By Samuel Boadi & Esther Awuah
THE MODE of transmission of the recent cholera outbreak in Ghana has taken a new twist. Contrary to the known gestation period of three to five days, the current infection manifests itself within a few hours, after a person comes into contact with the cholera bacteria, killing people within a twinkle of an eye. So far over 70 people are said to have died and the death toll appears to be rising. Kasoa, a sprawling community outside Accra is said to be the hard hit. Clinics and hospitals in the are full to capacity with reports of cholera disease.
Victims suffer from large quantities of watery stools alongside uncontrollable vomiting. The incidence keeps increasing at an alarming rate, according to health officials. Hospitals are choked with cholera patients, a development which has virtually caused fear and panic among the citizenry.
Unlike in previous years when the disease was prevalent in the rainy season, the current epidemic is taking place in the dry season. Medical officers are finding it difficult to determine the cause of the outbreak. A study has been commissioned by the Ghana Health Service (GHS) to determine its possible causes, but is yet to be presented to shed light on the origins of the widespread contagion.
Signs and symptoms
Cholera is an acute infection of the small intestine, caused by consuming food and water contaminated with the Vibrio cholerae bacterium (cholera bacteria). The period between being exposed to the bacterium and the presence of symptoms is very short.
Patients infected with cholera suffer excessive painless and watery diarrhea. Most persons also experience intense vomiting. This leads to severe and rapid dehydration and even death if treatment is not quickly administered. Symptoms of dehydration include a rapid pulse, sunken eyes, low blood pressure and wrinkled hands.
Most persons infected with the disease do not become ill and suffer from these symptoms, despite having the bacterium in their faeces for 7 to 14 days. In cases where illness occurs, most episodes are mild and difficult to differentiate from other types of diarrhea. Less than 20percent of cholera patients develop symptoms of severe dehydration.
Fortunately, cholera is easy to treat. According to the WHO, 80percent of people can be treated effectively using Oral Re-hydration Salts, while severely dehydrated patients require intravenous fluid administration, a common sight in our hospitals today.
Victims’ stories
Daily Guide visited the Korle-Bu Polyclinic and conducted interviews with some of the victims.
Twenty-eight-year-old Kwasi Agyei, a resident of Lapaz, Nii Boi Town, said he would have been dead by now were it not for the timely efforts of his co-tenants.
Recounting his ordeal, Kwesi said when his elder and younger sisters observed him dehydrating from passing excessive stools and vomiting, they rushed him to a prayer camp instead of a hospital.
Kwesi contracted the disease when he went to join his workmates at Suhum on Wednesday to connect a drilled borehole. When he felt thirsty, he could not immediately find water to drink so he tasted the water from the borehole.
“In fact” he said “it tasted so nice that I gulped down a lot and felt very full.”
On his way to Accra, he felt hungry so he bought some fried ‘turkey tail’ popularly called ‘tsofi’ and fried yams at Nsawam.
“As soon as I got home, I retired to bed because I was very tired he said. “But on Thursday morning, I sensed some discomfort in my stomach which was followed by frequent visits to the toilet. After the third time, I became very weak so I called my sisters to take me to the hospital.”
He recounted that instead, he was taken to a prayer camp where the pastor told him he was a witch, hence the reason for the infection.
“So there I lay unable to defend myself and receiving prayers in tongues upon tongues and almost dying. As if by divine intervention, my colleagues visited me in my house and sensing danger, took me to Korle-Bu from where I have received treatment since.”
Afrifa Rita, another victim who had fully recovered from the infection and was waiting to be discharged, is a resident of Mamprobi and sells rice by the roadside.
The 26-year old woman said she bought some beans and fried plantains on Saturday in the area where she sells rice.
“The environment where I bought the food was not neat at all” she admitted, “but the food tastes so nice that I am tempted to buy it anytime I go hungry.”
Then on Sunday morning, she sensed some weird sounds in her stomach. “I went to toilet and it was all watery. After about the sixteenth stool, I started vomiting so my housemates rushed me to Korle-Bu where I was put on fluids. I’m fine now but I have pledged not to buy from an unkempt environment again. I have learnt my lesson,” she said.
Kobina Tachie, a 33-year-old resident of Odorkor Official Town, sells pumping machines. Narrating his story, he described how he bought some boiled rice and stew at a junction near his shop where a refuse dump was situated on Sunday.
“At dawn on Tuesday, I started feeling cramps in my abdomen” he began. “Then the diarrhea began so I went to a drug store to buy some medication.” Still, the cramps worsened and did not cease.
Mr. Tachie went to a clinic, Rock Hospital, but the personnel there were unable to assist with his situation. He was made to wait for a doctor until 4pm. By that time, his situation had gotten worse so he was rushed to the Korle-Bu Teaching Hospital.
“I thank God I am doing fine” he expressed, “I want to take this opportunity to tell other members of the public to be careful with what, how and where they eat.”
