Be vigilant against cholera
CHOLERA is rearing its ugly face in Zambia today at a time when many people thought that Zimbabwe was the only country that was facing the diarrheal scourge.
By yesterday, Zambia had recorded at least 9500 cases of the disease with about 374 deaths.
The country has turned its giant national stadium into a cholera treatment centre as multitudes of people flock to seek treatment.
The disease has potential to spread to many other countries if action is not taken to contain it.
Our country is facing the same predicament with cases going up by the day. The main difference with Zambia is that the case fatality rate is higher in Zambia (3.9%) than in Zimbabwe (2.2%).
If cholera is not contained, death rate can surpass the 2008 one where at least 4200 people succumbed to the disease.
Everyone needs to be serious about the disease and blaming one person or an organisation is just but unfair.
Cholera, a water-borne disease, had its first global outbreak in 1817 with epicentre in Jessore near Calcutta.
To date, seven distinct cholera pandemics have been recorded in the past two centuries.
The current 7th pandemic started in South Asia in 1961, reached Africa in 1971 and the Americas in 1991.
The disease should not kill many people as case fatality rate is usually less than 2%.
The continuous spread of the is a serious test on primary health care which should orient its structures and functions towards the values of equity and social solidarity.
The principles required to sustain primary health care are its capacity to respond equitably and efficiently to the health needs of citizens, including the ability to monitor progress for continuous improvement and renewal, the responsibility and accountability of government, sustainability, participation and an orientation towards the highest standards of quality and safety and intersectoral approach.
Primary health care should thus dwell on health education and promotion, good nutrition, clean water supplies, good sanitisation, immunisations, affordable first line drugs, easy patient transfers to mention but just a few.
Cholera prevention and control has four key stakeholders, which are the patients themselves, councils, government and non-government organisations. It is thus prudent for each of these to act wisely for the disease to be contained.
Firstly, you and me have special roles to play especially now where almost all the districts are affected in the country.
Personal hygiene is very critical with hand-washing being dominant. Those who want to sanitise their hands can do so and it should be a taboo to eat any food without first washing your hands with soapy water. We are just after the festive seasons when behavioural determinants of health played significant roles in the spread of cholera. Many people were partying, braaing, dancing on open spaces where there was no proper sanitation and even water to wash hands. Cholera is a water-borne disease which can easily be transmitted through contaminated water and food. Vibrio Cholerae has an incubation period of between three hours and six days and many people may be harbouring the bacteria without symptoms.
Councils need to be serious with issues of water and sanitation. For long both sewer and water pipes have not been attended to and this is an embarrassment for the country. The coming of the rains can worsen cholera as there is further contamination of water bodies. There is great potential for faecal contamination of water with raw sewage from burst pipes. Those that make use of undisease protected wells have higher risk of contracting the disease.
Uncollected garbage is a serious matter that requires redress, alas, no serious measures are taken by city fathers. Garbage is everywhere including at shopping centres where food is served. Residents are continuously at risk of contracting diarrheal diseases like Cholera, dysentery, typhoid. If city council is responsible for garbage collection, why is it that we have perennial problem of uncollected garbage yet we have many office-bearers? That alone is an indicator of first-degree incompetence.
Government should chip in quickly with funds to sustain management of cases and of importance is the availability of necessary drugs and health workforce to fight the scourge. Case management of cholera has not been as robust as expected. The city council clinics and hospitals seem overwhelmed with cases and complicated cases may not get the required management. There is serious understaffing at council clinics and hospitals with fewer nurses being seconded to cholera units. All this is fueled by rampant brain drain in the health sector which has seen more than 5000 nurses leaving the country in the last 2 years for greener pastures.
Inter-sectoral approach remains fundamental in the mitigation and containment of cholera with councils expected to take leading roles. People should also be reminded to practice good hygiene which include hand-washing with soapy water as well as sanitisation. All of us have to flex our muscles if we are to win the cholera battle.
Dr Johannes Marisa is a private medical practitioner who can be accessed on doctormarisa@mail.com