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Cholera: UFS experts provide prevention and treatment tips

28 June 2023 Photo Supplied

Opinion article by Ms Akani Baloyi; Dr Olivia Kunguma, Disaster Management Training and Education Centre for Africa (DiMTEC) at the University of the Free State; and Dr Arishka Kalicharan, Department of Basic Medical Sciences, Faculty of Health Sciences, University of the Free State.

Since the 1800s, many countries globally have had a long history of cholera outbreaks, with several countries experiencing periodic outbreaks and the disease remaining a public health concern. In Africa, countries like Senegal, Malawi, Zimbabwe, the Democratic Republic of Congo, Tanzania and many more have suffered greatly from this water-borne plague.

South Africa is among these countries – one of its major outbreaks, in 2008, killed more than 65 people, with more than 12 000 cases reported. The outbreak spread from Musina in Limpopo to the other provinces. The spread of cholera from Musina was attributed to a 2008/2009 outbreak in Zimbabwe, which affected more than 98 000 people; this was a case of disease contagion.

The 2008/2009 Zimbabwe outbreak was rated the country and the world’s largest ever recorded. Due to its political and economic crises, thousands of Zimbabweans migrated to South Africa. The movement of people from Zimbabwe helped spread the disease, as it is highly contagious. Because South Africa also had its own political and economic issues, cholera started spreading like wildfire. Similarly to Zimbabwe, South Africa is struggling with service delivery by local authorities due to poor governance and corruption.

In an effort to improve Zimbabwe’s health system after that outbreak, the United Nations donated almost $5 million. Despite such a big cash injection, the country’s health system is still not of a standard that can help mitigate and prevent cholera. The country still finds itself losing people due to cholera outbreaks.

The challenge in Africa is that decision-makers suffer from ‘reactive syndrome’, i.e. they wait for an outbreak before intiating activities like surveillance, health promotion, encouraging of laboratory testing, assessing and maintaining boreholes/ municipal water plants, and providing temporary emergency water, sanitation and hygiene. Only when an outbreak is already under way do they remember the existence of emergency and response plans, and then start updating them.

A recent cholera outbreak in Hammanskraal, north of Tshwane in Gauteng, South Africa, had claimed 23 lives by 28 May after residents were diagnosed with diarrhoeal disease due to cholera. In the neighbouring Free State, two deaths had been reported by 9 June.

It has become common knowledge that the main source of cholera infection is poor sanitation, lack of clean water, and contaminated food. But it is important to also know that most people exposed to the cholera bacterium do not get sick. They are unaware they have been infected, unless they start displaying symptoms such as diarrhoea, vomiting, and muscle cramps. Excessive diarrhoea can lead to dehydration, making it difficult for the body to perform basic functions. If left untreated, diarrhoea can be fatal.

The root causes are exacerbated by poor investment in public health and an unsettled political environment, in particular governance of municipalities and neglect of water treatment plants. The prevalence of this preventable infectious disease demands immediate attention from policymakers, health organisations, and society in general. Addressing the root causes, boosting preventative measures, and ensuring access to clean water and adequate healthcare services to eradicate cholera in South Africa is crucial.

How can we mitigate and prevent the spread of cholera?

While we lobby for policymakers or people who hold political power to be called to account and advocate for large-scale investment in establishing and maintaining water and sanitation facilities and the strengthening of public health community engagement, we need to consider some methods the public can explore.

Most infected people will have few to mild symptoms, which can be successfully treated with an oral rehydration solution. This solution replenishes the body’s fluid levels and can treat mild dehydration caused by diarrhoea, vomiting, or other medical conditions. Oral rehydration solutions can be made at home with the following ingredients:

1 litre of preboiled water (an effective way to disinfect the water)
6 level teaspoons of sugar (improves the absorption of electrolytes and water)
½ teaspoon of salt (promotes water absorption, since there is significant fluid loss due to diarrhoea)
1 tablespoon (or a palatable amount) of white vinegar (contains antimicrobial properties for preventing and treating infections)

This solution should be consumed after every loose stool, or as often as possible. If a child has been infected with the disease, in addition to the oral solution, give the child 20 mg (over 6 months of age) or 10 mg (under 6 months of age) zinc per day (tablet or syrup).

We should also always adhere to cost-effective habits such as routinely washing our hands and consuming preboiled water.

There are also three World Health Organisation (WHO) pre-approved oral cholera vaccines, namely Dukoral, Shanchol, and Euvichol-Plus. They all require two doses for full protection. These vaccines are available at the nearest clinic or hospital, and are relatively cost-effective.

Cholera and several other public health crises should not exist in the modern economy we are living in. Africa has the resources needed, including several medical interventions. Africa must address its issue regarding political leadership, which is its biggest challenge. There is an urgent need for proactiveness among our political leaders and government authorities which should see them take the lead in continuous multi-sectoral collaboration. They should invest in preparedness programmes that include training health workers and surveillance. And lastly, there is an urgent need for an accountability system for all the funds donated and invested towards improving a country’s healthcare system.

News Archive

Media: ANC can learn a lesson from Moshoeshoe

2006-05-20

27/05/2006 20:32 - (SA)
ANC can learn a lesson from Moshoeshoe
ON 2004, the University of the Free State turned 100 years old. As part of its centenary celebrations, the idea of the Moshoeshoe Memorial Lecture was mooted as part of another idea: to promote the study of the meaning of Moshoeshoe.

