As cholera spreads across Sierra Leone, thousands of people have fallen seriously ill. Edward John-Bull, director of Caritas Sierra Leone, spoke with Caritas Communications Officer Laura Sheahen about the epidemic—and what Caritas is doing to help.
Can you tell me about the cholera epidemic in Sierra Leone right now?
The virus is spreading fast in our country. Cholera travels with people, and this makes the situation scary. It’s highly contagious.
A relative of mine talked about a 12-year-old girl. She came back from the market one evening and started vomiting. Her parents didn’t know what was happening.
Her father and mother were trying to clean the girl up. Three hours later they also started vomiting. The woman was a breastfeeding mother. The baby got sick too.
In less than 24 hours they were all dead. This is a common theme—a whole family wiped out.
Why has it gotten so bad this year?
Cholera is endemic in Sierra Leone. Every year during the rainy season, there are outbreaks. But as the sanitation infrastructure worsens, it gets worse. Poverty and poor sanitation are growing. There’s lot of open defecation or people throw it in the gutters. It’s a major problem. Cholera will decline as the rains decline, but there are fears that it will be worse every year.
Cholera is migratory–this wave is from Liberia. It first came into Sierra Leone via the border region–cholera-infected clothing, utensils, and food travel miles and miles. Cholera is expected to increase over September and October. The situation is alarming, and the healthcare system is overwhelmed.
What happens when a person gets cholera, and how is it treated?
The first thing to do is take ORS, oral rehydration salts. If it gets worse, back this up with very strong antibiotics.
Once you start vomiting and having diarrhea, the next thing you need to do is rehydrate yourself. At a clinic, they’ll give you a normal saline drip to rehydrate you.
It’s a basic disease that is absolutely controllable. It’s not HIV or ebola. Just simple ORS and saline drips will do. But for people living in remote areas, they don’t know what to do. People come too late the clinic, and their whole system collapses because they’re too dehydrated. Before they can do anything, they are dead.
What can individuals as well as organisations like Caritas do to stop the spread?
There are two major challenges: improving personal hygiene, that is, people’s habits, and improving the water and sanitation infrastructure here.
In the short term, what can be realistically done is to change people’s hygiene habits: improve hand washing, food hygiene and so on. Right now I am close to one of the cholera centres and people were eating food that wasn’t covered, with flies all over it. These are carriers for cholera.
When people do get cholera, they’re using chlorine solutions to wash the clothing, bedding and cookware.
You can also acidify food with lime juice, which kills germs. Lime juice is available, but people don’t know about it. Very poor people don’t know.
The infrastructure situation is more complicated. Sierra Leone is one of the poorest countries in the world. Lack of clean water is a recipe for cholera.
If something is not done about the infrastructure, cholera will remain a big problem. We need to build toilets, improve the sewage system and bring clean drinking water to people’s homes and schools. The sewage system question is difficult: how do you channel waste from kitchen and toilets and individual septic tanks, how do you put all of that somewhere safe where it won’t be a source of cholera infection?
What is the Church’s role in responding to the outbreak?
We are trying to reach into places where the government normally doesn’t work. There are health centres in the country and hospitals. They are all trying their best. But they are helping only those who attend the limited Cholera Treatment Units in the country, mostly in the capital, Freetown.
There are unreported cases—people who do not go to hospitals, either because they find out too late, or are living in remote places where they cannot reach hospitals/clinics/health outposts. If a person has cholera and the nearest hospital is 50 miles away, you can’t access anything. In other cases, some people are not properly informed about cholera and are unaware of the disease when they are hit by it.
The Church is in these other areas, like slums and small villages that don’t have water systems. Priests have called us from very remote areas, saying “people are dying.” Sick people can’t even access the most basic cholera treatment.
The bishops are well aware of the situation and have offered the use of pulpits and schools to spread messages throughout the country to educate people who are not reached by media or by the ministry of health.
Some people think this is a spell. No one understands what is happening. They don’t know the causes of cholera.
The ones who have gone to school, they are able to protect themselves very well. The illiterate ones don’t know.
Can you give me an example?
One of our Caritas secretaries here, a woman name Wuyatta, woke up last week and felt funny in her stomach. She had aches and pains all over.
Because she was educated and informed, she knew about cholera. She kept ORS and antibiotics in the medicine cupboard in her house. She rushed to the medicine cabinet and took tablets. Later she started vomiting and went to hospital. She was diagnosed with cholera, but her situation was better because she was diagnosed early. She was given a saline drip. Because she was experienced and informed, the disease could be kept under control.
Caritas wants to make sure every family, every household, has a stock of this medicine ready in case cholera attacks them. We want to make sure they understand how it’s transmitted, so it doesn’t recur year in and year out. With the support of the Caritas network, we hope to provide more hygiene trainings, especially in remote areas. We urgently need any assistance that we can get.
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