Cholera and human overcrowding are two concepts which seem to be intimately linked: urban enclaves, refugee camps and temporary emergency settlements are fertile ground for the spread of the epidemic. However in Chad, cholera is also transmitted in far more isolated circumstances, incubating in the bodies of the nomads who travel from one region to another. In this context, the unhygienic conditions, the poor quality of water and the lack of understanding about transmission of the disease make controlling the epidemic an enormously difficult task.
Mohammat Gana Ali is 11 years old, and he has spent the last two days confined to bed in the Cholera Treatment Center (CTC) in Chikutalia, an area surrounded by dunes and dried-up marshes where dozens of nomadic groups have gathered to harvest maize.
It is November, and there is an urgent race to finish the harvest, as little time remains before the waters once again rise to cover the entire Lake Chad region. This urgency has led to an acceleration in the spread of the disease here in the last few weeks. It is one of the areas worst affected by the cholera epidemic that has been devastating Chad since late August, and which has so far taken more than 160 victims and infected over 5,600 people.
Mohammat travels along with his Marabout – a Qur’anic teacher – and 20 other children, from one polder to another. By night, they take up positions around the fields where the maize is being harvested, in the hope of finding a little food and water among other nomads temporarily based in the area.
Food is scarce, however, and water, where available, will be taken from some unsanitary well which is used by both humans and cattle. Mohammat can only drink whatever water he happens to find on his way and he defecates in the open air, with few opportunities to wash his hands. He doesn’t know what cholera is, let alone what causes it.
Now, he is learning that lesson courtesy of his own body. The bacteria have been silently incubating for some four days. More than enough time for him and his companions to have left the polder in which they were harvesting – where over 10 infections have already been registered – and arrive in the outskirts of Mondowa, a small community within Oxfam’s zone of intervention.
For Mohammat, this was a fortunate move. When he collapsed, the villagers immediately called for an ambulance, as they had been advised to do by the Oxfam teams who had been working to raise awareness in the area just a few days before.
“Every case that comes in to the CTC gives us clues as to the possible location of the focus of contagion of the epidemic,” explains Mohammat Tidjani, the charge nurse at the CTC in Chikutalia. And immediately, that is where Oxfam’s disinfection and awareness-raising teams will be headed, in a race against the clock to eradicate the bacteria.
“The most urgent thing is to disinfect the places where the disease has hit, warn local families and residents of the dangers, and distribute soap and bleach so that they can immediately incorporate these into their hygiene habits,” explains Charles Mampasu, in charge of Oxfam’s response to the cholera emergency in Chad.
But this process, standard practice throughout the organization’s other aid interventions in the country, is a much more arduous task among the nomadic population. “The nomads keep on moving, and the bacteria travel with them from one enclave to another, making eradication a much more difficult and lengthy process,” adds Mampasu.
Oxfam’s awareness-raising team, kitted out on motorcycles with chlorine spray, continue their work among the enclaves around the fields. On their way, they come across dozens of nomads astride their camels, seeking new areas to harvest, or markets in which to sell their merchandise. With this objective in mind, they even cross the borders into neighboring countries – Niger, Nigeria and Cameroon – taking the bacteria with them. Therefore, they urgently need to be intercepted, so that the concept of cholera, and how it can be avoided, can be explained to them.
Mohammat is now out of danger, but his eyes still register the fear that comes from being on the verge of death. He now knows the importance of washing his hands, and of making sure that the water he consumes is drinkable. Neither he, nor his companions, will forget it.