6/8/2013 – A new strain of cholera with its origins in Southeast Asia has firmly anchored itself on African soil. More virulent than the ones traditionally found on the continent, this same strain was responsible for more than 8 000 deaths in Haïti and has touched down in West Africa in recent years. Although we’re only at the very beginning of the rainy season, when cholera outbreaks generally occur, several countries in the region already report dozens of cholera cases. Some of these are so-called residual cases from last year’s epidemics, but new outbreaks have manifested themselves in politically unstable countries like Guinea and Guinea-Bissau.
“We know that last year’s epidemics in Sierra Leone, Guinea and Guinea-Bissau are related. The first cholera patients emerged in fishing communities along the coastline and the transport and handling of fish were key in spreading the deadly bacteria all the way to the various capitals,” says Christophe Valingot, the European Commission´s Humanitarian Aid and Civil Protection department (ECHO)´s expert for water, sanitation and hygiene (WASH).
Sierra Leone was hardest hit and experienced its worst cholera outbreak in over 15 years. It infected over 22,000 people and killed almost 300 while Guinea counted some 8,000 cases and over 100 deaths. Although cholera treatment is straightforward and extremely successful once administered, hundreds of people continue to die each year because of wrong or late diagnoses and lack of treatment. A so-called ‘Shield & Sword’ strategy has therefore been devised by humanitarian actors in West Africa to deal with cholera epidemics across the region.
“Epidemiological studies co-funded by ECHO in 2009 and 2010 have helped us to better understand the dynamics of cholera transmission and identify the high risk zones in both Guinea and Sierra Leone. This led to the identification of sentinel sites where we combine prevention with early detection and response in order to halt contamination,” explains UNICEF’s WASH expert François Bellet.
“With this new strain we see cholera spreading across frontiers with people’s movements rather than the resurgence of outbreaks from dormant natural reservoirs. This means we have to be extra vigilant and invest in cross-border epidemiological surveillance.”
Realising that prevention is possible by narrowing down and focusing on the communities most at risk, ECHO funds Action Contre la Faim’s (ACF) cross-border cholera preparedness programme. Their surveillance through sentinel sites comes with heightened community awareness, early treatment and coordinated action by various partners. Last year’s success in curbing the epidemic in Guinea and building the health authorities’ capacities to act swiftly and effectively are now serving as an example for a similar approach in Sierra Leone and elsewhere.
“Since most actors only intervene when a city or capital has been affected, which is often four to five months after the appearance of the first cases, we advocate for an early response so as to contain the disease to the villages that act as a gateway for the cholera bacteria. By localising hotbeds with the help of GPS points, we are in a position to stop the spread and propose long term solutions such as improving the water and sanitation situation,” says ACF’s cholera advisor Jessica Dunoyer.
Without the ‘Shield & Sword’ strategy many more people would undoubtedly have died in Guinea. The challenge is now to sustain these advances and replicate them elsewhere, but also to link with development actors to address blatant shortcomings. Health centres are non-existent in some of the villages that act as entry points for cholera in the border area between Guinea and Sierra Leone. And Conakry’s public dump site continues to pose serious health hazards.
Resources to address the wider health and sanitation issues are obviously limited in West Africa, one of the world’s poorest and most volatile regions. Still, this did not prevent politically unstable and economically bankrupt Guinea from controlling the outbreak with relatively modest means. It also goes to show that investing in surveillance and improving water and sanitation in areas where cholera erupts on a regular basis will benefit the entire country and even region.
UNICEF’s Bellet who coined the name ‘Sword & Shield’ for the new strategy explains: “It is just a common language used between all our organisations and sectors. I want us to break with the fatalism and transcend the boundaries between emergency and development aid. Even if there’s still an awful lot that needs improving, we’ve already come a long way.”
By Anouk Delafortrie, Regional Information Officer in Dakar