Saturday, 28 August 2010

Cholera’s Killing Fields

It is not easy being a poor man in this country. You either live in abject penury, barely on the verge of emasculation, or you are brutally scythed by one mishap or the other. Security of life is not guaranteed, or available. Unnatural causes of death are too many. There are many diseases prowling all over the place, claiming innocent victims. For women and children, their killer diseases are well known - childbirth, malaria, polio. And for the men (and women), there is cholera, HIV/AIDS and (at least in Zamfara State lately) lead poisoning. Many of these diseases are wreaking their havoc all year round, but some are seasonal. Each one of them comes with its special brand of brutality, dispatching its poor victims to the great beyond. The sad part of it all is that most of the diseases killing people in Nigeria are curable and are in fact a history in many parts of the world. It only takes a responsible and responsive leadership to do away with them.

One of such “simple” diseases is cholera, an acute intestinal infection that causes severe vomiting and diarrhoea, leading to serious dehydration. It is caused by drinking contaminated water. And there is a lot of it in the country. In the north, where most of Nigeria's poor live, sources of water in the rural areas and indeed in many urban centres are mainly open wells, ponds and streams. People defecate and throw trash irresponsibly–in open spaces like bushes, uncompleted buildings and dung-hills. Now when the rainy season comes, rainwater washes the dirt into the water reservoirs, contaminating them. When people drink the water, which is collected for personal use or vended by street traders, they can be infected by the cholera virus. Cholera can kill fast if not properly treated.

Health experts say that cholera can be easily treated by giving an infected person some fluids, including an informed mixture of ordinary salt, sugar and clean drinking water, as soon as its symptoms appear. But as with all diseases, prevention is better than cure.

Ignoring this simple but essential dictum, however, often portrays us as an unserious nation. It is happening just as I write this. Within the past two months only, at least 352 persons–all of them poor people–have died from a cholera epidemic now ravaging most of northern Nigeria.

The Public Health Department of the Federal Ministry of Health (FMOH) reports that the states affected are Jigawa, Bauchi, Gombe, Yobe, Borno, Adamawa, Taraba, FCT, Cross River, Kaduna, and Rivers. A cursory look at this list shows that most of the devastation is taking place in the north, although the ministry said that epidemiological evidence indicates that the entire country is at risk.

Health officials also fear that the infection may spread further afield, taking more lives. These fears are not far-fetched. In 2001, when a similar outbreak of the disease occurred, the absence of coordination between the three tiers of government, as well as the lackadaisical response from the governments, led to more devastation. Within a short period of time, more than 1,000 people were killed, over 700 of them in Kano alone. The Kano State government only admitted to the outbreak and began a half-hearted response after that huge loss had been recorded.

We shouldn't forget, also, that the 2001 epidemic began in October and carried on through to the first weeks of the new year, claiming over a hundred more lives in Jigawa and neighbouring states. We are–this year–just in August, which means that if the disease is going to kill more people, it has just begun. Mansur Kabir, the then health commissioner in Kano, had said wistfully as the ugly figures rolled in: "The epidemic has been worse than we expected," echoing widespread belief that state officials had always underestimated the potential ravages of an oncoming health challenge.

Such underestimation appears to be playing itself out even now. As many northern state governors travel out to Saudi Arabia for the lesser Hajj, and others ponder their electoral fortune come next year, the cholera's killing field is becoming messier. Official response is still below average. As such, if the worst onslaught finally comes, God knows what the tally will be.

The northern state governments should declare an emergency on the cholera devastation now. No stone should be left unturned in the task of arresting the worsening situation. Governments at federal, state and local levels should embark on a big campaign to sensitise the people on the disease, telling them the simple methods of avoiding it. One of these methods is observing good hygiene. People should stop defecating or throwing trash anyhow. They should also imbibe the culture of washing their hands after going to the toilet or before eating anything. All foodstuff should be washed before eating.

More importantly, people should watch the kind of water they drink. Consuming water drawn from open wells and other sources carries the risk of getting infected. The awareness campaign should be on radio and television, as well as on posters, handbills and through town criers. The role of community leaders in this is vital. In the good old days, there were sanitary inspectors who went from village to village, and street to street, ensuring that the people's sanitary habits were correct. People were punished for defaulting. Why not bring back the tradition?

As I argued above, preventing an outbreak of a disease is better than the attempt to cure it. Governments should know exactly when to start preparing for an outbreak and work hard on it. Cholera comes around this time every year, so why should we wait until people have started dying in droves before jumping up to provide drugs and other relief materials? Such knee-jerk approach is responsible for the ugly scenes we are seeing today in public health centres in states where cholera is hitting hardest.

The federal government should also consider increasing the budget for the health sector. Statistics show that 70% of Nigeria’s health budget is spent on urban areas where 30% of the population resides, thus leaving 70% of the populace to rely on a paltry 30%–the dregs–of the health care allocation. I daresay that the 30% is spent not on the health challenges of the common man only, but also on the perks–salaries and allowances–of the health workers and irresponsible government officials, who also eat huge chunks of the donations from our foreign development partners. The figures also show that only 5% of our federal budget is allocated to health; to actualize the goals of the Millennium Development Goals (MDGs) and solve most of our health care problems, Nigeria is required to spend 15% of its total budget on health. When will that happen? Or should we continue to watch our communities being depopulated by diseases that are not ordinarily beyond our control?

Published in LEADERSHIP, on Saturday, 28 August 2010

Above photo: Cholera has killed at least four people in this village in Kaduna State as a result of contamination of open wells

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