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SANJAY GUPTA MD
Deadly Illness in Cambodia; Suni Vs. Sanjay: The Race is On!
Aired July 14, 2012 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Hello and welcome to SGMD. I'm Dr. Sanjay Gupta, reporting from Phnom Penh, Cambodia.
You know, I came here to investigate this medical mystery. And by way of background, this is the part of world that gave us SARS, the Nipah virus, the deadly H5N1 bird flu -- in fact, almost every new strain of influenza over the years.
So, when we started hearing warnings about a deadly new disease, we paid attention. It all started with this diligent doctor noticing something unusual. Young patients were coming into his hospital and dying very quickly, within 24 hours. He wrote a letter of warning describing a terrifying picture, a disease that he had never seen before that was nearly 100 percent lethal.
So, we decided to go to the Kantha Bopha hospital, which is in the center of the city.
DR. PIETER VAN MAAREN, WORLD HEALTH ORGANIZATION: The majority of these cases, and mostly maybe under the age of 3, were seriously ill and many of them had died within 24 hours of admission.
GUPTA: I mean, that's pretty frightening I think for people to hear.
VAN MAAREN: Absolutely.
GUPTA: There's a lot of diseases in this part of the world, many parts of the world, but to kill that quickly.
(voice-over): The backdrop is important here. Kantha Bopha Hospital treats thousands of children suffering from dengue fever, malaria, and tuberculosis every week. And remember, this is a part of the world where bird flu and SARS originated.
Still right away, Dr. Beat Richner knew this was different.
DR. BEAT RICHNER, KANTHA BOPHA CHILDREN'S HOSPITALS: It's a new picture for us. We've never seen this in Cambodia before. And --
GUPTA: He is the head of the hospital and allowed us into the ICU where the patients are treated. (on camera): Give you an idea how busy this is. Even as we were talking, the doctor got called, another child in shock. That's what we're going to see right now.
(voice-over): Dr. Richner says 66 children came to this hospital with this mystery illness. For 64 of them, it was 24 hours of hell before they died. You heard right. All but two died.
(on camera): In many of these children, it started off rather mild. A mild fever, but then things progressed quickly from there.
For example, in Motanam's (ph) case, who's 2 years old, we don't know what's causing his encephalitis. But this is typically what happens. The fontanel over here starts to bulge and the eyes over here, as you can see over here becomes this conjugate as well.
From there, it just becomes merciless. It goes from the head, to the brain, to the lungs.
RICHNER: You see these lungs. Age 2 and five hours later, this is the lungs --
(voice-over): In the last few hours of life, this unknown illness completely destroyed the child's lungs. And there was no way to stop it.
(on camera): Never seen anything like this before?
RICHNER: No, this is the first time at the end of April, and this make us worried.
GUPTA (voice-over): Something called enterovirus 71, typically associated with hand, foot and mouth disease was found in more than a dozen patients. But that's only adding to the mystery.
(on camera): The enterovirus lead to this?
UNIDENTIFIED MALE: Never, never, never.
GUPTA: So it has to be something else?
UNIDENTIFIED MALE: I think so, but we cannot prove. That they must look for.
GUPTA (voice-over): And that's where the investigation goes next. Cambodian health officials and the WHO say they're now looking into whether expired medication, the wrong medication, or inappropriate medication such as steroids could be to blame.
(on camera): Steroids can also make a relatively harmless infection something much more severe.
VAN MAAREN: Yes, that is definitely a possibility.
(END VIDEOTAPE) GUPTA: It was also heart breaking but it was also this puzzle that doctors and disease detectives had to solve. The first question right off the bat, is this contagious? And if so, how fast does it spread?
The answer to that was encouraging. It wasn't showing up in big clusters. Meaning it wasn't spreading fast from person to person. Instead, the cases seem to have come one by one from all around the country. I also learned most of the sick children came from smaller villages.
So I headed out to see for myself.
GUPTA: This is what a place looks like that ranks in the bottom 10 percent of childhood mortality anywhere in the world. It's rainy season here in Cambodia. It lasts from May to October and you can se what one of the worst problems is in terms of controlling disease.
Many of the people who had mysterious illness were told come from villages that look like this. There's no TVs here. There's no newspapers. The only way people are learning about it is from school children who hear about it in school.
And I was talking to 14-year-old Supoli (ph) and his 4-year-old sister Osli (ph) earlier. And they were told by their teacher that there is this mysterious illness. And if they get it, people die and they die quickly. They're healthy but this is obviously of great concern.
Just looking around here, you can see how challenging conditions are. For example, there is no indoor plumbing. So if you simply want to collect water, you oftentimes have to do it right outside your tiny little home. They get these big buckets. But one of the first things they're also told is no standing water anywhere near their home.
