Before a cholera outbreak struck on December 27 last year, Malawians on the northern shores of Lake Malawi were clearly at the risk of dying of diarrhoea, dysentery and other waterborne diseases due to open defecation.
In the worst hit district of Karonga, public health officials were worried that human excreta that dot the palm-fringed beaches and unkempt bushes make Africa’s third-largest freshwater lake not good enough for drinking and domestic chores.
The deadly diarrhoeal disease, which killed almost 20 people early this year, has birthed a consensus in the fishing villages that every household needs a latrine.
“We are living dangerously,” says Ngala resident Elina Msowoya. “Cholera aside, diarrhoea keeps haunting us because we rely on untreated water contaminated by open defecation. We are eating our own faeces because most of us and the migrant fishers have no toilets.”
Ngala, where toilets are emerging by the roadside and on the beach, was hit hard by the outbreak. Equally affected were the neighbouring Vuwa, Nomba Zgeba, Phapa, Chesese and Gumi where the latrines are not only few and far apart. They are mostly filthy and falling apart.
The shoreline is clustered by overpopulated shacks where thousands of mobile fishers and fishmongers put up in shacks for weeks with no latrines in sight.
Members of the fishing community say constructing latrines is not easy because the area is overcrowded and the soil so sandy that pits keep falling in.
Not many can afford resilient latrines walled with bricks and cement mortar from the bottom of the pit, they argued.
Following the public health crisis which left almost 250 bedridden by cholera, the story is different. They seem to abhor human excreta that dot the golden sands, saying the eyesore is washed into the lake when it rains.
The rural Malawians’ cry for safe water has persuaded World Vision Malawi to sink boreholes at Ngala, Phapa and other affected areas.
Increasing access to safe water, mass awareness about the dangers of open defecation and the emerging consensus to own latrines was pivotal to the slow rise from the outbreak which overwhelmed health workers in Karonga and almost paralysed service provision in clinics.
Fishing spots in trouble
Water, sanitation and hygiene activists salute the locals for heeding the mounting calls for households to own clean latrines, kitchens and racks for utensils.
“The worst hit strip was located along the lake where the fishing villages are silently eating their faeces,” said district health officer Lewis Tukula.
The zone, south of the district, left health workers at Nyungwe and St Anne’s Health Centre inundated with cholera cases. Nyungwe registered about 30 patients and three deaths.
“It was getting out of hand and we had to cope with the outbreak using limited resources. There was no time to rest, no breathing space,” says clinician in-charge Andrew Hauli.
The facility’s two clinicians and four nurses see up to 250 people daily.
The district last suffered the cholera outbreak in 2003.
As it were 13 years ago, the recent efforts towards combating the outbreak and spreading the vital messages hugely relied on support from non-governmental organisations, especially World Vision and Plan International.
Plan Malawi bankrolled a K1.5 million door-to-door sensitisation and water treatment in cholera hotspots surrounding Nyungwe.
On the other hand, World Vision has been working with community-based committees appointed by traditional leaders and area development committees to end open defecation in the area.
Health workers billed the intervention effective, saying the drop registered at Kaporo and other affected parts of the northern shoreline was a clear indication of its impact.
However, Plan disaster risk reduction manager Tambuzgani Msiska wants the awareness campaign to be sustained regardless of the outbreak.
He said: “We are doing well in spreading important message, but not well enough. The timing is important. Surely, the awareness campaigns were catalysed by the outbreak. However, we need to sustain it even when the area is disease-free. After all, we know most areas are vulnerable to the disease.”
Msiska urged the campaigners to package the preventive messages carefully to suit the prevailing realities, saying what obtains in the period before the outbreaks may not be equally persuasive when tragedy strikes.
A miracle in danger
In 2011, the territory of Senior Chief Mwilang’ombe had the least number of latrines in Karonga.
Interestingly, the cholera-prone area was declared free from open-defecation during World Toilet Day on November 19.
The feat, which the chief likened to a degree in sanitation and hygiene followed findings which showed almost 6 414 households out 7 546 in the area, had latrines.
With nearly 84 in 100 households using toilets, group village head Mujalibana commended World Vision for working with the task force against open defecation to scale up toilet use.
Among other things, the organisation deployed four bricklayers who construct cobbled latrines in the sandy terrain.
Mjalibana said: “The outbreak is over, but the fight against unsanitary practices must continue because many people are in danger since a few don’t know that things they take for granted have costly implications on the well-being of the whole population.”
Presently, almost 10 in 100 Malawians have no access to safe water, while about 1.4 million have no toilets at all and defecate in open settings.