Since May this year, a cholera outbreak has devastated Guinea Bissau. The epidemic has already caused the deaths of 190 patients and more than 10,000 people have been affected by the outbreak.

After reaching the epidemic peak recently, in the past few days there has been a significant decrease in the number of admissions to the main cholera treatment centre (CTC) opened in the capital, Bissau.

The country's capital has been the hardest hit area, with 70 percent of the total number of cases reported. This is why MSF, together with the Ministry of Health, opened a CTC next to the main hospital, Simao Mendes, with a capacity for 100 patients, operating 24 hours a day.

About 5,000 patients have already been treated at this centre. In addition to the CTC in Bissau, the intervention focuses on giving support to another 17 rehydration centres scattered across the other two most affected regions; Biombo and Oio.

"Patients can dehydrate and die in just a few hours if untreated," explained Daniel Remart, Emergency Coordinator. "This is why it is so important to cover the areas where there could be affected people in order to provide them with quick access to treatment and thus save their lives."

Cholera is endemic to Guinea Bissau and with the rainy season, which lasts from May to November, many areas are flooded and wells filled with fecal matter spreading the epidemic amongst the population.

"When not treated in time, mortality amongst infected people can reach between 20 and 50 percent, but drops to less than 2 percent when patients receive the necessary treatment, which in 80 percent of the cases consists of simply administering oral rehydration salts," added Remart. 

Stop the spread

In addition to decreasing mortality amongst the affected people, stopping the spread of the epidemic by taking disinfection and preventative measures is crucial.

Cholera is mainly spread by drinking contaminated water or eating contaminated food and is linked to the lack of garbage and human waste management as well as the lack of hygienic measures such as hand-washing, which is why crowded places such as markets, where sanitation and hygiene measures are inadequate, are more susceptible.

"The overall water and sanitation situation in the country continues to be very limited," said Agustpez, in charge of logistics in the project. "This facilitates the spread of cholera. Prevention depends on access to drinking water and proper sanitation systems to prevent exposure to the bacteria and stop transmission."

In many areas of Guinea Bissau, basic infrastructures are inadequate: drainage is non-existent, the electricity network is poor and, based on estimates, less than 20 percent of the population has access to drinking water. Most of them get the water they need from wells.

In addition, the bodies of those who die of cholera need to be treated with extreme caution and properly disinfected before being buried in order to prevent further contamination. According to local customs, a dead body can be kept at home for several days so that family members and friends are able to pay their last respects. They usually touch the body.

The government forbids these rituals when there is an epidemic. Their houses, as well as the houses of the patients admitted to the centres, have to be disinfected. This task is carried out by the brigades in charge of actively tracing cases and disinfecting, that MSF coordinates together with the government seeking to stop the spread. A special team disinfects houses using a chlorinated solution. They also deliver soap and bleach to the population and explain to them how to treat water and the hygiene measures needed to prevent the bacteria from re-infecting them.