As the fleeting storms of May give way to the persistent downpours of June, the National Cholera Taskforce in Freetown, Sierra Leone, is working to prevent a repeat of last year’s cholera outbreak.
In 2012, President Ernest Bai Koroma was forced to declare a state of emergency during Sierra Leone’s worst cholera outbreak in over 15 years. The disease spread rapidly through the 12 of the country’s 13 districts, fuelled by heavy rainfall and inadequate sanitation. By the time it was brought under control, over 20,000 people had been infected and almost 300 killed in Sierra Leone, a further 10,000 infected and 100 killed in neighbouring Guinea.
So far this year, there have been 365 reported cholera cases and two deaths - figures significantly lower than at the same point last year.
Fodae Dafae, acting head of the cholera taskforce, is confident that enough has been done to prevent a similar outbreak. He highlighted a campaign to raise awareness of the disease and how to avoid it.
“Awareness creation is ongoing,” he told IRIN. “People know about it now. They’re talking about it.”
Following the 2012 epidemic, donors, aid workers and health officials agreed that West African countries must do more to prepare for cholera, given it recurs each year. They called, in particular, for targeted investment in at-risk zones, such as in Kambia district, in northern Sierra Leone.
In addition to posters and billboards, Dafae says local radio stations are broadcasting cholera information in all of the Sierra Leone’s various languages. The UN Children’s Fund (UNICEF) has also been staging plays on the subject.
Efforts are also underway to ensure that medical centres across the country are fully stocked with saline drips and other relevant medical equipment before the rains intensify over the coming weeks.
Vaccination, however, which was used with some success by Médecins sans Frontières during a similar outbreak last year in neighbouring Guinea, is not being pursued as an option. “Cholera vaccines are not cheap,” Dafae said.
Improving water and sanitation
Sierra Leone’s water and sanitation situation remains grim. Only 12.8 percent of the population has access to “improved sanitation”, while just one in 10 households has both safe drinking water and improved sanitation. And out of around 28,000 protected water points in the country, almost 40 percent are not fully operational.
Victor Kinyanjui, the water and sanitation manager for UNICEF in Sierra Leone, told IRIN: “When the war set in, due to the emergency situation, protocols were not always followed in the construction of community water wells and toilets. Most of the wells we have today were built during that time.”
He also pointed out that the Guma Valley Water Company, which was built to serve a population of 500,000, is now struggling to cope with Freetown’s 1.2 million people.
“It’s overstretched, so now you have all sorts of water points that have been constructed… Most of them are not well protected against contaminants,” he explained.
UNICEF is currently rehabilitating 80 wells in diarrhoea hot spots across the country, and it is installing solar-powered water systems for larger communities that have been previously affected by high levels of diarrhoeal diseases.
Underpinning much of their sanitation work is a community-led total sanitation (CLTS) approach, wherein communities are mobilized to undertake their own sanitation improvements, such as the construction of latrines. This approach been largely successful, Kinyanjui said.
“We are standing currently at over 3,900 communities that have been declared open defecation-free in Sierra Leone, and that’s a big change, and a big step,” he said. Still, he acknowledged that much remains to be done and that fully resolving Sierra Leone’s sanitary deficiencies will be a long process.
Still waiting for change
In the low-lying slum settlement of Kroo Bay, near the centre of Freetown, the scale of the challenge is clear. Around 6,000 people live in cramped concrete and corrugated zinc houses. Paths and streams are choked with the city’s rubbish. Children play, swim and defecate in the muddy streams, which, every rainy season, inundate the surrounding houses and contaminate water supplies.
Kroo Bay resident Zainab Bangura (no relation to her namesake, Sierra Leone’s former minister of health) is concerned about the coming rainy season.
“People still use the river as a toilet,” she said. “When the cholera comes, I will have to buy Grafton [purified] water, but it is very expensive.” The mother of eight makes a living selling mangoes at four for 5,000 Leones (US$0.12).
Most Kroo Bay residents IRIN spoke to could not identify any improvements in their sanitary situation.
“The government has not done anything for us,” said Hawa Bah. One of her children contracted cholera during last year’s outbreak, and she wants to know why nothing has been done to protect her neighbourhood from flooding.
“We are afraid,” she said. “We have seen what the cholera can do.”