How cholera crept into IDP’s camp in Borno

The last eight years of slow and calculated advance and subsequent retreat of the insurgent Boko Haram in at least 22 Local Government Areas of Borno State has brought a litany of woes to the camp residents and non resident internally displaced people IDP’S. One of the bad annual omens of this lingering insurgency is the resultant burden of deadly communicable diseases like cholera, meningitis and hepatitis some of which had silently wiped hundreds away unannounced and unrecorded by relevant agencies. Sadly, cholera has come again and it is really embarrassing the state health emergency response team in the way it is wasting the lives of the idps, which could have been saved if not for the hazardous conditions they find themselves in the informal camps.

How cholera crept into the idp camps

Cholera is real in Maiduguri and has been killing the poorest of the poor people of Borno on a daily basis. But for the Borno State Health Emergency Response Team, which has been reaching out to the badly affected, many more would have perished beyond the 60 deaths recorded so far. Some IDP’S are having their worse period of existence since the 15th of August till date when health partners started taking special notice of the epidemic. Many postulations have been put forward for the origin but most of the health professionals concluded this was indeed a professional  leak from the water, sanitation and hygiene (WASH) sector especially through the tolerance of open defecation brought in by IDPs chased out of their ancestral residences by boko haram. That makes the insurgency theory a very strong one.

State chairman, Nigerian Labour Congress (NLC), Titus Abana, also from the health sector, equally agreed that it was insurgency that brought cholera to the state. “It is insurgents that have brought cholera we cannot run away from that reality. Our people have been traumatised both ways. They ran away from the wickedness of Boko Haram, and now in the camps where they are supposed to be protected from bullets, they are dying in doves from cholera and many other water born illnesses because of the type of food they consume and sometimes infected water utilised for all purposes. Their plight is now very pathetic because since the cholera epidemic engulfed some of their camps at the Muna Garage corridor, no effort was made by the relevant authorities until recently,” he concluded.

       The wash factor and BOSEPA

The Borno State Environmental Protection Agency (BOSEPA) has been a sleeping giant unable to help to stop the spread of the infection. The body was conspicuously absent in the desperate period when the scourge started. It was even unable to create some specialised distant dump sites for keeping cholera infested faeces. “Their initial inability to help has hampered the process badly because they have been completely crippled by strange factors except now that they have started shouting for help “ said Modu, an environmental staff of Jere Local Government and concerned watchers of the agency before and after the Environment Ministry’s Commissioner died. Other observers around this corridor of induced death said that such sites for dumping or burying packed cholera stools should be created at least some 500 metres from the sleeping tents of IDP’S  to avoid reinfection which had been the main cause of the lingering  spread until the management was partially taken over by the World Health Organisation (WHO).

Nigerian Tribune  investigation showed that the quarantined section of the camp was well guarded by soldiers so that non infected idps in the camp’s  commercial areas were not allowed to visit and pick the illness from the infected in the name of checking on relations. Some of the idps who interacted with the Nigerian Tribune showed a reasonable amount of enlightenment about the illness but a large percentage of them were displaying that sense of urgency for this desease that has killed as fast as Ebola. They watch their kids drop human excreta on the floor yet,  children age 0 to 4 years are the most badly affected in the records made available to the Nigerian Tribune. Muna idp camp of about 16,000 people  mostly women and children had just 48 toilets instead of a minimum of 500 which should be fitted with water to service them. As at the time the Nigerian Tribune visited the camp, a couple of the shallow  toilets littering the edge of the linear populated camp had already  being evacuated and cleaned up for use by non governmental organisations without involving Borno State Environmental Protection Agency (BOSEPA). But for the security at the entrance, there was really no barrier  between the residents of that corridor and the idps. Cholera or any other deseases can go in and out any day unnoticed and mock all their efforts the way the WASH sector has been dragging everyone down the management line.

Another medical practitioner with doctors without borders MSF international who equally prefered anonimity regretted that the cholera infection took charge as a result of delays in the implementation of the water and sanitation and hygiene WASH plan. He said that it was sad that some red tapes were involved in binding the progress of the 2017 plan knowing full that the raining season then was just behind the corner.

Inability to get quick results by incompetent mobilizers

Indeed, some of the enlightened idps now know that, the fear of cholera is the begining of wisdom but from our investigations, many of them went on with life without the consciousness of a more deadly killer than HIV\AIDS close by their huts. This obviously is as a result of the fact that the health partners relied only on some people they called mobilisers who had very ineffective communication skills to pass on the message to keep them alive. Most of them spoke in Hausa language which is not a first line language for the country side Kanuri who were gathered at the corridor of death. They utilised sophisticated flyers in Hausa language  which does not mean anything to the Kanuri villager resident in Mafa who hardly could speak Hausa language which is seen as a language from an inferior civilisation to theirs.

Chairman, Health Information Management at the University of Maiduguri Teaching Hospital UMTH Comrade Baba Garba, urged the health partners to increase the personnel who would pass the information to nursing mothers and vulnerable kids about the dangers of cholera. “They should form an association among the idps. The messages will go down easier if their own members are involved in passing it on. They should equally step up surveillance by installing cameras which would stop anybody from stooling on the ground. When such people defecating on the floor are stopped by the security on patrol, the spread will reduce.” The chairman called for more information to be passed through the electronic media which can easily be mounted in their camps for this purposes. Because of the emergency involved, many partners are now in the management of cholera. As many as nine of them have been moved from their primary medical callings into cholera including the Alliance for International Medical Action (ALIMA) based in Dakar Senegal team, also present in Maiduguri. They and msf had better communication personnel because of their pedigree.

