We K.O. Cholera Again, This Time in Congo

Once again, Action Against Hunger's swift response and expertise in sanitation has forestalled an epidemic of cholera. This time, the outbreak began in Kikondja, 30 miles south of Malemba Nkulu in the Democratic Republic of Congo, where we've had programs in nutrition as well as in water-and-sanitation since 2001. Between January 6 and January 13, UNICEF reported 160 cases of cholera, 44 of them in children younger than five, seven of whom died. Doctors Without Borders assumed the medical task of curing the victims, which grew to 50 new cases a day. We stepped in to halt the plague's spread.

Cholera is a potentially deadly bacterial infection of the small intestine that causes massive, watery diarrhea, usually accompanied by vomiting. Untreated, the disease kills by dehydrating its victims. The Vibrio cholerae bacterium is contracted through contaminated food and water, and large outbreaks are usually the result of contaminated water supplies.

Symptoms of cholera can appear within a day of infection. Surprisingly, most people who ingest the bacterium don't become ill, though their intestines can host the bacteria for as long as two weeks. More than 90% of patients who get sick have mild or moderate symptoms. The disease, however, wallops the rest, usually young children. And if communities lack treatment and sanitation facilities or are uninformed about the correct medical response, an attack of cholera can be devastating. Death rates have been known to hit 50%.

Effective Assistance: A Coordinated Field Response Reduces Mortality

Response to UNICEF's alert was immediate. Doctors Without Borders set up an isolated ward for cholera patients. Everything carried in and out of the ward was disinfected with chlorine (a mild 5% solution of bleach is effective). Patients' clothes were burned, and patients themselves were scrubbed with disinfectant and medicated with a solution containing rehydration salts that replace water and electrolytes lost through diarrhea. Cholera can also be treated with antibiotics, most often tetracycline, but medicine is seldom necessary if rehydration begins soon enough.

Action Against Hunger oversaw water treatment, disease prevention, and health education. Everyone needs a minimum of 20 to 30 liters of water a day for drinking and sanitation. But because cholera patients lose so much fluid and also need water for rigorous disinfecting, they require at least 50 to 60 liters a day. We identified 135 water sources that needed disinfecting, and we distributed chlorine at each of them that was mixed with the water to purify it. Chlorinated water is less appetizing than, say, Aquafina, but it's no worse than swallowing water in a swimming pool.

In addition, we also trucked in clean water for our nutrition centers, for Doctors Without Borders' cholera treatment facilities, and three other distribution points in Malemba Nkulu. We also checked the homes of cholera patients, particularly kitchen and toilet facilities, and scoured them.

At the same time, we launched a public education campaign. At public meetings, on the radio, and on posters we explained the nature and source of cholera, the symptoms to watch for, and how to stay healthy. We taught sanitary regimens: boil water; cook food thoroughly; eat it while it's hot; keep cooked food separate from raw food; avoid eating raw fruits and vegetables unless they're peeled or cooked; and wash your hands carefully after using latrines and before any contact with food and water.

In all, 866 villagers came down with cholera during this outbreak, and 53 died. But the situation could have been vastly worse. We estimate that through all our efforts we provided clean water to 131,000 people a day. And cholera is now gone from the province. Best of all, because our hygiene education trained 550 local leaders who in turn passed on their knowledge to their communities, we estimate that our campaign taught more than 265,000 people how to stay free of cholera in the future.