So, you imagine. You look at a situation like this where they have vats of water. And they collect it. It is the only way they can get any.
This is where mosquitoes live as well -- mosquitoes that transmit disease. Diseases like dengue. There have already been 10,000 cases this year alone. Malaria as well.
The mosquitoes that bite during the day are more likely to cause dengue, we're told, and the ones that bite at night more likely to cause malaria.
So many people getting sick here, in the thousands. And if they do, what happens next? Oftentimes they have to rally their neighbors, gather a little money and maybe hire a tuktuk (ph) like this one over to get them to a hospital as quickly as possible.
GUPTA: Meanwhile, back in Phnom Penh, there was another side of this investigation, in the lab. See, by the second day of our visit, there was a lot of attention on one particular virus, EV-71. Now that virus isn't new and it's been deadly before. More than 160 people died from it in China last year and 18 people in Vietnam just this spring, mostly children. But in those countries, children hadn't died as quickly as Cambodia.
So EV-71 was a big piece of this, but we knew it wasn't the whole story because it wasn't found in all the children who died. So, where did all that leave us?
GUPTA (voice-over): The only thing doctors knew for sure was when the child arrived at the hospital, they were dying, and fast. A fever, convulsions and encephalitis and then the lungs, completely destroyed.
Since the end of April, doctors in Cambodia struggled with a medical mystery.
(on camera): And that mystery was ultimately solved right over here. Blood samples from those sick and dying children were eventually brought to this laboratory, analyzed like you see right over there and eventually, they concluded that there were several different pathogens. There was enterovirus 71, there was streptococcus suis, and also dengue.
And all of those infections were made worse by the use of steroids.
(voice-over): To crack this case, the lab had to work backwards. First, eliminate known viruses like avian flu, SARS and Nipah.
DR. ARNAUD TARANTOLA, EPIDEMIOLOGIST WHO SOLVED MYSTERY: The first thing that goes through your head is to try to determine whether this is one of the usual suspects that you haven't detected before. If it is, has it mutated or changed in such a way that it causes more severe disease. Or is it something completely new?
GUPTA: Epidemiologist, Dr. Arnaud Tarantola, and the virologist, Dr. Philipe Buchy, two French doctors living in Cambodia, solved the mystery.
(on camera): One of the things that we've heard several times now from the World Health Organization is no steroids should be used. They seem to say that steroids made this problem worse.
TARANTOLA: When you have a dying child, you try to use what you have at hand. And they were right to try that. Now, whether or not it helps, it remains to be determined.
GUPTA: They -- I don't want to belabor this point, but they really seemed to indicate that it hurt, that these infections a lot of times, they can be a problem but they're not particularly dangerous. But something pushes them over the top. And they thought that the steroids seemed to be a common denominator.
TARANTOLA: From the cases that we reviewed, almost all of the children died and almost all of them had steroids. GUPTA (voice-over): Steroids can be a poet anti-inflammatory, but when given to children with aggressive infections, steroids can also suppress the body's own immune system, allowing the infection to become even worse, as was the case with the enterovirus 71, also called EV-71.
(on camera): You hear about a lot of different viruses. Avian flu, Nipah virus -- EV-71 as far as they could tell really had not been in Cambodia before, for sure. Why does it suddenly appear like this? And why does it appear with such a vengeance?
TARANTOLA: It looks like this has emerged strongly probably because it had not circulated to the same -- with the same intensity in the past years.
GUPTA (voice-over): It's believed that a slight variation in the EV- 71 made the virus stronger. And the steroids made the body's resistance even weaker.
(on camera): So case closed. It sounds like the case is closed from your standpoint.
DR. PHILLIPE BUCHY: Yes. I think we can -- we can close the case.
GUPTA: So here's the bottom line. The worst case fears did not come true. This is not a highly contagious deadly virus that's about to spread around the world. But these are terrible diseases. And they're still a major threat to children here in Cambodia and all of Southeast Asia.
For the time being, the WHO has told health care workers to stop using steroids in patients with these infections and, of course, reminding them to prevent transmission. Hand to mouth is still the most common way.
After all is said and done, the basics apply -- wash your hands often whether in Cambodia or anywhere else in the world.
The good news is there hasn't been another confirmed case in over a week.
These are tough challenges. But this is a place with people who are used to tough challenges. Coming up, a man who was handed an AK-47 at age 15, and he went from being a child soldier to learning medicine. (INAUDIBLE)
GUPTA: We are back with SGMD.
Many people know Cambodia for its so-called killing fields. That was that legacy of genocide that in the 1970s left at least 2 million people dead. Even today, they're holding trials for former leaders of the Khmer Rouge. At age 15, Sano Ray was forced to join that terrible army as a soldier. But somehow he found a way to put down his gun, become a healer and find hope.
