Via IRIN Africa, a thoughtful and informative report: WEST AFRICA: Cholera - lessons learned. Excerpt:
DAKAR, 31 December 2012 (IRIN) - The cholera epidemic that struck Guinea and Sierra Leone in 2012 is winding down. What to do now? Start preparing - for cholera.
That’s part of the message from donors, aid workers and health officials after the most serious cholera outbreak in years that infected some 30,000 people and killed 400 others in the two countries - mostly in Sierra Leone. They say there should be better preparations for cholera, based on lessons learned and on a strategy in Guinea that was put to the test in 2012.
Since 2009 the UN Children’s Fund (UNICEF), Action Against Hunger (ACF), the Guinean government, the European Union aid body ECHO, and the US Agency for International development (USAID) have taken steps to prepare for an outbreak - including setting up community detection sites, public information campaigns and drills.
“Cholera thrives on disorganization,” said Christophe Valingot, water, sanitation, and hygiene (WASH) specialist with ECHO. “Cholera spreads very rapidly - it can go from 30 cases to several hundred cases per week in a very short period. When there is little to no preparation, we’ve lost the chance to avoid all those infections.”
But preparation is hardly a motivator for governments and donors. “We had a very difficult time justifying funds for this preparation work in Guinea,” Valingot said.
Strategies needed
Data from the past decade in West Africa show that a country can go several years with few to no cases of cholera then be hit with thousands of cases. “Donors, NGOs, and governments go all-out during a serious epidemic then it’s as if that all disappears completely with a couple of calmer periods,” Valingot said. “What this means in the end is meagre progress against cholera.”
Health workers said UNICEF’s strategy proved effective in Guinea this year and ECHO and UNICEF are looking to replicate it across the region.
So why did Guinea still see some 7,300 cases? For one, the strain found in the region is far more virulent than past strains, said François Bellet, WASH specialist with UNICEF’s West and Central Africa regional office.
“Of course we can’t possibly know what the situation would have been in Guinea in the absence of this strategy,” he told IRIN. “But given the virulence of this strain we might well have avoided a Zimbabwe 2008-09.” In that period cholera infected some 100,000 people in Zimbabwe and killed more than 4,000.
As of mid-December Sierra Leone had 22,345 cases and 286 deaths in a population of 5.6 million; Guinea, whose population is nearly double that, registered 7,321 cases and 121 deaths.One of the notable consequences of any serious epidemic outbreak is collective amnesia: Whether you caught the disease or not, you forget all about it. The only effective reminder is the next epidemic.
