Cleaning up our Act

I just came back from holiday to find Sierra Leone grip(p)ed by a cholera epidemic.

Why I am not surprised? Cholera has had a lurking presence in the country for as long as I can remember and, from time to time, depending on the intensity of the rainy season, emerges and runs through the population like a dose of salts. I can recall, as a freshly-minted doctor, my first epidemic there. Bursting with knowledge about the way cholera and other waterborne diseases spread, I readily remembered lessons taught in med school, about how an astute physician, John Snow, had sussed out cholera by merely observing how the infection clustered around a street pump in the Soho district of Victorian London.

I recall also how I was immediately conscripted into teams managing cases desiccated almost to extinction by the diarrhoea and vomiting that are typical of the infection. We fought valiantly then, but the epidemic took its course, regardless, and faded away only at the end of the rainy season.

Yes, we have come a long way since Victorian days. Most of us no longer invoke mysterious forces when an epidemic rages. We know that a physical element is involved, and that in this case, if we keep feces separate from the food we eat and the water we drink, we will not catch diseases that have a fecal origin and die from them.

            And yes, we also know that the more crowded the environment, the more likely it is, when the barrier between excrement and clean food and drink is breached, that epidemics will occur. And yes, even in towns and villages that are not so crowded, run-off from heavy and persistent rain will enter pit latrines, cause them to overflow and discharge their contents into the environment, contaminating everything. This is what happened forty years ago and this is what is happening today and what has always happened.

Yes, hand-washing is crucial in breaking the cycle during epidemics and even in more settled times. But where do you get the clean water to wash your hands with when everywhere is contaminated?

The answer to this simple problem is beyond politics or ideology. Neither political posturing nor the dialectics of ideology can stem the tide. Germs will do what germs do. We know how the disease is caused, how it is transmitted. So all we need is a plan. I mean an actual blueprint of the future sewage systems in our main cities and towns.

Did I say beyond politics? I was wrong, of course.

I just read that the President of Sierra Leone recently signed a massive memorandum of understanding (MOU) with the government of China, in which they agreed to cooperate in a whole raft of activities including huge engineering projects. But, significantly, there was no mention of how to deal with sewage in the country’s towns and cities.

I know, I know. Such documents are drawn up months in advance of their signing, and yes, yes, the epidemic burst upon us in the last six weeks (surprise, surprise, it only rains torrentially every year from May to November). But here, we have an urgent, urgent public health priority that must be handled as urgently, even if it means adding a paragraph or two to that MOU. It would give us the chance to revisit the plan that imperial Britain proposed for Freetown more than a century ago, a vantage from which we can begin to talk meaningfully about how we can get this doo-doo out of our face.

Tell Fren Tru