Water Spouts will speak volubly and endlessly about all the issues concerning water. The ongoing degradation, and growing scarcity, of the water supply here in the US, and the rest of the world. The continued absence of potable water in so many parts of the world. The work being done by NGOs, and charities, in the third world, to help alleviate the situation. The emphasis on WASH ( Water, Sanitation, and Hygiene ) so health and healthy water are maintained. "Water Spouts" will spout it all out.
Cholera: MSF Intervenes After Outbreaks Hit Four West African Nations
An MSF Cholera Treatment Center in northern Cameroon.
After years of cyclical cholera outbreaks in West Africa, water and
sanitation standards are still notoriously low in most of the affected
countries, but in some areas the cholera response is working better now
than in the past. IRIN spoke to governments and aid agencies about
innovations and traditional wisdom for preventing cholera.
By the end of June 2012, cholera had killed nearly 200 people in West
Africa and infected 10,330 according to the UN Children’s Fund (UNICEF).
Numbers are continuing to rise, particularly in the Sahel zone, where a
recent upsurge has killed 60 people and infected 2,800. On 2 July 34
cases and two deaths - both children - were reported in northern Mali
near Gao, on the edge of the Niger River.
Elsewhere in West Africa case numbers are rising, but are lower than
this time in 2011, when 82,070 people had contracted cholera, or in 2010
when 60,000 West Africans in the Lake Chad Basin, which includes parts
of Chad, Niger, Nigeria and Cameroon, were infected.
But West Africa is just at the start of its rainy season – cholera usually peaks between August and December.
Cholera is characterized by diarrhoea and vomiting, and can cause death
within hours if it is particularly virulent, or hits weak victims like
The victims: children
Francois Bellet, the West Africa water, sanitation and hygiene (WASH)
programme specialist at UNICEF, worries that people who are hungry or
malnourished as a result of the food crisis in the region are
particularly vulnerable to infection. UNICEF is particularly concerned
about the Sahel, where the spread of cholera is aggravated by a massive
displacement of people fleeing the conflict in northern Mali.
In some areas - such as Niger’s regions along the Niger River - the
Ministry of Health reports nearly three times as many cholera patients
this year as in 2011.
An estimated 400,000 children in Niger are suffering from severe
malnutrition this year. “A child below the age of five who has recovered
from severe and acute malnutrition will be back for treatment in a
matter of days or weeks if he or she is drinking contaminated water,”
Guido Borghese, UNICEF’s advisor on Child Survival and Development, said
in a communiqué.
The transmitters: fish
Cholera spreads along West Africa’s waterways - coastal regions, rivers
and lakes - where busy fishing and trade routes run. The coast is “like a
cholera highway”, said Bellet, as are major waterways such as the Niger
River, which flows through Guinea, Mali, Niger, Benin and Nigeria.
The bacteria build up under the scales of fish and are often still there
if the fish on sale in the markets have not been properly cleaned.
Given the role of women role in cleaning, descaling, smoking and selling
fish in most of West Africa, it is they and their children who are
particularly vulnerable to infection. Children make up some 80 percent
of the cases in Sierra Leone’s Port Loko district, according to UNICEF.
The Guinea-Sierra Leone outbreak started on the island of Yeliboya in
Sierra Leone’s Kambia district before spreading to islands off the coast
of Guinea and into Forecariah prefecture. Islands in Boffa prefecture
are known for their poor sanitation services and high levels of trade -
perfect conditions for cholera to spread, said Bellet.
Vaccine: a new approach
The cyclical nature of cholera and the fact that immunity builds after
large-scale epidemics are some of the reasons for this year’s lower
caseload, said practitioners.
In Chad - which so far has zero cases this year compared to 5,000 in
2011 - widescale prevention efforts have paid off. And in Guinea the
response has been much quicker and more coordinated this year.
In addition, a new approach has been tested in Guinea - notably a
cholera vaccine used by Médecins Sans Frontières-Switzerland (MSF) for
the first time in Africa to stem an epidemic.
The vaccine has had good results so far. In the Boffa and Forecariah
prefectures of Guinea, where 77 percent of the population were given the
double dose, and 95 percent received a single dose, there have been no
cases reported since, said Iza Ciglenecki, innovation coordinator for
diarrhoeal diseases at MSF-Switzerland. It is too early to know the full
results, she said, but when used in other regions the vaccine has been
65-75 percent effective in stemming the spread of the disease.
This is potentially a huge step forward, but at US$3.70 for two doses
the vaccine is expensive. The World Health Organization (WHO) and NGOs
are discussing guidelines for when to use it in response to future
epidemics. “If we multiply these interventions in the future, we could
even create regional stocks to make it cheaper, but it is too early to
say - we need to learn more first,” said Francois Verhoustraeten, Guinea
programme officer at MSF-Switzerland.
