A row of rundown, grass-thatched pit latrines on the roadside at Ngara fishing village in Karonga is the first thing that greets travellers on M1 Road
These overgrown, tiny shacks that line up the heavily populated cluster on the northern shores of Lake Malawi offer a glimpse of the major cause of cholera in the fishing village.
They are too few for the locals and residents, leaving many defaecating in the open and in the lake where they draw drinking water.
The derelict latrines reflect the fishers’ struggle to find land for the sanitation facilities in the sandy beach strip.
The soils and population pressure force the locals to construct shallow latrines along the busy motorway where the soils are firmer.
“We can’t dig deep because the water table is just too high,” says Chief Mwirang’ombe’s adviser, Mwangende Sichali.
When it rains, running water washes away human waste into the lake, almost 50 metres away.
“It is a struggle here,” he says. “We can’t find proper land for toilets. Only concrete toilets can stand stronger in the lakeside sands.”
But the main challenge is that the locals lack financial muscle to buy cement for toilets, Sichali explains.
He explains: “The fishing village has just two or three concrete toilets. The other latrines, along the M1 Road, are mostly shallow, unsanitary and far from the camp.
Lack of latrines pushes the fisherfolk to defaecate in water or nearby shrubbery.
“We really need financial support to have concrete toilets,” says the village elder.
Ngara is among the hardest-hit cholera hotspots in Karonga where the outbreak has affected 199 people and killed four in three months.
According to Ministry of Health (MoH) spokesperson Joshua Malango, the watery diarrhoea caused by a breakdown in sanitation and hygiene has hit about 275 people in six districts countrywide.
Besides Karonga, other affected districts are Lilongwe, Nkhata Bay, Salima, Kasungu and Dowa.
The highly infectious sanitation-related diarrhoeal disease is also likely to spread to 16 districts of the country, the ministry warns.
Malango says Karonga remains the worst hit, having recorded almost two thirds of the national burden.
Over 20 cases occurred at Ngara alone, says Sichali.
The disease spreads rapidly because of the poor sanitation at the overcrowded camp.
“Fishers from far and wide camp here. They come in several boats carrying up to 10 people each. All these sleep in one house without a toilet. Some defaecate in bushes, others run to the lake. The first cholera case spread rapidly because of such poor sanitation practices,” he says.
Ngara’s vulnerability to cholera is a story of social, economic and geographical barriers faced by lakeshore communities.
In 2008, the country adopted the Community-Led Total Sanitation Policy to ensure every home owns and uses a sanitary latrine.
The push to end open defaecation was envisaged to reduce cholera and other sanitation-related diseases that account for 53 percent of patients in the county’s health facilities.
According to Minister of Health Atupele Muluzi, only 69 out 295 traditional authorities have achieved the open defaecation status.
“Balaka was the first full district to be awarded the status in November 2017. So far, 31 percent of villages still need to meet the required standards,” he said.
The sluggish race to ensure every household owns a latrine raises questions if there are any solutions to overcome the sanitation gap in beach villages?
Water and sanitation specialist Christopher Chindole urges locals to adopt eco-san latrines for sandy and waterlogged terrains.
“There are eco-san toilets, called skyloo. One doesn’t have to dig a foundation. The toilets are built from the surface as long as there is a slab,” he says.
Chindole says the low-cost latrines can be constructed using locally -found reeds, bamboos and other locally available materials.
“We need to upscale campaigns to make people in cholera-prone beach villages aware of technologies,” he says.
The cholera outbreak in Karonga is linked with an earlier spate in Mbeya District, Tanzania, which borders Karonga.
Chindole says the country failed to contain the first public health crisis because sanitation issues have been neglected nationwide.
“It appears government and most nongovernmental organisations have shifted their attention and funding from sanitation issues to disaster and climate change,” he says.
Government invested funds from the Global Sanitation Fund (GSF) in a project to create demand for improved sanitation and hygiene facilities in Nkhotakota, Rumphi, Balaka, Ntchisi, Chikwawa and Phalombe.
Only four out of the six districts have achieved the open defaecation-free (ODF) status when the project phased out last year.
“In most districts, people are still practising open defecation and we have a long way to achieve the ODF status across the country,” says Chindole.
But Malango says government has not shifted its attention away from sanitation.
“Water, sanitation, hygiene and climate change are all government’s priority areas.” n