Hygiene promotion is key to fighting cholera outbreak in Mabela

Published: 28 August 2012 12:53 CET

By Sanna Negus, Finnish Red Cross, in Sierra Leone

Narrow alleyways snake through the ramshackle Mabela slum, which sits on a slope facing the sea in Freetown. Rain washes down waste, turning the path gray and slippery. Mothers wash their toddlers next door to food vendors and pigs foraging on garbage. Metal water pipes give way to plastic tubes – unofficial plumbing which fouls the water.

The Sierra Leone Red Cross Society says this community of 20,000 people has one of the highest rates of cholera in the city.

Mabela community Chief Alhaji Alimamy Kamara says it’s the worst cholera outbreak he’s ever seen, and thinks the numbers are high because people seek treatment when it’s already too late. He worries about the community, but notes that he himself is at high risk. “As a chief, a lot of sick people come here in my house thinking it’s a clinic.”

His grandson Ibrahim Mansaraf has been a Blue Flag volunteer with the local Red Cross branch for five years. Together with 44 other volunteers in Mabela, he has become an expert on cholera prevention. “We are going house to house to sensitize people on how to prevent cholera, starting from the importance of handwashing,” he says.

It seems that the community is quite well aware of the importance of hand washing, but other problems abound.  “We don’t have any dumping sites so we use the river and sea. Furthermore, there are only four public latrines for the whole community. The water we are getting is safe, but the problem lies with illegal plumping: people cut the pipes at night and this is why the water is contaminated.” Mansaraf lists.

Cholera and malaria are endemic to Sierra Leone, but the magnitude of the outbreak has surprised many. “When the epidemic broke out and I heard about people were dying, I became scared,” says Adama Sesay who lives near the Mabela market. “We have cholera here, but usually it takes a week or two to come and go. This time it has been over a month – this is why we are afraid,” she explains.

Sesay understands the importance of handwashing and proper cooking, but has some misconceptions about the transmission of diseases. “I know that you get cholera from dirt, rubbish. This is how also malaria spreads,” she says.

Others believe that cholera comes from drinking large amounts of beer; some think the cure is gin. Mayeni Gontze who sells fish at the Mabela market thinks that cholera is airborne. “People still buy fish. From what I know, you get cholera from the air, not from the fish,” she says while slicing the scales.

But actually a lot of things can go wrong when handling fish. “It can be contaminated from the sea, from the person who fished it or cuts and sells it – or from a person who cooks it at home,” says epidemiologist Siri Helene Hauge from the Norwegian Red Cross. “So there is a lot of risk in eating raw fish. And if fish is caught close to sewage, then you have a big problem.”

Her job is to advise the International Federation of Red Cross and Red Crescent Societies’ emergency response teams on the spread of cholera, and to assist local health officials reporting the cases. At the moment there are over 200 reported deaths, but the situation is still in volatile. “We saw peak numbers a couple of weeks ago and then it went down again,” Hauge says. “So we just have to wait and see and follow the situation every day, every week.”