One beautiful Sunday morning would start with songs of praises to the heavens above and end with wailings of a grieving mother. As evening approached, I saw men lined up outside my health center and the women sitting in the grass singing softly. A few women’s cries pierced their harmonies. I saw my supervisor and a few other health workers discussing in hushed voices. My counterpart eventually came over and told me the case – a 17-year-old girl was DOA – Dead on Arrival. But the reason she was robbed of a proper funeral in her village was vibrio cholerae. She vomited and passed stool nonstop and by the time she arrived, it was too late. Cholera had claimed another life. Clothed with rubber gloves, ellow workers wrapped the body with plastic, disinfected the floor and room with chlorine, and stood guard at the door. Do not enter: Biohazard.
The Cholera Grim Reaper started showing up at our doors during rainy season. The beginning and the peak of season fared well for us in terms of cholera cases, but an outbreak in the capitol sent the Ministry of Health into a flurry of advertisements, campaigns, and debriefs. Over 1,000 were sick, resulting in many deaths. Then, about two moths ago, we started hearing about cholera cases in our district and then in our catchment area. As of last year, we had 0 cases. As of yesterday, we have 14 cases and well over 30 in our district.
According to my supervisor, one case is considered an outbreak, because chances are others are already infected. Cholera’s main transmission is fecal-oral. Rainy season spread it like wildfire… or should I say flashflood? And the little black flies become carriers that contaminate our food, water, and bodies. Hungry season is often the peak of cholera because the empty stomachs allow the vibria to release the toxins that induce the dehydration by means of vomiting and diarrhea. Once you’re out of water, you have little chance of surviving.
I tell you, it’s not pretty and it’s definitely not fun. People become so dehydrated they shrivel up like prunes and become immobile. Worst case scenario is probably how it’s like in the movies: eyes rolled back, vomiting, diarrhea, and sometimes bleeding. My counterpart shared about a major outbreak a few years ago when hundreds were going to his hospital that originated from one source. Due to his lack of proper hygiene, he had infected many others. The wards were flooded, so the health workers set up two tents: male and female. And the health workers never went home but stayed instead to ensure the patients were rehydrated, or the deceased properly wrapped, or the wards thoroughly sanitized. That year, over 50 died. Even now, the health workers are assigned night duty at my health center to handle any incoming cases since we’re now getting an average of 3-4 new cases per week.
Though cholera can be easily treated through rehydration, sometimes people don’t respond and die from complications. My supervisor told me, as if he were begging me, “I don’[t want another cholera funeral.” After a person dies, he immediately wraps her up in plastic and buries her the same night if possible. The aforementioned girl was buried no more than eight hours after death. Mummifying the deceased in plastic may seem unwarranted, but there was a case once upon a time that revealed cholera could indeed spread from a person’s graveyard to a borehole 100 meters away within 10 years. Cholera can actually survive in water for many years.
Since the onset of cholera, the health workers tested the quality of the water for all of their boreholes. They conducted litmus tests sent from Unicef and found that most were inadequate. In fact, almost half were considered unsafe. All I could think was, if these are protected boreholes, then where else are they supposed to get safe water?
Cholera actually thrives in environments of bad hygiene and sanitation. The most common contributing factors are improper hand washing, improper care of food, and lack of pit latrines. Where there are toilets in America, there are maize fields in Malawi. The field is one big latrine. The advantage is fertilization for the maize. The disadvantage is cholera. In my catchment area of 18,000 people, only 68% of households own a pit latrine – a proper hole in the ground.
Unfortunately, most people are still unaware of how easily cholera can be prevented and how dangerous it can be. I walk into the market and I see flies swarming all over the dried fish, hanging carcasses of raw meat, bowls of muddied water for washing fruits, and the strewn remnants of food due to a lack of refuse bins. The marketplace is the prime breeding ground for cholera! I remember last year’s cholera prevention campaign fared rather unsuccessfully. After blaring into the megaphone and talking to sellers, most just said “Yeah, yeah, yeah” and few were at least honest enough to tell us they didn’t care enough. The next time I walked into the market, I noted not one person had heeded our advice.
This year tells a different story. The outbreaks and deaths put many people on edge. Even the police and other community leaders partnered with us to prevent an epidemic like the ones they saw in the ‘90s and 2001-2002. The chairman of the marketplace wanted to ban the sale of dried fish and raw meat, though few people were willing to give up their means of living. So now we just see plastic hugging the raw carcasses and newspapers covering all foods.
I’ll tell you one thing that really scared us. The girl I started off telling you about? Turned out she vomited the whole way to the health center, which was not cleaned up. Worse still, her guardian took her soiled clothes and washed them IN THE RIVER! The very same river people bathe in, wash their clothes in, and drink from… All we could do was pray and hope for the best.
Though the cases were coming in steadily from various villages, the red flags started going off when we received five cases from the same village within three days. Not only were they from the same area, they were from the same household. The sixth member came in right as we were about to leave for their village. We practically ran to their village! It started with a child’s death at another hospital, where he was somehow overlooked as a cholera case. Shortly after, another child got sick and it spread to several others. We noticed that the contaminated household didn’t have a pit latrine and their surroundings were inadequate. After surveying 59 households in the same village, we found only 33 had pit latrines, 16 of which were considered satisfactory. We called a village meeting, explained thoroughly about the etiology and preventive measures for cholera, then distributed another round of chlorine.
Because of these outbreaks, we almost postponed one of my natural medicine workshops. The participants were coming from contaminated villages and the river was contaminated, so my cohorts and I discussed the issue. We decided to commence since the cases were going to increase instead of decrease. We were nervous of an outbreak, so we took extra precautions. Imagine that – a cholera outbreak at a workshop hosted by their very own health workers! We prayed hard, worked even harder, and by the end of the week, no one died on our watch.
Despite the gloomy news (sorry for depressing you!), everything else is well! I’ve just been working hard on wrapping up my major projects. The under-five and youth shelter construction has come to a complete halt since I’m waiting for my communities to pull their act together. I’ve just finished two weeks of natural medicine workshop for the local community-based organizations and HIV/AIDS support groups. I’ll update you on that next time. I’m still working with the youths, but they’re still flaky. I’ve got a few other little projects keeping me busy. But otherwise, I’m supposed to be wrapping up my last three months here… Wow, I can’t believe how fast time’s flying by!!! I’m just thankful that I’ve made it this far intact and alive!
I hope all is well with you!! Happy Easter! :)
