Two Fighters Fighting against Cholera in Bangladesh

Mix a little salt, sugar and water – A simple solution to the deadly cholera infection. Today we are bringing together the pioneer of this ORT (Oral Rehydration Therapy); Dr Richard Cash, and practitioner; Dr Mark Pietroni.

Cholera is caused by becoming infected with a bacterium called vibrio cholera. It’s a disease that affects the bowels but unlike other diarrhoeal diseases, cholera can kill a healthy adult within hours through severe dehydration and kidney failure.  The disease is mostly spread through contaminated water and food supplies.  Although the ramifications of being infected with cholera are severe, the treatment known as ORT is a simple mixture of salt, sugar and water.  

Water is one of the four essential elements of life, covers 70.9% of the Earth’s surface, and is vital for all known forms of existence.  The capital city of Bangladesh is surrounded by the distributaries of the two major rivers, the Brahmaputra and the Meghna. The surrounding rivers are Buriganga to the south, Turag to the west, Tongi khal to the north, and Balu to the east.  This notwithstanding, there is very little clean water supplies in the city and the lack of sanitation makes millions of Bangladeshi’s vulnerable to cholera (particularly around monsoon season).

 In 1967, Dr Cash along with his colleague Dr David Nalin was sent to Bangladesh (at the time known as East Pakistan) from the US to help fight the cholera disease, where for the first time these US Public Health Service employees faced the devastating disease.  At this time the treatment for cholera was known as intravenous therapy which was expensive as it attempted to replace the fluids lost through diarrhea and vomiting via therapy.  Together Dr Cash and Dr Nalin discovered ORT and a mixture of clean water, salt and sugar became the low-tech solution to a global health crisis.

 Dr Cash then teamed with the Bangladesh Rural Advancement Committee (BRAC) to teach village women how much 500ml of water is, so they could accurately mix the ORT. The women brought their own pots, into which 500ml of water was poured. The villagers then marked the pots, so they could duplicate the 500ml amount accurately at any future time. Then, with a pinch of salt and a bit of sugar, the villagers became their own best resource!!

In 1987, UNICEF (the United Nations Children’s Fund) released a report stating, “No other single medical breakthrough of the 20th century has had the potential to prevent so many deaths over such a short period of time and at so little cost”.  It is estimated that ORT has saved over 50 million lives since its development, not only in Bangladesh but all around the world.

 Although Dr Pietroni was living in the UK and earned his Medical degree from Cambridge University in 1991, specializing in respiratory and tropical medicine & infectious diseases, he decided to move to Bangladesh, in order to combine his passion for medicine with humanitarian causes.  He started as a missionary in a hospital in north-west Bangladesh for 10 years working on Project Lamb (a project to set up a healthcare system in rural Bangladesh) and has now moved to International Centre for Diarrhoeal Disease Research, Bangladesh (“ICDDR, B”) as an Executive Director at Dhaka Hospital.

 ICDDR, B is funded through a combination of research / government grants and charity funding (e.g. Ozaid) and it aims at addressing most critical health concerns facing developing nations worldwide.  Dhaka hospital treats patients for free and therefore relies on external resources to fund the US$40m budget per year.  It is estimated that Dhaka Hospital treats 140,000 patients per year just for cholera.  In addition, ICDDR, B sends out teams of qualified medical practitioners to assist with cholera outbreaks around the world.

ICDDR, B has taken ORT one step further, where including zinc in the treatment for children reduces the chance of subsequent episodes, as well as reducing the chance of mortality.  The UN has also added zinc to the outline of the treatment of cholera.
Dr Pietroni’s strong belief is to understand the problem at grassroots before implementing change and identifying solutions.  For this reason, when he joined Dhaka Hospital he had several discussions not only with his senior staff but also the nurses and security men.

Dr Pietroni’s goal for the next two years is to improve health levels of developing nations by implementing cost-effective treatment for pneumonia, HIV prevention and education, as well as treatment for acute severe malnutrition. YL volunteer Freshta had a chance to interview him: See below.

Tell me how the move from the UK to Bangladesh eventuated?
My wife and I were interested in missionary work and started some investigations through our church, one thing lead to another and we decided to move to Bangladesh as we lived in a suburb with Bangladeshi people. Then we only had had our first child.  In 1997 we made the move to Bangladesh to work in a missionary, taking the view that this is a 3 year deal.  The advantage of moving with a missionary is that you get 6 months training at the start on how to communicate in the local language.  For me now Bangladesh feels like home.


Tell me about Project Lamb

Project Lamb is a huge project (, with 500-700 staff working in rural Bangladesh in order to set up a healthcare system in the area.  There were 20 expats on the project and my role was quite broad where I would undertake the marketing in order to obtain funds as there was a constant shortage of funds, train staff and develop the fundamentals.

When did you move to ICDDR, B?
After 10 years of working in the missionary, a private practice role came my way.  Initially, I declined to progress the opportunity further but then after talking to my wife, we decided that we wanted to stay in Bangladesh for a little longer, so I took up the role of Medical Director at  ICDDR, B.  The length of the contract initially was 3 years but now it is 5 years and we still are here and loving it.  There are different issues we are addressing to Project Lamb.  
There are number of things that ICDDR, B do for the community including, sending out team around the world wherever there is a cholera outbreak.  Our initial work in the centre was on diarrhoea related infections and problems, however we have now moved to the whole ambit of diseases and health concerns in developing nations.  We have taken research further on ORT, where studies have shown that if you mix zinc in the treatment of cholera for children it reduces the likelihood of subsequent efforts and reduces mortality.
Other projects we are currently working on include the following:

  •  Acute severe malnutrition
  • Pneumonia
  • HIV adis

What’s next for you?
There are a couple of options, we could stay for a little longer as the family and I love Bangladesh and what we are providing for the people of this country is unique, whereas if I take a role back in the UK it is not something no one else in the country can contribute.  But let’s just wait and see.


Talking to Dr Pietroni what one learns is that not all problems in life require complex solutions entrenched in algorithms, scientific and technologic procedures; it is the simple treatments that can save a life.  Further, it is the empowerment of one person in a rural Bangladesh (i.e. Project Lamb) that can continue the system of healing.  Saving people’s lives or changing the world sounds difficult but when broken down to the simple elements, it is about using your strength or passion for the betterment of society.  Go on find your sugar, salt and water…


Freshta Mayar

She currently works as an Associate Director in Loan Capital Markets, Financial Institutions and is a lead steering committee member of Ladies in Leverage, as well as a member of Women in Banking & Finance.  She has completed a double degree; Bachelor of Commerce majoring in Finance and Laws, where she was awarded a Dean’s Certificate from the Law Faculty and she won the JP Morgan prize for coming first in Applied Corporate Finance.  She dreams of a world where human beings appreciate the small doses of happiness and are driven by the most difficult challenges–no one should ever give up.





Author: Nusrat Azim

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  1. hi there, very good blog, and a really good understand! just one for my bookmarks.

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