Cholera outbreak: Sharing the struggles of a country doctor

Plan's Dualta Roughneen taking part in a hand washing exercise

Bibemi is a rural health district in the North Region of Cameroon which  has been particularly hard hit by this outbreak. With a population of 90,000, there have been over 800 cases of cholera resulting in 62 deaths in the district. Not only is the number of cases far higher than other areas, but the fatality rate is extremely high at 7%.

The district medical officer, Dr. Janvier Djofack, struggles to maintain control of the situation. His major achievement to date: the elimination of out-of-hospital deaths. This means that the district population is now aware of the risks cholera presents. Those infected are going to health centres for treatment, though for some, it is still too late.

"The key now is to get the message out to the population - to teach them how to avoid cholera. Washing hands, washing fruit, using latrines, filtering and chlorinating water - all are quite simple instructions. Many people are aware of these basic hygiene practices, but do not realise their use can eliminate cholera in the region if people are diligent," said Dr. Janvier.

All hands on deck

With 12 health centres in the district, Dr. Janvier works with 11 other doctors to reach the resident population. That’s one doctor for 8,000 people. While not the worst statistic in the world, in the midst of a cholera outbreak, it means all hands on deck

Cholera is an extremely resilient bacteria. It is a master at hanging around, waiting for people to let their guard down and restart the cycle of infection. In Cameroon, the mobility of the population seems to be a factor in spreading the outbreak to new, random locations.

I heard of one man who purchased mangos in one area, which had come in contact with the bacteria, and transported them over 100km to facilitate a new outbreak. Another story is of someone who attended a funeral of a cholera victim and returned home, bringing cholera with him.

Vital support

Organisations in Cameroon, such as Plan, where I am seconded from a sister office in Ireland, are supporting the efforts of Dr. Janvier and his counterparts by training volunteers who spread the message on how to stop the outbreak. I can't help but admire the efforts of the doctor, under 40°C heat, dissecting information for me on MS Access, assessing the statistics, looking for trends that can give him a solution to the continuing spread. He can’t find any.

The computer tells him he needs money – more money for chlorine to disinfect the wells and the health centres, for fuel so he can travel around the health district, to provide a small stipend to volunteers so that they will continue to walk around in the searing heat, telling people how to avoid infection.

Disinfect

The North Region of Cameroon struggles with water access issues. Like much of the rural population, dispersed over vast expanses of semi-desert, latrines are not a priority. There are acres of 'bush' to go to the toilet. Most people collect water from open wells, dug by hand and lined with mud-bricks. The nature of the collection methods - buckets and ropes - means the wells are primed for contamination if there is cholera in the area.

Dr. Janvier explained to me how he has moved from community to community explaining how to disinfect these wells with standard household bleach. Unfortunately the markets in these areas seem to have run out of bleach.

Money matters

With the level of commitment displayed by Dr. Janvier, what really is missing is what his computer has been telling him: Funds. Not a lot, but enough to let him get on with his job.

When I arrived here I expected to have a different role to play. Of course there are areas where the knowledge I have gained working on water and sanitation programmes around the world can be of assistance. But I have also learned that by telling this story, sharing the struggles of a country doctor, may encourage support in lands far away from Cameroon.