Community health workers have helped reduce the number of cholera cases in Kanyama Compound in Zambia by going door to door and holding impromptu classes at communal water points to explain how disease can be prevented and how the sick can be treated.
Cholera has become an annual problem in Zambia over the past decade, with outbreaks being driven by high poverty levels, misinformation and rapid urbanisation. Kanyama Compound in Lusaka - which was the epicentre of this year’s outbreak - epitomises the growing problem of urban poverty.
The compound is a high density, unplanned settlement with little or no water and sanitation infrastructure. Refuse collection is erratic and inadequate, so rubbish is strewn all over the streets, and during the rainy season potholes in the untarred roads become vast ponds of fetid water in which children play, chasing resident flocks of ducks. There are not enough latrines, and many of the few that are there are filthy and flooded. Clean water is available for sale at municipal water pumps, but many residents cannot afford the K500 ($0.75 US dollars) needed to buy a day’s supply of drinking water. Instead they dig shallow wells, as the water table in Lusaka is very high. Unfortunately, the high water table combined with flooding during the rainy season means latrines often contaminate the wells, sparking an outbreak of cholera.
Numbers of patients falling
At Kanyama Hospital, a cholera treatment centre was set up by Medecins Sans Frontieres (MSF). Strict measures are in place to prevent contamination and all visitors must have their shoes sprayed with disinfectant and wash their hands with chlorine on entering and leaving. At the height of the outbreak, this mobile hospital made up of white tents was treating 200 patients. By the end of April, the numbers had dropped to 41 - a decrease many attribute in no small part to the efforts of community health workers.
At the hospital, I am chatting with the matron when suddenly I see a stream of people in bright yellow T-shirts approaching. They come pouring into the hospital, some chatting and laughing in loud groups, others carrying tiny babies on their backs, all wearing bright T-shirts emblazoned with the words “cholera sicimphepo” (”cholera is not airborne”). Soon the room is full and people start reporting back on the activities in their area: more than 10,000 households were given chlorine to treat their water for four weeks, and more than 50,000 people were educated on various hygiene practices, through door-to-door hygiene education, road shows and tap stand hygiene demonstrations. One hundred volunteers from Kanyama clinic were engaged and trained in public health issues related to cholera and data collection.
“I wanted to help fight this cholera,” explains volunteer Faith Moyo (29). “We educate people on how to prevent cholera and how to stop it spreading. Some people don’t understand that they should not dig those scoop hole wells, so we explain that water might be dirty. Others get sick and then they drink alcohol because they think it will kill the germs. I have even heard of people with cholera drinking chlorine. They think that because it is used to kill germs in drinking water, it can be drunk like medicine to cure cholera.”
Fighting stigma as well as disease
Moyo and her fellow volunteers work throughout the sprawling slum that is Kanyama compound, going door to door and holding impromptu classes at communal water points to spread their message about how cholera can be prevented, and how the sick can be treated. Fighting stigma is a major challenge, and many patients are isolated by family and community members or abandoned at treatment centres.
To bring the outbreak under control, the municipality lifted the charge for water from council water points. But volunteers point out that clean water is not enough - so they stand at the water points explaining how to keep water containers clean and the necessity of keeping containers covered. They also oversee the addition of chlorine to drinking water - a measure not necessarily popular with residents who complain that the water smells and tastes strongly of the chemical.
Simple solutions
In a place that uses communal pit latrines and has no running water, some of the ideas the volunteers are talking about - such as hand washing - seem difficult to implement.
Not so, says Oxfam’s public health coordinator Mutinta Chilimboyi - and then she proves her point by giving the volunteers a lively demonstration of how even the poorest members of the community can rig up an efficient hand-washing system, using easily accessible materials. A plastic bottle full of water is hooked onto a peg in the wall, with a piece of string attached to the neck running down to a stick on the ground that acts like a pedal. You stand on the stick, the bottle tilts and water pours out - and voila: a hygienic hand-washing system.
A couple of days later, the entire compound is abuzz as popular local musicians Mozegta, Brian Chilala, MKV and Banja Soap group arrive to perform in an Oxfam roadshow aimed at educating and mobilising the community about cholera. Within minutes, it seems as if the entire community is surrounding the flat-bed truck on which singers gyrate, tell jokes and make sure the messages about cholera get through - particularly to children. Flyers and posters are distributed, as the volunteers work the crowd, giving out bottles of chlorine and preaching the messages about safe hygiene practices.
While these short-term measures are necessary and save lives, longtime Lusaka residents warn that the same situation will repeat itself year after year unless access to water is dramatically improved and there is an investment in infrastructure such as drainage and proper sanitation in poverty stricken areas.
- According to the UNDP Human Development Report, 64% of the Zambian population lives on less than US$1.25 a day and only 42% have access to clean drinking water.
- Climate change is accelerating urbanisation, as subsistence farmers move the cities when their crops fail, and increased extreme weather events such as floods will drive the spread of diseases. This adds strain to an already overburdened health system, which has seen a massive brain drain of doctors and nurses who have left for South Africa and the UK.
- Globally, cholera deaths have increased by 27%. Ninety-eight per cent of cholera deaths occur in Southern Africa.
