Cholera epidemic - MSF supports overwhelmed local health authorities

A cholera epidemic has spread across all districts of Cameroon’s economic capital, Douala, home to 2.1 million people. The epidemic, which was officially declared 14 months ago, in September 2010, has peaked and troughed a number of times. In March and April, during the short rainy season, cholera peaked with an average of 120 cases per week. But since September the number of cases has been increasing further, with more than 400 cases per week reported in mid-October.

“The existing health structures were no longer able to care for patients adequately. We found two to three patients per bed, some lying on the ground or on benches, in an appalling condition,” says Dr Narcisse Wega, MSF’s emergency coordinator in Cameroon. “Health facilities had reached their limit and were no longer able to cope with the influx of patients.”

Médecins Sans Frontières (MSF) teams carried out an assessment and within days opened a cholera treatment centre in the hospital of Laquintinie. Staff treated more than 350 patients in the first two weeks. “We transferred the overflow of patients from existing health facilities to the cholera treatment centre, and established a referral system with an ambulance service,” says Dr Wega.

In early November, national stocks of oral rehydration solution (ORS) ran out and patients had to be treated with a home-made solution. MSF has since provided the Ministry of Health with more than 120,000 sachets of ORS. “This is enough to treat around 12,000 patients ­– a figure beyond the number of expected cases,” says Dr Wega. Each of the city’s 11 existing cholera treatment units now incorporates an oral rehydration point.

MSF’s emergency teams are also conducting prevention activities by purifying water with chlorine, and carrying out health promotion activities in communities and through the media.

There has been a gradual decrease in registered cases of cholera in the past few days, raising hopes that the current peak is over. During the third week of November, 15 new admissions were registered per day at the Laquintinie hospital treatment centre, compared with 40 daily admissions during the previous week. “This corresponds to the rain having stopped in the past ten days,” says Dr Wega.

Cholera is endemic in Cameroon, and is linked to the poor conditions in which many people live. “The majority of patients come from areas where living conditions are precarious, where houses have been built in flood-prone areas, and where hygiene conditions are poor. There is a lack of latrines and access to drinking water. Faced with these structural problems, which help the spread of the disease, the problem can’t be solved through medical intervention alone,” says Dr Wega.

“We treat patients, we raise awareness about hygiene precautions, but we must be prepared to start all over again in March or April when the next rainy season is expected.” 

As a result of the recent decrease in cases, MSF is preparing the end of its emergency response, in collaboration with the Douala health authorities. MSF teams are training local health staff on cholera treatment and hygiene management. “Our objective is to provide them with the tools to be able to respond to the next epidemic," says Dr Wega.

MSF has been working in Cameroon since 1984. It supports a pilot project in Nylon hospital, in Douala, to help HIV/AIDS patients who have developed resistance to their drugs to start second-line treatment. In Akonolinga, in central Cameroon, MSF treats people affected by Buruli ulcer.