THE CHOLERA MENACE, FOR HOW LONG?

The dreaded cholera is back! Or more accurately, it never really went away. But because the people afflicted were treated in facilities that do not draw attention, it did not quite make the news.

When Nairobi County Department of Health released a circular to the public, warning of a cholera outbreak in the city, few people even looked up from their smartphones because this did not affect them.

The notion that cholera is a disease of the poor is a fallacy. However, cholera is a disease of poverty. As long as 29% of Kenyans continue to live below the poverty line (living on less than $1.9 a day) cholera will continue to haunt us.

Individual people may live below the poverty line but if they are provided with access to basic needs, a right that they deserve from a responsible and responsive government, then poverty just might be a little bearable.

Top on the list of these basic rights is access to clean water. At the rate we are going, clean water is becoming a myth. This has never been more obvious as in has in the past year where we have been riddled with outbreaks of cholera in Nairobi and its environs, Kajiado, Narok, Garissa and Machakos. Coupled with the drought that we have experienced as a country, an unacceptably large number of Kenyans are at risk.

The government has demonstrated great effort to provide access to clean water. However, the Ministry of Water and Sewarage cannot work in isolation. Its efforts will only bear fruit if they are intimately linked with urban planning. The explosive growth of towns that we are witnessing in Kenya, accelerated by devolution is a time bomb, if not well managed.

 Very few towns in Kenya have a functional sewerage system. It is becoming a norm to see exhauster vehicles taking over many towns. Considering cholera is transmitted via the feco-oral route, the infection is politely but unapologetically reminding us that we are eating raw, unprocessed sewage.

The second basic right we all require is access to health care. As we speak, the universal health coverage (UHC) pilot is on-going. I sincerely hope that we are not missing out on these lessons. UHC in Kenya intends to shift the focus in health care from just a curative-based approach to a more comprehensive preventive and promotive approach, with curative services as a safety net where the rest have failed. 

I would hope that one of the take-home points will be the need advocate for expansion of the current provisions of immunization by the Kenya Expanded Programme of Immunization (KEPI), to include vaccines that are currently not catered for. With our current challenges, cholera vaccine, the human pappilomavirus vaccine (for prevention of cervical cancer) and the typhoid vaccine would be an immediate consideration.

This is a defining moment on putting the community health extension workers to good use. Working in conjunction with the public health team, they will, not only help identify populations at risk, but also help with supporting appropriate health education, distribution of water treatment solutions, making timely referrals for the sick and advocating for proper waste disposal to curb the spread of cholera.

In addition, the public health facilities will require adequate resources to deal with the disease burden. This does not just end with provision of drugs and fluids but also space for appropriate isolation, proper medical waste handling, and the training of the health providers on the most current infection prevention and control practices.

Therefore, while the more privileged sit in their ivory towers and assume that a poverty problem will not touch them, please take note, we are all at risk. As long as your office tea girl lives in Kibera without access to a proper toilet, she will surely bring the infection to your office and you will take it home to your child.

While you sit in the coffee shop enjoying a latte with your girlfriends, remember the girl who served you only earns enough to afford her a one-room house in Majengo and she has to buy water by the jerrican and has no idea where the vendor got it from.

While you faithfully honour your nanny’s weekends off and she goes to visit her family in Machakos, she will drink unboiled water from the local stream and bring the cholera to your house.

The day-scholar housekeeper at your furnished apartment will bring cholera from Kayole where her tap water got contaminated with sewage when an irresponsible contractor damaged the sewer lines during an unauthorized construction.

While you are at it, remember that nearly every highrise apartment complex in Nairobi is now serviced by its own borehole. A simple accidental contamination of the borehole means an entire complex of patients who are potential distributors of the infection in their workplace, the schools their children go to and even the church they attend.

It should not be a wonder that hospital employees have been felled by cholera. It is a highly infectious disease that spreads extremely easily, just like ebola, only not as deadly. How would a sanitation officer in the hospital, cleaning the toilets used by the cholera patient, escape the infection, yet this is what he does for a living? Unless he is vaccinated against cholera, his risk of infection is astronomical!

These at-risk populations are still a part of your society, you mingle with them more intimately than you think. If you want to be safe from cholera, speak up about their safety too!