This lecture comes at a critical point in South Africa's still-new democracy. There are indications that the value of public engagement that Moshoeshoe prized highly through his lipitso [community gatherings], and now also a prized feature in our democracy, may be under serious threat. It is for this reason that I would like to dedicate this lecture to all those in our country and elsewhere who daily or weekly, or however frequently, have had the courage to express their considered opinions on pressing matters facing our society. They may be columnists, editors, commentators, artists of all kinds, academics and writers of letters to the editor, non-violent protesters with their placards and cartoonists who put a mirror in front of our eyes.

There is a remarkable story of how Moshoeshoe dealt with Mzilikazi, the aggressor who attacked Thaba Bosiu and failed. So when Mzilikazi retreated from Thaba Bosiu with a bruised ego after failing to take over the mountain, Moshoeshoe, in an unexpected turn of events, sent him cattle to return home bruised but grateful for the generosity of a victorious target of his aggression. At least he would not starve along the way. It was a devastating act of magnanimity which signalled a phenomenal role change.

"If only you had asked," Moshoeshoe seemed to be saying, "I could have given you some cattle. Have them anyway."

It was impossible for Mzilikazi not to have felt ashamed. At the same time, he could still present himself to his people as one who was so feared that even in defeat he was given cattle. At any rate, he never returned.

I look at our situation in South Africa and find that the wisdom of Moshoeshoe's method produced one of the defining moments that led to South Africa's momentous transition to democracy. Part of Nelson Mandela's legacy is precisely this: what I have called counter-intuitive leadership and the immense possibilities it offers for re-imagining whole societies.

A number of events in the past 12 months have made me wonder whether we are faced with a new situation that may have arisen. An increasing number of highly intelligent, sensitive and highly committed South Africans across the class, racial and cultural spectrum confess to feeling uncertain and vulnerable as never before since 1994. When indomitable optimists confess to having a sense of things unhinging, the misery of anxiety spreads. It must have something to do with an accumulation of events that convey the sense of impending implosion. It is the sense that events are spiralling out of control and no one among the leadership of the country seems to have a handle on things.

I should mention the one event that has dominated the national scene continuously for many months now. It is, of course, the trying events around the recent trial and acquittal of Jacob Zuma. The aftermath continues to dominate the news and public discourse. What, really, have we learnt or are learning from it all? It is probably too early to tell. Yet the drama seems far from over, promising to keep us all without relief, and in a state of anguish. It seems poised to reveal more faultlines in our national life than answers and solutions.

We need a mechanism that will affirm the different positions of the contestants validating their honesty in a way that will give the public confidence that real solutions are possible. It is this kind of openness, which never comes easily, that leads to breakthrough solutions, of the kind Moshoeshoe's wisdom symbolises.

Who will take this courageous step? What is clear is that a complex democracy like South Africa's cannot survive a single authority. Only multiple authorities within a constitutional framework have a real chance. I want to press this matter further.

Could it be that part of the problem is that we are unable to deal with the notion of "opposition". We are horrified that any of us could become "the opposition". In reality, it is time we began to anticipate the arrival of a moment when there was no longer a single [overwhelmingly] dominant political force as is currently the case. Such is the course of change. The measure of the maturity of the current political environment will be in how it can create conditions that anticipate that moment rather than ones that seek to prevent it. This is the formidable challenge of a popular post-apartheid political movement.

Can it conceptually anticipate a future when it is no longer overwhelmingly in control, in the form in which it currently is and resist, counter-intuitively, the temptation to prevent such an eventuality? Successfully resisting such an option would enable its current vision and its ultimate legacy to our country to manifest itself in different articulations of itself, which then contend for social influence.

In this way, the vision never really dies, it simply evolves into higher, more complex forms of itself. If the resulting versions are what is called "the opposition" that should not be such a bad thing - unless we want to invent another name for it. The image of flying ants going off to start other similar settlements is not so inappropriate.

I do not wish to suggest that the nuptial flights of the alliance partners are about to occur: only that it is a mark of leadership foresight to anticipate them conceptually. Any political movement that has visions of itself as a perpetual entity should look at the compelling evidence of history. Few have survived those defining moments when they should have been more elastic, and that because they were not, did not live to see the next day.

I believe we may have reached a moment not fundamentally different from the sobering, yet uplifting and vision-making, nation-building realities that led to Kempton Park in the early 1990s. The difference between then and now is that the black majority is not facing white compatriots across the negotiating table. Rather, it is facing itself: perhaps really for the first time since 1994. It is not a time for repeating old platitudes. Could we apply to ourselves the same degree of inventiveness and rigorous negotiation we displayed up to the adoption or our Constitution?

Morena Moshoeshoe faced similarly formative challenges. He seems to have been a great listener. No problem was too insignificant that it could not be addressed. He seems to have networked actively across the spectrum of society. He seems to have kept a close eye on the world beyond Lesotho, forming strong friendships and alliances, weighing his options constantly. He seems to have had patience and forbearance. He had tons of data before him before he could propose the unexpected. He tells us across the years that moments of renewal demand no less.

This is an editied version of the inaugural Moshoeshoe Memorial Lecture presented by Univeristy of Cape Town vice-chancellor Professor Ndebele at the University of the Free State on Thursday. Perspectives on Leadership Challenges In South Africa

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