Cholera "going from bad to worse"

Cholera continues to spread in Papua New Guinea (PNG), where government health officials are now describing the disease as a major national public health concern.

“Things are going from bad to worse,” Victor Golpak, the government’s national response coordinator for cholera, told IRIN on 5 February.

“This is now a national public health concern. We cannot ignore it any longer,” he said.

Since the first case was reported in August 2009, more than 2,000 cases have been confirmed nationwide, including 577 in Morabe Province, 885 in Madang and 602 East Sepik Province, the country’s National Department of Health reports.

As of 5 February, 45 people have died.

Much of Momase - one of four areas in the Pacific island nation comprising East Sepik, Madang, Morabe, and West Sepik provinces - is now affected.

There have also been single cases reported in the country’s Eastern Highlands Province, as well as the capital, Port Moresby, in late January.

“The disease is very much mobile,” Golpak said. “Tragically, the government has not woken up to this fact yet,” he said, referring to a lack of funding so far to curtail its spread.

On the move

Cholera was first detected in Morabe Province, and a national response team was set up by the Department of Health, supported by the National Disaster Response Centre, the World Health Organization (WHO) and other international partners.

In October 2009, cholera was detected in the northern province of Madang, followed by another outbreak in East Sepik in November.

Despite that, resources to curtail the disease’s spread are in short supply.

Of particular concern is the situation in East Sepik, with cholera cases reported in Wewak, Angoram and Ambunti districts, as well as around Murik Lake - the home of Papua New Guinea Prime Minister Grand Chief Sir Michael Somare.

There, provincial health authorities have joined forces with staff from Oxfam New Zealand, Save the Children PNG, WHO, and Médecins Sans Frontières, to help contain the disease’s spread.

Provincial health officials, together with NGO partners, have set up cholera treatment centres in affected districts, but time is of the essence, aid workers say.

Of the 602 cases treated thus far in East Sepik, there have been 16 deaths, Oxfam said on 4 February.

Photo: David Swanson/IRIN
Large parts of the population do not have access to safe drinking water

“We are getting more reports of deaths coming in from the rural areas that we have yet to confirm,” said Andrew Rankin, Oxfam’s Sepik programme manager, who also described the situation around Murik Lake as particularly bad.

Clean water at a premium

According to health experts, cholera, an acute intestinal infection, is fuelled largely by poor sanitation practices and inadequate access to safe drinking water.

About 58 percent of the country’s six million inhabitants do not have access to safe drinking water, the UN Development Programme (UNDP) reports.

“People paddle for miles to fetch water. There is hardly any fresh and safe water around,” Rankin said.

Although water tanks, buckets and other essential items have been distributed to affected communities, they are useless without any rain.

Many residents continue to use water from the Sepik river - PNG’s second largest and a primary source of water for both drinking and washing.

In November, WHO confirmed large traces of the bacteria vibrio cholerae in the river.

“We found cholera in the water in more than one location and the bacterial results were very high,” Daniel Bleed, an epidemiologist with WHO, told IRIN at the time.

But even more worrying now is how to curtail the disease’s spread - and not just along the Sepik river.

“Madang and Morabe also have big river systems, but we have yet to test the water there,” Golpak noted.

Resources lacking

On the ground, Sibauk Bieb, the operations coordinator for the government’s cholera task force in Madang, says time is running out to stop the spread.

With resources largely depleted, and unable to pay his own staff, he is appealing directly to international donors for help.

“What other choice do I have?” Bieb asked reluctantly. “I continue to make representations to the government at the provincial and national level, but so far no funding is forthcoming. We need help and we need help now.”

In September, cholera was declared a public health emergency by the government, which committed more than US$4 million to combat its spread.

As of 5 February, however, just US$900,000 had been released nationwide, leaving provincial authorities and NGOs struggling to cope.