The Chairman, Medical Guild, Lagos, Dr Maruf Abdussallam, speaks on the government’s response to the outbreak of cholera epidemic in the state and the challenges posed by it to the general wellness of the people. Subair Mohammed writes.
HOW would you rate the Lagos State Government’s response to the outbreak of the cholera epidemic in the state, could it be better handled?
Since the outbreak of the infection and as it is with most infections that have become endemic, there are series of measures that the government should actually put in place to mitigate the outbreak. One of such measures is surveillance.
By surveillance, measures must be put in place to create awareness among the people that once they present with symptoms of the disease, they should visit the nearest health facilities. And of course, the health workers must have been trained to recognise the symptoms of the disease and then do active cases search because that person that presented at the hospital may not be the only infected person, you then go to the homes of the infected persons and do an active case search.
By doing this, you are able to identify the environment the disease broke out from. I believe the Lagos State Government has done this through its Ministry of Health and the Environment. I am aware that the Lagos State Government is working closely with the Ministry of Health and Environment because the cholera outbreak is something that has to do with personal hygiene, poor sanitation and infected water. These are the things human behaviours usually propagate especially these days that the rate of open defecation is on the increase. So far, our colleagues have been involved in the surveillance, tracing and educating the masses on the outbreak in all the health districts. Basically, I am satisfied with the response of the Lagos State Government and its handling the cholera outbreak.
As of now, the cases have risen to a stage where it would start to decline. It has gotten to a stage that it can only come down and not increase. And I must say, the Lagos State government has done quite a lot to contain the epidemic but importantly, the outbreak of cholera brings to mind the extent of poverty in the land.
Talking about the increasing rate of poverty, many Nigerians now settle for dried tomatoes and peppers since they cannot afford to buy fresh perishable commodities. Would you say the cholera epidemic is partly driven by the unhygienic practice and the food scarcity?
Absolutely, poverty and food scarcity are contributory factor to the cholera outbreak. Again, this is a reminder that we have multi-dimensional poverty in the land. In a poverty situation, for people to survive in places where there is no pipe-borne water, they have to parboil it. But these days, they buy water which is not safe for consumption and probably they cannot afford to buy either kerosene or gas to boil it before drinking. There are some homes where they probably parboiled water but because of the hike in the prices of gas and kerosene, they cannot afford to do so anymore.
There are many homes that rely on bottled or sachet water but because of the harsh economic situation, they can’t afford to do that anymore. Even water producing industries that produce sachet and bottled water, there is high probability that they would cut corners and reduce the treatment because of increase in the cost of production materials.
Like I mentioned earlier, we are beginning to see an increase in open defecation in Lagos State. It is on the increase and that is one thing I believe can fuel an outbreak like this. I am sure you are aware that the Ministry of the Environment are going about demolishing shanties across the state. These are some of the things that can worsen open defecation.
When people are displaced from their habitats and they are not properly resettled, they would probably moved to the slums where they won’t have access to good water and toilet facilities, therefore, majority of them defecate in the open. This, in my opinion, must have fuelled the outbreak of cholera in the state.
Who is susceptible to cholera?
Everyone is susceptible to cholera but like it is said, prevention is better than cure. Everyone is susceptible because we all touch surfaces, we drink water and eat foods. But some people are more prone to contacting cholera than others.
Importantly, people who live in slums and shanties and practice open defecation and those that don’t uphold personal hygiene are more susceptible than other members of the society.
The highest case load is still in Lagos Island followed by kosofe local government and Alimosho and interestingly, people in Ajeromi-Ifelodun and Ijora-badia have lower numbers compared to people on the Island. Those slums in the urban areas are where cholera is concentrated.
Is there any collaboration between the Lagos State Government and Medical guild towards containing this outbreak?
Members of the Medical Guild are those that work for the Lagos State Government. We are the on-field medical practitioners. It is our members that are medical officers even in the Ministry. As an association, the role that we are playing is to continue to educate our members and get them aware that this thing is there.
More importantly, we notify them of active case search. One of the things Lagos Government is doing is that they have begun to take samples. There are so many cases of diarrhoea that are mistaken for cholera. So you take such sample to the Laboratory where it is confirmed that it is actually a case of cholera. So, definitely there is collaboration between the Ministry of Health and the Environment to tackle the outbreak.
What is the role absence of infrastructural amenities in the outbreak of cholera?
When we talk about infrastructure, the only one that can contribute to the outbreak of cholera or any other contagious disease is the absence of pipe-borne water. Many homes have boreholes but there are many communities in Lagos state where there no pipe-borne water. They either fetch water from the stream, well or even rain water. We cannot divorce such habit from the rainy season that we are. People still fetch rainwater for domestic use which may have been contaminated.
What can limit the spread of cholera and how can it be prevented?
One of the things that can limit the spread of cholera is personal hygiene. Even when the bacteria are presence, once you cultivate the habit of personal hygiene then you will be prevented from contracting the disease. Another is the environment; make your environment clean and try as much as possible discourage open defecation. And of course, encourage those who depend on pipe-borne water to boil the water before they drink. Also the State government can also help in the development of vaccine. They need to keep sensitising and educating the public on preventive measures and coping mechanism.
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