Cholera outbreak could have been controlled better
By Agar Mayor Gai-Makoon
The rate at which cholera is spreading in South Sudan is alarming. It started a few months ago as six cases in Renk town, Upper Nile state. Now more than 9,000 cases have been reported across South Sudan including the Central Equatoria state that hosts the capital with more populated and slum areas. The camps around Juba that have become home to thousands of internally displaced persons are at a greater risk. The outbreak is too heavy for the country’s already overwhelmed health system. However given that cholera is an easily preventable and controllable disease, there is a reason to fault damages on the ministries of health and the partners.
The slow response from the Upper Nile State Ministry of Health and the National Public Health Laboratory in Juba could be the reason for the rapid spread of the disease. The date of the onset of the outbreak is recorded to be 28th September 2024 and it was officially reported on 30th November 2024. For two months, the Upper Nile State Ministry of Health and the National Public Health Laboratory in Juba were unable to confirm that there was a cholera outbreak. By definition, a cholera outbreak is at least one confirmed case of cholera and evidence of local transmission. Confirming a case of cholera requires collecting stool samples from symptomatic patients and sending them to a reference laboratory, for example, the National Public Health Laboratory in Juba for microbiological confirmation by culture or PCR. This process takes a maximum of 7 days. It does not take two months. There is no acceptable clinical explanation for such a delay in reporting the cholera outbreak. It only exposes the broken channel of communication and lack of work coordination between the state ministries and the National Ministry of Health. The health sector has got to mend such negligence that has cost the lives of the South Sudanese so far. If the outbreak had been reported earlier, for instance, it would have been easier to control. More cholera treatment centers could have been erected, and oral rehydration units would have been adequately provided. The awareness about hygiene and sanitation, drinking clean water, and eating freshly cooked and hot foods would have helped in areas the outbreak had not reached by October. Additionally, the vaccination campaign that started in Renk on 10th December 2024 would have been rolled out in October if the outbreak had been reported earlier.
However, the Ministry of Health and its partners still have the chance and responsibility to save the lives of the internally displaced persons, and the areas that have no access to clean water from cholera. Here are the recommendations
- Proper use of the $ 8 million allocated by the South Sudan Humanitarian Fund to support cholera response
The National Ministry of Health should make sure that this fund usage aligns with its target points in the response plan. The priority populations are the people in the protection of civilian sites and people in areas that have little or no access to clean drinking water. Perhaps, they have to be provided with adequate clean water points, oral cholera vaccines, and training about proper hygiene and sanitation (WASH programs).
- Proper distribution of the cholera vaccines
The 1.1 million doses of vaccine that are expected from the Global Alliance for Vaccine and Immunization should first be administered to the people at POCs across the country. There should be no business and some politics in handling this package of needful donations from GAVI. This is something that has to save lives and for that matter, it should be administered to the priority population timely and adequately.
- Establishing more reference public health laboratories at the levels of state
The national public health laboratory in Juba plays a great role in confirming outbreaks and other public health emergencies. It has been so helpful especially, during the time of COVID-19 in screening people and making sure that those who are screened positive for the virus undergo specific public health guidelines to protect themselves and the general population. South Sudan had fewer cases than most countries in the East Africa region because the NPHL was quick and efficient in identifying COVID-19 patients. Recently, I have personally noticed that the National Public Health Laboratory has less coordination with the state’s hospitals. This is evidenced in the slow manner in which the cholera outbreak has been handled by the Upper Nile State Ministry of Health and the National Public Health Laboratory in Juba. This communication issue can be solved by establishing more reference public health laboratories in all the ten states’ hospitals. Diagnosis and confirmation of a disease as an outbreak could easily be done at state levels while the National Public Health Laboratory remains the mother reference laboratory for diagnostic supplies to the states. This will help the country’s health system deal with future outbreaks more efficiently and effectively.
- Coordinating with ministries of water and irrigation, and environment
The National Ministry of Health in its search for a healthy population in the community has to cooperate with the Ministry of Water and the Ministry of Environment to prevent and control diseases. The three ministries are very critical to the well-being of people and the environment. They have to collectively produce and implement a policy that ensures there is clean drinking water, a clean environment, and proper sanitation. The joint policy by these ministries can easily get funding from our donors. Even the national budget committee can get motivated by this program and increase the budgets for these ministries in the next fiscal year.
South Sudan currently battles many wars, but the war with the unseen—sicknesses is the worst of all. We have got to win it so that the courage and strength to fight the rest of the wars is attained.
The writer has a background in socio-political philosophy. He currently studies medicine at Ain Shams University, Egypt. The insights shared above are his own. He can be reached at: +201129107334 by email: at thieng.thiengwada@gmail.com.
