Grappling with renewed cholera outbreak

In the face of yet another outbreak of cholera, Vietnam's capital city is closing down dog meat restaurants and unhygienic street food stalls, but not enough is being done to address Hanoi's decrepit sanitation system, a major source of the illness, according to health officials.

"The sewage from septic tanks flows into the lakes," Nguyen Huy Nga, director of the Ministry of Health's Preventive Medicine Department, told IRIN. "When people use the lake water for different purposes, such as washing food, they are helping to spread the disease."

Hanoi's sewers date back to French colonial times when the city was relatively small. Today, it teems with more than three million people yet the sanitation infrastructure is largely unchanged from the late 1800s.

According to the World Health Organization (WHO), 2,490 cases of acute diarrhoea were reported in Vietnam between 5 March and 22 April. A total of 377 people tested positive for vibrio cholerae, mostly in Hanoi.

Cholera is an infection of the intestinal tract, which is contracted through contaminated food or water. It can result in dehydration and kidney failure, which if untreated can result in death. So far no fatalities have been reported.

In response to the recent outbreak, the third since October, Hanoi's health department has closed dozens of dog meat butchers and restaurants in the capital. Because the dogs are not reared for consumption, the meat is often contaminated. In addition, it has urged people to avoid street food stalls. A ban on using excrement to fertilise crops has been put in place as well. Health authorities have also repeatedly warned people not to wash fruit and vegetables in the highly polluted lakes and ponds.


Photo: Martha Ann Overland/IRIN
Sugar cane for sale on a Hanoi street

But Hanoi's public health officials concede they can only do so much. "There are more than 260 inspection delegations at all levels throughout the city every day," said the frustrated director of the Hanoi Health Department, Le Anh Tuan. "We have shut down dog meat restaurants that failed to meet the food safety and hygiene requirements.

"We are trying to raise the awareness of all people, including restaurant owners and customers, so they understand about food safety hygiene. [But] we can't do anything if customers just ignore basic food safety."

Treating the lakes

Tuan said the 30 lakes in Hanoi that tested positive for the presence of cholera bacteria are now being cleaned. More than a tonne of chlorine was dumped into Linh Quang Lake after six people living nearby contracted the illness.

However, the real problem is a sewage system that dates back to the 19th century, says Ngo Trung Hai, vice-head of the Institute for Urban and Rural Planning at the Ministry of Construction. Rainwater run-off mixes with untreated sewage, exacerbating the problem.


Photo: Martha Ann Overland/IRIN
Washing vegetables in the polluted Hanoi lake

"Hanoi has no water treatment plants," says Hai. "It's crazy. It all goes into the lakes without being treated. It's easy to understand why the lakes are infected with cholera because the sewage flows into them."

The good news is that a water treatment plant is under construction, says Hai. It will be able to process 200,000 to 300,000 cubic metres of sewage a day. But Hanoi's houses still need to be connected to an urban sewer system, a long-term project.

Meanwhile, WHO and local public health officials are stepping up their campaign to warn people of the dangers of eating uncooked vegetables, using unhygienic food outlets and drinking contaminated water. They also warn that warmer temperatures are likely to bring an increase in infections.

Vietnam's state-controlled media is also ratcheting up the rhetoric, using "cholera" instead of "acute diarrhoea", in a move that health officials hope will encourage the public to take the threat more seriously.

Some people are getting the message. Many say they are paying more attention to sanitation and are washing their hands before meals. But there is little evidence that people are actually changing the way they eat.

"Eating on the street and at pavement stalls is unclean and is destroying the city's image," said 21-year-old Pham Tien Quan. But at the same time she was buying sugar cane juice, a virtual cholera cocktail, from a local vendor in Hanoi.

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