S. Sudan: Cholera Claiming Lives in Upper Nile State

Emergency medical coordinator Sophie Sabatier, who runs the Gudele 2 cholera treatment centre, checks up on a cholera patient and his family

The United Nations World Health Organization (WHO) has advised that while travellers should be aware of Ebola, medications they will not contract the highly-contagious, often fatal disease unless they actually touch someone who is showing active symptoms.

“So one can travel, ” Gregory Hartl, WHO spokesperson on epidemic diseases said on Twitter, one of the social media sites where concerns of the spread of Ebola is generating much traffic on a day when a West African airline stopped flying to Liberia and Sierra Leone amid growing concern about the spread of the Ebola virus.

Liberian President announced Wednesday on television that her government was shutting all schools and placing “non-essential” government workers on 30 days’ leave in a bid to halt the spread of the deadly Ebola epidemic raging in the West African country.

AFP reports that the country, alongside neighboring Guinea and Sierra Leone, is struggling to contain the epidemic that has infected 1,200 people and left 672 dead across the region since the start of the year.

“All schools are ordered closed following further directives from the Ministry of Education,” President Ellen Johnson Sirleaf announced in a televised address to the nation.

“All markets at border areas are hereby ordered closed until further notice and all non-essential staff to be determined by the heads of ministries and agencies are to be placed on 30 days’ compulsory leave,” Sirleaf added.

She also noted that Liberia, where the death toll stands at 129 from 249 cases, would be contributing $5.0 million as an “initial contribution” to the regional fight against Ebola.

WHO Explains

Meanwhile, WHO has issued answers to questions about what is now being reported as the worst Ebola outbreak in history that has killed hundreds in West Africa.

WHO has also warned health workers deployed by relief organizations to strictly apply infection control measures recommended by the Geneva-UN health agency as there is currently no specific treatment to cure the disease.

“It’s vital for health care workers deployed by relief and similar organizations to come fully trained, equipped to help respond to Ebola,” WHO said.

According to WHO, health workers treating patients with suspected or confirmed illness are at higher risk of infection than other groups, as demonstrated by the reports of doctors treating Ebola victims contracting the disease in West Africa.

The issue of personal safety is a concern for response teams, especially for medical workers in direct contact with patients.

“Prior to my arrival to Kenema, (Sierra Leone) I was scared about my own safety but I realized later that we can be in control of the risk,” says Dr. Mauricio Ferri, a Brazilian intensive care specialist, deployed by WHO to one of the most affected areas of Sierra Leone since the outbreak was declared in late May. “We need to strike the right balance between caring for patients and our own security.”

Dr Ferri was deployed through the Global Outbreak Alert and Response Network (GOARN), a WHO-based network of experts and institutions that can assist with the international response to disease outbreaks.

According to WHO, Ebola, formerly known as Ebola haemorrhagic fever has a death rate of up to 90 per cent. The illness affects humans and nonhuman primates (monkeys, gorillas, and chimpanzees). The origin of the virus is unknown, but fruit bats are considered the likely host.

“Once a person comes into contact with an animal that has Ebola, it can spread within the community from human-to-human Infection occurs from direct contact (through broken skin or mucous membranes) with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen) of infected people,” according to WHO.

Sudden onset of fever, intense weakness, muscle pain, headache and sore throat are typical signs and symptoms. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.

WHO says the incubation period, or the time interval from infection to onset of symptoms, is from 2 to 21 days. The patients become contagious once they begin to show symptoms. They are not contagious during the incubation period.

“Travellers should be aware of #Ebola, and aware that if they do not touch someone who is showing active symptoms of the disease, then they cannot contract it,” Hartl told Twitter.

While there is no specific drug against Ebola, WHO says the best treatment is intensive supportive treatment provided in the hospital by health workers using strict infection control procedures.
Communities and displaced populations living in congested camps with poor hygiene and sanitation are at high risk of contracting cholera in South Sudan.

Since the beginning of July this year, ed Médecins Sans Frontières (MSF) teams in Upper Nile State have treated over 904 patients for cholera.

The teams have set up two cholera treatment centres in Malakal and Wau Shilluk where, viagra 60mg they are treating cholera patients from affected areas.

“Cholera is a treatable disease that can be fatal if not diagnosed and treated promptly. It causes severe dehydration that can lead to death in a matter of hours, treat ” says Llanos Ortiz, MSF Medical Emergency Manager for South Sudan. Only three weeks into the MSF intervention, 19 people have lost their lives to cholera, making the situation a humanitarian concern that needs rapid response to contain.

“The vulnerability of populations in these areas has been exacerbated by the conflict that started in December last year, which has forced people to move into crowded internally displaced persons (IDP) camps and protection of civilians (PoC) camps with poor living conditions favourable for the spread of the disease.

“Cholera is a treatable disease that can be fatal if not diagnosed and treated promptly. It causes severe dehydration that can lead to death in a matter of hours”

Lack of clean and safe drinking water is a common problem in the area. In Wau Shilluk, an area with an estimated population of 50, 000 people, IDPs have been forced to use unprotected surface water and most people undertake open defecation given the extremely low number of latrines. The ongoing heavy rains wash the faeces into drinking water sources, thus completing the oral-faecal transmission and allowing communicable diseases like cholera to spread.

Aid agencies in the area are working to ensure that more latrines are constructed and sanitation standards maintained, to help improve the population’s ability to break this oral-faecal transmission. Since conflict broke out in South Sudan on 15 December 2013, different areas of Upper Nile including Malakal, the state capital, have faced violent attacks.

Civilians are paying the price of these attacks and the violence in general. Continual insecurity in the state is barring people from seeking medical help in good time as they are living in fear. It is imperative therefore that all parties involved in the conflict ensure that security is restored and people feel safe to access healthcare.

The prevalent food insecurity situation in Upper Nile and resultant malnutrition makes the population even more susceptible to infectious diseases such as cholera as their immunities are weak and they can easily succumb to death.

To date, MSF teams have admitted over 3, 195 people, mostly children to its therapeutic feeding programs in Malakal, Wau Shilluk, Kodok and Lul in Upper Nile State. The on-going rainy season makes it impossible for the population to plough their lands and means that malaria and other diseases characteristic of the season are to be expected in the near future.

The upsurge of cholera cases and the need to prevent further spread of the disease has prompted MSF to mobilise its teams from different parts of South Sudan and the world to Upper Nile to help respond to this outbreak.

Together with community health workers affiliated to the Ministry of Health and other organisations present in Upper Nile, MSF is creating awareness on the causes, spread and prevention of the disease.

However, with an already precarious health situation and a vulnerable population, there is still need for more medical personnel on the ground to ensure better preparedness in tackling such outbreaks to ensure that they are contained and spread of the disease in curbed.

Since April this year, a total number of 4,765 cases of cholera have been reported in South Sudan. 109 people have died of the disease, 19 of them from Upper Nile State.

MSF says it has set up cholera treatment centres in different parts of South Sudan, including Torit and Juba. The organisation is also supporting the Juba teaching hospital with water and sanitation activities.



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