8.14.2012

Cholera Returns to Sierra Leone

Streets in Sierra Leone's Capital, Freetown, During the Rainy Season
Cholera is back in the news. This time it’s not Haiti who is the victim, but rather Sierra Leone. After I was recovering from a not-so-fun bout of typhoid in early July while on my most recent trip to the tiny West African nation, conversations around the NGO hospital I was working at started to reference the increasing number of cholera cases across the nation. The current cholera crisis in Sierra Leone is the worst since 2007, with 9,613 cases being reported since the beginning of the year, and as Dr.Wondimagegnehu (WHO) observed, “For a population of six million, [this is] significant”. Freetown, Sierra Leone’s mountainous and slum-filled capital city has had 1,500 diagnosed cases with 17 deaths.

During mid-July, the second largest city in the nation, Bo, where I was working, started to prepare for the inevitable arrival of the disease. The Bo government hospital held a collaboration session with health clinics and NGOs working in and around Bo to discuss how best to prepare for and respond to the cases that would arrive only in a matter of time. During this meeting, local NGOs, such as the one I was working with, prepared themselves with the necessary treatments, such as Oral Rehydration Salts (ORS). Larger health facilities and NGOs, such as MSF, are collaborating with the Sierra Leonean Ministry of Health. MSF currently has three cholera treatment centers in Freetown (which have treated more than 500 patients) and has agreed to establish another in Bo – a decision I think will be well worth their effort.

Although the cases were limited to the Northern part of the nation in the beginning of the year, it is quickly spreading. Cholera cases have now been reported in the districts of Port Loko, Bo, Kambia, Pujehun, Kailahun, Western Area, and most recently Kenema– where 11 cases have been reported.

It hasn’t just been NGOs and the MoH responding to the spread of cholera – the company African Minerals (SL) Limited has recently announced that it is donating1,000 bags of Oral Rehydration Salts (ORS), which are used for cholera treatment, to communities in the north-western district of Port Loko.

Sierra Leone is now in the middle of its rainy season, and let me tell you, this one is rainy! Besides the annoyance of endless rains and terrible storms, this particularly stubborn rainy season means much worse – the facilitation of the spread of water-borne diseases such as cholera and typhoid, and the increase in diseases spread by mosquitoes, such as malaria and yellow fever. Not only is Sierra Leone battling all these diseases at once, but also Lassa Fever, which is also on the rise. During a visit to the Gondoma MSF hospital, a staff member stated that nearly every day there is a confirmed case of Lassa Fever. During this rainy season in West and Central Africa, there has been 29,000 cases of water-borne diseases with around 700 deaths.

Increased Collaboration Needed
Sierra Leone is no stranger to outbreaks of diseases such as cholera, and there is no shortage of both local and international NGOs throughout the country (in fact, in my opinion there are too many NGOs currently operating and launching projects, but I’ll save that for another day). But despite the abundant number of NGOs and their capabilities, what will remain imperative for the successful response to the cholera crisis is for the continued (and increased) collaboration between NGOs and the government. From what I observed in Bo, there was unnecessary competition between the various local health clinics, and between the government and NGOs. Personally, if people’s health (and lives) is at risk, then it is not the place for competition to be getting in the way of making a coordinated and quick response.


The government’s and NGOs’ response to the increasing number of cholera cases will need to include sensitization campaigns to raise awareness of basic prevention techniques. African Minerals has recently announced that it will be conducting health talks on the radio as well as visiting villages and teaching hygiene techniques. MSF-Gondoma has a unique way to monitor their patients’ hygiene: outside of the hospital bathrooms there is a guard to make sure that the patients properly dispose of their waste and wash their hands. Although this approach functions great in a smaller facility such as an MSF hospital, it is obviously not implementable on a larger scale. Sensitization campaigns work well, but an added problem remains the lack basic necessities such as clean water and soap. Even in Bo, a comparatively well-off city, there was poor hygiene (even in health facilities), feces in the downtown markets, and lack of basic sanitation techniques. When conditions such as these are combined with the intense rains that wash waste and rubbish along the roads and through the markets where it comes into contact with both humans and food, it is no surprise that cholera has spread throughout the country.

Sierra Leone is not the only country dealing with cholera. Neighboring Guinea is also battling the disease (MSF responded by using a two-dose oral vaccine for the first time in Africa), Niger, Mali, and most recently in Kismayo, Somalia.

I hope that during the coming weeks the Government of Sierra Leone and local and international NGOs can collaborate to best respond to the crisis. These cases of cholera are an added burden to the already preoccupied government, which is preparing itself for elections in November. As Tom Murphy notes on his blog, some are arguing that the authorities are not taking the crisis as serious as they should. The government’s continued response to the crisis will illustrate its capacity at handling national issues as well as collaborating with the international community and non-governmental organizations.  Although the government’s response to cholera will likely not be a large playing factor in the election, it will be an interesting added dynamic to an already heated election.

One of Freetown's Many Slums

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