South Sudan Journal: Cholera Prevention Saves Lives
Nick Radin is our Water, Sanitation and Hygiene Advisor (WaSH) for our programs in South Sudan, where conflict that erupted in December 2013 has displaced more than 1.7 million people and left 4 million people food insecure. In September, Nick returned to South Sudan to see the impact of our WaSH programs on the health and lives of communities. Nick met with South Sudanese parents and our local staff to learn about the needs on the ground and what we need to do to improve things.
On his trip, Nick kept a journal about his travels. This is the first entry in a series of four that we will share over the coming weeks.
I arrived in South Sudan after an overnight flight from London to Nairobi, and a connecting flight from Nairobi to Juba. The first stop upon disembarking was a visit to the Ebola tent, where I had to fill out a form listing the countries I’ve visited in the last three weeks, and my temperature was taken. Like many other African countries, South Sudan is terrified of Ebola crossing into its borders and has taken as many precautions as possible.
Having passed the Ebola screening, Jack Odengo, our local WaSH coordinator, was there to greet me, and we drove to the base, where I had a security briefing from the country director. Despite it being Saturday, Jack was keen for us to get straight to work and I was taken to see our cholera response projects.
Sporadic cholera cases started in Juba in April 2014, an outbreak was declared in May, and at its peak there were more than 100 new cases per week. Since May, we have been carrying out hygiene promotion to ensure people understand how to avoid cholera, as well as providing hygiene kits and clean water to help reduce cholera transmission risks.
I visited some poorer communities where many cholera cases had been recorded. It was clear why cholera had thrived here. Sanitation conditions were poor and tiny shacks that served as houses were located on any available plot of land. There was no piped water, very few latrines, and people did not have the means to purchase basic hygiene items. Under such circumstances, cholera will spread easily.
During the outbreak, our WaSH teams had distributed a water treatment product called PUR, which both clarifies and disinfects dirty water. Alloya Kismalle, a mother of four and host to 15 other family members in her small home, was extremely appreciative of the PUR and other items we provided her including a bucket for storing water and soap. She was able to perfectly demonstrate how to use PUR and even specified the need to wait 10 minutes before drinking the water, in order to give the product time to react. This was extremely pleasing as it showed that our team had not only distributed the product, but had also taught people how to use the product. Alloya went on to explain other changes in people’s behavior that had taken place since our cholera prevention campaigns started. She described how people now systematically wash their hands after using the latrine, and that families always clean up their children’s feces if they are not old enough to use the latrine yet. We parted with her reassuring us that if people maintained these improved hygiene practices, and if God was with them, then cholera would not return.
A woman receiving PUR at a one of our Cholera-Prevention Meetings in Juba, South Sudan. Credit: C. Fibla
We also met a hygiene worker who we had trained to share cholera prevention messages with the wider community. He showed us a range of related images he uses to help spread his message – a picture paints a thousand words. He was passionate about his role, which he saw as constituting the frontline barrier between the population and the spread of cholera. He explained how he moves from house to house talking with families, usually mothers, to ensure they are putting into practice cholera prevention techniques. We also saw posters that had been put up in public areas to remind people about the risks of cholera, how to prevent it, and what to do if you suspect someone has cholera. Finally, we visited three boreholes that our team had repaired. These boreholes provide clean water from deep aquifers so people have access to water that is safe to drink. As well as the repair work, our staff had also trained local committees to ensure that the water point will be maintained for years to come. If we had had more time then we would have visited more, but it was late in the day, so we headed back to the base.
Over the weekend, while driving through Juba, I was astounded by how much the place has changed since I last visited in 2010. There are so many multistory buildings now, and major construction projects remain ongoing. This rapid development is linked to independence, as well as foreign companies and states seeing opportunities to invest and forge ties with the world's newest nation. Seeing this rapid development reminds me that Action Against Hunger has worked with populations in what is now South Sudan for over 25 years and can take pride in the humanitarian assistance it has provided, and continues to provide. There have been many difficult periods over this time, but some good ones too, such as independence in 2011. However, the ostensible development in the capital Juba paints a misleading picture for the country as a whole that has been in conflict since December 2013. Large swathes of the country remain engulfed in conflict or the imminent threat of it, almost half of the population requires some kind of humanitarian assistance and around 1.7 million people have fled their homes due to fighting. Unfortunately, our presence in South Sudan today is as vital as it has ever been.