Cholera epidemic fails to dissuade pilgrims from flocking to Touba

Hundreds of thousands of Senegalese pilgrims descended on Touba, a Muslim shrine some 100 kilometres east of the capital Dakar, this week, disregarding a cholera epidemic that has been raging in the area for the past three months. Several fire brigade trucks distributed clean drinking water to the pilgrims who came by car, bus and truck from every region of Senegal for the annual pilgrimage of the influential Mouride brotherhood, which reached its climax on Monday and Tuesday. Most of them slept in the open air for up to three nights, while they prayed at the shrine of Cheikh Ahmadou Bamba, the founder of the Mourides and a hero of Senegalese nationalism, who was buried at Touba following his death in 1927. The government laid on plastic tanks of disinfected water for pilgrims to wash in before eating. But no special latrine or toilet facilities were laid on for the crowds who mobbed the town, which is dominated by an imposing mosque.

Touba's main mosque at dusk

Several Senegalese companies, seeking to promote their image, handed out free plastic bottles of mineral water. According to the Ministry of Health, 2,054 cholera cases were reported in Touba and the neighbouring districts of Mbacke and Bambey between 1 January and 23 March. During this three-month period, eight people died from the highly infectious water-borne disease, which causes accute diarrhoea and vomiting. Cholera leads to rapid dehydration and can be fatal unless treated rapidly. The Ministry of Health set up seven medical posts in Touba with cholera treatment facilities ahead of the pilgrims' arrival. The number of new cases reported started to increase soon after they began to flood in last weekend, enduring a fierce sun and searing temperatures. “We had gone from 25 new cases of cholera per day within the town of Touba to just one, but with the pilgrims coming to town, the numbers have soared back up,” Amadou Moustapha Sourang, the head doctor in Touba, told IRIN. "And you know, just one case of cholera is considered an epidemic," he added. Sourang said many pilgrims had died on their way to hospital, but it was difficult to know how many of these deaths were caused directly by cholera. “Some people died of anemia after contracting cholera," the doctor said. "But we also had to deal with people who were dead on arrival (at the hospital). They became so dehydrated as they were carried here by horse and cart that they died on the way." The Ministry of Health reported 757 new cholera cases in Senegal as a whole in the week to March 27, up from 428 previously. The World Health Organisation (WHO) warned that the outbreak in the centre of the country could also be exacerbated as the pilgrims to Touba head back home,taking the vibrio cholerae bacteria with them. Over the course of the festival, information campaigns were carried out to heighten awareness about the way in which cholera is spread, by the infection of food and water with fecal matter.

Mourides share a bowl of the traditional dish, Tchep

Pilgrims were encouraged to drink boiled water, choose their food carefully, wash their hands regularly and avoid drinking water bought in plastic bags from hawkers on the street. “We have never eaten with dirty spoons or without first washing our hands,” said Mamadou Dieng who opens up his house in Touba to pilgrims every year. This year some 200 people slept in his compound, on floors, in the yard – wherever they could lay their head. The Mouride brotherhood is led by Cheikh Salihou Mbacke, a descendent of Bamba, who preached self discipline and tolerance. Mbacke carried out his own information campaign to warn pilgrims about the dangers of cholera and how to avoid the disease. “Just this afternoon, the radio twice sent out messages from the Khalif. He asks us to follow the rules established by the health authorities to combat cholera. All the Mourides will follow the advice because the instruction has come from our Marabout,” said Massamba Seck a young Mouride who had travelled to Touba from Dakar. Information leaflets in French and Arabic with illustrations for those who could not read were also handed out.

The Khalif traditionally provides food and water for the Mourides

An aide to the governor of Djourbel province in which Touba is situated, told IRIN that the authoriites reckoned that between one million and 1.5 million people had descended on the town for this year's pilgrimage, doubling its normal population of 600,000. The main road to Dakar was blocked solid with traffic the day before the celebrations began and for 24 hours afterwards. Residents in the capital who stayed at home grumbled that they couldn't find a bus or taxi on the streets because they had all gone to Touba. Health officials suspect that the cholera epidemic in Touba may be connected with town's spectacular growth in recent years. Its creaking infrastructure of water and sewerage pipes has failed to keep pace with a rapid rise in the population, they said.

A mouride sports an image of the Khalif on his headscarf

Sourang told IRIN that tests by the Pasteur Institute had given the Touba water supply a clean bill of health, but he believed that it had been polluted in some areas by people clandestinely tapping into the water mains to secure their own supply. Some of the traditions of ‘Touba’ heighten exposure to cholera. These include ‘Sujott,’ the act of bringing someone’s proffered hand to the forehead as a sign of respect and greeting. “The simple act of taking someone’s hand is very risky,” said Sourang. “It is necessary to keep washing your hands in disinfected water to cleanse off the germs.” But to tell a Mouride not to shake hands at all is unthinkable, he added.