“With a large chunk of Muna Garage being infected, most of them who have relations in different parts of the state have been going about spreading the desease. They travel to anywhere they want. We don’t have that much control over them as informal camps except when they are sick. That is why we just transferred fourteen of our patients from here to the bigger clinic” said another Kanuri communication partner from ALIMA, a non governmental agency which built a smaller and less populated make shift clinic at the Customs House idp camp which houses over six thousand  men, women and children.

Culture, religious beliefs and shallow laterines inside individual tents

“Some of these people are from Mafa and surrounding  villages. They are used to their freedom which gives them the right to go into the bush and drop their human wastes. You don’t expect them to come here and change overnight because that is their culture. It is like someone who is used to sitting on a toilet and others squatting. No matter what you do, somebody used to squatting cannot use a modern toilet facility. He or she will not feel comfortable. They are used to open defecation which spreads this thing,” said Baakura, another source who spoke mainly in translated Kanuri. On the laxity of supervisors allowing people to dig shallow toilets in their individual tents, he went on: “I agree with you, it’s our culture that our women do not go about when they want to ease themselves, that is why you might have some of them urging their spouses to build their own toilets attached to their big tent where their wives and children can easily ease themselves instead of  going outside and another man seeing their half nakedness even at night. Remember that at the height of the insurgency, it was a big risk moving beyond fifty metres to ease one’s self.

“But they are doing that out of ignorance. I do hope that the state government will work on that because it took them a long time to even accept that we are here and we have lots of ophans wandering about at the mercy of care givers. If not for Non Governmental Organisations which used to help us with soaps and detergents in the beginning some of our people here did stay up to three days without taking their baths.” Said Baakura.

Again “Because kids of idps defecate anywhere, and any time, it gave a multiplyer effect on the people around and increased the threat to life around all the sub camps in that corridor including Farm Centre, Shuwari village, Customs House and now Dikwa and Monguno where infected people have taken the bacteria to their loved ones who then pass along based on the strength of their immunities. The infection is believed to have gone as far as Dikwa, Mafa, Bama and even Konduga,” said Commissioner of Health, Dr Haruna Mshelia, in a briefing recently. He said he had visited Monguno and Dikwa to stabilise things. Indeed this is the worse of times for the head of the Ministry of Health, Haruna Mshelia, a physician who also leads the state health emergency response team. As at the time of writing this report, he had just returned from an urgent trip to Monguno to see first hand why the statistics coming out of that local council area were screaming higher than even the notoriously dangerous Muna Garage idp camp. From the conference room of the eye clinic on Damboa road, he told reporters that a lot went wrong in Monguno and Dikwa but had gone with his team to intervene to slow down the mortality rate in these areas.  The slow down has been working even though figures change on a daily basis. However as at 4th October the total number of suspected cases of cholera reported stood at 4505, with 60 deaths (CFR = 1.3 per cent); 2201 cases in the Muna corridor, 717 cases in Dikwa, 1543 cases in Monguno, cases in MMC and Mafa stood at 38 and 6 respectively. The total number of suspected cholera cases reported as at 4th October, 2017 showed about 20 per cent decrease from the cases reported on the 3rd October 2017. Active case search continues in hot spots and high-risk areas. Said the cholera report of that day.

Cholera vaccination targets

“The health sector in conjunction with partners has already started a massive vaccination against cholera. This is the first of its kind,”  said Dr Collins Owili in one of the daily cholera meetings he co-presided with Dr Kido. The sector undertook a five days vacinatioion in Jere,  Konduga, Monguno and areas badly affected by the epidemic  so that the idps would remain immune for at least six months before thinking of another one. The vaccine which is the first of its kind in Nigeria will last for at least six months before the thought of another dose. The current 900,000 doses received were not enough but partners assured that more  vaccines were expected to arrive the country soonest. Dr Meshelia,  however, urged the people to always wash their hands after the days activities to avoid catching cholera because of the hand shake culture prevalent in the state. He assured newsmen in a recent briefing that the new vaccine had at least 80 per cent protection, adding that any age groups could consume it. “The vaccination is meant to ensure that we target the most vulnerable groups. About 915,005 doses of OCVs arrived in the country on 15th September, 2017 to nip the problem in the bud. Medical observers and epdiomologists say that the spate of deaths had showed down but the reality on the ground showed a slight differential. The mortality is likely to rise beyond the one hundred mark before the end of the year if further care is not taken the way the WHO is stamping its feet down. New areas are under investigation like Farm Centre, Kwanan Yobe, CBN quarters, Shuwari and many others  which would be further looked into. The fumigations which has commenced should get to these areas. Above all, BOSEPA, boss Alhaji Nasiru Nsurindi, should be summoned and made an integral part of the kill Cholera campaign in Maiduguri if the health seçtor should ride into a cholera free 2018. The government has not done wrong to allow its partners to rebuild its battered health system and drive communicable illnesses out of the state. They just have to do more even in personnel recruitment for the WASH sector. At least ten thousand more workers must be hired by BOSEPA to man the 27 Local Government Areas of the state to stem this annual infection.

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