It came on me suddenly. I found I was holding my stomach, feeling
nauseous. The strength drained out of me.
I had developed the runs!
My mind went through all I had taken up to that point,
particularly the bottled water I took only an hour before.
Even as a medical doctor, I had cause to be worried. Only a few
days ago, in Lagos where I live, there had been three cholera related deaths
out of 134 confirmed cases.
It did not start in Lagos.
It first broke out in a refugee camp in Namu village, Qua’pan
Local Government Area of Plateau State where at the last count 11 lives had
been lost out of 130 that were hospitalised.
After this, the Federal Ministry of Health said it would
investigate it and that “the investigation would determine the kind of
intervention to be deployed in the community.”
While it “investigated”, cholera took its time to visit other
states, and more lives were lost. They are Zamfara State with 1,110 cases and
51 deaths, and Nasarawa State with 105 cases and five deaths. Ogun State has
115 cases, five deaths and Oyo State, has 29 cases, six deaths, and of course,
the earlier mentioned Lagos.
Luckily for me, I only had mild enteritis which responded to
treatment.
Cholera is acute watery diarrhoea, caused by Vibrio cholera, which leads to severe dehydration. Cholera is a global threat,
especially in areas with poor sanitary conditions and where clean water and
proper sewage disposal are not available.
Eleven per cent of the world population or 783 million people are
still without access to drinking water. Some try to get round it. In Nigeria,
sachet water popularly called “pure water” is sold commonly. The business is an
all-comers affair, a typical startup for any down on their luck wannabe. The
source of the “water’ for “processing” is questionable. Many of the “factories”
are found in slums and very unhygienic places, when you can trace them. Each
sachet is a potential fomite.
Don’t be taken in by the containers and the labels, even the
bottled water aren’t any better.
Unsightly surroundings associated with underdevelopment are
familiar in Nigeria. It is common to see streets with open filthy gutters. Even
more unfortunate is that new road constructions don’t take congnisance of this.
A particular bukateria had a signpost like an arrow saying “Food is ready”. It
pointed down at a gutter surrounding the bukateria.
According to a UN study, it is estimated that out of the seven
billion people in the world, six billion have access to mobile phones.
Incidentally, only 4.5 billion have access to functional toilets. And of the
2.5 billion who do not have proper sanitation, 1.1 billion defaecate in the
open. With an estimated 30 million people, Nigeria is among the top five
countries where people defecate in the open.
Even in many Nigeria’s higher institutions, the toilet facilities
are not functional with students doing it in nylon bags or on a paper and
throwing it into the bush, what is called the “shot-put”.
There was a story of a fellow who in the night went into a
dumpsite where people used for defaecating and was suddenly joined by three
men. He greeted them thinking they also came for the same business. But they
seized him and told him to hand over all he had. It was when one of them
brought out a gun that the fello knew they meant business. So he quipped: “So,
you guys now operate here.” He got the beating of his life for his jibe before
being dispossessed of all he had.
Someone you might not have seen in a while might come visiting.
Don’t be surprised when they ask to use the toilet. Many who live in poorer
facilities never pass up the opportunity of doing it decently.
Terror groups can still do more than bomb and slit throats. Their
presence is also a potential factor for the spread of cholera and other
diseases like it. Plateau State where it all started has had more than its own
fair share of terrorism. As people seek refuge away from their normal abode in
the fear of being killed by them, or are camped together, they can start and
spread infection.
Even the security forces that are fighting the terrorists can
start an outbreak where they are camped as was believed to have been
responsible for the Haiti case that the UN is now said to be culpable.
It is also believed that the terrorists have a large number of
them that are foreigners. The source can be from outside Nigeria. Nigeria can
also spread it to other countries, and it does not help that our borders are
porous.
Even more terrifying would be the prospect of people dying from
cholera in terrorists’ havens and health workers can’t get access to them or
are attacked by them as in the case of polio in Afghanistan. Even terrorists
themselves are not immune to cholera; they also need to be saved.
Many traditional practices can aid the spread of cholera and
infectious diseases. In 1992, as part of Guinea Worm Association of Sokoto, an
NGO under the auspices of Global 2000 to eradicate Guinea worm, we went to Gada
Local Government Area and were warmly received. After doing our job, their
traditional ruler entertained us with the local delicacy called Tuwo Shinkafa and Mia Kuka (Pound rice and soup).
We sat on mats with the meals in front of us. Even though I was from the
eastern part of Nigeria, I knew of course that you do not use cutlery for this
kind of meal. So, I whispered to the leader of our team who incidentally hailed
from Sokoto State, “What of the water to wash our hands? He whispered back with
a sly grin, “They will feel offended if you refuse the meal.” I got the message
all right. I cringed at every swallow.
What of the market woman who sells pepper and tomatoes whose
toddler defaecates, and in one moment, she has poured kettle water and washed
the child’s buttocks and in another moment, she is selling her wares to a
customer with the unwashed hands?
Again, Nigeria has one of the dirtiest abattoirs in the world,
notably the one in Oko Oba, Lagos. Stinking bloody water regularly flows
through major streets and flies infested meat glare at you.
Once a month, Environmental Sanitation is observed, especially in
Lagos. But it is just a day to add to the heap of refuse. And all the rubbish
brought out from the filthy gutters is left on the side of the roads to be
washed back in when it rains.
Strategies at tackling epidemics like cholera dwell more on
treatment of the victims. That’s fine. But all clinical efforts will be wasted
if the victim is sent back to the “offending zone”. There must be renewed
efforts at limiting re-exposure to pathogens and even more efforts at removing
those factors that will make the pathogens thrive. Critical infrastructure are
needed, reduction in illiteracy and improvement in standard of living, that is
if corruption will let money go work where it should work.
Just as well, when they say filthy lucre, they had Nigeria’s naira
notes in mind. Not just with the money, it is a good idea to be in the habit of
washing your hands. There are obsessions that are lifesaving.
Dr Cosmas Odoemena
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