Why cholera has refused to go away

Dar es Salaam. It is without doubt that cholera is still a threatening epidemic in Tanzania.

When Health, Community Development, Gender and Elderly minister Ummy Mwalimu warned of possible cholera and related waterborne disease outbreaks across the country in December last year, it raised concerns about the country’s capability to eradicate it.

She said 458 cholera cases and six deaths were reported in November last year in six regions: Morogoro (282 cases), (Dodoma 96), Mara (31 cases), Kigoma (30 cases), Arusha (11 cases) and Dar es Salaam (eight cases). According to a report released at the end of last year by the Health ministry’s spokesperson, Mr Nsachris Mwamwaja, 26 cases were reported in five regions, including Dar es Salaam, Dodoma, Singida, Morogoro and Katavi.

During cholera outbreaks immediate and long-term measures are taken to contain it by both saving lives and preventing further disease transmission. Preventive measures include raising public awareness on food, neighbourhood and personal hygiene, training community volunteers and health service providers on mitigation methods.

Unfortunately, it always comes back to business as usual with cholera survivors after recovery to live in almost the same unhygienic conditions that caused the disease.

The most cholera-affected areas are those with poor sanitation, near dumps and poor toilet facilities. A few days ago this reporter visited Mfaume Street in Upanga, Dar es Salaam, and discovered that there was a broken sewerage system that had not been repaired for over three years.

This situation causes overflow of waste that in the end flows to the neighbourhoods. There are also cracked water pipes near the area, so the combination of water from the pipes and waste from toilet chambers has been a nuisance to residents.

This reporter recently interviewed one resident called Mama Tiffu, who wondered how a place like Upanga would have a broken sewerage system for three years without the authorities being aware of it in the same way it would be on the outskirts of the city.

“This is sad because there’s no way we can avoid epidemics if our area is surrounded with heaps of waste all the time,” she explained.

Generally, the sewage system around the city is inadequate and most of the time out of order, which is a potent contributing factor to the cholera epidemic. The drainage system is also unreliable.

Food and fruit vendors also contribute to the spread of the disease due to their poor handling of their businesses from preparatory to selling stages.

Furthermore, the majority of people are not aware of spotting infected neighbours to help those, who have developed cholera symptoms without containing the disease. Cholera is said to be an acute diarrheal disease that can kill within few hours if left untreated. According to the World Health Organisation Report of October last year, it is estimated that each year there are 1.3 to 4 million cases of cholera and 21,000 to 143,000 deaths worldwide due to cholera.

Most of those infected will have no or with mild symptoms and can be successfully treated with an oral rehydration solution. Severe cases will need more treatment with intravenous fluids and antibiotics.

The sensitive part of the epidemic lies in water and sanitation and if economic development and universal access to safe drinking water and adequate sanitation is achieved cholera will be a myth.

According to Dar es Salaam City Council Director Siporah Liana, her office is in a process to buy two areas that will be developed as dumps to deal with the waste problem in the city.

She identified those areas as Vikindu (in Mkuranga) and Kigamboni (in Dar es Salaam). Besides this, she explained that the project to recycle waste aimed at eliminating household and industrial waste.

“We have one dump in Pugu and it’s time we put in place workable strategies that will keep our city clean. The project will be ready by July this year,” she explained.

She also talked about plans to raise public awareness on food and fruits sold in the streets and how risky to health they were if not hygienically prepared.

“We have always told food vendors, who sell their commodities beside roads to make sure they use tables or stalls to reduce the disease risk. We are trying hard to address the issue of hygiene,” she elaborated.

She warned the habit of fruit vendors, who sold pealed or cut open fruits like watermelons and oranges without covering them with plastic papers, saying they highly the spread disease.

Ms Liana explained another problem being lack of public awareness on how to identify persons suffering from cholera and how to help them without contracting the disease.

Cholera is characterised in its most severe form by a sudden onset of acute watery diarrhoea that can lead to death by severe dehydration. The dehydration caused by cholera is usually severe and can cause tiredness, moodiness, sunken eyes, dry mouth, shrivelled skin, extreme thirst, reduced urine output, irregular heartbeat and low blood pressure.

“Whenever people see a person with these symptoms should be quick to seek help from medical practitioners without having physical contact with them because any direct bodily contact with their vomit or stool increases the disease risk.

She thus called upon Regional Commissioner Paul Makonda to issue a statement on the issue of plastic bags by giving a grace period to all traders to finish their stock before the actual execution of the directive.

“This will boost our efforts to keep this city as clean as possible,” she said.