A Christmas dish turned out a nightmare for Charity Nkhoma when four family members started vomiting and opening bowels profusely.
“We ate rice, meat and other treats befitting Christmas, but four people were hospitalised when they ate the remaining food without heating it first,” she said in an interview at Ngara fishing camp in Karonga.
Nkhoma rushed the four to Nyungwe Health Centre where clinicians diagnosed them with cholera and admitted two to an isolated treatment camp. The rest were treated as outpatients.
The populous Ngara, where many households defaecate in the open and drink untreated water from Lake Malawi, has become the epicentre of the cholera outbreak which has hit 199 and killed four people in Karonga.
Nkhoma rues rice, saying it contained the germs which cause watery diarrhoea which kills fast if not treated.
“I no longer eat rice. I don’t want to suffer the disease again” she says.
But public health officials attribute cholera attacks to eating stools carrying the germs.
The patients may have ingested it through untreated water or houseflies buzzing from the open defaecation zone landing on foodstuffs.
In the heavily populated fishing village, toilets are few, shabby and far apart.
The locals say they prefer to defaecate in the lake and on beaches because it is difficult to construct resilient latrines in the loose sands.
The foul smell of human excreta may be overpowered by whiffs of sun-dried fish, but houseflies hover freely from the unsanitary spots to foodstuffs.
When it rains, run-offs wash solid waste, including faeces, into the lake where many households draw drinking water.
Despite this culture of open defaecation, Ngara residents shun salty water from boreholes in the locality. They find meals cooked using the saline water as less tasty than those prepared using lake water.
Sadly, most people do not boil or treat lake water before use. Some say chlorine smells awful.
Even as government and its partners are distributing chlorine in the cholera hotspots, most of it goes unused.
The ongoing outbreak of cholera has hit 274 Malawians in six districts—Karonga, Kasungu, Lilongwe, Nkhata Bay, Dowa and Salima—since November 28.
The Ministry of Health and its partners have intensified efforts to educate the masses, contain the outbreak and treat the patients.
But widespread open defaecation, low toilet use, are slowing down the fight against cholera.
In Karonga, Malawi Red Cross Society is supporting government interventions to improve diagnosis and treatment of cholera cases. Besides construction of cholera treatment centres, the humanitarian organisation is promoting behaviour change, distributing chlorine and encouraging people to own and use hygienic latrines.
The change agents are sensitising community committee to the importance of safe water, sanitation and hygiene practices.
According to Red Cross health programmes manager TaongaNyekanyeka, the organisation has deployed 100 volunteers in highly affected fishing communities to end the outbreak.
“The volunteers, together with health surveillance assistants and community leaders, have been conducting door-to-door visits to ensure every household accesses sanitation and hygiene messages, especially the importance of toilet use and treating drinking water,” he said.
Red Cross is also supporting surveillance efforts by Karonga District Health Office.
The Story Workshop has also intensified sensitisation campaigns in cholera hotspots.
Both organisations are getting their funding from Unicef which provides cholera treatment centres with protective clothing, buckets, chlorine and drugs.
Nyungwe Health Centre clinician in-charge Martin Banda said stock-outs of protective materials put both health workers and guardians at risk.
“For a few days, we didn’t have enough gloves and now we have three cholera patients who were once guardians,” she says.
According to Karonga district medical officer Lindani Chirwa, the number of cases diagnosed daily has “somehow been constant”.
“This means the interventions are working. There is hope that soon the numbers are going to drop,” he says.
So far, three deaths occurred at a health facility and two in the community.
Chirwa commended the locals for responding accordingly to calls for improved sanitation.
“It is pleasing many are constructing latrines and using them. They are beginning to use chlorine and Water Guard which they have despised for a long time,” he said. n