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Uzima against cholera

© Photo Unicef/RDCongo

“We have taken our survival are into our own hands.” .. is the response to cholera from the UZIMA women in Kalemie
In Kalemie, the capital of the district of Tanganyika, north-east of the province of Katanga, cholera is never a thing of the distant past.  The women of UZIMA will tell you “it’s with us all year round, and peaks from time to time.”  The last epidemic was in June, and also recently, when the dry season ended and the rainy season set in.”  Seventeen cases of cholera had already been recorded around the district during the first two weeks of January 2009. Eleven new cases were confirmed the week after that. As far as Helene Afouah, Coordinator of UZIMA is concerned, “even one case of cholera is still not good. When one person is affected, it may become a problem for his whole family.”
They call themselves Mamans UZIMA  meaning “life” or “survival.” They began with awareness creation around the communities and on the local radio station – speaking to families about the need for better sanitation and the use of purifiers to prevent cholera in the town of Kaelmie.  In November 2008, when the women heard that Antenna Technologies de Grands Lacs, (ATGL) the local NGO which produced chlorine was about to fold up, they organized themselves to take over the production.
They use sea salt as the main local ingredient for the chlorine production. “It is our way of stemming the tide of cholera in this district.  Cholera is pandemic and we experience sharp increases about twice each year….  children and adults are equally affected” says Helen Afouah. 
“We negotiated with ATGL and got three of their Maxiwater machines. We also got them to train four of our members on how to the use and maintain these machines. If we operate at full capacity,   we can produce 1,500 litres of chlorine a day.”  UZIMA chlore is packaged in 250 ml bottles and sells at 300 Congolese francs (about US$0.50 cents). Refills sell for a third of the cost, at 100 Congolese francs. The 5 ml bottle top full of chlorine is adequate to purify twenty litres of water.  For the average household, each bottle lasts 4 to 5 days. Though this represents an exorbitant capital outlay for the over 2,300 households who live on less than a dollar a day, UZIMA says they cannot provide the product free as did ATGL, because they have to cover all operational costs - electricity bills, diesel for the generator, as well as the purchase sea salt, the main ingredient for the chlorine production. 
Mamans UZIMA has teamed up with 200 Clubs de meres (Women’s clubs) subsidiaries of the local Red Cross society and who work in the communities to promote better sanitation and the proper use of chlorine.  We met the Ndungu Women’s Club just as they were ending their community meeting. After that, they broke up into groups and some went from door to door to talk to households about sanitation and prevention of diseases.  Others took up their positions in the many chlorination points strategically placed along the routes leading to and from Lake Tanganyika and the river Lukunga. Many people stop there to allow the women to put the right amount of chlorine into each container of water fetched from the river.              
Trained by the Red Cross society, the Ndugu women’s club teaches the households how to safely dispose of rubbish, use the chlorine correctly and to wash their hands regularly at critical moments.  They also engage in income-generating activities, which Mme Mulentu their president says they would like to use to procure megaphones and other educational materials.
Mamans UZIMA is a highly regarded partner of the health and local officials in Kalemie.  They participate in the weekly cholera surveillance reporting meetings at the general hospital.  They then identify the most vulnerable areas in which to intensify their sensitization activities. Helene admits that it’s not always easy to convince every household.  “We get the most resistance from some religious sects. But we do not give up on them” she says.  “We participate in programmes on the local PAREK FM radio station. We try to use all avenues to reach the pastors and religious leaders, but we also keep going back to their members at home… Even if they do not publicly accept our message, they often end up coming secretly to buy our chlorine.” 
When in full operation, Regideso, the national water works only serves about 35% the population of 1.6 million inhabitants in the Tanganyika district through its obsolete distribution network. As a result, the conditions for cholera outbreaks still pertain.  Power cuts are frequent in Kalemie, and Regideso cannot supply water without electricity. On such occasions, people simply head for the lake and river.  They wash there and then fetch the water from the banks to use at home creating a high risk of diarrhea and cholera.  Helene Afouah wears a determined look ‘We cannot afford to stop the work we do.  We do not expect anything as reward… we’re helping our own population, saving lives and helping with development by taking things into our own hands.”
“Our greatest fear is that one day ATGL will ask us to return the machines we’re using. Each of them costs about 2.500$ and we cannot afford to buy new ones, not with all the other production expenses … We can continue the sanitation work in the households, but the chlorine is indispensable in the water we drink in order to prevent cholera. 
When cholera broke out in Tanganyika district (Katanga province) in 2008, UNICEF had the role of “leader” and coordinated all partner-interventions to prevent the spread of the cholera and to provide clean water and facilities in Kalemie.  UNICEF itself provided chlorine for purifying and treating water for household use.  As a result, there were relatively fewer deaths – 30 people in total – compared to the previous years.
UNICEF’s programme of cooperation with the government of DRC supports the establishment of “clean schools” and “clean villages” as a sustainable way of preventing diseases and reducing child mortality. Fashioned after local initiatives such as those of Mamans UZIMA and the Clubs de meres of Kalemie, UNICEF promotes the participation of entire communities and schools to initiate their own sanitation programmes, construct latrines and adopt participatory management arrangements to keep their schools and villages healthy, and by so-doing prevent disease. 
UNICEF intends to promote and support the operations of 12,000 “healthy villages” in the Katanga province by the end of its current programme cycle in 2012.  400 of them will be in the district of Tanganyika.     Joyce Brandful – Jan 2009
Surveillance epidemiologique:
Total de cas pour l'an 2008
Nombre total de cas: 2354
Nombre total de deces: 31
Enfant moins de 5 cas
Nombre de cas: 324
Nombre de deces: 3
Superieur a 5 Ans
 Nombre de cas: 2030
Nombre de deces: 28
1) Les Urgences
-   Dans le cadre du projet de la prevenntion et la prise en charge de cholera dans le district sanitaire de TANGANYIKA, les Urgences ont remis tous les intrants de la prise en charge de 5.500 malades planifies pour l'ans 2008 (detail).  Medecin du Monde executant de projet.
Ringer flacon de 500 ml    88 000
SRO                                77 000
Trousse à perfusion           88 000
Touque Chlore 45 KG             30
Jerrican 20 L pour les démunis  60
Tentes                                        8
Bâches 200 m²                         20
Savon hygiénique  CTN/72    5 500
-  ont rendu disponible 30 touques de chlore pour la chloration d'eau au niveau de points de puisage aux partenaires de MDM et l'usage dans le centre de traitement de cholera (CTC).
- Les baches et tentes pour la réhabilitation des CTC.



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