Cholera in Malawi escalates as rain pounds down

While cholera is endemic in Malawi, it has been eight years since the
country's worst outbreak, which killed almost 1,000 people, so much of
the memory' of how to respond to cholera is lost.

As the cholera outbreak in Malawi escalates, the number of cases more
than doubled in January with 1,142 cumulative cases recorded and 39
deaths – and the number continues to rise.
Exacerbated by poor sanitation and rainy season floods, the outbreak
started in the capital, Lilongwe, on November 17, quickly spreading to
two of the capital’s densely-populated slums where there is no running
water. The disease has now spread to more than 30 percent of the
districts in the country, with the highest concentration remaining in
and around  Lilongwe.

Thirtynine people have died from cholera with more than 1,000 cases
recorded," said Dr. Moses Massaquoi, Medical Coordinator in Malawi for
Médecins Sans Frontières (MSF). 

"It's extremely worrying as the disease continues to spread and numbers
mount. Every day the rain pounds down and people with no access to safe
water resort to drinking untreated water from swamps or from
unprotected wells in slums. As one of the poorest countries in the
world, water and sanitation levels are extremely low. On top of this,
the floods cause latrines to overflow and sewage then mixes with
drinking water.

MSF teams are helping to set up special isolation units in the most
affected areas in Lilongwe and also installing latrines and donating
special cholera beds and plastic sheeting to help with the response.

Authorities here are doing their utmost to try and contain the spread,
but it is a real struggle," said Dr. Massaquoi, "At the best of times,
the country has an acute shortage of healthcare workers so, when
cholera breaks out, it puts an unbearable strain on an already creaking
health system and overworked medical staff.

While cholera is endemic in Malawi, it has been eight years since the
country's worst outbreak, which killed almost 1,000 people, so much of
the memory' of how to respond to cholera is lost.  As a result, MSF
medical staff  are carrying out intensive bedside training and
mentoring for national Malawian nurses and assisting them in handling
cases to increase their capacity to respond to and contain this
outbreak.

People have forgotten about the disease so it spreads faster," said
Dr. Massaquoi.  "Right now, there aren't enough health staff in Malawi
with the training or experience needed to respond to a serious cholera
outbreak. Time is life in a cholera outbreak so it's essential to act
fast, but people are going to clinics too late. Cultural practices are
also contributing to the worrying increase in cases as people continue
to wash dead bodies before burial, look after and visit the sick, and
eat together during funerals.

MSF has worked in Malawi since 1986.–MSF