Rampant cholera prompts UN regional appeal

The United Nations is asking donors for US $3.2 million to help six West African countries fight cholera, which the UN says has killed at least 700 people and stricken over 42,000 in the region since June. This is the first appeal of its kind for West Africa, where cholera appears every rainy season but where unusually heavy rains this year sent infections skyrocketing. The movement of populations throughout the region – including religious pilgrimages and rural-to-urban migration – also contributes to the spread. “We must contain cholera in the sub-region and assist health care systems to eradicate this epidemic, in order that it not become a chronic problem or spread to neighbouring countries like Chad, Nigeria and Cameroon,” said Herve Ludovic de Lys, head of the UN Office for the Coordination of Humanitarian Affairs for West Africa. About half the funding – which will bolster ongoing efforts by governments and UN humanitarian agencies – is earmarked for Guinea-Bissau, a country of about 1.5 million where cholera had killed 320 people and stricken 20,415 as of mid-October, according to the UN World Health Organisation (WHO). While cholera is now receding in most of the region as the rains let up, new infections are still appearing in some areas and considerable immediate and long-term challenges remain, health experts say. “If we do nothing now to reinforce governments’ capacity to respond, to draw the attention of the international community and to improve hygiene and sanitation, cholera will continue to be a grave problem,” said John Mulangu, WHO’s regional emergency coordinator for West Africa. Striking in already destitute areas, cholera holds back development, according to the UN appeal. "In addition to human suffering, cholera outbreaks cause panic, disrupt the social and economic structure of affected communities, put tremendous strain on already precarious health systems and impede the development process.” Governments in the region – some of the world’s poorest countries – are struggling to treat their ill as well as keep the highly infectious disease in check. In some cases authorities have prohibited the ubiquitous street vendor peddling plastic bags of water and other food items. In Guinea Bissau, the government has also temporarily banned traditional ceremonies, but health officials say such measures have proved difficult to enforce. As part of the appeal, the UN has proposed basic needs investments such as training of medical professionals and community health workers and the construction of proper sanitation facilities; shortages in both have aided the spread of the disease, UN said. Also covered under the six-month appeal are the Gambia, Mali, Mauritania, Sao Tome and Principe and Senegal. In Senegal cholera has killed nearly 400 this year, with over 27,000 cases, according to WHO. Cholera is an acute intestinal infection quickly causing severe dehydration and death in as little as 24 hours, though a simple mix of water, sugar and salts could save many. And health officials say simple hygiene measures can substantially reduce transmission rates. Cire N’Dao, who sells jewellery in a market in the capital Dakar’s Medina neighbourhood, said ever since she heard about cholera on the radio and from religious leaders she has been faithfully carrying out the recommended hygiene regime. Behind her stall in the market are two buckets – one with chlorinated water for washing her hands and another for discarded rinse water. She said she keeps old toothbrushes handy, motioning to show how she and her family use them for scrubbing fingernails. She said some people practice good hygiene only for a short time while there is a lot of talk about cholera, then slack off. “They get tired of it and just stop. Or others will do the right thing in the morning – washing hands and chlorinating their water – but not in the evening. But what they must understand is that cleanliness must be for 100 percent of the time.” A disease of the poor “Cholera is a mark of poverty,” Dr Malang Coly, WHO programme officer in Dakar said. The outbreak in the region this year “is a sign that the people are becoming poorer and poorer.” Health officials say poverty and behaviour are inextricably linked in creating conditions where cholera spreads rapidly. “Poverty and behaviour go hand in hand,” the WHO’s leading cholera expert Claire-Lise Chaignat told IRIN from Geneva. “When people are less poor they are better educated and better able to prevent cholera.” The UN Children’s Fund (UNICEF) representative in Mali, Frances Turner, added, “People apply health and hygiene information to the extent they have the means to do so.” Bleach and soap are out of reach for some. And for many people, a clean water source might be several kilometres away – if it exists at all, she said. “Expediency often trumps healthy behaviour.” Turner pointed to lack of education as a contributor to the spread of infectious disease such as cholera. “Only one in five women in Mali is literate. This is another factor in slow behaviour change.” Indifference hindering the prevention message? Moussa Dieng Sarr of Senegal’s health ministry contests the idea that cholera is simply a problem of poverty and urged for more analysis into why some people do not heed health warnings. “The reasons appear to be more profound than just that people do not have the means,” he said. “Until we get at that and figure out why some people do not take preventive measures, unfortunately cholera will continue to be a problem.” Sarr said he believes health workers going door-to-door and speaking with people directly – an approach the UN project calls for in some of the affected countries – is more effective than media campaigns alone. A 28-year-old electrician, who did not want to give his name, said he has seen public service announcements about preventing cholera on television. “Some apply the measures, some don’t. It’s difficult to say why,” he said. But he has a guess. He said many people – including him – have never seen someone with the disease, so they do not feel affected by it. Too often people will react only once someone close to them has died of cholera. “Here, we slam the stable door shut after the horse has already bolted.”