Concerns in Namibia as cholera outbreak reaches nation’s capital

Published: 21 March 2014 8:19 CET

Erin Law, IFRC

As we wind our way past homes, down muddy tracks bordered by rubbish, I wonder how much more we will have to walk to reach the home of the woman with the pleading eyes. It is a hot day in this informal settlement on the outskirts of Namibia’s capital, Windhoek, as five teams of Namibia Red Cross Society volunteers navigate similar winding routes in the heat and rain.

We are here to assess the situation in the informal settlements after a cholera outbreak in early February. This is the first time cholera has been identified in Windhoek. It is a different strain from the outbreak which is affecting northern regions, and as of yet, there is no indication it will spread through the capital. However, health care workers are concerned. There have now been 39 suspected cases of cholera in Windhoek, with three confirmed cases. Following the death of a 60 year old man in Katutura, just eight kilometres outside the capital, the Namibia Red Cross Society moved quickly. Five teams of volunteers were deployed to conduct 25 interviews with residents to better understand the situation and plan a response.

Marea, whose eyes implore us to do something,  is one villager with whom we talk. Rounding the last corner, and after an awkward jump over what looks like a stream, we reach her home. There, outside her shack made from corrugated iron sheeting, is a little garden, cultivated with care for many years. Despite the obvious pride Marea takes in her home, the situation just outside is much more dire.

“I don’t know what to do. We can’t use the toilet here. I’m worried about my girls,” she explains. She points across the stream to a toilet block perched on a rocky slope. This one toilet, she estimates, is for 200 people. It is dirty, broken and, as we frightfully witnessed, drains partially into the stream below.

Marea’s story of not having safe access to toilets and worrying about the quality of the water she can access is familiar. Her concerns are well founded. In communities where people do not have access to proper water and sanitation,  and for those not armed with the knowledge of how to prevent diseases, they can easily get sick.

Marea’s girls are 14 and 9 years of age. They will not use the toilet, instead preferring to relieve themselves in the river. This exacerbates the risk of cholera infection, as many other residents in the settlement collect water from the river for cooking.

All over Windhoek’s informal settlements, streets are overcrowded and there is a lack of basic toilet facilities. In Katutura, where the first death from cholera was recorded, an estimated 200,000 people live in a settlement that is designed for less than 45,000 people. The toilets which are available are located near houses and are often broken. Water from broken toilets and other sources runs down roads, and pools in dips in roads and shallow drains. Along these roads, children play with tires, rolling them through the dirt and water nearby.

Since November 2013, Namibia has been affected by cholera outbreaks which have affected the northern regions of Kunene, Omusati, Oshana and Ohangwena. 504 cases have been recorded, with 16 deaths. Education is critical, both for prevention and early treatment. If patients are treated early, the fatality rate can be less than one per cent. If people go untreated, the severe, watery diarrhoea and vomiting can kill within hours.

Wanting to know what the needs of the community were and how to best meet them, Khomas Regional Red Cross Manager, Abia Uhongora, led volunteers from the regional office into Windhoek’s informal settlements. Staff from headquarters also gave up their weekend to join the rapid assessment team. It is the information gained from assessments like this that will help to guide messages and intervention for these communities and potentially lead to fewer lives lost to cholera.