Creating a common front against cholera

Why Cross-border Coordination Matters

James Chavula
The beds at the cholera treatment centre were supplied by Unicef so as to ease the burden
UNICEF Malawi/2022/Elephant Media
15 May 2022

Since cholera broke out in early 2022,  workers at Ndamera Health Centre in Nsanje have been working day and night to stop the outbreak.

The patient, a young man who arrived by boat from Migaza in Murumbara District on the Mozambican side, has left the health workers in a tedious triangle. Now the 11 health surveillance assistants (HSAs) in the border strip take turns to combat the deadly diarrheal disease at the rural facility's cholera treatment centre as well as in patients' communities and all points of entry.

"Primarily, we have to ensure that preventive measures are followed to stop the spread of cholera," says senior HSA Beatrice Kamvazaana.

The 44-year-old community health worker has battled several cholera outbreaks in two decades.  However, the current spate has proved tricky because the majority of the patients pour in from a wetland with limited access to safe water and latrines in Mozambique. 

The risk factors were made worse when floods caused by Tropical Storm Ana ripped the sparse latrines to debris, washing away human waste into waterways.

"So far, the cholera treatment centre at Ndamera has seen nearly 70 patients and only seven were Malawians, mostly from Kalikokha, Pensulo, Bitilinyu and Fatchi villages where the suspected cases from Mozambique take shelter in their relatives' homes before seeking treatment here," says Kamvazaana.

The HSA cannot just cross the porous border to share the dos and don'ts required to eliminate cholera at the source.

She states: "When a cholera case is detected, we rapidly go where it is coming from to disinfect the household and identify the possible causes and contacts.

"We cannot do this outside our country. This is why we need to coordinate better with our colleagues on the Mozambican side than we are currently doing. Meanwhile, the numbers are increasing while we have not reached the source.

The senior HSA calls for cross-border coordination to ramp up the fight against the shared public health threat. 

"Like the Covid-19 pandemic, this cholera outbreak illustrates that any infectious disease in one country should be a concern for its neighbours. Contagious infections usually spread at the speed people and goods are crossing the porous borders," she explains.

Fred Minyaliwa,District Environmental Health Officer,Nsanje District HospitaL
UNICEF Malawi/2022/Elephant Media
Fred Minyaliwa, the District Environmental Health Officer at Nsanje District Hospital

UNICEF has supported Nsanje District Council officials with medical supplies and financial resources for key stakeholders to travel to the worst-hit, marshy district of Murumbara in Mozambique for a two-day cross-border coordination meeting. 

Nsanje District Environmental Health Officer Fred Minyaliwa will be part of the delegation led by Nsanje District Commissioner Medson Matchaya alongside the Director of Health and Social Services. The public servant who facilitates case management and contact tracing is excited about the prospects for the two neighbouring nations uniting to end cholera ravaging the border region.

"For every case that we get, we conduct follow-ups to establish the patient's history, how the case travelled for the past three days, people met, the food taken, water quality, hygiene standards as well as links to past cases and risk factors. 

"This cannot succeed unless we work closely and share notes with our neighbours in Mozambique, where most cases are coming from," he explains.

Both Malawi and Mozambique belong to the Southern African Development Community (SADC), which promotes shared responses to common challenges, including contagious diseases.

"We need to join hands because none of the two countries can combat cholera without the support of the other. But communication and collaboration with the worst-hit part of Mozambique remain difficult because it is hard to reach," Minyaliwa says.

Nsanje district is surrounded by Mutarara, Murumbara and Dowa across the border. However, all the imported cases come from Murumbara across the Shire River and Ndindi Marsh.

To get to “the hotspot next door”, Minyaliwa and his delegation from Nsanje will have to endure a 12-hour road trip via Blantyre City to Muloza Border in Mulanje on the Malawi side, then proceed through  Milanje on the Mozambican side.

A longer alternative route to Murumbara takes travellers from the tip of the landlocked country through Blantyre City and Mwanza District via Tete in the vastness of the neighbouring coastal nation.

Minyaliwa explains: "If we leave at 6 am, we will get there no earlier than 6 pm. This has complicated collaboration, and we are not able to share data and necessary skills.

"Meanwhile, our surveillance systems first detected the outbreak on 13 March 2022, but our colleagues at the source haven't confirmed any cholera cases yet. While we are using all cholera protocols, our neighbours are treating it as general acute diarrhoea."

The preparations for the two-day cross-border meeting are underway. This is good news for Minyaliwa, who spearheads the fight against cholera in the border district.

"We have to move at the same pace, share notes and have a common understanding on the extent of the outbreak, efforts underway and how we can work together to safeguard our people," he elaborates.

The news is exciting to Kamvazaana and her team. Her cadre has jumped to the front line in the fight against cholera transmission. She hopes the hosts of the cross-border crunch talks will start treating cholera patients so that patients do not cross the porous borders, spreading the disease on the way.

"If the talks are successful, we will be able to effectively and decisively manage future disease outbreaks as neighbours. If one district detects an outbreak,  it will alert the other and receive the necessary support," she states.