The diarrhoea and vomiting started before dawn. By 8 am, 12 year old Steward Okoulokami was weak and losing weight. His panicked father, Dimitri, packed Steward into a canoe and took him to Brazzaville. “In the morning around 8am, when I looked at my son, he had lost a lot of weight and looked like a skeleton,” explains Dimitri “So I thought, no - I must go to Brazzaville. When we got to Brazzaville, he was hospitalised and we spent 5 days there. On the 6th day we left and now he is alive and in good health.”
Dimitiri and his family live on Isle M'bamou, a large island of 13 villages on the Congo river, not far from the twin capital cities of Brazzaville and Kinshasa. There is no electricity, running water nor hospitals on the Isle, so when the cholera outbreak hit, it was devastating. No one knew what it was or where it came from. While Steward survived, his cousin was not so lucky.
“For my nephew, it was a short illness,” explains Dimitiri. “When he started having diarrhoea, we noticed that he became like a skeleton in only half a day. He lasted only one day. By the second night he was dead.”
The Congo river is a porous border. Traders move continuously between the Democratic Republic of the Congo (DRC), the Republic of Congo and the islands in between carrying their cargoes of fish, manioc and charcoal. But they can also carry disease. The cholera outbreak that devastated Isle M'bamou originated in the northern DRC before moving down and across the river into the Republic of Congo.
When the outbreak hit Brazzville, squatter settlements with poor sanitation in areas like Tsieme bridge were the worst hit. Makeshift latrines feed directly into the same stream in which children play and people bathe.
“In Brazzaville, the hygiene conditions are very precarious in some of the suburbs like the Tsieme zone,” explains WHO cholera specialist in Brazzaville, Jean de Dieu Konongo. “The sanitation system is not working properly and there isn’t enough drinking water available and most of the houses are informal. Cholera is a disease linked to poor hygiene, poor sanitation, and lack of access to clean water. “And that’s why it is called the ‘dirty hands’ disease,” he continued.
CERF supports cholera response
The Republic of Congo recorded 785 cases of cholera and 32 deaths, although the real numbers may be higher. In response to the outbreak, UNICEF and WHO with the support of the Central Emergency Response Fund (CERF) have launched a series of initiatives throughout the affected areas to treat, combat and prevent cholera. CERF allocated US$1.3 million to the two UN agencies to provide life-saving assistance to the fight against cholera.
On Isle M'bamou, chlorination points have been set up and workers trained to purify water from the Congo river that households use for drinking, cooking and bathing. Latrines have been built in public spaces such as markets and schools and a social mobilization programme has been put in place to teach villagers the importance of hygiene and clean water. Children at school learn about washing their hands with soap and using the new latrines.
“The Central Emergency Response Fund has been very vital in bringing quick assistance to the areas that were affected by cholera,” says Marianne Flach, UNICEF's Representative in the Republic of Congo. “For example, in these islands here in the river, between the two countries, there's no electricity, there's no clean water, there is no health centre. It’s a population that needs a lot of our assistance and we often forget about them, so it’s very good that we've been able to use the grants of the Central Emergency Response Fund to provide assistance to these islands.”
But despite the interventions throughout the affected areas in the Republic of Congo, the threat of cholera from across the river remains. In response, the Central Emergency Response Fund has also committed $4 million to the cholera response in the DRC in 2011. To stop further outbreaks, CERF provided an additional allocation of $9 million at the start of 2012.
The next rainy season is fast approaching and with it, the potential for new outbreaks of waterborne diseases like cholera on both sides of the Congo River and the islands in between. But with better access to clean water, latrines, and, most importantly, knowledge of hygiene and sanitation, communities in both countries have a much better chance of protecting themselves and their families.
“There is a saying that “ignorance kills” says Dimitri, “Before I didn’t know about cholera and that is why I lost my nephew. But now that I have this knowledge, it won't happen again.”
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Dimitri Okoulokami folds the shirt of his nephew who died of cholera, Isle M'bamou, Republic of the Congo © Guy Hubbard/UN CERF/UN OCHA