Cholera as an agent of change?
Health & Wellness

Daddy, Daddy there is cholera!!!” Exclaimed Chikondi. That’s our 5 year old daughter after being informed (more like lectured) by the mother on the dangers of Cholera. “So what do you do to prevent cholera?” I asked. In rapid fire fashion likened to machine gun burst the answers come out “you wash your hands with soap before eating, after using the toilet….” All the responses are on point.

So Daddy being a doctor could not be upstaged so he decides to add the following “Cholera is caused by a gram negative, comma shaped bacterium with a flagellum at one end. This bacterium is called vibrio cholerae most likely the Ogawa serotype. During infection v.cholerae produces a toxin that leads to profuse watery diarrhea which causes dehydration…..” the bewildered look on her face was a cue that I had lost my audience.

The City of Lusaka is reeling from one of the challenging outbreaks which ground the city to a halt. Hats off to all who are at the front line of fighting the disease and those who made contributions in one way or another. As for the meme generating machine which was in overdrive, no comment.

“Cholera is a change agent” laments one colleague. Why? One would ask, well it is a manifestation of the impact of the environment on one’s health. Health is defined by the World Health Organizations as “a state of complete physical, mental and social well-being and merely not the absence of disease or infirmity”. Other definitions include “the state that allows an individual to adequately cope with all demands of daily life” and the “state of equilibrium or balance an individual has established within oneself and between oneself and the social and physical environment.

These definitions show that health is influenced by social and environmental factors. This also means we are in control of our health (to a certain extent). These factors in Public Health are known as social determinants of health. These are the conditions in which people are born, grow, live, work and age.
The identified social determinants of health include;

i. Social gradient/ladder – this is the leading predictor of health outcomes. It is measured by income, education, residence (the kwa- or ku- conundrum) the identified Cholera epicenters are the high density areas. To the uninitiated Kwa is the prefix for the high density areas ie Kwa Kanyama and Ku is for low density areas ie Ku Kabulonga. Though even the Ku- areas also had their cases of the disease. Having financial resources means having healthier longer lives.
ii. Stress
iii. Early life
iv. Social exclusion
v. Unemployment
vi. Social support
vii. Addiction
viii. Food – consumption of contaminated food aids transmission of cholera through the fecal-oral route
ix. Transport
The social determinants of health advise us what we as individuals can do to improve our health. Truth be told am not a fan of the “boma iyanganepo” (meaning the government should come and sort out this) approach but prefer as individuals we do our best to look after our health and our loved ones while letting the government do their part.
What actions do we undertake as individuals to protect ourselves from Cholera?
i. Hand washing with soap and clean water
ii. Boil drinking water or treat it with chlorine. Like doomsday preppers, the house was stocked with chlorine so that the water can be used for cleaning plates and vegetables.
iii. Have your borehole water tested for contamination. Home is in one of the developmental areas of Lusaka and the borehole is the water source. After her lecture Chikondi drops a nuke in the form of a question. “So Mommy you are saying that we shouldn’t drink water from the tap but we can drink from the dispenser, then what about brushing the teeth? BOOM!! Hence the importance of testing the borehole. If one can afford it is worthwhile investing in a chlorinator for your water storage tank.
iv. Buy your vegetables and fruits from clean sources
v. For those with house helps who also handle food for you and your loved ones have them certified free of typhoid, cholera and other bugs
vi. Keep your surroundings clean. Get together as a neighborhood or street to form a Neighborhood Health and Safety Committee that will make sure the neighborhood is clean.

The Government’s role is to provide the necessary legislative frame work for its citizens to thrive. The citizenry had this opportunity through the Referendum of 2016 for the amendment of the Constitution to include the Bill of Rights 2016. Included in the Bill of Rights under Economic, Social, Cultural and Environmental Rights are, a person has the right, as prescribed;
i. Health care services
ii. Decent housing
iii. Food of acceptable standard
iv. Clean and safe water
v. Decent sanitation
vi. Social protection
vii. Education

Sadly though, people voted against it, but that’s another story. These rights are in the same Whatsapp group as the social determinants of Health. It must be stated that this is not a political issue but rather a governance issue. Now this is the only time the “Boma iyanganepo” will be entertained so that we can have these Rights as part of the Constitution of the land.

Sources
1. Constitution of the World Health Organization, In WHO; Basic Documents 45th Ed. Geneva, WHO, 2005
2. Sartorius N, The Meanings of Health and Its Promotion, Croat Med J. 2006 Aug; 47(4): 662-664
3. The Constitution of Zambia Amendment Bill No. 37, 2016.
4. www.who.int/social_determinants/sdh_defintions/en/

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