Cameroon’s Far North Region experiences short rainy seasons and long dry seasons. The national water company only supplies the main town, leaving neighboring villages without potable water. Consequently, less than 19% of the population has access to drinking water.
Local livelihoods in the region include agriculture, small scale animal husbandry and trade. Women also sell Bil Bil, a local beer made from fermenting millet. The very long dry season does not favor agricultural production, compromising local livelihoods and nutritional needs.
Mokolo, the capital city of the Mayo-Tsanaga division, has more rain than any other part of the Far North region. Yet because it is surrounded by mountains, rainwater water recedes towards towns in the valley, leaving behind a dry and desolate landscape. Consequently, many of Mokolo’s residents have to walk for miles to fetch water from springs, open wells or the regional dam.
Since May 6, 2010, an unprecedented cholera outbreak has been raging in the Far North Region, affecting 22 out of its 28 districts and resulting in 10,759 reported cases. With a fatality rate of over seven percent, the outbreak spread to neighboring countries—such as Chad, Central African Republic, Nigeria, and Niger—that were already weakened by food shortages and deteriorated health care, sanitation, and water supplies. Cameroon’s government worked hard to control the epidemic, but its interventions have not been able to stop the spread.
International Medical Corps, which has been working in Cameroon since 2008, launched cholera treatment and prevention interventions for the country in October 2010. With support from the Bill & Melinda Gates Foundation, International Medical Corps implemented the Response to Cholera Diseases Outbreak Support Program in Mokolo Health District. Our project aimed to strengthen national preparedness and response to rapidly contain the cholera epidemic, reduce adverse effects on residents of Mokolo District and contribute to long-term cholera prevention strategies. In large part due to the activities we carried out in cooperation with the Ministry of Public Health, only one cholera case was recorded in Mokolo during the program period.
If left untreated, cholera can have a fatality rate as high as 30-50 percent. International Medical Corps’ comprehensive cholera services include treatment, surveillance, water and sanitation, infection control, social mobilization and prevention. In the short-term, we focus on early cholera detection, as well as effective treatment and case management for cholera patients. To this end, we deployed medical teams to support the Ministry of Health and provided one mobile medical clinic in each of the target districts. Our long-term strategy focuses on increasing context-specific water and sanitation infrastructure while strengthening community and government capacity to manage them through training and education.
Before International Medical Corps’ interventions, residents of our partner communities had to travel long distances to retrieve drinking water. Existing water pumps were often not maintained, easily contaminated and inconsistent in their water supply. To ensure convenient and sustainable access to safe drinking water and sanitation, International Medical Corps worked with local villages to build water pumps, latrines and nine new wells. We successfully drilled six boreholes and fit them with hand pumps, and completed five ventilated improved pit latrines. In addition, we trained sixteen participants on hand pump repair and maintenance.
Because the effective prevention of cholera requires widespread knowledge of safe sanitation practices, International Medical Corps uses the Community-Led Total Sanitation (CLTS) approach to build local knowledge and encourage communities to take action on sanitation. We launched CLTS in 24 villages in the Mokolo division, reaching 37,732 community members and resulting in the construction of 1,417 new latrines. We trained 50 volunteer community health workers from 18 villages on cholera prevention and good hygiene practices, and donated 15 bicycles to enable volunteers to have extended coverage outside their villages. In addition, we trained 18 committees comprised of 50 women and 129 men on water management. To reach broader audiences, we conveyed sanitation messages over the community radio with a reach of over 200,000 people and distributed 1,000 posters with cholera messages throughout Mokolo.
In March 2011, there was a much larger outbreak of cholera affecting all ten regions of Cameroon, which overwhelmed local communities, even those receiving support to mitigate future epidemics. By September 2011, 16,562 cases were reported, with 622 deaths. In September 2011, International Medical Corps received additional support from the Gates Foundation to continue our response to the cholera outbreak in Cameroon, this time focusing on Kousseri, Maga and Guere health districts. Though Cameroon remains vulnerable, and long-term mitigation of cholera will require a sustained and coordinated response, International Medical Corps’ Cameroon project demonstrates that CLTS promotes healthy and sanitary behavior at the individual, household and community level.
Dada (meaning “mother” in the Fulfuldé language) MERGANGA, an 80 year old widow, is grateful for the new water point in her local village. She used to have to fetch water in a neighboring village or dig in the sand to collect water, but this has become hard for her in her old age. Now that International Medical Corps intalled a water pump near her house, she can collect water several times a day and bathe and wash her clothes regularly. Her animals have water to drink as well, and she spends more time on income-generating activities to take care of her household and her family.
Bourha, a 60 year old inhabitant of Zouba Chugulé, reported that his village believes its water point is God’s answer to their prayers. The village is located in a valley down a narrow road several miles from the center of town, forcing people to walk very far to fetch water from the dam. The water point International Medical Corps constructed has tranformed the village, enabling people to collect water just steps from their homes. As a result, locals can spend more time on other activities such as farming, and the local doctor reports a significant reducation in children that fall ill from waterborne diseases. Bourha strongly believes the water point has increased his neighbors’ “life experience” because the pain around fetching water has disappeared, people and animals have enough water to drink, and waterborne diseases like cholera have been reduced.