October 23, 2008

More than 10.000 people have been affected by a cholera outbreak that has devastated Guinea Bissau since May. The epidemic has already caused the deaths of 190 patients. After reaching epidemic levels, there has recently been a significant decrease in the number of admissions to the main cholera treatment center (CTC) opened in the capital, Bissau.

The country?s capital has been the hardest hit area, with 70 percent of the total number of cases reported. This is why Doctors Without Borders/Médecins Sans Frontières (MSF), together with the Ministry of Health, opened a CTC next to the main hospital, Simao Mendes, with a capacity for 100 patients and which operates 24 hours a day. About 5,000 patients have already been treated at this center.

In addition to the CTC in Bissau, the intervention focuses on giving support to another 17 rehydration centres scattered across the other two most affected regions: Biombo and Oio.

"Patients can dehydrate and die in just a few hours if untreated," explained Daniel Remartínez, emergency coordinator. "This is why it is so important to cover the areas where there could be affected people in order to provide them with quick access to treatment and thus save their lives."

Cholera is endemic to Guinea Bissau and with the rainy season, which lasts from May to November, many areas are become flooded and wells fill with fecal matter, spreading the disease.

"When not treated in time, mortality amongt infected people can reach between 20 and 50 percent, but drops to less than two percent when patients receive the necessary treatment, which in 80 percent of the cases consists of simply administering oral rehydration salts," said Remartínez.

Stop the spread

In addition to decreasing mortality among affected people, stopping the spread of the epidemic is crucial. Cholera is mainly spread by contaminated water or contaminated food and is linked to a lack of garbage and human waste management, as well as a lack of clean drinking water. This is the reason why crowded places such as markets, where sanitation and hygiene measures are inadequate, are more prone to it.

"The overall water and sanitation situation in the country continues to be very limited," said Agustín López, in charge of logistics in the project."This facilitates the spread of cholera. Prevention depends on access to drinking water and proper sanitation systems to prevent exposure to the bacteria and stop transmission."

In many areas of Guinea Bissau, basic infrastructure is inadequate: drainage is non-existent, the electricity network is poor and, based on estimates, less than 20 percent of the population has access to drinking water. Most of them get the water they need from wells.

In addition, the bodies of those who die of cholera need to be treated with extreme caution and properly disinfected before being buried in order to prevent further contamination. According to local custom, a dead body can be kept at home for several days, so that family members and friends are able to pay their last respects. They usually touch the body. The government forbids these rituals when there is an epidemic. Their houses, as well as the houses of the patients admitted to the centers, have to be disinfected. This task is carried out by government officials in charge of actively tracing cases and disinfecting. MSF coordinates with these government officials to stop the spread. A special team disinfects houses using a chlorinated solution. They also deliver soap and bleach to the population and explain to them how to treat water and the hygiene measures needed to prevent the bacteria from re-infecting them.

MSF worked in Guinea Bissau in 2005 fighting another cholera epidemic.

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