If the health authorities in KwaZulu-Natal are to be believed, there is little cause for worry about the cholera epidemic that has struck the northern parts of the province.
As hundreds of new infections continue to be reported daily, Minister of Health Manto Tshabalala-Msimang this week said there was “nothing to be concerned about at this stage”. Rates of infection with the water-borne, potentially fatal bacteria have spiralled since cholera was first detected in the province in August last year, but provincial health authorities say the situation is being “exceptionally managed”.
Meanwhile, the departments of health, water affairs and forestry, and local government battle to keep the epidemic at bay. Although people are still reporting at hospitals and clinics in the affected areas worst hit are northern parts of the province, the Richards Bay, Lower Umfolozi, Empangeni and Ngwelezane areas the province has shown a slight decrease in the past three days.
But the epidemic, which reinfects as easily and rapidly as it infects, shows no real signs of abating and has apparently spread to Mpumalanga, where the Rob Ferreira hospital in Nelspruit has opened an emergency isolation ward.
Cholera is endemic to the northern coastal areas of the country, but has a relatively long dormancy period and usually only occurs in the presence of certain conditions, such as heavy rains, shortage of water supply, and poor sanitation.
The latest outbreak the worst to hit the country since the late 1980s has jumped from a mere handful of people in August to about 12?000 infections. More than 6?000 new cases were reported in December alone. The number of fatalities remains minimal at 52 which health authorities are trumpeting as proof of the success of their efforts.
“For any cholera outbreak, this is excellent,” said KwaZulu-Natal health chief Professor Ronald Green-Thompson. “We should consider how many more cases could have been reported had not efficient measures been put into place.”
Green-Thompson said that in terms of criteria laid down by the World Health Organisation (WHO) which regards management of the epidemic as an unbroken, 10-day period free of cholera the province, at this stage, has not got matters completely under control.
Earlier this week, WHO regional representatives indicated they had relayed a government request for international aid to the international body. But provincial health authorities have rejected rumours that they are running out of funds to battle the epidemic.
Green-Thompson said efforts to contain the outbreak are “well within” the provincial health budget and the provincial treasury has also allocated an additional R11,8-million to continue aid programmes. He also said that, like all health departments in the country, there are emergency funds available to deal with unexpected health-related problems. “We dealt with the malaria, and we will deal with the cholera we anticipate surprises all the time.”
A demographic map outlining the areas hardest hit indicate that it is a disease of poverty. Poor communities in far-flung areas have little access to the luxury of tap water, and often have to rely on a communal water source, such as a river or stream, to survive. Patients exposed to the bacteria, which is carried in water contaminated by faecal matter, can become severely dehydrated from loss of fluids, and can die unless treated.
The thrust of the government campaign to halt the spread of the disease focuses on the provision of mobile rehydration centres in the affected areas, as well as education campaigns about hygiene and water safety. In some cases, the Department of Health has provided free water purification materials, including bleach, to communities.
The Department of Water Affairs and Forestry, in partnership with the health authorities, and various NGOs, such as Dorcas Aid, have also provided water tanks and tankers. But experts have expressed doubts regarding the long-term success of the campaign. Authorities say it remains a daunting task to ensure that people develop sustainable hygiene habits, which prevent a cycle of reinfection.
“It’s like HIV/Aids; you can tell someone that unsafe sex can kill them, but aside from warning them, there’s not much else you can do to stop them,” said one health worker.