- The first seasonal rains are falling in Guinea Bissau, damping the searing midday heat but inflaming fears of another cholera outbreak in the poorest districts of the capital, Bissau.
Among the maze of dirt pathways between houses, women and children gather around street taps, filling up every available bucket and pot while they can in the crowded Bissau district of Bairro Militar.
Last year, Guinea Bissau bore the brunt of a cholera epidemic that afflicted over 42,000 across West Africa. Some 26,000 people were stricken and more than 400 died of the water borne disease in tiny Guinea Bissau alone. The first cases of cholera in West Africa this year have already been confirmed in Niger and neighbouring Guinea.
Worst affected in Guinea Bissau in 2005 was the poor 30,000-strong population of Bairro Militar.
“This tap is not on all day,” explained resident Julia Mane, as she filled up an orange plastic flagon that she’ll carry home on her head. “And sometimes, the taps aren’t on at all. We’ve just been four months without any running water.”
Access to clean drinking water - along with electricity, telephone lines and refuse collection – is sparse in the crumbling neighbourhoods of Bissau. The former Portuguese colony lurched from a fierce battle for independence in 1974 to deep internal instability and as a result the national infrastructure is in a shambles.
Most Bissau residents have less than US $1 a day to pay for food, rent and clothes, so few in Bairro Militar manage to pay electricity and water bills.
As a result, the quarter is plunged into darkness at nightfall. The water company frequently switches off shared street taps, forcing the women and children to scoop their drinking water from a nearby well.
“We know the well water is not good,” said Mane, who has five children, “but if we don’t drink it we would die of thirst!”
Now, as the rains fall again on Bissau, the annual threat of further fatal cholera outbreaks reappears as faecal matter from open and broken sewers floods into drinking water sources.
The women lining up for chlorinated tap water agree that the untreated well water tastes odd, and that they probably ought to boil it before drinking it. They also know that when cholera was at its height last year, they had only well water to drink.
During the epidemic health officials told the women to boil drinking water, but it’s an added burden and expense they would rather do without.
“If the health people tell us to start washing our hands and boiling water again before drinking it, then we will do so,” said Mane. “But we can’t be messing about like that all the time.”
Cholera epidemics have instilled fear in populations for centuries and for most of the developed world the disease has been consigned to the history books. However, poor countries with inadequate sanitation and low access to clean drinking water are highly vulnerable to large-scale epidemics.
Africa is the world's poorest continent, and according to the World Health Organisation (WHO) recorded 87 percent of cholera cases worldwide in 2000.
Cholera is an acute intestinal infection that is highly contagious and leads to acute diarrhoea and often vomiting. If untreated it can kill within days. However, simple and cheap re-hydration salts and fluids nearly always result in a cure.
Since last year’s cholera epidemic, the WHO has built 400 pit latrines in Bairro Militar in a bid to prevent future cross-contamination of drinking water.
But WHO health experts warn that cholera prevention needs more attention to ensure that the rainy season is not the cholera season every year.
“More people were killed by cholera last year than by bird flu the world over,” said Inacio Alvarenga of WHO in Bissau, adding that although 2005 was an exceptionally bad year with higher than average rainfall, cholera is a perennial problem in Guinea Bissau.
The Italian government made the sole contribution to the UN’s 2005 appeal for emergency funds, giving 100,000 euros to fight cholera in Guinea Bissau.
The donation came too late to save lives last year, but Alvarenga explained that the funds have been used to purchase cholera treatment kits – enough for at least 6,000 cases.
In central Bissau, at the main Simao Mendes hospital, director Agostiho Ca surveys the crumbling ward used to house cholera patients last year and explains that treatment kits alone are not enough.
“The conditions are not hygienic,” complained Ca, explaining the ward needs a new roof, running water, electricity – in fact it should just be rebuilt, he says.
“Last year we had 50 cholera patients in here at a time. Some had to be laid on the floor and if you include the people outside,” Ca said, gesturing to the hospital gardens, “then there were about 100 cases at the hospital at a time.”
The walls of the hospital are peppered with cholera prevention posters.
But residents of Bairro Militar have other things on their mind.
“Cholera attacked many people around here last year,” agrees 28-year-old Mandim Camara, who rents out a string of houses in Bairro Militar, “but right now it’s the malaria season, so what can you do?”
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