Friday, April 8, 2011

Cameroon: Cholera epidemic linked to acute poverty

By Mofor Samual Che,Health Correspondent
Ensuring good health requires many good actions.One of which is consuming a sufficiently balanced diet.Others include: social security and domestic stability. 

These must be provided by socio-economic policies, which lie outside the direct sphere of action of the medical profession. Living standards ,for example ,are directly linked to income levels and educational status- and these in turn depend on social and economic policies.

Physical environment and in particular sanitary environment has for long been recognized as having a profound influence on health. Cholera is a classic example of a waterborne disease among the 80% of diseases associated with unsafe water and poor environmental hygiene. It spreads along man’s route of travel from the endemic area as a result of contaminated water supplies along the route. 

According to statistics from the Ministry of Public Health, the fact file for cholera epidemics in 2010 reads as follows: total number of cases affected: 10000; number of deaths: 600; start of epidemic: May 2010; most hard hit region: northern region; other areas affected: Yaoundé, Buea, Douala, Bafoussam etc; peak of epidemic was in the Far North with 150- 200 cases per day; 8830 of the 10000 cases were registered in the northern region of the country; of the 600 deaths, the northern region recorded 573 deaths. 

The causes of the epidemic was the consumption by the local population of contaminated water and food, poor hygiene and sanitation, drinking from the same source with animals, drinking bilibili(local gin) produced with water of doubtful quality with people drinking from the same calabash. UNICEF says only 5% of the people in the Far North have access to latrines; while less than 30% have access to safe drinking water.
As far as this year’s World Water Day is concerned, it was being celebrated against the backdrop of another cholera epidemic right in the heart of the seat of state institutions. Currently there are 2052 reported cases by the Ministry of Public Health as Yaoundé and the Centre Region as a whole was the scene of action. Here again, 14 deaths were recorded. Only close to 44% of Cameroonians have access to potable water and the coverage rate in the national territory is 36%. Authorities of Camwater Utilities Corporation talk of stepping up the coverage rate to 60% by 2015. 

The science of preventive medicine is now being directed more and more towards a study of the relationship between man and his environment; and it is becoming increasingly evident that the ultimate elimination of disease must depend on the adjustment between them. This adjustment can be effected in two ways- either man must alter his way of living to suit his environment or he must modify his environment to suit his way of living. The ultimate objective must be the creation of conditions of living in which disease cannot survive. These conditions can be brought about only by coordinated progress in economic, cultural and social spheres leading to a better pattern of living, since the process is an evolutionary one it must be watched and guided if the final result is to be integrated whole.
The decline of communicable disease in the more educated and wealthier countries followed this pattern because, as they advanced in culture, people demanded such sanitary amenities as pure water supplies, safe disposal of human waste and adequate housing and could afford to live in conditions which reduced the degree of contact between members of the community and disease-producing agents. A minimum standard of living was accepted by public opinion and was enforced by legislation governing working conditions and wages, housing, environmental sanitation and control of communicable disease; and by instrument of social welfare such as free education, free medical treatment, old age pensions, unemployment benefits and financial help for those in need.

The history of the recession of communicable disease in advanced countries has important lessons for those concerned in promoting the health of people in tropical countries like Cameroon. Medical science alone cannot eliminate ill health and disease from a community. 

Poverty and the diseases with which it is associated can be abolished only by a long term policy of education and economic advancement resulting in better standards of living. The campaign to improve conditions of life requires the combined efforts of agriculturalists, educationists, doctors, engineers, economists and others, and their efforts must be integrated in such a way that development is balanced and continuous.

In many cases faulty habits of living are important factors in maintaining a disease in a community. Low economic and social levels as is the case in Cameroon, particularly in the northern half of the country and most urban communities, are associated with apathy, ignorance and low standards of personal hygiene. A system for disposal of human excreta, no matter how well planned, will not succeed so long as individuals continue to see no evil in indiscriminate defaecation in the vicinity of their dwellings.

Low standards of personal hygiene are reflected in low standards of public hygiene, and efforts to raise the latter will have little effect if the former remain low. The end result being the creation of a fertile ground for endemic communicable disease like cholera to thrive as is the case with Cameroon where the disease is on a ten region ride having “walked across” eight regions already. 

Community development designed to help people to help themselves is one of the most successful ways of raising standards of living in Cameroon. All important environment conditions fall within scope and self- help schemes of various kinds can be started. These schemes have an important cultural influence because they are educational and they develop initiative, cooperation and a sense of responsibility in those who participate in them. 

Specially important are programmes connected with agriculture, housing and sanitation. Public health activities which are suitable for self-help schemes are: the construction of protected wells, protection of springs, composting of wastes and construction of houses of better design. 

With assistance and supervision improvements can be effected in all of these, and since they have been carried out at the wish and by the labour of the people themselves they will be valued. Such is the kind of doctrine that has to be inculcated into the minds of Cameroonians. Secondly before any decision is made as to the object of the community’s activities, public opinion should be consulted about a number of improvements needed locally and these should be widely discussed. The people should be led to select the objective which is most necessary and desirable. 

Cooperation in the programme will be facilitated by forming a committee of locally influential people who will lead the community and be responsible for organizing its purpose and value. It should be noted that the standards set should be reasonably possible of attainment by a poor and uneducated community (as is the case with some communities in the Far North); and the type and construction and method of usage must be related to local social, educational and economic levels. 

Large scale, forceful development schemes imposed on a population from outside have often failed in the past. Real development must be for the people and achieved through the people if it is to be stable, advance and bring the benefits hoped for.

Unless development schemes are broadly based and cover all important aspects of human activity, they tend to lead to unbalanced progress and create fresh problems. 

In order to put these cholera epidemics under control the powers that be, must aim at the development of appropriate water and sanitation systems technically adapted to local skills, materials and economically feasible, culturally acceptable and environmentally sound. Greater emphasis should be given to sanitation development and to closer links with water supply and solid and liquid waste management in the planning of new programmes.

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