Zambia’s Pathetic Cholera Strategy

It seems to me that the government response to the latest cholera outbreak in Lusaka is mostly wrong, treating symptoms rather than causes. The epidemic started last year around October and has claimed the lives of more than 50 people and infected over 2,200 people with as high as 100 new cases in 24 hour periods.

GRZ has swung into action closing down markets and restaurants, demolishing illegal street vendor stands, cleaning up various areas including drainages, banning gatherings of more than 5 people and other measures. I totally applaud all these actions that are at least 30 years too late because of corruption in successive governments that have failed to enforce laws on hygiene and building standards. But this only solves about 20% of the problem in my layman estimation.

The big massive elephant in the room is the fact that cholera in developing countries is mostly spread through unsafe contaminated water, poor sanitation and inadequate hygiene. The Centers for Disease Control and Prevention (CDC) on their website say:

The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill…. Individuals living in places with inadequate water treatment, poor sanitation, and inadequate hygiene are at a greater risk for cholera.

The World Health Organization (WHO) states the following on how cholera is spread through contamination:

Bacteria present in the faeces of an infected person are the main source of contamination. The disease can thus spread rapidly in areas where sewage and drinking water supplies are inadequately treated. New outbreaks can occur sporadically in any part of the world where water supplies, sanitation, food safety, and hygiene are inadequate. The greatest risk occurs in overpopulated communities and refugee settings characterized by poor sanitation and unsafe drinking water.

It is clear that most of the cholera is coming from the filthy Lusaka shanty compounds that have no clean running water, no flushable toilets nor a literate population that fully understand hygiene and practices it. Shanties are full of pit latrines that are contaminating shallow wells and boreholes sunk nearby.

Residential areas like Chalala or Saint Bonaventure in Makeni which are full of septic tanks and boreholes on the same plot are a secondary source of cholera although not significant since we have hardly heard of cholera coming from there.

According to the World Health Organization (WHO) and to a water engineer I consulted, the recommended minimum effective distance for constructing a soakaway from any drinking water source is 30 metres. ie there should be no borehole within a 30-meter radius of a septic tank and soakaway as part of the mitigation of underground water contamination. Our conversation was very fruitful since like him, I also majored in Fluid Mechanics when doing my Engineering degree in Manchester (my final year project was also in the same subject).

A former University of Zambia student Luke Banda released a dissertation research paper in 2013 on Makeni Saint Bonaventure and excerpts are as follows:

A study on groundwater that was conducted in 2010 in selected areas of Lusaka showed high levels of contamination with bacteria…. The study population … included all the 490 households in the study site. A sample size of 55 households was found at 95% confidence level…. The majority (67.27%) of water samples collected from households in St. Bonaventure were satisfactory, while 32.72% were unsatisfactory. The study revealed that only direction of groundwater flow had an association with water quality (total coliform and feacal coliform) at 5% significance level….

… siting boreholes and septic tank systems in the same area was not suitable for St. Bonaventure Township and Lusaka at large because safety of groundwater cannot be guaranteed. Partners in water resource management such as ZEMA, Department of Water Affairs, Geological Department and Lusaka City Council should, therefore, work together each time projects that involve groundwater development and onsite wastewater treatment are to be implemented. LWSC to provide piped water and sewage services to St. Bonaventure.

There are many other studies and reports and they conclude that a lot of Lusaka water is contaminated and unsafe. To make things worse, we now have pirated mineral water taken from taps which are not safe. All this shows that GRZ is sleeping at the wheel. They have done very little, despite studies going back seven to ten years showing the source of the problem.

Our leaders would rather line their pockets with corrupt deals involving fire trucks, ambulances and expired drugs. They don’t care about us Zambians and it is only because people have died in dozens that they are now pretending to be working. Where have they been the last 30 years with tens of thousands of people affected?

The Lusaka City Council (LCC) clearly does not follow any standards. Everything goes out the window as long as there is a brown envelope. Health Inspectors are obviously useless and impotent, or we would not have cholera in Hungry Lion and Pick N Pay. What do they do to justify their pay?

