Many patients are confined to wheelchairs, their legs are too weak to support. They were crammed into an old hospital tent in Malawi’s capital, where some of the dozens were not fortunate enough to have a bed on the filthy floor.
The paramedics, far outnumbering the sick, rushed from person to person, hoping to prevent them from ending up among the dead in a nearby tent.
“What is happening is terrifying,” said Patrick Manuel, 35, who recently watched his nephew’s bed in a hospital tent. “Today alone I have witnessed seven people die.”
Not so long ago, Malawi looked like a huge success story in global fight against cholera, a bacterial disease primarily transmitted by water, mainly affecting low-income countries. National sanitation and vaccination efforts have completely eradicated the disease in Malawi, reducing the number of recorded cases to just two by 2021.
However, in the past 11 months, this landlocked land of a country in southern Africa has recorded more than 28,000 cholera infections and at least 900 deaths. Health experts say cholera usually kills only about 1% of those infected. But the death rate in Malawi is three times higher, hovering around 3.3%, with hospitals short of basic supplies and many people only seeking help after becoming seriously ill. This is the country’s worst cholera outbreak in two decades.
The number of vaccines available in Malawi has not kept up with demand. Hospitals are overcrowded with untrained and overworked medical staff, and lack basic supplies like gloves and intravenous fluids. Cholera emergency tents, like the one at Bwaila District Hospital in the capital, Lilongwe, have popped up across the country.
“The conditions are terrible,” said Mirjam Molenaar, Médecins Sans Frontières coordinator for emergency response. “The staff are doing their best in this situation, but they are clearly overwhelmed.”
When Cholera has spread around the world – with outbreak in 31 countries over the past year – Malawi stands out as a warning of how suddenly the disease can kill even countries that have almost eliminated it. Experts say a bad outbreak could sweep through a country as long as there are communities without access to clean water and hygienic bathrooms.
Several years ago, Malawi launched a campaign to vaccinate millions against cholera and help dozens of communities access clean toilets and drinking water.
Dr Charles Mwansambo, chief secretary of the Malawi Ministry of Health, said: “Perhaps we have not done enough.
Public health experts and government officials point to several potential causes of the outbreak, including devastating hurricanes, disruptions from the coronavirus pandemic, and accelerated urbanization. rapidly and the decline in the immunity of the population.
outbreak is important not only in the number of infections and deaths, but also in the extent of its spread — all of Malawi’s 29 administrative districts have recorded cases, upending the lives of a country of about 20 million people.
Schools are closed for about two weeks this month in major urban centers. Some food vendors have stopped working. The simple task of getting water to drink suddenly carried the weight of a life-or-death mission.
When nausea hit 22-year-old Wezi Masese, recently as he finished his housework, in a town of cramped, shacks, he felt as if he were on the verge of death. He vomited, fell on the bed and couldn’t get up, he said. He has no money to recharge his mobile phone to call for help.
Luckily, a friend who was expecting to hear from him that day stopped by and spotted him.
“If he had been an hour late, I would have passed out,” Mr. Masese said. “I could have gone – dead.”
The government of Malawi made a public appeal to the public, companies and others this month for donations of basic medical and hygiene supplies, such as soaps, buckets and aprons.
According to critics, who say the government’s slow response has contributed to the current crisis, those kinds of appeals are long overdue.
Dr Adamson Muula, a professor of epidemiology at Kamuzu University of Health Sciences in Blantyre, Malawi’s second largest city, said: “My feeling is that nobody really predicted that it would turn out. such bad. “They think it’s one of those things that come and go. But then it went unmanageable.”
The key to preventing cholera is to keep human waste out of drinking and washing water. That can be difficult in countries like Malawi, where about 30% of the population does not have easy access to clean drinking water and nearly 60% lacks hygienic toilets. according to UNICEF.
Since the outbreak, Malawi has deployed water trucks to areas without running water. Officials are reconnecting taps in rural areas, including unpaid ones, and providing chlorine to families to purify water.
There are also ongoing efforts to administer the cholera vaccine, a small tube of liquid that is taken by mouth. But some communities have kicked out health workers, accusing them of trying to trick people into taking the Covid-19 vaccine, said Chisomo Kankhwali, who works at the Lilongwe district health office. Since the beginning of the pandemic, Covid conspiracy theories have been rampant in Malawi, some of which are spread by religious leaders.
“They accused us of simply turning the Covid vaccine into an oral vaccine,” said Kankhwali.
In 2015, Malawi began an extensive effort to eradicate cholera, working with traditional leaders to build toilets, hand washing facilities and other infrastructure in vulnerable areas. trauma — efforts to prevent defecation in open areas such as streams and lakes. In total, 155 out of 293 traditional communities have been certified to be free from open defecation, said Dr. Mwansambo, the health official.
Then in 2017, Malawi started using more than three million cholera vaccines. The number of cases plummeted from 1,792 in 2016 to single digits five years later.
However, last year’s heavy rain and flooding caused by Tropical Cyclones Ana and Hurricane Gombe destroyed toilets and handwashing facilities in some communities, Dr. Mwansambo said. He added that the increase in illegal fishing along Lake Malawi also contributed to the outbreak. Miners create informal settlements, he said, using the lake for bathing and toilets.
Some argue that the economic hardship caused by the pandemic has exacerbated conditions. John Phuka, associate professor of health at Kamuzu University, says many people have gone hungry, which can weaken the immune system. Rapid development in Malawi’s cities has also led to new informal communities that rely on shallow wells for drinking water and do not have suitable toilets, he said.
Andrew Azman, an infectious disease epidemiologist at Johns Hopkins who specializes in cholera research, said Malawi’s weakened immunity could also be a factor. Dr Azman, who used to live and work in Malawi, said vaccination efforts not only slowed after the 2017 campaign, but the low incidence could reduce natural immunity in the community.
“One of the big lessons is that you can’t just ignore the cholera,” he said. “If it’s in the area, and you still have poor water and sanitation, you’re at risk.”
As it sickens and kills, cholera is also undermining the social fabric of Malawi.
At the funeral of Nambewe Chisankha, a woman in her 50s who died of cholera in Bwaila this month, one of her village chiefs told mourners that his chiefs wanted “a warning.” people that there was a cholera outbreak that was dangerous and killing us. “
“This cholera was invented,” someone in the crowd howled.
Then a gravedigger, who was considered one of the community’s custodians of burial ceremonies, interrupted the head – a notable defiance – and demanded to know why a Some rituals, such as viewing bodies and laying wreaths, were not observed. . Traditions were ignored to prevent the spread of cholera.
Returning to Bwaila the next day, the mood was less tense. More than two dozen women, gathered for a weekly vigil before the outbreak, sang Christian hymns in a hospital ward. But on this day, as with many prayer circles in recent months, the focus is on cholera.
“We have faith that God will give us victory over cholera,” said Florence Chikapa, raising her hands to the sky for divine intervention. “A great miracle awaits us.”