All responding agencies, including MSF, stressed that the vaccine is not
a standalone solution and should be seen as a supplementary activity.
“We put a lot of effort into all the strategies at once,” Ciglenecki
told IRIN, referring to the need to raise awareness of public hygiene,
targeting cholera hot spots, setting up early warning systems, and
treating water. Agencies such as MSF, UNICEF and Action contre la faim
(ACF) - Action against Hunger - an international NGO, have been
implementing these measures for years in West Africa's cholera-prone
Modern medical breakthroughs should not replace important basic hygiene
practices: wash your hands after defecating, before cooking or eating,
and try to disinfect water that may be dirty, say aid agency staff.
Neither should they negate the usefulness of age-old techniques, said
Guinea’s response has been quick this year. People have learned lessons
from the 2007 and 2008 outbreaks, the latter of which took one and a
half years to clear up, said Grant Laeity head of emergencies for UNICEF
in West Africa.
The Sector Chief of Khounyia in Kaback Island, Forecariah, told UNICEF
that this year’s cholera strain was particularly virulent (he has
witnessed six outbreaks on the island). But the local health clinic
managed the cases within a couple of hours, and the next day sent
samples for confirmation to Conakry, the capital, 35km away. A full
water and sanitation package was sent to the island four days later.
In late June Guinea reported 997 cholera infections and 41 deaths, with about 50 cases in Conakry.
Monitoring has also improved. Six surveillance posts have been set up in
high-risk zones across the country to detect potential cases and
respond to them immediately, said Beatriz Navarro Rubio, head of ACF in
“In Guinea we saw good surveillance plus an early declaration by the
authorities, leading to prompt action by all, which was encouraging,”
said Laeity “If we could have what we had in Guinea across the region it
would mean… when cholera broke out we could go and nip it in the bud.”
Coordination between the responding actors has been “very good” said
Rubio. Inter-agency disaster simulation exercises had taken place
shortly before the outbreak, so everyone was ready to step into gear
when cholera hit.
Guinea’s Ministry of Health has taken a strong lead in bringing the
Ministries of Education, and Energy and Water Resources on board to
agree on simple countrywide messaging that is spread in schools and on
local radio said Guarav Garg, a communications specialist at UNICEF in
Sierra Leone. The messages have reached an estimated one million of
Guinea’s six million people. “Coordination ebbs and flows, but they [the
Health Ministry] are in control,” said Garg.
“Most of the cases have been addressed, which shows that the individual
and collective prevention measures that we have taken are starting to
work,” said Dr Hawa Touré, national director of the Ministry of Health.
Sierra Leone: slow
In Sierra Leone the response has been less efficient. UNICEF said some
2,742 cases have been reported since February, starting in Kambia and
Port Loko in the north, then moving to Pujehun in the south.
A spike in the number of cases in Kambia town in late May “set off alarm
bells”, said Garg, as it is just a 2.5 hour drive from the capital,
Freetown. “Rains have come early and a lot of people live close to
rivers and openly defecate - this is a bad combination,” he noted.
So much untreated sewage has been pumped into Sierra Leone’s rivers and
coastal waters that much of the water itself is contaminated with the
cholera bacteria, UNICEF said.
The Ministry of Health has tested and chlorinated water points since
December 2011, but most people use private wells, so it is not known
whether they have been chlorinated or not, Garg told IRIN.
Innovations in cholera prevention here include UNICEF’s community-led approach to improved sanitation
- which has vastly improved public hygiene in parts of the six
districts where it has been implemented, but Kambia is not among them.
Sierra Leone has two things in its favour, said Garg: improving WASH
services is a strong pillar in the government’s upcoming poverty
reduction strategy, and elections will be held in December. “The last
thing you want is a cholera outbreak before the elections - they’re [the
government] realizing you can keep on responding, or you can start to
prevent,” he commented.
As well as improving surveillance, better understanding the region’s
cholera hot spots, and speedier government declarations of an outbreak,
in a region with high volumes of cross-border trade and people-movement,
coordinated prevention and response now needs to be a priority, say aid
In Côte d’Ivoire for instance, the current outbreak spread from Ghana;
in 2011 cholera spread from Nigeria to Chad to Cameroon; cholera
regularly passes between Guinea and Guinea-Bissau.
The governments of Sierra Leone and Guinea should quell further
cross-border spread by quarantining the disease and creating a
“protective shield” in the forested area between the countries, says
And all affected countries need to carry out cross-border simulation
exercises – as recently took place in the Lake Chad Basin – so agencies
understand their role as soon as an outbreak hits.