Cholera Outbreak​—A West African Diary

By Awake! correspondent in West Africa

DECEMBER: An elderly woman was the first victim. Diarrhea was the first symptom, watery and frequent. Then came vomiting. Cramps knotted her thighs and belly. Her breathing became rapid and shallow, her skin wrinkled, and her eyes sank in their sockets. Forty-eight hours later she was dead.

The following day, another person in the same house was stricken, then another. Next, some neighbors got sick. The disease began to appear in nearby villages and towns. The story was the same​—diarrhea, vomiting, and in a third of the cases, death.

The Pasteur Institute examined stool samples and confirmed the worst fears of medical experts. It was the disease that has scourged 93 nations in the past 25 years, a disease so lethal that its very name elicits fear: cholera!

In the capital of one West African land, I witnessed some of the drama attending the outbreak of this dreadful disease. Following is a diary of the events of that year.

“No Need to Fear”

February 13: Amid growing rumors, a newspaper carries the front-page news: “Diarrhoea: 70 Dead but Crisis Subsides.” The article assures its readers that there is “no need to fear an outbreak of cholera.”

April 25: I ask Dr. L. Bakka,a a pediatrician and head of the nation’s Control of Diarrhoeal Diseases program, if the persistent cholera rumors are true. “They’re true,” he says. “There is cholera and it is widespread. Out of 13 districts, 10 have cholera.”

I ask about mass inoculation. “We won’t be vaccinating people,” he says. “It doesn’t do much good either in preventing or in controlling an epidemic. The present vaccines are effective for only three to six months.”

“Are you saying that the vaccines are of no value in combating an outbreak?” I ask.

“No, it is the World Health Organization that says it.”

“Have you been vaccinated?”

“No. And I’ve been in many areas where there is cholera, and I have treated many cholera patients.”

Bakka explains that cholera is caused by a certain type of vibrio, or bacterium, that gets into the body through contaminated food or water. The vibrios then collect in the intestines, where they multiply and produce a poisonous substance that causes diarrhea and vomiting. These vibrios can then get into drinking water or on food contaminated by unwashed hands​—and the disease is passed on.

The doctor points to his mouth. “The important thing is what goes in here,” he says. It is said: “You can eat cholera and you can drink cholera, but you can’t catch cholera!”

Was the disease likely to hit the capital? “It already has,” says Bakka. “We’ve admitted five cases to the hospital today.”

May 7: The overburdened hospital is ill-equipped to cope with a cholera epidemic. The cholera patients are isolated in a large room with a concrete floor and a single ceiling fan. Toilets are too far away to be used, so excreta is collected in bedpans and plastic buckets, then disinfected before disposal. There are now 12 patients​—men, women, and 2 children. All look exhausted and miserable.

The stricken lie on wooden benches. There are no beds, no hospital meals, no private rooms. Yet, nobody complains. Life is being offered to these emaciated and shriveled victims, life in the form of one-quart [1 L] plastic bags marked “Ringer’s Lactate.” It is a solution that is fed intravenously.

I learn that cholera kills through dehydration. As vital body fluids and essential salts are lost through vomiting and diarrhea, the human body withers and dies. The lactate drips serve to rehydrate, or replace, these fluids and maintain them until diarrhea and vomiting stop​—usually within a few days. The drug tetracycline kills the vibrios and shortens the duration of the illness.

The News Breaks

May 29: A British radio news broadcast breaks the news that cholera has killed from 300 to 600 people throughout this country. I know one of them. When the father left for work, his young son was happily playing. When he came home in the evening, the boy was dead.

This afternoon the local branch office of Jehovah’s Witnesses decides to send information to every congregation in the country, explaining how to guard against the disease.

June 2: Beds covered with plastic sheets have now been moved into the cholera ward. A dozen new patients arrive each day. Those who arrive in a state of shock and are unable to drink ORS (Oral Rehydration Salts) solution are given lactate drips, often three or four quarts [3-4 L] in the first hour.b After a day or two, they are released. Mild cases are put on ORS and sent home after a few hours.

Supplies of Ringer’s lactate and ORS packets pour into the country and are rushed to provincial health centers, where the demand is presently greater than in the city. Over 600,000 packets of ORS have already been distributed. The government is providing vehicles to transport medical teams and supplies to areas in need. Radio broadcasts and leaflets inform the public as to how they can avoid contracting the disease and what to do if symptoms appear. Sound cars patrolling the capital carry the same message.

June 10: Admissions at the cholera ward jump to a peak of 71. Fifteen nurses now staff the clinic. Relatives of patients work with them to care for the stricken. The room is full​—two to a bed. Some patients lie on the floor.

People arrive carrying their sick on their backs. Some have walked for miles and are soaked with excreta. Their eyes plead: ‘Can you save the life of my child . . . my brother . . . my mother?’

June 21: A press release states: “The Ministry of Health . . . wishes to assure the general public that there is no need for any alarm or panic.” Yet people are alarmed! There are reports that Ringer’s lactate is being hoarded. Taxi drivers charge exorbitant fares to carry cholera patients to the hospital​—if they take them at all. Children walking to school past the cholera clinic are seen covering their mouths and noses with their hands. Some people are foolishly taking tetracycline daily, hoping this will ward off the disease.

I speak with Alafia, a student nurse at the hospital. She is clearly agitated. “One of the cooks at our hostel has come down with cholera!” she exclaims. “Some nurses are taking vacation time to avoid dealing with the outbreak.”

But not all shy away from helping out. Susan Johnson is matron in charge at one cholera clinic. Though she is usually a jovial person, the strain is showing today. As I enter the ward, a patient’s relative is taking a paper cup and dipping it into an urn of clean water. “Don’t put your hands in there!” Susan snaps. “Contaminated water is how this disease is spread!” She looks at me and says in frustration: “They just don’t understand.”

The Battle Drags On

September 1: Throughout the country, there have now officially been reported 10,200 cases, 796 deaths. Most deaths have been when victims have not received medical treatment or have not received it fast enough.

Of the 3,341 patients admitted to the clinics here, only 1 in 93 has died. Most of these were already dying when they were brought in. Some were unconscious due to advanced dehydration. At that point the blood grows thick and black, and veins collapse. As an emergency measure, the Ringer’s lactate is infused directly into the jugular vein or the femoral artery.

December 30: The outbreak has waned. Roughly 14,000 people have been stricken, and 1,213 have died. It is ironic. Doctors know what causes cholera, how it is spread, and how to save the lives of victims. But cholera is far from vanquished. Man’s helplessness in preventing such epidemics dramatically underscores Jesus’ prediction that “pestilences” would mark these “last days.”​—Luke 21:11; 2 Timothy 3:1-5.

I showed Dr. S. Harding, a key figure during this epidemic, the Bible text at Isaiah 33:24. This foretells a time when “no resident will say: ‘I am sick.’” He looked carefully at the verse, then said: “If that’s what the Bible says, it must be true.” Indeed, it is true! And what a relief it will be when that promise is finally fulfilled!

[Footnotes]

[Box on page 22]

When Cholera Strikes!

Drinking water is the main source of cholera infection. The germs responsible for cholera come from human waste and get into drinking water because of a lack of hygiene. Drinking or handling this polluted water may result in infection. A major symptom of cholera is diarrhea. This brings on severe fluid loss, often resulting in shock and even death. To prevent cholera infection:

1. Use only boiled, clean, or treated water.

3. Cover food to protect it from flies.

4. Wash raw food with clean or treated water.

[Picture Credit Line on page 21]

WHO photo by J. Abcede