More barriers are needed against the disease, say critics Khadija Magardie As KwaZulu-Natal braces itself for the latest serious outbreak of cholera, critics say the government is not doing enough to contain the epidemic. The province’s health authorities have confirmed as many as 214 new cases, concentrated in Ladysmith in the north. Both the national departments of health and water affairs and forestry say they have comprehensive campaigns in place to manage the epidemic. They include setting up rehydration centres where patients are given oral solutions to treat their symptoms, and educating the public about cholera, the need to purify their water and good hygiene habits. But critics say the government’s efforts to stem the tide of the epidemic are off the mark. The number of infections reported close to 108 000 people since August 2000 shows something is still going wrong. The government needs to spend more time and resources “putting up barriers against disease”, said Lindy Morrison, regional manager for the Mvula Trust, a national body involved in the provision of water and sanitation to rural and indigent communities. Instead of “creating a public scare” around available water sources, they should be building toilets and washing and ablution facilities for communities that have little infrastructure. Most at risk of contracting cholera are those who do not have access to piped safe water and adequate and proper sanitation. Cholera, a water-borne bacterial infection that can be fatal if not treated, has been endemic to South Africa since the early 1970s. The germs that cause cholera are found in human faeces and a water source becomes infected when people defecate into or near it. People may become infected from drinking the contaminated water, or eating food that has been in contact with it. Severe muscle cramps, vomiting, diarrhoea, renal and circulatory failure, and eventually death may follow if not treated. Morrison said strident warnings to “keep away from the water” could have the effect of discouraging people from using water at all, instead of managing the cholera by encouraging people to purify water sources and use different sources for different activities instead of using a single source for everything.
She said the latest outbreak was not limited to Ladysmith’s water sources, and had, for instance, a lot to do with migrant workers coming into the province for the holidays, many bringing infections with them; so focusing on drinking water is not the answer. Building facilities like latrines for communities, in a way that is cheap and sustainable, goes “hand in hand” with ensuring that water sources are safe. In the long run, said Morrison, what is needed is not short-term quick fixes or “gimmicks”, but a focus on reducing inter-household transmission. The Department of Water Affairs and Forestry, with local district councils, is delivering potable drinking water to areas worst affected. The Uthekela District Municipality, under which Ladysmith falls, has used R670 000 of government funds to set up 75 water tanks each with a 5 000 litre capacity.
According to municipal manager Cassie Rautenbach, local government authorities are also working closely with health and water affairs and forestry to test the quality of the water sources. He said the success of the intervention could be determined only in a few weeks’ time, when it would be possible to gauge whether the infection rate had stabilised or risen.
The Department of Health, which is following the guidelines and treatment protocols for cholera management laid down by the World Health Organisation (WHO), is running education campaigns in communities informing them about sources of contamination and ways to avoid infection, including how to sanitise water the simplest of which is chlorinating water by using bleach.
The department’s head of communications in the province, Dave McGlew, said the latest outbreak was not entirely unpredictable given the summer rains, the influx of people, especially migrant workers, into Ladysmith and the fact that the months from November to February are traditionally cholera-prone.
He said: “There’s also not much that can be done once infection has occurred, except to ensure that treatment protocols are in place.” Last year the national Department of Health made supplementary allocations in its health expenditure budget R120-million for 2001/2002 for short-term poverty relief measures, including interventions in response to cholera outbreaks. An additional R580-million was designated for water supply and sanitation projects, particularly in cholera-affected areas. McGlew said the department has so far spent more than R150-million on the supply of water to the affected areas. But he acknowledged this was a short-term measure. “We’re [the department] like a goalkeeper; people always blame the goalkeeper when there’s a goal, forgetting it had to get past 10 people first,” said McGlew, adding that until proper water and sanitation services are in place, cholera would regularly flare up in the province.