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New wave of worry: cholera waits in the wings

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FEARS CHOLERA WILL RETURN — Wedenig

If people in cholera hotspots return to unsafe drinking water, poor hygiene and sanitation practices, the outbreak, which has not been recorded anywhere the past three weeks, is likely to return, ALICK PONJE writes.

AT the peak of the cholera outbreak that affected nearly a thousand people and claimed 30 of them nationally, in a shantytown on the outskirts of Lilongwe City, a woman almost lost one of her three sons one night.

Steria Justin, 27, recalls how Peter, 10, swiftly grew weak after short diarrhoea that got worse at dawn before she took him to hospital where he was diagnosed with cholera.

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“Had I not rushed with him to hospital, we would have lost him,” she said on Monday as she studied her son sitting beside her on a windblown considerably elevated mud veranda of a house almost falling apart.

With no electricity and running water, Mitengo, a peri-urban location on part of Lilongwe’s western strip, is practically excluded from all its neighbours.

Across a muddy stream on the slum’s eastern tip, Area 36 has most households with running water and electricity though not so reliable.

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“We only envy our fellow mothers who draw water from their taps and use electricity at night. I know that my son got cholera from unsafe water that we used to draw from a nearby well,” she said.

Steria had heard about the dangerous outbreak that lasted five months after the first case was recorded in Karonga in November last year. In Lilongwe alone, it affected 388 people and claimed 18 lives.

The cause was a familiar one.

Principal Secretary (PS) in the Ministry of Health and Population, Dr Dan Namarika, told a parliamentary committee that almost all cholera cases recorded since the onset of the rainy season were related to water.

He appealed to the lawmakers to lobby for more potable water, mostly in the outbreak’s hotspots where poor sanitation practices still abound.

Information on how to prevent the disease was handy but residents of Mitengo seldom heeded it. They continued drawing water from unprotected sources and never bothered to treat it.

“The water from the wells was for everything. We used it for cooking, bathing and drinking. That is how my son got cholera. I don’t want to experience what happened that night again,” Steria recounts.

Many others who were affected by cholera in Mitengo were aware of what causes the outbreak but claim it was beyond their control. Now, as fear fades, heaps of wet waste in this area also keep accumulating.

“Initially, treating water was not easy.

It meant we had to regularly buy chemicals for the activity. We don’t always have money. Boiling water meant more firewood or charcoal,” Martha Matchaya, a mother of two, says.

Like all normal human beings, she does not want the outbreak to return; yet, like Steria, she fears it could just be waiting in the wings as its end also entails the conclusion of humanitarian interventions that have saved thousands of lives.

For instance, Unicef, which was providing emergency services during the cholera crisis, will be phasing out the delivery of water through bowsers from where Mitengo residents got hope revitalised.

In the wake of the development, such hope is fading again as a more sustainable solution to the sanitation crisis is yet to be found.

The UN agency’s Country Representat ive, Johannes Wedenig, does not want to pretend that all is well after the outbreak’s present end.

“It is very good news that cholera is over but the truth of the matter is that it will come again if behaviours don’t change and safe water is not brought to this community,” Wedenig says.

The long-term solution to the water crisis in Mitengo can be provided by Lilongwe Water Board (LWB) which has the mandate of providing the city with clean and potable water.

But between now and mid next year, it appears there is little that residents of this shantytown can expect from the utility body as its current plan to provide the precious liquid for the area is at a very young stage.

LWB acting planning engineer for the Geographical Information System (GIS) office, Emmanuel Sumbwi, states that water will only come to Mitengo when they are done with engineering surveys.

“However, I cannot say when,” Sumbwi says. “All I can say is that this area will be provided with water during the second phase of a project on the same and that will probably be after mid next year.”

Such news plunges Mitengo residents into a deeper state of misery as cholera lurks again, from the same sources where they are likely to return to.

“After Unicef has stopped providing water here, it is obvious that we will return to unprotected wells. We have nowhere to go,” Steria says.

This should trouble Wedenig. As much as he appreciates that LWB has to provide clean and potable water for this densely populated township, he also believes that residents have to change their behaviour and start treating the water they get from unprotected sources.

“They also have to engage in good hygiene and sanitation practices because the reality is that the only safe water in Lilongwe rural is the water provided by Lilongwe Water Board,” Wedenig says.

The unsafe disposal and management of human waste in Mitengo—as the few pit latrines that are shared by several households here are mostly full or without drop hole covers—also threatens to bring cholera back.

So, in terms of behaviour change, more needs to also be done on simple activities such as hand washing which is the most effective health intervention for many diseases.

Perhaps, only then, will cholera be ultimately defeated in this thickly populated shantytown and many other areas where the sanitation-related disease reared its ugly head.

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