And the media has also not been as useful as they should have been. Most media houses haven’t even bothered to conduct proper investigative journalism. They would rather copy and paste a shouting match between Chishimba Kambwili and Bowman Lusambo or Mr Steven Kampyongo. The media could have easily gone into the shanties and residential areas and got water samples from taps, boreholes and wells and taken them to University of Zambia (UNZA) labs for testing.

If I had the time, I could have found the main sources of cholera within a week. I have previously documented in pictures in the last 2 years the filth in Soweto Market and the University Teaching Hospital (UTH). I posted on Facebook with little reaction from authorities. Only now are people taking the situation seriously after seeing my pictures in light of the cholera epidemic.

A05 ablution block

Lusaka Water and Sewerage Company (LWSC) has shown no interest in stopping the leakages in underground water pipes which is another source of contamination because cholera-infested water can enter the piping system through cracks in pipes, especially during the rainy season. LWSC know full well about this link of cholera to their leaking pipes but like corrupt politicians, they simply don’t care as long they get their salaries. The “Boma ni Boma” mentality.

I was further told by my water engineer friend that the way to solve the current cholera outbreak is to isolate the source. Start testing water from Kafue until you get to distribution centres where you can follow the branches. Where you find a high concentration of cholera bacteria, you fix the leaking pipes and flush out the bacteria.

This whole disaster was and is very easily preventable by sorting out water and sanitation. Shanties should have been demolished 30 years ago and people relocated after compensation. High rise flats with small and medium apartments can replace a lot of the small structures so that less space is used. If you sell off Misisi for example, you have enough cash to build tall high rise flats in Chibolya after flattening it. You can engage property developers and managers to maintain standards through monthly collections from residents.

LWSC can take water to areas like Chalala and St. Bonaventure. It costs between K15,000 to K20,000 for a household to sink a borehole, buy a water tank and piping and install everything. If LWSC used their brains and acted, they can pipe up the whole area and add sewage pipes. If they charge every household K5,000, that would be enough to recoup their investment and they would have thousands of paying customers every month.

If water coming into Lusaka is inadequate, LWSC can get a loan from Development Bank of Zambia (DBZ) and set up more water treatment plants at the Kafue River and combine all output into a massive master pipe or they can add an extra pipe alongside the current one. They can issue a Utility Bond if borrowing is not desirable. LCC can similarly issue a Municipal Bond.

The garbage problem is easily solved by installing lots of bins, outsourcing collection to the private sector and regularly cleaning drainages. You can set up the “Hygiene Police” who arrest people littering and fine them K50 (it can finance itself).

I would suggest that the fines collected should go to the Policemen and women so that they have a huge incentive to catch everyone, with a small 10% commission for GRZ. Ditto for minibuses who contravene on the road. You just need a special unit of plain-clothes police people to be randomly patrolling minibuses and stations. You can even offer a reward to anyone who has video evidence of misbehaviour and this can be sent as talk-time and funded by fines.

In conclusion, all these basic problems have simple solutions but people have refused to think or they are too corrupt or comfortable to care. I really wish performance contracts were introduced in the Civil Service and Cabinet with clearly stated targets every month, quarter and year. Anyone below target at year-end review is fired immediately.

REFERENCES:
CDC: General Information on Cholera
https://www.cdc.gov/cholera/general/index.html

WHO: Frequently asked questions and information for travellers
http://www.who.int/topics/cholera/faq/en/

UNZA: Effects of siting boreholes and septic tanks on groundwater quality in Saint Bonaventure Township of Lusaka District by Luke Banda
http://dspace.unza.zm:8080/xmlui/handle/123456789/3150

RESEARCHGATE: The Effect of Distances between Soakaway and Borehole on Groundwater Quality in Calabar, South- South, Nigeria by Ibiang Ebri, Ekeng Emmanuel, Bejor Ebaye, Department of Civil Engineering, Cross River University of Technology, Calabar, Nigeria
https://www.researchgate.net/publication/308622474_The_Effect_of_Distances_between_Soakaway_and_Borehole_on_Groundwater_Quality_in_Calabar_South-_South_Nigeria