SANO RAY, FORMER CHILD SOLDIER: You're ready to fight or to run.
GUPTA (voice-over): Sano Ray's childhood memories are filled with unimaginables.
(on camera): Did you see, I mean, violence? Did you see people getting killed?
RAY: I see my friend and fellow soldiers, you know, killed by gunshot, by landmines, blown off their legs, chest gone, hand gone or face gone.
GUPTA (voice-over): At age 15, Sano says he was taken from his family and forced to be a child soldier under the Khmer Rouge regime.
RAY: I didn't know where my parent. I have one sister and I don't know where they were during that time.
GUPTA (on camera): When this was happening, you're so young. You're a child soldier at a very violent time. I mean, did you ever lose hope?
RAY: I just want to have a break and hope -- not have a hope that one day I don't have to do what I've done. I don't have to live like this. I think that was -- but I want to even smell that hope, something like that.
GUPTA (voice-over): His initial nightmare training was with a gun, but then Sano got his break. The regime decided to make him a paramedic.
RAY: I did not know anything at that time, but when I look back, I think that was when I am safe from being a killer, a real killer, to be a life saver.
GUPTA: Today, Sano Ray is saving lives at World Vision's Crisis Trauma Recovery Center in Cambodia.
(on camera): These children that you help now, I mean, can you see part of your -- your own life in them? Tell me about them. Who are they? Where do they come from?
RAY: They were children who are victim of sexual abuse and trafficking.
GUPTA: This is what happens. I mean, they're actually abused and they're sold.
RAY: Yes, precisely, yes. I don't want these children, this boy, this girl to experience that kind of life I have. I want them to have a big dream for themselves.
GUPTA: Is this your life's work now? Is that what you will do for the rest of your life?
RAY: This is the thing that I hope make joys in my heart and that dream that these children one day become a good mother, a good wife and good father. Those are the dream I think I want. I had dream and I really want to have that dream in their heart too.
GUPTA (voice-over): Sano is now turning his childhood nightmare into hope for others.
GUPTA: And that's part of the reason we do these "Human Factor" stories -- the stories of people turning tragedy and really challenging conditions into hope. We'll have much more from Phnom Penh right after this.
GUPTA: And we are back with SGMD.
You know, while I'm here in Phnom Penh, up in Russia this weekend, NASA astronaut Sunita Williams is set to blast off with the International Space Station.
Now, Suni, believe it or not, is going to be racing the Nautica Malibu triathlon along with me and our lucky CNN viewers in September. But she is doing it from space.
Before I left for Cambodia, I visited Suni at the Johnson Space Center in Houston to see what life is like up there and also, how she is planning on training for this race.
GUPTA: What goes on in here?
SUNI WILLIAMS, NASA ASTRONAUT: This is a place we spend a lot of our time. These are sleep stations. Sleeping in space of course is just as important as Earth.
GUPTA: Can I go inside here?
GUPTA: You literally go inside here.
Roomy. But then I guess, you know, it doesn't really matter your position.
WILLIAMS: Right. You can be upside right, down, sideways, backwards, forwards. As soon as you close your eyes, you don't know. It just sort of floating there.
ANNOUNCER: Booster ignition and lift-off of the space shuttle Discovery, lighting up the nighttime sky --
WILLIAMS: When I flew before, we were right in the middle of the construction of the space station. And so, it was pretty regular that people going up to the space station were going to be doing space walks.
UNIDENTIFIED MALE: And a good view of Suni Williams helping to tie down this aft radiator.
GUPTA: That's so wild.
WILLIAMS: We're going to put you right on the front. You'll be facing backwards but, you know, you're like a statue on the front of a car. So, you're right on the front of node 2, but looking back toward the space station.
GUPTA: Let's fly a little bit.
WILLIAMS: Fly around a little bit?
GUPTA: Yes. Wow. What a view.
WILLIAMS: We might have a space walk. We have lots of science.
GUPTA: And the triathlon.
WILLIAMS: And the triathlon.
GUPTA: You're going to do this triathlon.
GUPTA: You're going to be doing it on Earth.
This is the gym.
GUPTA: Is this going to be the model for swim?
BRUCE NIESCHWITZ: It is a resistant exercise. Swimming is resistance with water, so there's no reason why we can't do it. This is really the only other thing we have for her to do other than pretending to swim in zero Gs.
GUPTA: While we're down in the Pacific Ocean, she'll be doing this up in space. This will be her version of swimming. About 11 minutes you think, right?
WILLIAMS: So if we go from node 3 over to the lab and we'll start out on the bike.
