March 22, 2006
Doctors Without Borders/Medécins Sans Frontières's (MSF) has treated more than 500 people suffering from cholera in Malakal, a port town on the Nile river. This city, home to 125,000 people, is one of the three biggest cities in southern Sudan, although that's hard to believe if you see its sandy, dusty roads with open sewers on each side. MSF is providing care in a special cholera treatment center located in the city's local soccer stadium. And many more cases are expected in the following weeks.
Cholera causes continuous diarrhea and is often accompanied by vomiting. If left untreated, the disease can lead to severe dehydration and be fatal. The bacteria that causes such outbreaks spreads very easily. To prevent more and more people from becoming ill, cholera patients must be isolated from the community. That is why MSF did not put the treatment center on the grounds of the city hospital. The football stadium, built on the outskirts of the city center, was more suitable to isolate the patients, without hindering normal medical care. Although it lacks shade and has a sandy floor, the fence that surrounds it makes it possible for the MSF team to keep healthy people out of the cholera center.
This was not an easy task as Ingrid Barnett, a Dutch nurse working with MSF, experienced: "The first few days, big crowds of people wanted to get into the cholera center to carry out their duty to take care of their family members. At the gate of the stadium, we explained why they couldn't come in and that we were taking good care of the patients. But most people got really upset and seemed to prefer taking the risk of becoming infected to not fulfilling their duty towards their family."
The cholera center itself is divided into different sections. In the "contaminated areas" patients receive treatment. Severely ill patients lie on special beds outfitted with a hole in the middle under which a bucket catches the diarrhea. An IV drip prevents them from becoming more dehydrated. Most patients lie motionless on their bed when they arrive, exhausted by dehydration. Patients who are still able to drink themselves are encouraged to drink water containing oral rehydration salts around the clock. The whole treatment area–floors, walls, and beds–are regularly cleaned with a strong chlorine solution. Tania Verdemato a British water-and-sanitation specialist on her first assignment with MSF, explains that the cholera center maintains strict rules and procedures to stop the bacteria from spreading. "A way of controlling the disease is by spraying staff's feet and hands with a chlorine solution when they pass through any of the centre's entrances or exits. In that way, the clean area stays clean so that staff can safely eat their meals."
MSF believes this outbreak of cholera probably started because many people in southern Sudan are forced to drink contaminated water. After the decades of war that raged here there is no infrastructure for water and clean water is scarce. This is especially true at this time of the year, when the rains have yet to start and most natural water sources are drying up. People have to use what is available–safe or not. At any moment of the day you see women getting water from the White Nile. They do this at the same place that fishermen clean their fish and clothes are washed.
Containing the outbreak is the first priority of MSF's team in Malakal. However, this may prove difficult: many people are now on the move in southern Sudan. Since the signing of a peace agreement in January 2005, tens of thousands of refugees and displaced people are returning to their homes and families. Many of them travel south in barges on the Nile and pass through Malakal. As a result, the disease continues to spread.
The cholera treatment center seems to have slowed the outbreak in this city, but it is still a fragile situation. The local radio station broadcasts messages to raise awareness about the disease in the region and to inform people about the need for proper treatment. As soon as people infected with the cholera bacteria travel to other towns and cities, containing the outbreak will become an even bigger challenge. A national staff member working as a physician with MSF in Malakal, makes this clear when he says, "The sooner the patients are brought in once the symptoms start, the better, as that makes a quick recovery the most likely ending."
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)