By Julie Mollins
LONDON (AlertNet) - Poor road networks and heavy rains are limiting the ability of aid workers to accelerate the fight against a severe cholera outbreak in Sierra Leone, which has claimed the lives of at least 250 people and infected more than 15,000, according to charity ChildFund International.
Insufficient resources, a lack of proper toilets and insecure access to safe drinking water are also complicating relief efforts, Billy Abimbilla, national director for ChildFund Sierra Leone, told AlertNet.
Cholera is also spreading throughout West Africa in Guinea, Liberia, the Republic of Congo, the Democratic Republic of Congo and in western Niger, according to the World Health Organization (WHO) and UNICEF, the U.N. children's agency. The cholera emergency in the region has killed more than 1,100 people, and more than 55,000 cases have been reported in 15 countries -- an increase of 34 percent compared to the same period in 2011, according to the U.N agencies.
Cholera is an acute intestinal infection caused by the vibrio cholera bacterium. It is transmitted by ingesting food or water contaminated with fecal matter containing vibrio cholera, prompting diarrhoea and vomiting. If left untreated, infected people can die of dehydration, sometimes within a matter of hours.
Abimbilla shared his thoughts on the cholera emergency with AlertNet:
Q: What is the scale of the problem you are tackling? How does this differ from other outbreaks?
A: The cholera problem is a huge one and started about 35 weeks ago in a few locations and quickly spread to all parts of the country. To date, there are over 15,000 reported cases of infection and nearly 250 reported deaths, a good number of these being children. A lot of efforts and resources have been made by government, its international partners and the non-governmental organizations to address this national tragedy and emergency. However, these efforts have encountered challenges such as poor road networks to reach out to many communities, the heavy rains at this time of the year facilitating faster spread of the disease and hindering movements of health workers and insufficient resources.
This outbreak is different from other ones because of the speed with which it spread, the ease with which it kills and the scale of the geographical spread of the problem. Cholera, even though can be treated with basic medicines and by maintaining proper hygienic conditions, can be fatal if not detected and treated early. Children are most vulnerable to this outbreak. The other difference in the current outbreak is that neighbouring Guinea is also affected and with the frequent movement of people across the two borders, this had the propensity for a faster spread of the disease in both countries.
Sierra Leone, and in fact the whole of West Africa, experiences very small scales of cholera outbreaks in the rainy season almost every year. But this is normally localised and of very few numbers and easily contained.
Q: What is causing the outbreak?
A: It is not particularly known what caused this outbreak but it is suspected that the unusually heavy rainfall this year may have sparked it off. Several factors can contribute to cholera outbreak and its rapid spread including environments of improper hygienic conditions such as the lack of adequate toilet facilities, safe drinking water, improper personal hygiene and unclean environments. Travellers can also carry cholera from one country to another and start the outbreak.
Q: What is the treatment for it?
A: It is quite easy to treat cholera if it is reported in time. This infection causes severe diarrhea and can lead to dehydration and death. It occurs in places with poor sanitation and can be treated by drinking clean fluids and also treatment in the emergency health centers throughout the country.
The use of ORS (Oral Rehydration Solution) and other electrolyte solutions such as locally prepared salt solutions, environmental and sanitation education and the protection of water sources that are used for domestic purposes are other ways used in addressing the situation. However, it is always better to work towards prevention rather than treatment.
Q: How can this outbreak end?
A: There are several factors and efforts that can contribute to the early end of the outbreak. The first is to carry out widespread and massive awareness raising and education on the need for proper personal and environmental hygiene to prevent its further spread. As of now, this approach, which has been properly coordinated by all stakeholders, is yielding the desired results. The initial rapid spread has been curtailed and the spread has more or less stabilised and is beginning to decline.
The second effort is to rapidly respond to reported cases in the clinics through the availability of treatment drugs and health personnel. The two approaches are not mutually exclusive and should go side by side. The widespread information by the government that all cholera treatment in all clinics throughout the country is free is encouraging people to report early to the nearest clinic for attention when they are faced with the signs of cholera.
Q: What role did your organization play in addressing the outbreak?
A: ChildFund Sierra Leone used its long standing good and cordial working relations with the communities in which we operate to carry out awareness raising on how to prevent the spread as well as the need to report early to the nearest clinic when the signs are detected. Our local partners also carried out a house-to-house education on the outbreak. We empowered our local partners to give additional support to the peripheral health units (PHUs) beyond the normal assistance that is given to address this problem.
ChildFund Sierra Leone is currently providing safe water facilities in some communities to support the immediate and longer term solutions to the problem. ChildFund also attended and contributed to the discussions at the interagency meetings on this issue.
Q: What is the overall impact on the local community?
A: The impact of the cholera outbreak on local communities has been devastating. Families lose their loved ones, mostly the most productive family members or breadwinners, very young children and infants. This can be very traumatic to local communities and families. In addition, a lot of time is spent in caring for the infected rather than going about productive activities such as farming and other income earning ventures. Infected persons are not able to go to school or work and this is an overall loss to local communities.
The death rates have been higher for the urban slums than the sparsely populated rural areas. The Western Area which also includes Freetown, the national capital, experienced the highest death rate.
Generally, the recovery rate has been encouraging nationwide because of the massive efforts shown by the government and NGOs who moved in quickly to address the problem.
Q: How can this kind of outbreak be prevented in the future?
A: An outbreak of this nature can be prevented in future through a combination of actions and efforts. First, the dwelling environments in the slums will have to be improved. These should have proper toilets, proper waste management and disposal systems, safe access to safe drinking water and maintenance of good and proper personal hygiene.
Second, there is the need to address the inadequacy of access to toilets and safe water in other urban and rural communities. Like in many parts of West Africa, investment in this area needs to be increased significantly, not only by government but also by other partners.
Third, there has to be continuing education and awareness raising on how to prevent outbreaks of this nature, including possible outbreaks of other diseases. The need for communities to practice good environmental hygiene needs to be emphasised.
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