Cholera fight not over

In Blantyre, a health centre once choked by cholera patients now provides water to its underserved populous settlements around it.

From as early as 2am, women and children are seen queuing for water at Makhetha Health Centre’s borehole as scarce taps in the neighbourhood have been running dry for days since July.

The fierce scrambles for clean water persist all day, a reminder of the water, sanitation and hygiene (Wash) crisis that reduced Blantyre City to a hotspot of Malawi’s deadliest cholera outbreak in the past two years.

“Government has declared an end to the cholera outbreak, but the battle isn’t over yet,” says Chifundo Alumando, 26, shoving her bucket in a snaking queue. “We cannot win the war on cholera when safe water remains beyond reach.”

The Wash gaps fuel cholera, an acute diarrhoeal disease that kills within hours if left untreated.  It claimed 1 772 lives from 59 376 patients between March 2022 and August 2023.

Experts associate the disease with poverty and inequality typical of underserved low-income settlements like Makhetha.

When inundated by over 70 cholera cases daily, its roadside health centre stopped treating everyday diseases to concentrate on the emergency.

Now, Alumando, a nursery school teacher in Makhetha, wakes up around 3am and walks over a kilometre to fetch water at the health centre.

She narrates: “This has been a daily routine since July when the taps started stuttering.

“Water only runs for a few minutes, often at night when we are fast asleep. We endure sleepless nights to fetch water at a borehole meant for the health facility.”

Regina Tingo, a mother of six, lives near a communal tap that dried up six months ago.

“We are tired of reporting the matter to Blantyre Water Board [BWB],” she says. “Since there is no response, I have to queue at the borehole as early as 2am, leaving my husband in bed. This affects my marriage. “

Those who cannot stand the jostling or afford water which costs K200 per 20-litre bucket draw filthy water from Mudi River.

Nearby communities and factories dispose of various waste in the river.

“This water is not safe for anyone, but what can we do?” asks Ishmael Lipenga, 34. “We go to the river to bathe, wash clothes and fetch the water we drink and use in our homes.”

Makhetha Health Centre clinician-in-charge Derrick Saka calls the water, sanitation and hygiene situation a time bomb.

“We are sitting on a time bomb,” he warns. “If nothing is done about it, history will repeat itself and the battle against cholera will not be won.”

Saka says most people in the township have no access to Wash facilities such as toilets.

“They are still prone to cholera and other waterborne diseases,” he says.

Saka says the health facility requires piped water for infection prevention as gushes from the overwhelmed borehole are contaminated.

“We have to live by example. The water from the overcrowded borehole has to be treated with chlorine,” he says.

Makhetha Health Centre recorded 14 deaths from 778 cholera patients.

The facility has treated over 5000 diarrhoea cases since July.

Disease surveillance and control assistant Emerson Mndala says cholera prevention messages cannot work where people still drink unsafe water.

“We preach prevention measures to make cholera history, but prolonged water and sanitation problems wash down our efforts,“ he laments.

BWB supplies the southeastern side of Blantyre City from the Likhubula River on Mulanje Mountain.

The water stress is caused by drought induced by the El Nino weather pattern that hit the Southern Region in the past rainy season.

The prolonged cholera outbreak brought fresh urgency to improve the provision of safe water and sanitation for all.

Both President Lazarus Chakwera and Minister of Water and Sanitation Abida Mia have dialled up the call to close the gaps.

However, the neglected Wash gaps punch holes in the national response plan and global push to make cholera history by 2030.

The gaps are prevalent in low-income urban areas, especially slums and clustered settlements such as Makhetha.

Chisangalalo Mombezi, 32, says although the township is supplied with communal kiosks, most of them were closed down since many people could not afford water from the facility.

“Water kiosks are too expensive for low-income settlements like ours. We cannot spend over K1000 daily on water “she lamented.