GUPTA: In terms of hills and stuff. WILLIAMS: So I can get a profile of what the race looks like. Yes. Now I'm feeling it. I'm feeling it. I'm doing all right. So this will be how many miles?
WILLIAMS: Eighteen miles. So we're going to have to do this on time. I don't have a distance here.
GUPTA: You're going 17,500 miles.
WILLIAMS: I'll be done like that, what I am a saying? I'll be done way before you.
GUPTA: Maybe an hour roughly? I'd say about --
WILLIAMS: Eighteen miles an hour. Yes, that sounds good.
WILLIAMS: We're back to node 3.
GUPTA: Back to node 3. OK.
WILLIAMS: We'll transition. Get a little walk. Not really. A little float. Then we jump on the treadmill. To get on the treadmill, you need a harness, of course. If you were just on the treadmill and you ran, you would float away.
WILLIAMS: So you need to get your harness on that's going to ill connect you to the treadmill.
Here you can do distance in time. So I can get the four miles done this way.
GUPTA: You ran the Boston marathon like this.
GUPTA: That's amazing.
WILLIAMS: It was in December and the marathon was in April. So, it took me that long to build up to it.
GUPTA: Two hours and thirty minutes?
WILLIAMS: Oh -- no.
GUPTA: A little bit longer, huh?
WILLIAMS: A little longer than that.
GUPTA: What about your hydration and food requirements? Do you take that into account for training and for the actual events? WILLIAMS: I always have a couple bags of water in the vicinity very close by.
VICKIE KLOERIS, ISS FOOD SYSTEM & SPACE FOOD SYSTEMS LABORATORY: This is how we send all the beverages to orbit.
GUPTA: Look familiar?
WILLIAMS: Oh, yes.
KLOERIS: They're all in dry form. They have -- there's a septum adapter assembly that allows -- has a septum inside that allows the addition of water using the rehydration station in orbit. And then in order to drink, they're going to insert the straw into the septum. Hold it open and they can sip and they have a clamp to keep it from flowing out of the package.
GUPTA: I imagine you want really energy dense foods that give you a lot of calories in a small amount of space.
WILLIAMS: first of all, taste. You don't want to torture yourself, right, with eating something you don't like. But a big consideration people have is how convenient it is.
GUPTA: I imagine foods that are crumbly --
GUPTA: Awful. You would get crumb everywhere.
WILLIAMS: Everywhere. People think, you know, one of those things like potato chips. Yes, some people bring up little Pringles and stuff but they'll find out real quick it's a mistake. As soon as you break one, stuff is everywhere. So, it's a mistake.
GUPTA: That's how you haze the rookies.
WILLIAMS: Yes, exactly. Even big chocolate bars. I was like., don't send big chocolate bars because you break them and there are little pieces flying everywhere. So, you want to have like little mini's. It's my recommendation in space.
GUPTA: Now, as you can see, Suni is no rookie. If all goes according to plan, we'll be racing while she is some 250 miles high in the sky. It's going to happen in just about two months. Last year, as you might remember, I had to pull out of the New York City triathlon the day before to go cover the famine in Somalia. This year, I'm ready. In fact, I'm wearing my fit bit trying to exercise on the road. I'm going to kick my training into high gear when I get home.
So get ready, Suni. It's on.
Coming up, living longer and better. My chasing life tip from Cambodia.
GUPTA: And we are back with SGMD, reporting from Phnom Penh.
You know, one of the things you may know about Cambodia is that the official religion is Buddhism. You can see reminders of this just about everywhere you look. For example, this is a prayer area here in Phnom Penh. You see these sprinkled throughout the city and really the entire country. Buddhist statue over there.
And, you know, you're reminded that there is a strong tradition of meditation along with Buddhism. I've always been fascinated by this because of the proven health benefits of meditation. For example, if you meditate, you can actually reduce your stress. You can become more empathetic toward others. You can even increase your attention span.
There's more than that even. There's this recent study that showed simply mediating can reduce your risk of heart disease. They found people who meditated for 20 minutes two times a day cut their risk of a heart attack and stroke by half. It sounds pretty good.
I do it myself. A lot of time I focus on a single word. My word is gentle. I focus on that word. I do this in the morning. I do this in the evening.
I can feel my blood pressure start to drop. I can feel high heart rate start to slow. Who doesn't what that?
My phrase is more meditation, less medication.
I hope you enjoyed the show from Phnom Penh. Unfortunately, that's going to wrap things up for us. Let's keep the conversation going at CNN.com/Sanjay. Also join me on Twitter @SanjayGuptaCNN.
Time now, though, to get you a check of your top stories in the "CNN NEWSROOM."