Zambia’s deadly cholera outbreak offers lessons for our warming world

A heartbreaking contradiction is unfolding in Zambia, a country in southern Africa. While heavy rain brings relief to fields that have faced difficult growing conditions for months, the stagnant water left behind after the storm poses an even more frightening reality. cholera outbreakthe deadliest our country has ever seen.

Since October, Zambia has been facing the worst cholera outbreak in its history. Over 20,000 people infected, nearly 700 dead. Contaminated water, poor sanitation, and inadequate medical care create fertile ground for bacterial diseases, which are usually spread through contaminated food and water.

As public health experts, including the Zambia country director of Columbia University’s global health organization ICAP, we are deeply concerned by the recent cholera outbreak. This is not the first time we are facing this disease. This is a stark reminder of the cyclical nature of waterborne diseases in our region. Although effective interventions have been implemented against past epidemics, emerging infectious diseases remain a threat, highlighting the need for long-term preventive measures.

Outside the National Heroes Stadium in our nation’s capital Lusaka – once a beacon of sporting glory but now a makeshift cholera treatment center – we meet Chikoti Lungu, a retiree from Lusaka’s Bauleni area. I met you. His story illustrated the devastating effects of this epidemic. Mr. Lungu recently contracted cholera.

“Everything happened so quickly,” Lungu said, recalling her arrival at the treatment center. “We had a lot of people. The wards were full, some patients were vomiting, and medical staff were struggling to save critically ill patients. We even witnessed deaths.”

Prompt treatment is important because cholera causes rapid dehydration, which can lead to electrolyte imbalances and organ failure within hours. If left untreated, cholera can be fatal in up to half of cases. Fortunately, Lungu was able to receive treatment in the nick of time, but the experience left him shaken.

“Other diseases at least give us some warning,” he said. “Cholera doesn’t negotiate.”

Cholera does not give much warning to infected people, but the warning signs for this epidemic have been around for a very long time and we must start paying close attention to them to prevent further infections in the future. It won’t.

Unusual rainfall patterns, rising temperatures, and extreme weather events are exacerbating existing health system vulnerabilities, particularly the spread of waterborne diseases, and pushing our communities to the brink. In the overcrowded residential settlements common in Zambia, hygiene is a luxury. Every sip of water or food reveals the daily fear. With each season, we fear the emergence of cholera and other waterborne diseases, especially as weather patterns become increasingly unpredictable.

Our team at ICAP: Requested for support to Zambia Ministry of Health to combat the recent cholera epidemic. Leveraging our experience in COVID-19 preparedness, we quickly adapted programs and trained health workers in cholera case management, infection control, and data collection. We also worked with the Ministry to ensure efficient supply chain management of essential resources.

Although this intervention provided important support, it only temporarily bandaged wounds throughout the body.

Long-term solutions to disease outbreaks require resilient public health systems that prioritize prevention. Cooperation between governments, international organizations and local communities is essential to address the root causes of cholera outbreaks, including erratic access to safe water, inadequate sanitation infrastructure and limited medical capacity. It is also important to implement context-specific solutions and consider a variety of sanitation technologies tailored to local needs.

Many countries, including Zambia, have successfully introduced community health worker programs to address a variety of health challenges. These programs leverage the trusted role of community members to bring needed services close to where people live. Building on existing models like this, hygiene promotion units can be established to raise awareness about important hygiene practices such as hand washing and proper hygiene. This approach fosters behavior change, encourages the adoption of safe hygiene practices, and ultimately contributes to the fight against waterborne diseases such as cholera.

A one-size-fits-all approach will not work when dealing with cholera and other waterborne disease outbreaks. Effective solutions require tailoring interventions to the specific circumstances of each community. Factors such as different levels of infrastructure development and cultural practices regarding sanitation and available water sources all influence how diseases such as cholera spread and how best to prevent them. For example, a community that relies on shallow wells may require different interventions than a peri-urban area that suffers from overflowing pit latrines.

To reap these benefits, we need to change our tendency to respond to outbreaks reactively, rather than proactively investing in long-term prevention. Meaningful collaboration among diverse stakeholders, with joint ownership and decision-making between government agencies, local communities, and international organizations, is critical. Government leadership and policy direction, community knowledge of needs and cultural context, technical expertise, funding sources, and best practices from international organizations are all important pieces of the puzzle of ongoing waterborne disease outbreaks. is.

Thankfully, the rain has subsided in Lusaka this month. As a result, the number of cholera cases is on the decline, giving rise to hope that there will be a respite from the relentless assault on health and well-being. But with every drop of rain, the fear of cholera looms larger.

The responsibility lies with all of us – funders, governments, public health professionals and communities – to build public health systems that weather every storm and where every drop of water brings life, not suffering.

Tafadzwa Dzinamarira MA, MPH, Ph.D. is a public health instructor at Columbia University in Zambia and country director of ICAP. Dr. Charomba Chitanika, MD, is an internal medicine physician and infectious disease specialist currently working as ICAP’s COVID-19 Clinical Coordinator at Columbia University in Zambia. Sarah Hendery, communications officer at Columbia University ICAP, contributed to this article.

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