However, the victims at Korle-Bu Polyclinic have complained about the payment of bills after their treatment. They claim they cannot understand why Government has announced a free treatment for victims but yet they are being asked by the Polyclinic to pay amounts ranging from GH¢24 to GH¢30.
But Mr Aryee, Disease Control Officer at the Polyclinic told Daily Guide that the payment is meant for giving sets, canolas and other required items which are not covered under the Government’s package.
Prevention
According to Dr. Salamatu Attah Nantongma, a medical officer at the Korle-Bu Teaching Hospital, who also works at the Family Medicine Department of the Korle-Bu Polyclinic, the mode of transmission is through the faeco-oral route, meaning from hands contaminated with the bacterium and passed on into the mouth.
“One can get cholera if one eats fruits and vegetables that are not washed or boiled, eats cooked foods that have gotten cold and have been handled with people’s hands, or drinks un-boiled and untreated water in places where there is an outbreak of cholera,” she said.
To prevent it therefore, she stated that people must practice washing of hands before meals, washing of hands when you come in from outside where you have greeted people and touched a lot of things, washing of hands after using the washroom, and avoiding communal drinking of water.
She said that the people must boil their drinking water and keep it in clean covered containers and eat cleanly prepared hot food. In addition, that people should be selective about where they purchase their food
“You have been told how to protect yourself, but you still have the choice to go and eat from anywhere, so exercise caution” she stressed.
The number of patients seems to rise during the weekends, when people are busier and purchase food and drinks outside the home. “People should be careful especially when they attend funerals and other functions” she said, “They are rushed in here in numbers and the situation is very appalling.”
Although Dr. Nantongma was unable to confirm to what extent sachet water consumption contributed to the current outbreak, she emphasized that the public should exercise extreme discretion when purchasing from unknown or unpopular sachet water producers.
“There are some brands where we are not really sure whether they have been approved by the standard board or the Food and Drugs board” she said, “So as much as possible we advise that you stick to the popular brands”
The Current State
Cholera has spread widely throughout the world since 1961. In Ghana, it was first reported in 1970. Major epidemics were recorded in 1971, 1977, 1983, 1989, 1991, 1995, 1998 and 2005 in all ten regions while localized outbreaks have cropped up in coastal regions.
The unprecedented amounts of rainfall experienced in 2010 necessitated the opening of the spill ways in both the Bagri Dam in Burkina Faso and the Akosombo Dam in Eastern Region. These led to floods in most low-lying areas. All these, together with other high risk factors such as poor sanitation, lack of potable water, poor personal and food hygiene, have provided favourable environment for the transmission of diarrhoeal diseases including cholera.
Current statistics on the epidemic
Though the most recent study on the epidemic is expected to be made public next week, statistics available from the Ghana Health Service (GHS) for 29th September 2010 to 27th March, 2011 indicate that from the 10 districts in Greater Accra, cases reported stand at 4,499 infected with 36 deaths. This is followed by 573 cases from 12 districts in Eastern with 9 deaths; 554 cases from 7 districts in Central with 24 deaths; 8 cases from one district in Upper West with no deaths and 32 cases from a West Gonja, district in the Northern region, with no deaths.
According to Dr. Joseph Amankwah, Public Health Director of GHS, in an interview with Daily Guide, between 800 and 900 cases are reported each week. He describes the recent outbreak as a mysterious one.
He said another factor that could be contributing to the situation was that most landlords in Accra have rented out rooms without toilet facilities. This has contributed to a lot of people defecating in bushes nearby, packaging faeces in black polythene bags and throwing these into gutters among other unhygienic acts. The faeces are washed into water bodies which serve as source of drinking water to homes whenever it rains.
“This is weird because yet the Accra Metropolitan Assembly (AMA) doesn’t seem to care! This shows how Ghanaians are dirty” stated Dr. Amankwah.
The Way Forward
The GHS has warned that the prevention and control of cholera require an integrated multi-sectoral approach since the control of most of the risk factors are beyond the health sector.
“The outbreak is not under control and is still spreading rapidly. The possibility of it spreading to other regions and districts is very high,” it noted in a memorandum.
GHS notes that the control of the infection depended largely on the collaboration of various ministries, namely the Ministry of Local Government and Rural Development, Ministry of Water Resources, Works & Housing, Ministry of Information and the Ministry for the Interior. GHS has stated that sustainable improved water management, as well as general environmental sanitation were crucial and critical.
“It is about time that the needed resources (financial and material) are timely made available for the implementation of key activities outlined in the National Short Term Action Plan.”
Dr. Nantongma of Korle Bu warns that the situation might yet get worse, unless government, health agencies, civil society groups and the public take proactive measures towards preparedness and response
“The rainy season is around June and July” she states with concern. “There is a potential that the outbreak could get worse. We usually don’t have cases during this time. We are all just hoping that people are listening. We are hoping that people are changing their practices,” she said.
