Cholera outbreak: Burning questions

Cholera is ravaging the country, with Karonga being the worst hit. In this interview, our reporter AYAMI MKWANDA asks Minister of Health AtupeleMuluzi to explain how the country is responding to the sanitation-related outbreak which has affected over 200 people and killed four.

What strides has the country made towards achieving Total Sanitation Policy and open defaecation- free (ODF) goals government adopted in 2008?

So far 69 traditional authorities have achieved ODF status and Balaka District was the first full district to be awarded the status in November 2017. Thirty-one percent of villages still need to meet the required standards.

As Minister of Health, how do you feel that some Malawians are still defaecating in the open 53 years after independence?

ODF is an important standard as it provides a level of confidence for both residents and the government that communities are being serious about eradicating the act of open defaecation.  We are now in the 21st century and as a society we need to evolve quickly.  There is no reason why in 2018 anyone would need to defaecate in the open, public facilities are generally available across the country and most homes now have either a latrine or a lavatory.

For those who believe it is culturally acceptable, they need to remember that only 50 years ago, Malawi was populated by just 3.8 million people with a life expectancy of just 38 years, today we are just over 18 million and we have a life expectancy of 64 years.

This progress means we need to be much more aware of how we live and show courtesy and respect to those who we live with.

What are the main challenges to open defaecation? How can we overcome this?

Open defaecation is a legacy of our past when many worked on the land and we lived in small village conurbations. Today we live ever more urban lives and our cities, towns and villages are significantly more congested. This means that the risks of defaecating in the open are significantly higher, simply because of quantity.  With the large amount of human waste that we now generate as a country, we are at ever more risk of polluting our food and water sources, leading to an increase of risk not just of cholera but other waterborne diseases such as typhoid, malaria and yellow fever.

How do we overcome this risk factor for cholera outbreaks?

Overcoming these risks is extremely simple. We must use a latrine or lavatory when we need to urinate or defaecate, and we must wash our hands with soap after we have been to the toilet. It really is that simple!

When there was Ebola outbreak, health ministers within Sadc came together to affirm the need to work together to combat it. Now there is a cholera outbreak in Malawi, Tanzania and Zambia. How is Malawi coordinating with its neighbours to combat the outbreak? What is Sadc doing?

The Government of Malawi is in direct communications with authorities in both Tanzania and Zambia. Thankfully at this stage we are not suffering the same scale of challenges that are being seen by our neighbours.

What is the country doing to combat the outbreak? What are the major pillars, challenges and successes of our national response?

As we have already published, Malawi is operating a three tier response to the outbreak.  (1) We established a number of emergency clinics in affected areas to help test, diagnose and treat patients once they show any symptoms. (2) We have procured and started to distribute vaccinations to those most at risk in high threat areas of the country. (3) We have increased our health education activity to try to improve hygiene and sanitation practices at home. This has included a roadshow that is travelling around the affected areas and a public cinema team with health education videos.

Why is our national response not as firm as Zambia which has deployed the army, banned restaurants and gatherings and warned against handshakes?

At this stage, the scale of the issue in Malawi does not warrant the sort of response that has been required in Zambia. Thankfully, we are containing the number of cases, and the public have reacted quickly to tighten up health and hygiene at home, long may this continue!

So far, what are the prospects of national interventions? Are we winning?

It is not a question of winning or losing, but of managing the situation. Cholera is a live risk that will not go away overnight. We need to continually be looking at ways to improve how we manage the risk and over time we will beat this dreadful disease.

What advice would you give Malawians right now?

My advice has not changed from any of my previous statements. Please ensure you continue to follow the four basic rules:

  • Wash your hands with soap before you eat or breastfeed a child and after you have been to the toilet.
  • Wash all food before you cook or eat it
  • Only drink safe water, that means water that has either been treated with chlorine or has been boiled hard for over 1 minute – it takes that long to kill the bugs!
  • If you are living in a high threat area, please visit your doctor to see if you are eligible for a vaccination.

Cholera is one of a number of medical issues that we can stop at home.  By following these simple rules we can together, beat cholera.

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