A year of cholera teaches prevention is better than treatment

Almost a year into a cholera outbreak, aid agencies and Angola’s government have learnt to address the symptoms, but tackling it’s causes remains a challenge.

At the start of the year, new cases of the waterborne disease seemed to be coming under control, but severe flooding at the end of January caused cholera cases to jump. “Following the heavy rains there were up to 100 new cases a day a week ago - up from 5 to 10 a day - and now the numbers are declining again,” Mark van Boekel, head of MSF Holland in Angola told IRIN.

The Angolan government officially recognized the outbreak on 13 February 2006. Over 70,000 cholera cases and nearly 3000 deaths have been counted since, according to World Health Organisation (WHO) figures.

“Over the past year the ministry of health, NGO’s and aid agencies have become better at dealing with the outbreak but there is little coordination and there is a lot of work outstanding: there is still a lot that has to be done about the underlying causes,” van Boekel said.

Poor sanitation, crumbling sewage systems, streets filled with garbage and a lack of potable water are the root causes of the outbreak.

"We usually get our water supplies from our neighbour's water tank, but because there has been a lot of rain I suppose that water might be dirty now,” said Samuel Lucamba, who last week brought his brother to the Cholera Treatment Centre in Cacuaco, a municipality north of the Angolan capital, Luanda.

"Another problem is the rubbish in our neighbourhood - there is nowhere to put it and no-one comes to clear it away, so there are a lot of areas where there are big piles of rubbish and we often see kids playing there. That's dangerous, because they can get cholera and then contaminate others,” Lucamba added.

“These issues need to be addressed and there is a risk that when cholera seems under control again, with 5 to 10 new cases a day, efforts will cave in and the cases will once aging start to rise,” van Boekel warned.

I'm worried that the cholera epidemic will keep on growing

"I'm worried that the cholera epidemic will keep on growing,” Lucamba said. The WHO described cholera - an intestinal infection leading to severe dehydration from chronic diarrhoea and vomiting - as "an easily treatable disease" cured with rehydration salts. If left untreated it can result in death within 24 hours.

“My brother woke up at 3 o'clock in the morning. He went to the bathroom more than six times in just a few hours, then he started getting cramps in his legs and lost all his strength - he couldn't walk. We didn't know what was wrong, we gave him water to drink but the diarrhoea continued,” said Lucamba.

"We brought him to our local health centre. The nurse didn't realise it was cholera and gave him some medicine, but then the doctor arrived and said it was cholera and so we took him straight here to Cacuaco by taxi-bus. He was very sick but he has been here for two days now and he is starting to get better.”

According to van Boekel, prevention messages seem to have been effective in educating the public about cholera. The radio has broadcast messages about improving hygiene, recognition of symptoms and safe drinking water.

But the messages could not prevent the need for treatment for Lucamba’s brother. "Before my brother got sick, we didn't know cholera existed in our neighbourhood. On top of that, we didn't know cholera could give you cramps, so that made it even harder for us to guess what was wrong with him. But now we know what the symptoms are, and what to do if we think someone has it,” Lucamba said.

TM/OA