Health workers prepare a water carrier with oral reyhydration salts at Mokolo Health Centre in northern Cameroon, where UNICEF has provided emergency supplies to help those affected by a cholera outbreak.
By Jeremy Sprigge
MOKOLO, Cameroon, 27 October 2010 – At the temporary cholera treatment centre in Mokolo village, northern Cameroon – a series of specially built tents accommodating cholera patients – Aminatou, 14, lies listlessly on a bed, weak from days of severe diarrhea. An intravenous drip is in her arm to stave off extreme dehydration.
“I came four days ago” she says quietly. “I’m sick with cholera. I’m sick.”
Aminatou is not alone. Of the 20 other people receiving treatment in the tent, most are women and children, and four are members of her own family. Among them are three young cousins: one-year-old Abu Baka, three-year-old Abdul and 24-month-old Faisal, along with his mother Rokiato. All have contracted cholera from drinking contaminated water.
While most of the patients at the centre are responding well to treatment, a number of them, including a heavily pregnant woman, are desperately ill.
Worst outbreak in 20 years
Northern Cameroon is in the grip of a cholera epidemic. Since May, the country’s worst cholera outbreak in over 20 years has led to more than 7,000 cases, resulting in some 500 deaths.
Villagers in Yambaram celebrate their new ‘open-defecation-free’ status following the implementation of the UNICEF-supported Community Led Total Sanitation programme.
Cholera is spread through contaminated water and food, often as a result of poor hygiene and sanitation practices. It causes acute diarrhoea and vomiting. Left untreated, it can quickly lead to serious dehydration and death.
With a population of over 5 million, Cameroon’s Extreme North and North Regions are characterized by limited access to piped and clean water, and an absence of latrines – strong contributing factors to the cholera outbreak. Flooding during the rainy season has further contaminated the water supply in many areas, worsening the situation.
‘Children are particularly vulnerable’
“Around two-thirds of the people we have treated with cholera in Mokolo have been children or women,” says nurse Mirabelle Akwei. “Children are particularly vulnerable. They dehydrate very quickly. They need treatments such as oral rehydration salts and [saline] drips urgently.”
Sali Bouba, a member of the Yambaram village sanitation committee, shows one of the village's 138 covered latrines, which have helped to reduce instances of waterborne disease.
With children and women at heightened risk, UNICEF and its partners – including the World Health Organization and the Red Cross – have been quick to mobilize essential emergency supplies.
“As soon as the outbreak hit, UNICEF distributed supplies, including sachets of oral rehydration salts and courses of Doxycycline for the immediate treatment of people with cholera,” says UNICEF Water, Sanitation and Hygiene (WASH) Specialist Suzanne Gbaguidi, adding that the organization has provided water purification kits and soap, as well.
“We are also providing chemicals and other materials for disinfection, training health workers and distributing information posters and have sent a WASH specialist to the region,” adds Ms. Gbaguidi.
Community Led Total Sanitation
But apart from emergency assistance, which has reached more than 1.2 million people, UNICEF is working on long-term, sustainable solutions to address the root causes of the outbreak: a lack of knowledge about proper sanitation and a desperate lack of latrines, resulting in open defecation, contaminated water and, eventually, waterborne diseases such as cholera.
Through the UNICEF-supported Community Led Total Sanitation programme in Cameroon, villagers take responsibility for improving sanitation and hygiene practices.
The main innovative solution UNICEF has advocated is known as Community Led Total Sanitation, or CLTS.
In the crowded square of Yambaram, a village in the same cholera-stricken region as Mokolo, men in flowing gowns and women and children in brightly colored clothes look on as a line of drummers beat out a rhythm to welcome their visitors – a group of water and sanitation experts.
Today, the village, untouched so far by cholera, is celebrating its status as an ‘open-defecation-free zone’ following the implementation of the UNICEF-supported CLTS programme. Through CLTS, the villagers, led by a four-person sanitation committee, have built latrines with local materials, educated their neighbours on the importance of proper sanitation and
sensitized the community on the need to stop open defecation in order to avoid diseases such as cholera.
Through this community-driven approach, the villagers themselves have taken responsibility for keeping disease at bay.
“The change in our village has been huge,” says Sali Bouba, 30, a father of three who volunteered for the village sanitation committee. “Before, only a few households had latrines, and most didn’t even use them. People defecated anywhere they wanted. Now we have 138 latrines for 533 people in 75 households. Everyone uses them and everyone understands why they are important.”
UNICEF Cameroon Representative Musu Clemens Hope explains why CLTS works so well: “Because the community itself has taken the decision to improve its own sanitation. The community takes full responsibility for its success and sees the benefits it brings, ensuring sustainability long after UNICEF and other partners have left. Long-term solutions such as CLTS are especially important in the Extreme North, where open defecation is very common and cholera affects many children and their communities.”
Together with the Ministry of Health, the Ministry of Water and Energy, and its other development partners, UNICEF is not only addressing the short-term emergency needs of those affected by cholera but is also working on long-term improvements in water, sanitation and hygiene across the region.
“Since we have had the latrines, my children and my grandchildren are ill much less often,” says Hassana Sale, 70, a grandfather in Yambaram. “And our village hasn’t had cholera here like many others nearby.”