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Cholera in Zambia: 'People do not want to talk about it. It's a dirty disease'

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What are the symptoms of cholera?

Watery diarrhea and vomiting, according to the case definition we are using. When people show those symptoms they are hospitalized, even if they are not too severe, because we never know, they might develop a severe cholera very fast. In addition to the patients that come directly to the CTC, we have a team that visits the smaller Cholera Treatment Units (CTU) in town to identify potential cases. A lot of them arrive in a severe state due to the fact that cholera develops very fast and people loose a lot of fluids. A case can get severe just in a couple of days.

How is it transmitted?

Through the food, but mainly through contaminated water. This outbreak is really due to a problem of water and sanitation. It affects first of all the most vulnerable people, those living in the poorest areas, with poor water and sanitation conditions.

How do you treat it?

Most of the cases that are hospitalized need intravenous fluids and oral rehydration salts (ORS) in order to replace the fluids they have lost. Normally, with this simple treatment they should recover promptly. It is only when a patient does not get better after a few days that we give him antibiotic.

Other diseases such as malaria or HIV are endemic in Zambia. Can it make it more difficult to treat cholera when a patient is coinfected?

Of course, when the patients are coinfected they generally get worse faster. In the CTC we also provide treatment against malaria whenever a patient shows very high fever. Regarding HIV, we suspect some cases, but we do not know.

When we have strong clinical suspicion of HIV infection, we advise the patient to go and do the test and we inform them of services offered by other organizations in Lusaka working on HIV projects. We are not in a position to adequately care for an HIV patient during this type of emergency intervention. MSF has HIV projects in other parts of the country but not in Lusaka.

Is MSF's capacity sufficient to face the outbreak?

So far, MSF's teams have treated more than 3,000 patients, more than 300 per week in the lasts weeks. We still expect a lot of new cases, but the situation is a bit more stable now, at least in George, where the peak has passed already. In the south of the city we have not reached it yet. But the team has worked a lot to set up a new CTC in the south. So we don't know exactly what will happen, but I think we are quite prepared.

What is the result of our intervention? Has it been successful?

So far we have had a case fatality rate (CFR) of 2.8% [which means a recovery rate of 97,2%], and this percentage has been going down. So we can consider that the intervention has been very successful.

Is there any risk for the health staff?

Of course there is always a risk. We have to be very careful and wash ourselves with chlorinated water all the time. It is also very important to train properly the local staff so that they follow strictly those measures. It has not been a problem so far; they are very careful, as they don't want to get infected.

How do the people react to the outbreak? Do they panic?

There has been no panic so far; it has been very quiet. But of course there is a lot of stigmatization around the cholera. It is always the most vulnerable people that are affected and there is a lot of wrong information about how one can get infected. Although it is not the first time a cholera outbreak occurs in Lusaka, we see that some people have never heard about it before. In general terms, people do not want to talk about it; it is a dirty disease.

How do the families of the patients react?

Families do not tend for their relatives while they are admitted in the CTC for safety reasons. Some families come to give food for the patients and other never show up. What we do is that we go to the house of each patient and we spray it totally to disinfect it.

The family receives information about the disease and how to prevent it. It is one of the most important things we can do to stop the spread of the disease. Beside, all the patients that are discharged receive chlorine to disinfect the water, ORS and soap, so that they wash their hands before and after meals.

Was the local health system prepared to face such an outbreak?

No. If the local authorities had been able to deal with it, we would not be here. When our team first entered in George treatment center, in December, there were mattresses and vomit all around. Of course they try, but they do not have the resources and the organization to do it. It is strange because it is not the first time there is a cholera outbreak here.

What could be done to avoid future outbreaks?

The information is very important, on how the disease is transmitted and how to prevent it. But the most important is a proper water and sanitation system.