Public health leadership the answer

Thursday July 20 2017

A lady washes utensils next to sewage on Kirinyaga Road, Nairobi, on July 20, 2017. Burst sewers are now an eyesore on city roads, and it has never been easier for water to be contaminated. PHOTO | ANTHONY OMUYA | NATION MEDIA GROUP


When whispers about a possible cholera outbreak at a top hotel in Nairobi began circulating in the blogs three weeks ago, it was a narrative that was dismissed as an isolated case of food poisoning.

However, within hours, the murmurs turned into roars when doctors and other participants at a health conference were treated for symptoms that clearly pointed towards cholera.

I was at that ill-fated conference. I enjoyed a delicious meal served in take-away lunch boxes, but nothing indicated that there would be such a public health scare until 10 doctors later began complaining of abdominal discomfort and other telltale signs of cholera, including vomiting and diarrhoea.

My own lucky escape was either as a result of prophylactic medicine or that the bacterium was not in my body yet.


An earlier cholera outbreak at a wedding in the Karen suburb led to two deaths and five people being hospitalised.


The current cholera outbreak that has claimed three lives in the city and infected some 336 people is a symptom of a frail health and sanitation system, a failure of the city county government, which is tasked with the promotion of primary health care in the capital.

With poor management of health and sanitation services by the county government, foecal bacteria is easily finding its way into food and water.


Under Schedule 4 of the Constitution, in 2013, public health was devolved to the county governments.

Soon after, the surveillance and supervision of eateries and food handling companies in Nairobi began to fail.

Burst sewers are now an eyesore on city roads, and it has never been easier for water to be contaminated.

The county government’s health department has become preoccupied with other business, ignoring its core duty to ensure that environmental sanitation is top notch and that the health facilities countywide run efficiently.

Stocking hospitals with the best drugs will not solve the recurrent current cholera outbreaks.

Banning food handlers and revoking their licences is a kneejerk reaction that may return to haunt us sooner than we will be thirsty for a glass of water.


Nail the sewer system, as well as water and sanitation.

Cholera infection is not about the food, but what you use to cook the food with.

The public sanitation levels need to be improved and the sewer system in the city is crying out for an overhaul.


The cholera bacterium is not visible to the naked eye, therefore, the authorities need to ensure that the water sources are not compromised.

Whereas washing hands is a preventive measure, if you had everybody in Nairobi wash hands with contaminated water — this might just spread it further.

Cholera is an infection caused by the ingestion of the bacterium Vibrio cholerae, through contaminated food or water.

Acute watery diarrhoea and vomiting can lead to death through dehydration.

The World Health Organization recommends that intervention strategies ideally should aim to reduce the number of deaths to less than one per cent by ensuring access to medical treatment and controlling the spread of disease.

The disease has an extremely short incubation period — two hours to five days — and it is known to kill within hours if not treated promptly.

It is treated through giving the affected person oral rehydration salts and antibiotics to enable the patients to regain lost fluids and energy.


But why do we have to wait until we admit patients to hospitals for cholera treatment?

Disease prevention and management through surveillance and an early warning system fall under the county government.

Safe adequate water and sanitation should be provided.

And as most of the blame game is placed on public health officials in the county government, health education programmes should be strengthened to ensure that everybody observes personal hygiene.

Basic hygienic behaviour such as thorough washing of hands with soap under running water after visiting the toilet should be emphasised before handling food.

Cholera can be easily prevented by ensuring the people’s access to safe water and appropriate hygiene.

We need to put our health care system in order to prevent these needless illnesses and deaths.

We need to revive our public health leadership!

The writer is the health and medicine editor, The Conversation Africa. [email protected]