Cholera is a highly contagious disease with potentially fatal outcomes (Maponga et al., 2015). Since medical experts first documented it, in the 19th century, many researchers and health organizations have reported its devastating outcomes in different countries around the world (Bao et al., 2015). Relative to this assertion, Maponga et al. (2015) say thousands of people die from the disease, annually. Cholera affects the human intestines and manifests through known symptoms, such as diarrhea and vomiting. However, during the early stages of infection, a patient would show mild symptoms of leg cramps and occasional vomiting (Bao et al., 2015). When it gets serious, these symptoms worsen and include diarrhea. Filth, lack of fresh water and poor sanitary infrastructures are the main causes of cholera (Bao et al., 2015). Although many countries have minimized the potential of an outbreak through improved standards of living, some developing nations are still vulnerable to the disease. International health agencies and governments, around the world, have expressed their concern regarding periodic outbreaks of the disease in some parts of the world (WHO, 2014; Maponga et al., 2015). This concern has prompted some of them to seek better ways of preventing cholera and stopping its spread when it occurs. This paper focuses on managing periodic cholera outbreaks in Congo.
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Background of the Topic
Congo is among the worst-hit countries by cholera (WHO, 2015). The World Health Organization reported repetitive outbreaks in 2011 and 2013 (WHO, 2014). In March 2015, international health organizations reported new cases of cholera (Medical Express, 2015). The latest outbreak caused the deaths of dozens of people and new infections of thousands more (Tereshchuk, 2014). In 2013, more than 800 people died from cholera in rural Congo (Tereshchuk, 2014). In 2012, there were more than 7,000 confirmed cases of cholera in the country (Medical Express, 2015). This figure increased to 9000 in 2014 (Medical Express, 2015). The worst epidemic occurred in 2013 when health authorities reported more than 14,000 cases of cholera (Medical Express, 2015). The epidemic hit most parts of Southern Congo. Particularly, Katanga province (a province in the south of the Congo) accounted for most of these cases because half of all new infections occurred in the area (Tereshchuk, 2014). Congo has had a difficult time managing the crisis because of limited access to fresh water and sanitary facilities. For example, in the Katanga province of Southern Congo, less than 35% of households have access to freshwater supplies (Medical Express, 2015). Furthermore, less than 5% of households have access to proper sanitary facilities (Tereshchuk, 2014). A weak health system, coupled with poorly trained caregivers, has further worsened the situation (Medical Express, 2015). These outcomes emerge from increased exposure to the disease. The following section of this report assesses these exposures.
Assessment of Exposure
Congo suffers several cholera exposures that cause the periodic rise in cases of the epidemic (Medical Express, 2015). Armed conflict and the lack of access to clean water and proper sanitary facilities have made it easy for the disease to spread (Tereshchuk, 2014). They have also made it difficult for health service officials to provide proper health care to victims. The influx of people from neighboring countries has further increased the country’s exposure to the disease because people cross borders without proper screening (Tereshchuk, 2014). This way, infected people easily cross borders and affect regions that do not suffer from the disease. Nonetheless, armed conflicts have played a more vivid role in contributing to cholera outbreaks in Congo because they have displaced human populations from their homes, thereby forcing refugees to live in makeshift camps that lack proper sanitary facilities (Medical Express, 2015). Flooding that occurs during the rainy season often exacerbates the risk profile of contracting the disease because it could lead to the contamination of drinking water (Sozzi, Ebdon, Fesselet, Fabre, & Taylor, 2015).
Refugee camps do not have access to freshwater. Congestion in these camps has also made it easy for the disease to spread if an outbreak occurs (Sozzi et al., 2015). Armed conflicts in the Congo have made it difficult for residents to seek better housing arrangements to prevent the spread of cholera. The same challenge has made it difficult for the country to develop better health response plans for managing new outbreaks (Sozzi et al., 2015). Therefore, poor sanitary conditions, filth, and lack of freshwater characterize the lives of most inhabitants of Congo, thereby leaving them exposed to waterborne diseases (Sozzi et al., 2015).
The lack of proper sanitary facilities in the rural parts of Congo has also made it easier for its inhabitants to contract the disease because most people use “bush latrines.” During the rainy season, water washes fecal matter to streams, rivers and other water bodies (Mukandavire, Wang, Modnak, & Posny, 2015). Exposure happens when people use water from these water systems for drinking and domestic use. The lack of piped water in many households has further elevated the risk of contamination because many households have to depend on these water systems to get water for cooking and drinking. Being a largely forested country, Congo also has many brackish rivers that provide residents with their daily water supply. Contamination in one part of the river could cause a chain of infection in all villages and towns that depend on the water supply (WHO, 2015). Cultural practices relating to food preparation in the rural part of Congo also increase the risk of infection because many communities that live in the forested areas eat raw foods (usually fruits) (Sozzi et al., 2015). Health agencies have reported many cases of infection that have happened this way. For example, America has reported cases of cholera that emerged when people ate raw shellfish from the Gulf of Mexico (WHO, 2015).
