Guinea 2012 © Holly Pickett

Cholera spreads through contaminated water and flourishes in unsanitary conditions. At Bunfi Port in Conakry, Guinea, fishing boats float in water choked with garbage and sewage. Cholera is spread when fishermen, vendors, and their customers come into contact with contaminated fish. #

Guinea 2012 © Holly Pickett

Conakry is the capital of Guinea. This densely populated city is home to an estimated two million people. Poor drainage and waste disposal in some of the most impoverished parts of the city have allowed cholera to spread quickly.  #

Guinea 2012 © Holly Pickett

In Conakry, MSF is working with the Ministry of Health at Donka Cholera Treatment Center. Here, female cholera patients receive treatment. #

Guinea 2012 © Holly Pickett

MSF doctor Djibeirou Yay talks with Assitou, who is recovering from cholera, at the Donka center. #

Guinea 2012 © Holly Pickett

Camara, top, sings to her mother Fatmata, who is battling cholera at Koloma Cholera Treatment Center in Conakry. Since the beginning of the outbreak, cholera has claimed the lives of at least 80 people in Conakry alone. #

Guinea 2012 © Holly Pickett

Ten-year-old Ousmane receives fluids through an I.V. at Donka Cholera Treatment Center. MSF treats cholera patients with a rehydration solution of glucose and electrolytes that is administered orally or, in severe cases, intravenously.  #

Guinea 2012 © Holly Pickett

Guinea is struggling to contain the outbreak, which has infected more than 3,300 people throughout the country. In Coyah, an hour’s drive from Conakry, 17-year-old Lia and other patients occupy beds outside a government-run cholera clinic. #

Guinea 2012 © Holly Pickett

Beds are placed outside at Coyah because the facility has no electricity, and without electric lights medical staff are unable to find veins to insert IVs. Here, Nurse Makalé Keita searches for a vein in the arm of 18-year-old Fatoumata. #

Sierra Leone 2012 © Holly Pickett

Across the border in Sierra Leone, men stand near their fishing boats on Mabella shoreline in the capital of Freetown. Here, trash and untreated sewage flow unchecked into the ocean, creating a breeding ground for cholera.. #

Sierra Leone 2012 © Holly Pickett

Mabella Quarter is one of the most densely populated—and impoverished—areas of Freetown. Here cholera has affected more than 10,000 people and claimed the lives of at least 180. #

Sierra Leone 2012 © Holly Pickett

Children collect buckets of water from a tap near an open sewer in Mabella Quarter. A scarcity of clean drinking water and toilets has left Mabella rife with cholera. #

Sierra Leone 2012 © Holly Pickett

Dehydration brought on by cholera can cause painful muscle cramping. At Freetown’s Wellington Cholera Treatment Center, Nurse Amie Koroma massages 14-year-old Aminata’s hand and arm. #

Sierra Leone 2012 © Holly Pickett

Sixteen-year-old Sylvester looks up from his bed at Wellington Cholera Treatment Center a nurse prepares a fortified porridge for him.  #

Sierra Leone 2012 © Holly Pickett

Mariamah, 14 years old, lies in her bed at Mabella Cholera Treatment Center in Mabella Quarter. The last major cholera epidemic struck in 2007, and in the years since many people gradually lost their immunity to the disease. #

Sierra Leone 2012 © Holly Pickett

Left untreated, cholera can kill within 20 hours. Outside Wellington Cholera Treatment Center, MSF health promoter Mariama Turay advises people on what they can do to avoid catching the disease and what treatment is available if they do. While treatment and vaccines help to fight the disease, education on proper hygiene and improvements to water and sanitation networks are the only way to control the disease in the long-term. #