemic in 1971 was instrumental in proving that untrained people could successfully administer ORS solution. From 1975 to 1979, he worked in cholera control for WHO in Afghanistan, Egypt and Yemen. During the 1980s, he worked as a WHO consultant on research on the management of bacterial diseases.

Millions of lives are saved every year thanks to the development of a simple treatment called oral rehydration salts (ORS) solution, once dubbed “potentially the most important medical advance” of the 20th century by the Lancet. Yet for years Dr Dhiman Barua, at the World Health Organization (WHO), and Dr Dilip Mahalanabis, at the Johns Hopkins International Center for Medical Research and Training in the Indian city of Kolkata, struggled to convince a sceptical medical fraternity that it could be administered by people with little or no training.

Q: The Bangladesh war of independence sparked an influx of refugees into Bangaon, why did you go there and what did you see?

A: In 1969 and 1970, I was working on research on diarrhoeal diseases in children at the infectious diseases hospital in Kolkata. When the cholera epidemic began in 1971, we had to leave our research and go out into the field to work with the refugees. The government was unprepared for the large numbers. There were many deaths from cholera, many horror stories. When I arrived, I was really taken aback. There were two rooms in the hospital in Bangaon that were filled with severely ill cholera patients lying on the floor. In order to treat these people with IV saline, you literally had to kneel down in their faeces and their vomit. Within 48 hours of arriving there, I realized we were losing the battle because there was not enough IV and only two members of my team were trained to give IV fluids.

India, 1971. Refugees from former East Pakistan, now Bangladesh, seeking shelter, food and medical attention at the Bangaon refugee camp.
Courtesy of D Mahalanabis
India, 1971. Refugees from former East Pakistan, now Bangladesh, seeking shelter, food and medical attention at the Bangaon refugee camp.

Q: That was when you decided to allow non-specialists to administer ORS – a decision that went against the prevailing wisdom of the time. Did you realize the risk you were taking?

A: I didn’t have the privilege of consulting knowledgeable people at that time. I had to decide on my own what to do. I had no choice but to go ahead and use ORS to the maximum, hoping for the best. I was confident that it could work, but not necessarily in these circumstances. I also feared that if it didn’t work, we would have no more options. It was a huge relief when we saw that it really did work.

Q: Bangaon was a stunning victory for ORS. At what stage did you know that it was working?

A: Within two or three weeks, we realized that it was working and that it seemed to be all right in the hands of untrained people. However, people did need some supervision and persuasion that it really would work. People knew that IV saline was the treatment for cholera because cholera is endemic in the region. At that time we coined the term ‘oral saline’. We told them that this was also saline, but that it was given by the mouth. At the time, we didn’t know that it would become so well known and that people would take it up everywhere. We were just happy that it worked there and that we could help these people. We prepared pamphlets describing how to mix salt and glucose and distributed them along the border. The information was also broadcast on a clandestine Bangladeshi radio station. The cholera outbreak was not just among refugees, but also in Bangladesh itself. ■