March 20, 2008

MSF has been responding to an outbreak of cholera in the Arua district of northwest Uganda since early January 2008. In Arua town, 381 patients were diagnosed with cholera and six of them died between February 11 and March 16. In the Oli neighborhood of Arua town, MSF is supporting a cholera treatment center (CTC) in collaboration with the Ugandan Ministry of Health. Medical staff at the Oli CTC have admitted up to 40 patients per day.

“Cholera causes severe dehydration, and patients’ bodies do not have enough fluids to keep their vital organs working, causing circulatory collapse or shock,” says MSF nurse Anna Hess. Patients are treated with simple intravenous fluids, but cholera’s effects are rapid, and timely medical care is critical to survival. “If patients don’t present in time, the mortality rate can be quite high,” Hess says.

The team is seeing a high number of children, many of whom arrive in critical condition. “Their moms are working all day and they’re home alone with their brother or sister. When their mother arrives, she finds the child very, very sick,” Hess says.

Cholera is a water-borne disease endemic in this area of Uganda, but this year’s outbreak is worse than usual, partly because of disruptions in the city’s water supply systems due to power shortages. Normally functioning with 18 hours of electricity a day, Arua had been cut to six for most of February, which seriously affected water pumping capacity.

“Access to water has been limited, so people are going to find water where they can find it, and these water sources may not be safe,” says MSF field coordinator Alfredo Gonzalez.

An MSF logistical team is currently working to expand access to free and safe drinking water in one parish in Oli, where the highest number of cholera cases has been recorded. The objective is to provide 60,000 liters a day for 3,000 people. The team will also be tapping into Arua city water lines to provide free water to residents of two other highly affected parishes. MSF is also assisting with chlorination at hand pumps and various city water points in heavily affected areas.

A nurse on the MSF mobile team drives out to outlying health centers in the district to check whether there are new cases and to provide supplies and IV fluids when needed.

“This shouldn’t be a deadly disease. If you get fluids in your body, you should be all right,” Gonzalez says. “But sometimes these health centers don’t have the fluids to give the patients.”

MSF has been working in Uganda since 1980.

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