GUINEA - GUINEA-BISSAU: Driving home the cholera message

Photo: Anna Jefferys/IRIN

Poster in Bissau clinic showing steps to take when babies contract diarrhoea

BISSAU, 15 October 2009 (IRIN) - In Bafata, Guinea-Bissau, children go door-to-door counting mosquito nets, monitoring hand-washing and checking the distance between kitchens and latrines. The activities are among efforts by health NGOs and authorities to fill the gap between cholera-prevention messages and behaviour, after a 2008 epidemic killed some 220 people and infected at least 13,000.

The national flag is hoisted in front of the cleanest house, and the family is feted in schools and on local radio, Ingrid Kuhfeldt, head of NGO Plan International in Bissau, told IRIN. Plan International, which has been working in Bafata for 15 years, launched the scheme to prevent future cholera outbreaks.

“There is much more competition now on who has the best hygiene materials and the cleanest house – we hadn’t seen this kind of rivalry before,” Kuhfeldt said.

Children also try to dispel hygiene “myths” with families – for example that lemon juice can disinfect water – and show people how much chlorine to drop into a well to clean the water, Kuhfeldt said.

Rather than resenting the children, adults listen, partly because of children’s rising status in society over recent years, according to Kuhfeldt. “[People] have a growing respect for their children having seen them make speeches in front of audiences in schools, heard them on the radio and seen them set up committees,” she said. “They’re starting to realize they can learn from [the children].”

In Guinea, with the support of aid agencies and the local health services, a local radio station in Kindia helps spread hygiene messages through radio spots and village contests. A team from the radio station organizes public games in remote communities, quizzing people on hygiene and cholera prevention and asking people to make up songs on a hygiene-related theme, according to Aboubacar Sylla, head of programming at the station. Prizes include radios, water buckets or farming tools.

"Hundreds of people come out for these activities; people really like it," Sylla said. "And it is quite interactive; we encourage everyone to talk about the subject at hand."

Bafata and Kindia recorded no cholera in 2008, despite infections in neighbouring regions.

Jeroen Ensink of the London School of Hygiene and Tropical Medicine – which recently studied prevention and preparedness efforts in Guinea and Guinea-Bissau – said it is not enough to simply impart knowledge; people must have incentives to begin forming new habits. He noted that research at LSHTM showed just 60 percent of the university’s staff clean their hands after defecating, despite “knowing better”.

Plan International's Kuhfeldt said programmes such as Plan's in Bafata work well because of the long-term trust the NGO has already built up among inhabitants and local authorities in the small community. The NGO has been engaged in education, clean water, children’s rights and health in Bafata for 15 years. “In Bafata we know everyone – the governor, the ministers of education and health and the communities."

But not all at-risk communities have the long-term presence of an international NGO. The European Commission humanitarian aid department (ECHO) says in a paper on cholera in West Africa: “The reported lethality rates in most of the countries show weak response mechanisms to the [cholera] outbreaks, mainly in those [countries] where no external assistance has been provided; and the low lethality rates of some countries are due to an external assistance.”

Health experts say it is essential that locals apply and perpetuate long-term education and prevention measures.

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