Health workers have set up oral rehydration salt (ORS) tents and a cholera treatment centre on this tiny island in western Papua New Guinea, all the while advising people to "boil your drinking water, wash your hands, and cook your food", in a bid to control an outbreak that has killed dozens in this region.
Of the 870 reported cases at Daru hospital on this island in Western Province, near Australia, there are now 30 confirmed deaths, but the outbreak is described as under control by health workers.
There is, however, growing concern over the spread of the infection to the mainland, at the mouth of the Fly River.
"We're confident about Daru and the cases here, but we're not confident about the delta. There have been two confirmed cases near the mouth of the river," said Geoff Clark, a World Health Organization (WHO) technical officer.
Survey teams left on 17 and 19 November to collect samples from communities at the mouth of the river to conduct further assessments.
The outbreak - the first time cholera has been recorded in Daru - began at end-October, and has affected 4.9 percent of the population, said Naomi Pomat, a doctor working with the cholera response team.
"Initial cases tested positive for typhoid, but the clinical staff realized the symptoms leaned more toward cholera than anything else," Pomat told IRIN.
After two weeks, 14 out of 17 patient samples confirmed cholera. From two to three deaths each day in the beginning, the toll has dropped to one or two per week, she said.
Shared water, poor sanitation
Daru has sufficient water, including piped tap water, but people are exposed to the cholera bacteria because of open defecation and "black bucket" toilets that have to be emptied regularly.
"People are advised to boil water, but no one is going short of water," said Geoff Miller, a Daru-based adviser with the Capacity Building Service Center (CBSC), an Australian Agency for International Development (AusAID)-funded technical support facility.
However, some communities, who pay for their piped water, refuse to share, forcing neighbours to walk long distances to access taps they are allowed to use. Community leaders are being encouraged to discuss issues of limited access with their neighbours.
Photo: Alisa Tang/IRIN
|A billboard in Daru tells residents how to prevent cholera|
"We have identified this as one of the major issues that needs to be rectified. There is a need for taps to be connected to each individual settlement," said Berry Ropa of the National Disease Control Command Centre. "This was brought to the governor's notice and to the provincial administration's. The person who can make that happen, the water board manager, is part of the cholera response committee in Daru."
With respect to open sewage, Daru's water table is so high that pit latrines would contaminate the ground water. Many communities collect water from open wells for cleaning.
"We're telling people, 'don't defecate freely, use the black bucket', but I think the number of people has outgrown the system," Clark said, adding that those who defecate in the open are asked to cover it with earth.
A basic message, repeated
In Giwari Kona, a muddy coastal cluster of ramshackle huts, leaders say there have been 14 suspected cholera deaths.
Health workers pitched an open-air tent to provide ORS. Serious cases were referred to Daru hospital, where AusAID and WHO established an isolated cholera ward. AusAID on 20 November also sent a 2,600kg planeload of supplies, including water containers, chlorine and intravenous (IV) fluids.
Although water purification tablets were distributed, people were encouraged to boil water as a more sustainable practice. Radio announcements and billboards reminded villagers to wash their hands with soap before eating, and to peel or cook their food.
"It's a very basic message, but we send it out every day, hundreds of times if we can," Pomat said.
According to the WHO, cholera, an acute diarrhoeal disease caused by contaminated food or water, is a global threat, affecting an estimated 3-5 million people in developing countries around the world and killing up to 120,000 every year.