By Dr. Miriam O. Laker-Oketta
It is not unusual in Uganda, especially in the towns that we hear of a cholera outbreak. Cholera is mainly in countries with warmer climates. In the past, cholera epidemics used to occur in the now rich countries of Europe and North America with majority of the casualties being the poor living in the overcrowded parts of the town. However, today, cholera is almost never seen in those countries. For instance, the last cholera outbreak in the USA was in 1911. Instead, it has become endemic in the poorer countries of Africa, Asia and South America where it remains a disease of poverty, insanitation and overcrowding.
Outbreaks of cholera occur in communities with poor sanitation and unprotected water sources. Endemic means the disease in question is constantly present in a geographical area so that at any given time, someone in the community is suffering from it. For cholera to occur, there must be a mingling of faeces and food or water. Toilets in most poor places are either latrines or flush toilets emptied in a way that allows faecal matter to seep into the water sources that the community uses for drinking and cooking.
The link between cholera and water ingestion was first made in London by an epidemiologist called John Snow. During one of the deadly cholera outbreaks in London, he noticed that people who were falling sick resided in a neighbourhood that fetched water from a particular borehole and that those who did not reside in that area and were getting cholera had either left their nearest borehole and fetched water from the suspected one or had ingested food or water fetched from that borehole. To test his theory, he removed the handle of the borehole so that its water could not be accessed and just like that, the cholera epidemic came to an end.
Cholera is one of the deadliest illnesses known because of how rapidly it kills and its non-discrimination. It can take even a very healthy adult from feeling extremely well to being dead within a few hours: a person who woke up healthy this morning and went to work as usual can develop the cholera symptoms and be dead before the sun sets today.
Cholera is caused by bacteria. Millions of the bacteria are required to make someone sick. The bacteria, once in the testiness of its victim, produces toxins which causes the body to lose a lot of water and minerals that a human needs to stay alive and healthy. It causes a lot of diarrhoea and vomiting. A person with cholera can lose a litre or more of water within one hour over several hours resulting in severe dehydration. It is the reason why cholera patients die quickly.
Once a person is suspected to have cholera, they must be rushed to a health facility that has the ability to quickly replace the water and minerals that have been and continue to be lost. If people with cholera are not quickly started on the fluid replacement, 1 out of every 2 will die before the end of the day.Most people who get the cholera virus, however, do not fall sick. Some may have a little diarrhoea or vomiting which soon stops on its own.
However, these people are dangerous because they pass the bacteria in their stools which in places with poor water systems can contaminate water or through not washing their hands after using the toilet people with cholera may touch food which then gets contaminated with the bacteria.
Symptoms of cholera
The diarrhoea from cholera is the same colour as water that has been used to wash rice. It is referred to, for this reason, as rice water stool.
A person with cholera will have a lot of diarrhoea, so much that they soil themselves and fail to leave the toilet. Cholera beds have been developed to allow patients continue passing stool comfortably even while on their beds.
A person with cholera may vomit a lot as well. They complain of muscle-aches due to loss of minerals. They will be weak and sometimes confused as a result of losing large amounts of water and minerals from their body. They may lose consciousness.
However, the only way that the medical workers can confirm that all the signs and symptoms are as a result of cholera is to do a test of the stool. The bacteria may be seen under a microscope or using a dipstick, the presence of cholera toxins can be confirmed.
Things that increase the risk for cholera
• All people who have not received the cholera vaccine are at risk.
• Using water from sources that are not properly protected. Even water from taps in poor countries like Uganda are a risk for cholera because the pipes pass through places that may be contaminated and if the pipe has a leakage, then the virus from the surrounding can get into the pipe. For this reason, all water must be boiled before consumption and kept in a container that is sterile. Only drink bottled water from companies that are properly certified; some bottlers are known to bottle tap water. If you are in a place whose water source you are not certain of, drink only bottled water and even brush your teeth with bottled water.
• Eating food from food vendors. If you must eat the food, make sure that it is very hot food and that it is prepared in your presence.
• Eating salads and fruits that you have not washed and peeled yourself. In Uganda, roadside raw salads like in the rolex chapatti or served with road side chips and chicken and ready to eat fruits are very common and these are potentially sources of cholera infection. Even washed fruits and raw vegetables can transmit cholera if the water used to wash them is contaminated. I have seen market people washing vegetables in swamps and dirty springs.
• Not washing hands after visiting the toilet and before eating anything. Washing hands must be with soap and rubbed for at least 15 minutes. If you have no access to soap and water, then use a hand sanitizer.
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