Eliminating cholera outbreak myths in Karonga: Deaths, cases on the rise
It was soon after she had a bath in the lake that she started to complain of stomach pains. No sooner than we thought of ignoring her complaint than she started purging and vomiting.
In 30 minutes time, things became worse. We then realized it was persistent diarrhoea and vomiting and the girl became so weak.
Upon taking her to Nyungwe Health Centre, we were told it was cholera. Sadly, it was too late to save her and she bid farewell and closed her eyes forever.
As Mama Mwakyanjala (not real name) narrates her ordeal, tears quickly fill her eyes and run down her cheeks. She can no longer continue to explain circumstances leading to the death of her nine-year-old daughter.
Such is the situation at Ngara fishing camp in the area of Traditional Authority (TA) Mwilang’ombe in Karonga District.
The area, located along M1 road to Mzuzu, about 40 kilometres from Karonga Boma, has been well known for fresh fish over the years.
Many traders from Mozambique, Tanzania and within the country come to Ngara to purchase usipa and other fish types.
On arrival at the camp, one is greeted by smells of usipa, some of which is seen sundried on wooden benches.
A walk around the camp, one appreciates that the place is just squeezed to a 300-metre radius filled with shacks constructed by the fishermen along the lake.
Spells in the lake
Despite the positive economic attribute, Ngara is also famous for being the hub for cholera outbreak in the district. Ironically, most people around the area have been blaming it on witchcraft and fishermen at the camp.
The people believed that cholera originates from witchcraft, saying the outbreak is magically thrown into the lake from Tanzanian side and people get sick once they use the water for a bath or cooking.
However, Senior Group Village Headman (GVH) Mayereka within Ngara area says there is no connection between cholera and witchcraft.
He argues that people should understand and learn from the sensitization campaigns being carried out by Karonga District Hospital and other organizations that cholera originates from poor sanitation and unhygienic practices.
“People should always rush to hospital when they experience the signs of cholera. This is not from witchcraft. It comes from poor sanitation and lack of proper hygiene.
“For a longtime, most people in this area have been drinking water from the lake, yet others use the same lake for defecation,” says Senior GVH Mayereka adding that the area remains the worst hit during cholera outbreaks due to lack of proper latrines.
As part of the solution to the problem, he says traditional leaders in the area have instructed people to be sweeping beaches and other areas along the lake.
Mayereka adds that Karonga District Council needs to advise people on how to construct strong toilets as the area at the fishing camp is mostly sandy.
Due to the sandy soil, some households constructed temporary pit latrines on the edge of the M1 Road, taking advantage of the compacted soils within the tarmac road’s boundaries.
Mwiza Msiska, a Ngara resident, says fishermen are to blame for the cholera outbreak at the fishing camp.
She says many fishermen converge at the camp from elsewhere during rainy season because it is the only place where usipa is caught in abundance.
Msiska adds that most boreholes around Ngara have salty water hence many people prefer fresh water from the lake which is not treated.
Combating the outbreak
Cumulative cholera figures show that Karonga registered 307 cases including five deaths as at February 27 out of 630 cases with 12 deaths countrywide.
District Environmental Health Officer at Karonga District Hospital, Lewis Tukula, says since the outbreak in November 2017, Ngara has registered the highest number of cases among other areas like Gumi, Mlare and Kaporo.
He says despite several interventions by different stakeholders, communities are still not adopting good hygienic practices.
“Response to the outbreak is always difficult because some communities remain rigid when it comes to adopt best practices. This has undermined efforts in eliminating cholera, resulting in prolonged outbreaks and wasting of resources,” Tukula says.
Malawi Red Cross Society (MRCS) is one of the organizations that is helping in combating the outbreak in the district through awareness meetings.
With K17million support from European Union Humanitarian Aid, MRCS has engaged volunteers and Health Surveillance Assistants (HSAs) to carryout door-to-door awareness campaigns on cholera prevention in the district.
The Red Cross Communications and Humanitarian Diplomacy Manage, Felix Washon says the door-to-door tool is an effective way of delivering cholera messages to the communities because it reaches out to more people and allows for direct interaction.
“We have trained and engaged our community volunteers and HSAs on cholera, its signs and symptoms so that they go out and teach others on how they can prevent the outbreak.
He said apart from door-to-door concept, the organization is supporting construction of temporary latrines and bathing shelters in all treatment centres and revamping village beach committees to improve sanitation and hygiene issues along the lake.
Karonga District Commissioner Richard Hara recently invited chiefs and councilors surrounding Ngara to discuss with the people on how best the place can be improved.
The meeting outlined a number of resolutions such as to continue sensitizing the people to use chlorine whenever they use water direct from the lake.
Senior Chief Mwilang’ombe feels the long-term solution to deal with the outbreak is for the people to move to upland where they can construct proper houses with toilets.
“If you don’t know, this epidemic started in Kyela sometime back; then it came to Iponga, then Mwakaboko and now it’s in my area, Ngara, where it seems to have found a fertile ground.
“Please, let’s find ways of removing these people. They build shabby houses with no toilets. How can we win the battle against cholera with the presence of such unhygienic structures?” wonders Mwilang’ombe.
Meanwhile, government, through the Ministry of Health, procured 108,000 cholera vaccines for Karonga District as a way of ending the epidemic in the district.
The vaccination campaign is underway in cholera hotspots especially fish camps like Ngara, a development which gives hope as a lasting solution to the annual epidemic.
Karonga District Director for Health and Social services Dr. Phenious Mfune says the campaign is going on very well as many people are going to the sites to get the vaccine.
However, Mfune says the vaccine is not enough to cover the entire population in the district.
“We got 108,000 dosages of vaccine against the population of 369,000. That is why we have targeted cholera hotspot areas such as fishing camps like Ngara, Nyungwe and Mlare,” he says.
According to Mfune, after taking the vaccine, one can take five years without catching cholera as they continue practicing good hygiene and sanitation.
But Hara cautions people against being contented with the vaccine by continuing to live under unsanitary conditions.
“Practicing hygiene is the only way we can fight cholera. We still need to intensify hygiene and sanitation in your homes,” the District Commissioner says.
With all the interventions in place, one can only hope that they will help eliminate the myths surrounding cholera outbreak among people of Ngara that the disease comes with magical waves from across Lake Malawi.
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