Cholera which first broke out in Guinea Bissau in May in the southern region of Tombali has now broken out in the capital Bissau killing four people and infecting 214, according to Daniel Kertesz, representative of the World Health Organization (WHO).

So far across the country 325 cases have been reported and twelve people have died.

“We are still assessing the situation but we could be looking at two separate outbreaks,” Kertesz told IRIN, “We managed to contain the situation in Tomboli going several weeks with no cases, but then it broke out in Bissau.”

Cholera is essentially a disease of poor sanitation that occurs in areas where people lack access to clean drinking water and basic sanitation facilities. The WHO describes it as “one of the key indicators of social development” because it only occurs regularly in poorly developed countries.

Intervention

The Ministry of Health is working with its partners, including the WHO and the UN children’s fund UNICEF, as well as many non-governmental organisations and civil society groups, on a two-pronged strategy to try to prevent people from contracting the disease as well as to contain it.

“The prevention side involves telling people about public hygiene – they need to regularly wash their hands for instance - and telling them to only drink clean water and to cook their food well,” Kertesz told IRIN.

The Ministry of Health in setting up special sanitation brigades which go house to house showing people how to treat water by boiling it or purifying it with small amounts of bleach.

Health minister Eugénia Saldanha also asked the population to suspend all traditional ceremonies, which may involve killing large quantities of animals, handling food in unhygienic conditions and exchanging food between people, which can cause the disease to spread.

Treatment of cholera is fairly straightforward, using oral or intravenous rehydration to replace lost fluids. “Cholera is a very treatable disease”, said Kertesz, “if you can get access to treatment quickly then there’s no reason why you should die.”

According to him there is an adequate amount of rehydration salts in the country to combat a large epidemic, but the real constraint is getting treamtnet to the right places in time.

In the capital Bissau a special unit with ten health professionals has been set up to attend to cholera patients at Simão Mendes Hospital.

But health minister Saldanha said at a press conference that while health centres in Bissau are set up to care for cholera patients, obstacles such as lack of safe drinking water can hinder treatment in them.

Preventing cholera in the long term would involve drastically improving Guinea Bissau’s water and sanitation infrastructure. The country has some of the worst coverage of modern water and sanitation facilities in the world according to the UN. In rural areas under half of people have access to clean water and under a quarter can access a modern toilet.

Over the past 10 to 15 years the country has experienced large-scale cholera outbreaks every two to three years.

“Many people misinterpret cholera as a health problem when it is a problem of water and sanitation,” said Kertesz. “If people have clean water and access to sanitation facilities, they won’t get cholera.”

He added, “We all have a lot of work to do in Bissau on this issue, and this requires the efforts of all development partners.”

IRIN