DRUG RESISTANCE TAKES DEVASTATING HUMAN TOLL.
Note: This story is part of a sixpart multimedia series by reporters from The Canadian Press who travelled to India and South Africa as recipients of the R. James Travers Foreign Corresponding Fellowship.
Canadian Press reporters travelled to South Africa and India to investigate the growing epidemic of drug resistance, which experts describe as the single greatest threat to human health on the planet. This is the second story of a six-part series exploring how the unfettered use of antibiotics pushes humanity closer to a postantibiotic era in which common infections may be impossible to treat. The R. James Travers Foreign Corresponding Fellowship helped fund the project. Vikali A Zhimomi’s face is tearstreaked as she reaches out to touch her infant grandson, who is receiving intravenous fluids after emergency surgery. She is forbidden from picking him up, as desperately as she wants to. His tiny body is simply too fragile. The little boy developed severe diarrhea just days into his life. A Zhimomi rushed him to a hospital in northeast India, where doctors discovered necrosis in his bowels and removed part of his small intestine. But a bacterial infection soon spread into his bloodstream and antibiotics were not working. The panicked grandmother took the child and boarded an air ambulance to Sir Ganga Ram Hospital, a private New Delhi facility, where another surgery was performed. Doctors placed the four-week-old on colistin, a last-resort antibiotic and the only drug left that might cure his otherwise resistant infection. “Every day I pray to God,” says A Zhimomi, her eyes bloodshot with exhaustion. “I’ve been touching his abdomen every day. I pray for the doctors every day.” She is terrified - and with good reason. A 2013 study estimated 60,000 infants in India die annually from sepsis caused by antimicrobialresistant infections, and the expert who calculated the figure now believes the rate to be double that. Doctors increasingly treating babies with colistin see even those just born carry a frightening resistance to the drug. They worry about what to do when that last line of defence fails. The situation is desperate and not confined to developing countries. In Canada, hospitals also grapple with the rise of dangerous superbugs. The rapid spread of a highly resistant enzyme from South Asia to the West illustrates the global nature of drug resistance. Families of victims are calling on global leaders to pay attention and curb the rampant overuse of antibiotics that accelerated the crisis. A Zhimomi is raising her grandson after his teenage mother, who had a relationship with A Zhimomi’s young son, decided she could not care for the child. The 43-year-old is a community leader in Dimapur, in the northeastern state of Nagaland, where she ran for political office and founded a women’s empowerment group. She has high hopes for the grandson she named Atomika, meaning a leader among leaders. “The moment I saw his face, I stopped calling my friends . ... I felt that this is my life,” she says. “A big happiness has come inside of me. I am focusing on him only.” Colistin eventually eradicated the little boy’s infection and he was discharged from hospital, where staff are also grateful for his survival. “We never thought he would make it,” said Dr. Neelam Kler, chairwoman of the neonatology department at Sir Ganga Ram Hospital, adding the family consented to a very high-risk surgery. “They said, ‘Do anything to save the baby.’ ” Infant mortality In India, 26 million babies are born every year. Of those, Kler says roughly 650,000 die in infancy, and about 25 per cent of those deaths are caused by infection. “If I see a 500-gram baby or a 28-week baby, my biggest concern is that this baby should not get an infection because he’s the most vulnerable,” Kler says. “If he gets an infection, and it’s multi-drug resistant, then I’m doomed, totally.” Over her 30-year career, Kler has observed a dramatic rise in bacterial infections resistant to numerous antibiotics. Organisms such as E. coli and Klebsiella evolved to fight off more powerful drugs, to the point that many cases Kler sees are resistant to meropenem, a broad-spectrum antibiotic once reserved for severe instances. There are many reasons for the growth of antimicrobial resistance, but Kler is particularly concerned about three issues in India: pharmacies sell antibiotics without a prescription; crowded hospitals lack strong infection control; and few diagnostics are available to confirm bacterial infections before antibiotics are started. “It is depressing. It is alarming,” Kler says. “I think there is a need for action.” While A Zhimomi’s grandson received care in a private hospital, millions of Indians rely on government hospitals that are free but overcrowded. At Chacha Nehru Bal Chikitsalaya children’s hospital, the number of patients often exceeds its 221 beds. In the summer, when infectious diseases are particularly acute, up to 270 children are admitted. “We have to double them up,” says Dr. Anup Mohta, a pediatric surgeon and director of the hospital. “We do want one patient, one bed (but) the government policy as of now is to not refuse any patient.” The crowding leads to obvious challenges with infection control, but hospital staff do everything they can to prevent the spread of resistant bacteria. There is no doubling up on beds in the intensive care units and babies and children are sent home as soon as possible to reduce the risk of infection.