Cholera has hit Nairobi.
This is a disease that regularly appears across sub-Saharan Africa, spreads quickly, and kills easily.
With cholera getting closer and closer to the children of Future Stars, perhaps you’d like to know a bit more about the enemy and the realities of the situation.
(These headings allow you to skip to the part that interest you, or just read it all!)
What is it?
- Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.
- The bacterium that causes cholera is Vibrio cholerae.
- It is spread through ingestion of contaminated food or water, including touching/handling contaminated sources and then putting hand to mouth.
- Cholera is always considered a potentially serious infection and can cause high morbidity and mortality.
- It has the potential to spread extremely rapidly.
- Symptoms show between 12 hours and 5 days after infection.
Who is at risk?
- Those with inadequate access to clean water and sanitation facilities.
- Children, especially those aged between two and four years old.
What does it look like?
Cholera causes diarrhea so severe that a person can become dangerously dehydrated within just a few hours. This is exacerbated by the vomiting that often accompanies it. Dehydration can result in electrolyte imbalances, in particular a lack of potassium, and can lead to shock where the blood pressure drops dramatically.
An untreated person with cholera can produce 10-20 litres of diarrhea a day.
What is the treatment?
The primary treatment is oral rehydration therapy. Where commercially produced solutions are inaccessible, a substitute can be made with 1 litre of water, ½ teaspoon of salt, 6 teaspoons of sugar, and some mashed banana.
In severe cases (and particularly in children), intravenous fluids are needed along with antibiotics. In the first 2-4 hours of treatment, a sufferer may require 10% of their body weight in fluid. This means a 70kg individual would need at least 7 litres of fluids.
Severe cholera, without treatment, can kill within 2-4 hours of symptoms appearing and has a mortality rate of more than 50%
PROMPT ACCESS TO TREATMENT IS VITAL
Vaccinating Against Cholera
Currently there are 3 oral cholera vaccines, each requiring 2 doses for full protection.
Travellers generally receive a product that requires 150 ml of clean water. This is difficult to access reliably in places like Kibera. The alternative oral vaccinations require a minimum of 2 weeks delay between each dose – unhelpful in emergency situations and also where compliance may be an issue.
These vaccines provide a maximum of around 65% protection from cholera.
In 2013, the World Health Organisation established a stockpile of 2 million doses for use in outbreak control and emergencies. At this stage, they have not released any of this supply in Nairobi.
An injectable form of the vaccine was developed but there were difficulties with its manufacture. As a result, there is very little available and it is much more expensive than its oral counterparts.
The Current Outbreak in Nairobi and Kibera
Kenya has been suffering from outbreaks of cholera since the beginning of the year. It is not an uncommon event and is thought to be related to the heavy rainfall of El Nino.
This most recent outbreak has been provisionally traced to two events. The first was amongst participants attending a conference in a Nairobi hotel on 22nd June. A total of 146 people present at the conference were subsequently treated for cholera in hospitals around Nairobi. The second event occurred at the China Trade Fair between 10th and 12th July and resulted in reports of 136 cases of cholera with one fatality.
Of course, the people who attended these events went home. This is how cholera spreads – through the movement of people. With regard to Kibera, the disease is thought to have arrived via those who worked at the events doing tasks such as cooking and cleaning.
Of the identified ‘hot spots’ in Nairobi County, the various slums feature prominently. With open sewers and a lack of clean running water, this is unsurprising.
A treatment centre has been activated in Kibera South, along with five other centres across Nairobi. Whilst the risk of death amongst cholera sufferers is usually less than 5%, it may be as high as 50% among groups who have poor access to treatment. And with treatment costing valuable shillings, the residents of Kibera are at a real disadvantage.
Cholera at Future Stars
Thankfully, cholera has not hit Future Stars…yet. However, there have now been two cholera-related deaths within metres of the centre, as well as further fatalities elsewhere in Kibera. The mood is sombre and tense. We can’t help but be aware that an outbreak at Future Stars could be devastating. Children are so much more vulnerable to this disease than their adult counterparts and there is a much smaller window in which to receive effective treatment. It is more important than ever to be careful with water supplies and attend to basic hygiene. However, in a place where open sewers run freely and resources are limited, it will be nothing short of a miracle if the outbreak spreads no further.
Cholera has not yet hit Future Stars and we desperately hope it won’t. You can join us in praying for the safety of the children who use the centre as well as the wider community of Kibera. Of course, there are also those who have lost their lives and whose loved ones are grieving. Please remember them as you go about your day.
The moment any of the children shows the slightest sign of infection, Chaffinch will work to ensure that medical care is available immediately. A child with cholera can die within a matter of hours without medical treatment so we need to be prepared to act.
If you would like to donate a small amount to help us act quickly in the event of an outbreak at the centre, please click the button below. We hope it will not be necessary for us to fund medical care. In this case, any donations received will be used to further our work in other areas such as the provision of food, educational supplies, and other essentials.