Water, Sanitation and Hygiene interventions strengthened to prevent Ebola

Big problems sometimes require simple solutions

By Joachim Buwembo
ebola preparedness and response
19 February 2019

Big problems sometimes have simple solutions, as that is what the Water, Sanitation and Hygiene promotion campaign has shown in Uganda’s Ebola high risk districts of Kanungu and Kisoro. 

Since Ebola broke out in Beni – Congo in August 2018, the Uganda Government mapped the districts in Western Uganda according to risk levels. Volunteers were recruited through Uganda Red Cross to spread the hand washing gospel and from an initial 30 who were trained then, the number has grown to 120 who are relentlessly traversing the districts and vigilantly manning the border points of entry to ensure people accept and adhere to washing their hands with soap or water mixed with acceptable measurements of chlorine.

Working under the Red Cross and supported by UNICEF with funding from UKaid, the health volunteers spare no efforts checking on the many public points where hand washing facilities  have been provided to ensure they are properly used and to encourage people to wash with soap or the chlorine water being provided all over the high risk districts which also have fairly large populations. Kisoro for example has 380,000 people, not counting the many in transit to the border and to its wonderful tourism sites. Kanungu, also a great tourism gateway, has a quarter of a million people.

At the points of entry along the Congo border, washing is not optional. Whoever wants to access the country must wash their hands properly in chlorinated water and also step in a chlorine bath to sterilize their feet/shoes.

“We have no choice,” Rose Manirakiza, the Vice Chairperson of Kisoro District explains. Our little districts border two equally poor countries, DR Congo and Rwanda, whose citizens routinely come to our public hospitals for free treatment. Yet the Ministry of Health and National Medical Stores only supply us with personnel and medicines according to our numbers of citizens, meaning they can never be anywhere near enough as we treat patients from three countries with the budget of one district. So it is crucial that we emphasize preventive measures, therefore the WASH campaign has been very useful and nothing can make us relent on it.”

The Kanungu District Health Officer, Dr Stephen Sebudde lauds the (ironical) benefits of the Ebola inspired hand-wash campaign, saying there has been a sharp fall in diarrheal diseases and as a result, they are no longer the lead health problem of Kanungu. Instead respiratory infections resulting from too much dust take the lead.

Dr Sebudde who hails from Central Uganda but has permanently settled in Kanungu is all praises for UNICEF for supporting the communication campaign that has had a transformative effect on people in his adopted home. 

The importance of washing hands is aptly summarized by Jimmy Mugasha, Uganda Red Cross Manager for Rukungiri and Kanungu districts who explains that hands are the part of the body that mostly comes into contact with other persons and objects, but also most used to touch everywhere.

Mugasha considers as one of the biggest achievements of WASH is getting witchdoctors in the sub region – at least twenty of them - to accept hand washing with soap in their interactions with their clients.

In Kanungu District, adoption of hand washing with disinfectant has been made easier by the energetic Chief Administrative Officer, Eriab Begumya, who has simply made it a law at public places. No staff or client can access a public office without first having a chlorine hand wash.

If these things are being provided free by UNICEF, what excuse can you have not to use them?

he asks

The CAO also has another reason to be happy; the chlorine water has no other use – so far. This means it is not being stolen, like soap would be.

The religious leaders are also playing their role. At St. Joseph Kinamira Catholic Church, the Parish Priest Rev Fr Francis Havugimana now makes washing with disinfectant part of his sermons, by quoting parts of the Bible that reminds the faithful to keep their bodies clean for their souls to be well as well.

What makes the border districts vulnerable is not only the usual movement of travellers but also the refugees who are fleeing the intermittent fighting in Congo. These can pass anywhere as they flee and may not go through the known point of entry. But they have to end up at the refugee transit centre if they are to be helped. At Matanda transit centre, washing with disinfectants is a key activity, above everything else.

But where does all the chlorine water to cover the affected districts come from?  At Muramba Health Centre 3, we meet one of the trained volunteers who churns out the wonder liquid. Godfrey Munyazikwiye demonstrates how one of the Chlorine Machines supplied by UNICEF works. He measures out Sodium Hypochlorite pellets and with exactitude, mixes them in units of 20 litres of water. His chlorine generator, using a solar powered controller to ionize the water does the rest. The chlorine water produced is then distributed to different public places. After a day of generating and dispatching the chlorine water, Munyazikwiye then uses vinegar to clean and protect his precious machine.

At Kisoro’s Voice of Muhavura, the most powerful broadcaster in the sub region, popular presenter Gerald Ngarama relentlessly preaches hand washing every day.  But it is Emma Ndyomugabo, a Primary Five pupil at Bunanagana Primary School, who tells the story of hand washing with the simplicity that only a ten-year-old can: “Wash hands, don’t shake hands!”