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#WhyHVO – Remarkable Results

Editor’s note: The following guest post comes from HVO volunteer and leader Leila Srour, MD, MPH, DTM&H. Dr. Srour is a member of the HVO pediatrics steering committee who has volunteered in Bhutan every year since 2015.

For years, Bhutan pediatricians have tried to save the lives of multiple infants presenting with suspected meningoencephalitis. These infants were previously healthy, exclusively breastfed and, typically, under the age of six months. Despite aggressive treatment with antibiotics, painkillers, antivirals, intensive care, and mechanical ventilation, the mortality rate was nearly 80%. Survivors were often neurologically impaired. An infectious cause has not been found, despite sending specimens to international virology institutes.

In 2018, Dr. Christoph Funk, a German pediatric intensivist and HVO volunteer, spent three months working with the pediatric department at Jigme Dorchi Wangchuk National Referral Hospital in Thimphu, Bhutan. Dr. Dinesh Pradhan, a 4th year pediatric resident, observed that one infant, treated with multivitamins, survived. Dr. Funk reviewed the pediatric literature and suspected thiamine deficiency. The pediatric department approved a proposal to add a therapeutic dose of thiamine to the treatment of these infants. The doctors compared the outcomes, before and after the addition of thiamine, with dramatic reversal of mortality and morbidity rates.

The pediatricians suspect that these infants suffer from meningoencephalopathy due to infantile beriberi, caused by thiamine deficiency. Pregnant and lactating mothers in some Asian countries may have diets deficient in thiamine due to common practices of eating polished rice, and consuming tea and betel nut that contain enzymes which break down thiamine.

In January 2019, Dr. Dinesh was awarded HVO’s Wyss Scholarship to travel to a pediatric global health conference in Germany where he and Dr. Funk presented their findings. Their research was received with great interest and garnered them the conference award for best presentation. The potential offered by the addition of thiamine may be life-saving.

Dr. Mimi Lhamu Mynak, pediatric department head, supports research to quantify thiamine levels in suspected cases. Further research may lead to the prevention of thiamine deficiency, saving lives and preventing suffering. Not only is this is a wonderful example of the excellent collaboration between Bhutan pediatricians and HVO volunteers, but it is the epitome of how people working toward a common goal can have remarkable results.

You can read Dr. Dinesh’s account of the work to identify & address infantile beriberi in the Summer 2019 Volunteer Connection.

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