Assessment of Public Health Impact
It is important to contain any outbreak of cholera because it has the potential to cause many deaths. For example, in 1994, a cholera outbreak at a refugee camp in Congo caused more than 23,000 deaths (WHO, 2014). Besides the loss of life, cholera could also cause considerable socioeconomic disruptions to affected communities and families. Health reports have shown that the disease could cause panic among affected family members and impede social and economic progress in the affected regions (Mukandavire et al., 2015). For example, instead of investing in building the health infrastructure of affected areas, to manage non-communicable diseases, health authorities would be struggling to prevent the spread of communicable diseases. Furthermore, when people are sick, they are out of work and unable to be productive. This situation is worse for many families in Congo because men are breadwinners (WHO, 2015). Therefore, if they are sick and unable to work, the entire family could be economically “impaired.” In the same manner, if the breadwinners die, the social and economic progress of their families could stagnate. Studies that show panic as a detrimental effect of cholera outbreaks cite the imposition of travel restrictions as another impact of the disease (Mukandavire et al., 2015). In such cases, countries often introduce food embargoes, thereby increasing food insecurity in countries that suffer from the problem in the first place. For example, civil conflict has created food insecurity in Congo (Tereshchuk, 2014). Communities have often survived on the goodwill of well-wishers and international humanitarian organizations for food and shelter. When countries impose food embargos, they further exacerbate the food insecurity problem in the area. For example, a 1991 cholera outbreak in Peru forced countries to impose a food embargo on the South American nation, thereby creating food insecurity problems that cost the country more than $700 million (WHO, 2015). The same food embargo significantly affected the country’s tourism sector, which further created a bigger economic problem for the nation (WHO, 2015). Comprehensively, the insights highlighted in this paper show that cholera could have serious social and economic implications for affected communities.
Status of Action or Proposed Action
Stopping another occurrence of cholera in Congo would require a multipronged approach that would tackle the social, political, and economic challenges that lead to the emergence of the disease in the first place (Moore, Thomson, Depina, Miwanda, & Sadji, 2015). So far, well-wishers and community organizations have made significant strides in improving the quality of health care services offered to residents of the Katanga region and other affected provinces in the country (WHO, 2015). For example, the United Methodist Committee on Relief (UMCOR) has made significant strides in starting health programs that have “medical” and “preventive” components in their analysis (Tereshchuk, 2014). The medical part involves supplying medical equipment to affected populations, while the preventive part involves improving the health and sanitation infrastructure of some of the most affected places. Some of the organization’s efforts have been concentrated on Bukama town, a small town located along the Congo River, which has suffered periodic cholera outbreaks during the rainy season (Tereshchuk, 2014). Its water and sanitation infrastructure is also inferior to most parts of the country. Health agencies and welfare groups have contributed to the area’s progress by educating local communities about the prevention and spread of cholera (Tereshchuk, 2014). Others are engaged in disease surveillance and health communication programs. The World Health Organization says its partners, such as Médecins Sans Frontières (MSF), Merlin, and International Rescue Committee (IRC) have also been instrumental in managing the disease when it occurs, and providing safe drinking water to local communities (WHO, 2014). At a governmental level, health agencies have made little progress to minimize the possibility of another outbreak. However, the WHO (2015) is working closely with the Congolese government to tackle some of the broader political problems that cause the periodic outbreaks of the disease. Minimization of armed conflict has been the top of the agenda for this global organization.
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Based on the existing status of action for managing cholera in the Congo, there is no national plan for preventing cholera in the central African country. The Congolese government needs to create a national plan for cholera prevention and control, which would direct the country’s cholera prevention program (Shiode, Shiode, Vinten-Johansen, Ran, & Rod-Thatcher, 2015). While some health agencies have created comprehensive plans for responding to an outbreak, there is a clear lack of a national policy for responding to such cholera. Its absence has similarly created a lack of coordination among health care service providers who undertake their duties independently (National Institutes of Health Bethesda, 2013). The presence of a national plan for preventing cholera would not only outline measures for managing outbreaks when they occur but also provide a strategy for preventing them. More importantly, it would help to bring all stakeholders involved in the prevention of the disease together (Shiode et al., 2015). In this regard, there would be space for the media, government, international health organizations, and environmental agencies (among other stakeholders) to create a holistic national prevention strategy for cholera. Active involvement of all health stakeholders would make it easier to actualize the goals of the national cholera prevention agenda and similarly help to improve its implementation process. At social and economic levels, the government could review efforts to improve the supply of fresh water in households and refugee camps (where most of these disasters start in the first place) by seeking private-public partnerships between government authorities and health agencies. Furthermore, there needs to be more effort by the government to improve disease surveillance and detection methods because cholera is a highly contagious disease and delayed detection could magnify the problem. So far, Congo has been suffering from this problem because there is no strong government presence in some rural provinces where these outbreaks occur (Tereshchuk, 2014). Consequently, there is delayed information relay to health authorities who are unable to contain the outbreak when it occurs. This weakness in surveillance and detection often explains the high number of deaths reported when an outbreak occurs in the country. Congo should try adopting health communication strategies that other developing countries have used to contain such disasters when they occur. For example, it could borrow from Kenya, which uses text-messaging services to report cases of cholera when they occur (Tereshchuk, 2014). By adopting these strategies, the country would improve its national response strategy for managing cholera.
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