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Daggers out, cholera fight on

FILE: DEBRIS of make- shift stalls piled along Lumumba Road in Lusaka after defence forces moved vendors out of the streets. Right, Cairo Road after the clean up recently. PICTURE: COLLINS PHIRI

SHIKANDA KAWANGA, Lusaka
THE letter is stuff humour is made of.

“Dear Cholera,
Hope all is well, please can you stay a little bit longer so that you can save me from paying school fees, I am just recovering from unnecessary spending on Christmas and New Year, [and] my pockets are dry.
“I love you and don’t listen to people who are saying that ‘we are cleaning Lusaka to eradicate you’, am not one of them, it is the soldiers.
“Please, find it in your heart to accept my plea.
“Your number one fan…
“Viva cholera…”
But when you see the defence forces on duty in the central business trading area, then you know that the fight against cholera is no laughing matter.
The first case of cholera was recorded on October 4 (although the outbreak is said to have occurred in late September) in Lusaka with the Ministry of Health spokesperson Maximillian Bweupe saying the initially affected areas were Chipata, Mazyopa, and Kabanana townships as well as SOS Children’s Village.
The outbreak initially started in Chipata township and then spread to Kanyama before moving to the peri-urban townships on the western side and then to the east.
On October 10, Dr Bweupe gave an update on the cholera situation and confirmed that cases had been recorded in Chipata, Mazyopa, Kanyama, Ng’ombe compounds in Lusaka and Kasenga village in Chisamba District.
”The current outbreak was declared on 6th October 2017, after laboratory confirmation of two initial cases that were presented to Chipata Level-One Hospital on 4th October. As of 10th October 06:00 AM, the cumulative number of cases was 32, with the youngest being a three-month- old baby who was certified dead within a few minutes of arrival,” he said.
“The child tested positive to the rapid test. Thirteen out of the 29 stool samples tested from the affected patients were positive for vibrio cholerae. Currently, 18 patients are under admission and receiving appropriate treatment at Matero and Kanyama cholera treatment centres.
“One patient, a child, absconded aided by the mother from Kanyama cholera treatment centre. The other 11 patients have stabilised after receiving treatment and have since been discharged.”
Dr Bweupe said the risk factors associated with cholera in the affected communities include poor hygiene practices, erratic supply of clean water, and poor sanitation.
The Ministry of Health opened cholera treatment centres in Matero and Kanyama to specifically manage cholera cases.
Additionally, the ministry, working in collaboration with various partners including the Lusaka City Council (LCC), Lusaka Water and Sewerage Company (LWSC), the Zambia National Service (ZNS), the Disaster Management and Mitigation Unit (DMMU), World Health Organisation (WHO), UNICEF, USAID Discover Health, Pharmanova and the Centre for Infectious Disease Research in Zambia (CIDRZ), provided alternative supply of clean water to affected residents by deploying water bowsers, supplies of chlorine, laboratory requisites and information, education and communication materials.
But the efforts seemed not to be enough.
By the end of last week, 41 lives had been lost and 1,550 people had been affected by cholera.
President Edgar Lungu, who is also the Commander-in-Chief of the Armed Forces, deployed all defence units to help combat the water-borne disease, which goes hand in hand with poor sanitation, and, although readily treatable, can be lethal if unaddressed.
“I have directed all the three wings of the Defence Force to join the Ministry of Health… to escalate efforts to minimise the spread of cholera in our capital city and the rest of the country,” President Lungu said.
“Lusaka has been recording an average of 60 new cases every day. I’ve noted with great sadness that a total of 41 people have died of the disease since its outbreak. The outbreak was initially linked to contaminated water from shallow wells and unsanitary conditions in the residential and public areas affected.
“But we now note that the spread of cholera is being propagated through contaminated food.”
For effect, the President added that there would be a crackdown on street food stalls, bars and restaurants that do not meet minimum food hygiene standards.
That is exactly what has been happening since New Year’s Eve.
The victims of the crackdown have not just been street vendors and marketeers but also established franchises like the cherished Hungry Lion and Pick n’ Pay.
It is estimated that over 10,000 illegal trading structures have been demolished in various parts of Lusaka by the defence forces.
Government has also issued Statutory Instrument 79 of 2017, which mandates a public ceremony or gathering of over five people, which does not belong to a single family, not to be held in an infected area without written permission from the local authority or medical officer.
The Ministry of Health, Ministry of Local Government and Ministry of Water Development, Sanitation and Environmental Protection also issued a joint statement to ban public gatherings, including funerals, in some parts of Lusaka.
Minister of Health Chitalu Chilufya said it is evident that the cholera situation in Lusaka is extraordinary and requires an extraordinary approach in implementing required measures.
The SI also mandates health personnel and environmental officers to inspect public premises to ensure proper sanitation and prevent the spread of cholera.
Government has also secured vaccines to prevent infections in townships that have recorded cholera, mainly in slums.
Local Government Minister Vincent Mwale says markets will only be opened when certified safe by the Ministry of Health.
“This is a matter of life and death, we want you [traders] to understand that this is for your own good,” Mr Mwale said. “If we allow you to trade at these markets, you will die and that means we will have no traders and consumers will not be there, too.”
Ministry of Water Development, Sanitation and Environmental Protection Permanent secretary Ed Chomba, who stopped a gathering in Lusaka’s Bauleni township barely a day after the ban on public gatherings was announced last week, says public health should be Government and people’s priority.
“Cholera is a very embarrassing disease which can be contained if people heed to our advice,” Dr Chomba said.
On its part, the LWSC says it will put up new water infrastructure in Chawama, Garden, Kanyama, Bauleni and Chipata townships to increase supply in the areas.
LWSC managing director Jonathan Kampata says the company has requested for funds from Government to improve water supply in urban areas so as to contain and possibly eradicate cholera outbreak in the affected areas.
The company has set a budget of about K214, 627,400 for the implementation of various projects that will improve water supply and sanitation in Lusaka.
Reactions from the public have been mixed although the majority have appreciated the new outlook of the central business district after the defence units moved in.
“We’re happy that Lusaka is now clean but agony is soon the defence force officers will leave the streets and that will mean the continued indiscriminate disposal of waste that Zambians are used to,” says Ntini Himusa, a resident of Bauleni township.
“We need a mind-set change. People must learn to dispose waste at designated places like they are doing now when there is a heavy presence of defence and security officers.”
Bupe Kangwa, a resident of Garden township, says it is possible to completely eradicate cholera if these interventions are strengthened.
“In fact, with the way things are going, it is possible that we will never experience the outbreak again,” Kangwa says.
According to the WHO cholera country profile for Zambia, the very first case of cholera in Zambia was reported in the country in 1977/1978 before re-appearing again in 1982/1983.
However, the first major outbreak occurred in 1990 and lasted until 1993, and since then, cholera cases were registered every year except in 1994 and 1995.
WHO says generally, most cases are recorded in the fishing camps of the rural areas and in the peri-urban areas of Lusaka and Copperbelt provinces.
In Lusaka, cases and deaths mostly appear in the western suburbs of the city where access to safe water and good sanitation is poor.
“The observed ongoing cholera occurrence in Zambia corresponds to the progressive decline in the economy which started in the late 70s early 80s and still persists,” WHO says.
“Analysis of available rainfall and epidemic data in Lusaka shows a very strong association between rainfall and epidemic outbreaks in the city.
“Outbreaks usually start during the month of October and end between mid-May/beginning of June of the following year corresponding to the rainy season.”


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