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Cholera outbreak in Cameroon

Plan International - Wed, 22 Jun 2011 11:18 GMT
Author: Plan International
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The cholera outbreak in Cameroon is falling under the radar in the international news. With events in Syria and Libya dominating the World News and a more substantial epidemic in Haiti, the fight against cholera in Cameroon is one of those forgotten emergencies. Dualta Roughneen of Plan Ireland has spent the last month working with Plan’s team in Cameroon who are working to stop the outbreak turning into an epidemic.

Bibemi is a rural health district in the North Region of Cameroon. It takes about 19 hours to drive there from the capital, Yaoundé, along many dirt roads. Bibemi has been particularly hard hit by this outbreak. With a population of 90,000, there have been over 800 cases of cholera resulting in 62 deaths in the district. Not only is the number of cases per population far higher than other areas, but the fatality rate is extremely high at 7%. Of the total reported cases since April, 10% have been in Bibemi.

The District Medical Officer, Dr. Janvier Djofack struggles to maintain control of the situation. His major achievement to date: the elimination of out-of-hospital deaths. This means that the district population is now aware of the risks cholera presents. Those infected are going to health centres for treatment, though for some, it is still too late.

“The key now is to get the message out to the population- to teach them how to avoid cholera. Washing hands, washing fruit, using latrines, filtering and chlorinating water- all are quite simple instructions. Many people are aware of these basic hygiene practices, but do not realize their use can eliminate cholera in the region if people are diligent” said Dr. Janvier.

With 12 health centres in the district, Dr. Janvier works with 11 other doctors to reach the resident population. That’s one doctor for 8,000 people. While not the worst statistic in the world, in the midst of a cholera outbreak, it means all hands on deck. Dr Janvier described two terrible days in Adoumri, a village with about 400 residents, to me. The 25th and 26th of May are now the “black days of cholera” in the village as 47 cases were presented for treatment.  

This is not a ‘flies in their eyes’ story. Cameroon is a functioning, stable country. With a strong government, the Secretary General of the Ministry of Health hosts a twice-weekly coordination meeting with its partners on the cholera response. The Ministry of Health is putting pressure on other government departments to provide assistance. The Ministry of Mines, Water and Energy is trucking clean water into urban areas where cases have been reported. Cholera treatment is free, and this outbreak is quickly consuming the operating budgets of the health clinics.

Cholera is an extremely resilient bacteria. It is a master at hanging around, waiting for people to let their guard down and restart the cycle of infection. In Haiti, it is predicted that it could take decades to remove cholera from the country, now that it has bedded down. Lack of access to safe water, lack of use of proper sanitation and less than ideal hygiene practices, are the implements that keep the bacteria in circulation. In Cameroon, the mobility of the population seems to be a factor in spreading the outbreak to new, random locations. I heard of one man who purchased mangos in one area, which had come in contact with the bacteria and transported them over 100km to facilitate a new outbreak. Another story is of someone who attended a funeral of a cholera victim and returned home, bringing cholera with him. Cholera is a difficult opponent, but it can be overcome.

Organisations in Cameroon, such as Plan, where I am seconded from a sister office in Ireland for one month, are supporting the efforts of Dr. Janvier and his counterparts in other affected areas in training volunteers who spread the message on how to stop the spread of cholera. I can’t help but admire the efforts of the doctor, under 40° degree heat in the Sahel, dissecting information for me on MS Access, assessing the statistics, looking for trends that can give him a solution to the continuing spread. He can’t find any.

The computer tells him he needs money – more money for chlorine to disinfect the wells and the health centres, for fuel so he can travel around the health district, to provide a small stipend to volunteers so that they will continue to walk around in the searing heat, telling people how to avoid infection. He needs money for cholera cots- simply adapted hospital beds, with easily cleaned material and hole in the centre to allow people in the worst stages of a cholera infection, too weak to go to a toilet, to not end up soiling themselves. This means there is less likelihood of further infection of those working in the health centres, but also allows those suffering some degree of dignity in the face of a sickness that really does try to take it all away.

The North Region of Cameroon, like other countries on the edge of the Sahel, struggles with water access issues. Like much of the rural population, dispersed over vast expanses of semi-desert, latrines are not a priority. There are acres of ‘bush’ to go to the toilet. Most people collect water from open wells, dug by hand and lined with mud-bricks. The nature of the collection methods - buckets and ropes - means the wells are primed for contamination if there is cholera in the area. They are not covered and protected like wells with hand pumps. Dr. Janvier explained to me how he has moved from community to community explaining how to disinfect these wells with standard household bleach if necessary. Unfortunately the markets in these areas seem to have run out of bleach.

With the level of commitment displayed by Dr. Janvier, what really is missing is what his computer has been telling him: Funds. Not a lot, but enough to let him get on with his job. When I arrived here I expected to have a different role to play in supporting the cholera response. Of course there are areas where the knowledge I have gained working on water and sanitation programmes around the world can be of assistance, and add value. But I have also learned that by telling this story, sharing the struggles of a country doctor, may encourage support in lands far away from Cameroon. Financial contributions from compassionate people who want to help Plan in its work supporting the efforts of Dr. Janvier and others in Cameroon stop the spread of the disease.  

“The ways to prevent cholera are simple, with enough support we can be faster than the disease and stop it from taking any more lives,” concluded Dr. Janvier.

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