cholera outbreak in south sudan, june 2014
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A photo essay and first person account from South Sudan about the effects and responses to the out break of cholera, June 2014.TRANSCRIPT
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Cholera Outbreak – Juba, South Sudan
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On June 10th 2014 the cholera outbreak in Juba entered its fourth week. More than 30 people have lost their lives and more than 1,300 have been treated for the disease in the South Sudanese capital. Medical humanitarian aid agency, Médecins Sans Frontières (MSF), is running three Cholera Treatment Centres (CTCs) and three oral rehydration points (ORPs) in key areas of the city. Its medical teams have already provided cholera treatment to 282 people and are in the midst of building two additional CTCs and further ORPs. MSF is also continuing to provide technical assistance to the Ministry of Health to help reduce the burden on Juba Teaching Hospital. On 9th June MSF sent an additional four staff to Juba and plans to further scale up water and sanitation support to the hospital to help control the outbreak.
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Treating Cholera:Cholera causes profuse diarrhoea and vomiting, which can lead to death by intense dehydration, sometimes within a matter of hours. Children are especially vulnerable, and need immediate treatment. Cholera is treated simply and successfully by immediately replacing the fluids and salts lost through vomiting and diarrhoea – with prompt rehydration, fewer than one per cent of cholera patients die. Cholera victims are always treated with oral rehydration solutions - prepackaged mixtures of sugars and salts that are mixed with water and drunk in large amounts. Severe cases will need to be medically rehydrated intravenously via a drip, and antibiotics are sometimes administered.
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“As Matthew became worse, I started to worry. Then Ludia started to get sick, and I was afraid. I had heard there was cholera in Juba, and I knew it was serious. People said there was treatment in the main hospital (Juba Teaching Hospital), but it was too far away from me to get to. I live on the other side of the city and didn’t have any money to pay a driver to take me to that hospital. I rushed to my uncle nearby and he was able to lend me 5 SSD (less than US $2) to buy some treated water for the children. Still they kept getting worse. I was troubled but I didn’t have enough for a bus or taxi. Then some neighbours told me that they had heard that an organization had built a special clinic for cholera in our area. I picked up my children, and carried them here - Matthew on my back, and Ludia in my arms. When I got to this clinic the doctors gave both of them special water to drink. Ludia started to get better, but not Matthew. He stopped wanting to drink and became weak. So, they moved us to this tent. They put a needle in Matthew’s arm with a stronger liquid to help him. They say he will be better soon. My message to the people is to keep everything clean. Don’t let your children play with dirty water or drink water that you don’t prepare. Boil it for a long time. Be careful, even with eating fruits like mangoes and bananas. Now that cholera is here in Juba, you must watch your children. If you see signs like vomiting or diarrhea then you must try to rush them to a special centre like this one. If this clinic wasn’t here, I don’t know what I could have done. I would have had to wait. And just hope that they would somehow recover.” Matthew, 4, and his younger sister, Ludia, 2 1/2, were both successfully discharged from MSF’s cholera treatment centre a few days later, and able to return home with their mother, Mary.
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Mary Keji, feared the worst when her two young children fell ill in Juba, just as a cholera outbreak was taking hold.
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A child lies in the inpatient department of MSF's Cholera Treatment Centre in Gudele 2, Juba, South Sudan. Photo: Nick Owen/MSF
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“As Matthew became worse I started to worry. but I had no money to pay a driver to go to the main hospital.” – Mary Keji
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Mary: “When I got to this clinic the doctors gave both of them special water to drink. Ludia started to get better, but not Matthew.” Photo: Andreea Campeanu
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Mary: “We moved into this tent. They put a needle in Matthew’s arm with a stronger liquid to help him. They said he would be better soon.” Photo: Andreea Campaneau
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Mary: “My message to the people is to keep everything clean. Don’t let your children play with dirty water or drink water that you don’t prepare.” Photo: Andreea Campeanu
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Mary with her children Matthew, 4, and Ludia, 2 and a half. Both children are being treated for cholera at an MSF Cholera Treatment Centre in Juba, South Sudan. Photo: Andreea Campeanu
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Mary Keji, Juba, South Sudan.Photo: Andreea Campeanu
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Unice Keji, 58, sits beside her three grandchildren: Simon Jeden, the eldest, Rizik Jeden, and Alfred Idi, the youngest. All of Unice's children are thought to have cholera. Photo: Nick Owen/MSF
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Unice Keji,watches over her youngest grandson as he receives treatment for cholera at the MSF CTC in Juba, South Sudan. Photo: Nick Owen/MSF
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Segerina’s son, 1 year-old Peter Wanii James, was among the first patients in the Cholera Treatment Centre (CTC) MSF opened on 24th May 2014, in Gudele 2, one of areas most affected by the cholera outbreak in Juba, the capital of South Sudan. Photo: Suzan Kiiko/MSF
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Day one of setting up the CTC, construction work ongoing. Juba, South Sudan. Photo: Lara Jonasdottir/MSF
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MSF staff setting up toilets for the Cholera treatment Centre in Gudele, one of the most affected suburbs in Juba, to relieve some of the pressure on the Juba Teaching Hospital. Photo: Lara Jonasdottir/MSF
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Latrines in the MSF Cholera Treatment Centre in Gudele 2, Juba, South Sudan. Photo: Nick Owen/MSF
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MSF staff receive training on patient flow and infection control before opening the Cholera Treatment Center in Gudele, JubaPhoto: Lara Jonasdottir/MSF
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Education session for those suffering from cholera and their carers. Photo: Andreea Campeanu
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Mududuzi Chandawila (left), from Zimbabwe, is the head nurse at the Gudele 2 Cholera Treatment Centre. "As head nurse, I guide the work of the national staff and monitor the patients to see that they are given the ORS and drip to the patients at the right time." Photo: Nick Owen/MSF
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A sanitation worker carries cleaning equipment into the inpatient department. Sanitation in the CTC is taken very seriously. Photo: Nick Owens/MSF
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Vigilant sanitation in the CTC, Juba. Photo: Nick Owen/MSF
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Washing cutlery used by the patients. Photo: Nick Owen/MSF
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Good infection control is essential during a cholera outbreak. Different strengths of chlorine solution in water are used for washing hands and for making the water safe to drink. Gudele 2 district of Juba. Photo: Andreea Campeanu
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The brother of a seriously ill patient in the inpatient department of MSF's CTC in Gudele 2, Juba, South Sudan. Having a family member or friend to care for cholera patients is very important as they encourage their friends or relatives to rehydrate. Photo: Nick Owen/MSF
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Joyce, 13 years old, drinking an oral rehydration solution.CTC in Gudele 2, Juba. Photo: Andreea Campeanu
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MSF has set up a CTC in the district of Gudele 2, and two smaller CTCs in two IDP camps in UN bases. There are several MSF Oral Rehydration points close to the affected areas of Juba, and support is provided to the Ministry of Health in the Juba Teaching Hospital.Photo: Andreea Campeanu
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Guy ropes for securing the tented CTCinpatient department, Gudele 2, Juba. Photo: Nick Owen/MSF
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Inpatient department at MSF's Cholera Treatment Centre, Gudele 2, Juba, South Sudan. Photo: Nick Owen/MSF
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A young cholera patient at the MSF Cholera Treatment Centre in Juba, South Sudan. Photo: Nick Owen/MSF
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Gudele 2, Juba, South Sudan. Photo: Nick Owen/MSF