E-newsletter Issue 45 | May 2006
From the middle of a cholera epidemic: South Sudan
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Helen Cox is a Melbourne epidemiologist currently working with the Spanish section of Médecins Sans Frontières (MSF) in Africa. Based in Nairobi, Helen is advising projects that respond to outbreaks of disease in the region. Her latest letter comes from South Sudan where, since January, MSF has been responding to an outbreak of cholera. |
I am in Juba, the new capital of South Sudan; Juba is a city of anywhere between 250,000 and half a million people. The population is somewhat important as we are currently in the midst of a cholera epidemic in Juba. Since the end of January there have been anywhere between 2,000 and 4,000 cases reported, and at least 100 deaths. We have set up two treatment centres in town and so far have treated around 1,000 cases of suspected cholera. At the moment it looks like the numbers are decreasing each day, but the rainy season is due to start very soon. If the rains start, we are worried that it will wash cholera contaminated material into the river. The Nile is unfortunately the direct source of water for much of the population in Juba. People either take water directly from the Nile by bucket or from a water tank that pumps water directly from the river. People are recruited from around the city to put chlorine in every bucket, but I’m sure that many are missed. There is very little sanitation in Juba, if at all; hence the concern about the forecast rains.
On a personal level, it has certainly been physically hard and mentally demanding. Working with two Ministries of Health - one from the north and one from the south of Sudan - along with other agencies has been challenging. Many people really do not understand how infectious cholera is, nor do they understand the need for stringent infection control, as well as the most appropriate case management strategies. At the start of the epidemic, some people handing out antibiotics (the full range) and even worse using insecticide as a disinfectant! Luckily we managed to convince them otherwise; now they are just supplying us with water each day. But every day there is a new problem to deal with.
At the moment we are trying to find ways to reach people who may be sick but have very poor access to the treatment centres. We are still hearing about people dying at home before reaching any care. This is very difficult to deal with as traditionally the family need to wash the body prior to burial, but as bodies are highly infectious and most families cannot afford soap, we need to prepare the bodies ourselves and spray the house with chlorine. Trying to explain to grief-stricken families that they should not touch the body and that we will, is very hard, as is the physical task of preparing the bodies. This is a skill that I really wish I did not have to learn. So, to deal with this we are trying to put up small health posts that can provide treatment in these areas and we will try to arrange transport for the sickest people.
Today I’m in the office trying to catch up on all the paperwork and have a rest. We are trying to get a flight for me back to Nairobi, where I can hopefully take some days off. We have planned that if the number of cases starts to increase I might come back to Juba again, and help with preparations for the next epidemic. The team here are fantastic, very competent and dedicated, but still with the ability to laugh. I feel really quite privileged to work with them all.
MSF has since been successful in limiting mortality caused by the cholera outbreak in Juba (South Sudan), but now there is a second peak and the emergency continues. Since writing this letter Helen has been on an exploratory mission investigating a suspected outbreak of meningitis in Wau, also in South Sudan.