Thousands of lives at riskPoor hygiene fuels hepatitis Inadequate sanitation facilities continue to fuel the spread of hepatitis E in Windhoek's informal settlements, which has already led to 17 deaths.
A site visit to the Samora Machel constituency where some of Namibia's poorest residents have been affected by the hepatitis E outbreak, showed that although several kilometres of water pipes have been laid and new water points installed, thousands of people continue to face a high risk of infection as they are forced to defecate in the open due to a lack of public toilets.
David Kamati, a branch coordinator of the Peter Nanyemba informal settlement, who oversees around 3 000 residents, said while authorities should be applauded for efforts to install more water points, a complete lack of toilets in the area is hampering efforts to halt the outbreak.
“We suffer here. There are more water points, but the big problem is we need toilets. This disease is here because we don't have toilets,” said Kamati. He said residents are forced to either defecate in the open, mostly in riverbeds, or use plastic bags when it is too cold or dark to go outside.
The plastic bags are then discarded in riverbeds, where children often play. The outbreak has been confined to informal settlements in Windhoek, and the Omusati and Erongo regions, where tens of thousands of Namibians live without basic services creating an ideal breeding ground for the virus.
Recent surveys estimate that there are now about 140 000 urban shacks in Namibia and 12 000 new shacks are erected every year at a higher rate than the installation of services.
In 2011 it was estimated that more than 57 000 households had no access to formal toilets in Namibia.
Last week health minister Bernhard Haufiku said although the lack sanitation infrastructure has fuelled the outbreak, ongoing vandalism and theft of newly implemented water taps and toilets is a major challenge that hinders effective containment.
All hands on deck
The site visit on Friday was spearheaded by US ambassador Lisa Johnson who wanted to “see first-hand what the challenges faced by the residents are and how the response is working”.
She said although new cases in several areas of Windhoek are recorded every week “that is not unexpected, because it does take months to get a hepatitis E outbreak under control”.
Johnson was joined by local and international health experts from the health ministry and the Centres for Disease Control and Prevention (CDC), in addition to City of Windhoek technicians, local constituency and regional councillors and Khomas governor Laura McLeod-Katjirua.
The US embassy has assisted health authorities to address the outbreak, which started in December 2017, and has led to 17 deaths, 1 867 cumulative cases and 147 lab confirmed cases to date.
Johnson said the visit highlighted the continuing challenges faced by “thousands of people who do not have access to a public toilets” and other services.
She also praised efforts by the national response teams, including the installation of extra communal water taps, and weekly water tests to ensure safe drinking water.
She further emphasised the crucial need for continued education and awareness programmes.
Apart from basic sanitation education, health officials warn residents to ensure that water is collected in sanitised containers and not kept for more than a few days, which increases risk of contamination.
Johnson said US authorities through the CDC have assisted Namibian health officials to build capacity and to ensure that they are the “front-line detectors and responders”.
The CDC has to date brought on board several experts to assist with the response, including a water, sanitation and health (WASH) expert who provided technical assistance in proper water treatment and testing and to provide recommendations.
Field epidemiologists travelled to the country to train Namibian health officials to detect outbreaks like hepatitis E, and to boost education and awareness campaigns.
She added that US officials are currently in talks with Namibian health authorities to link them to a specialised CDC team that can travel to the country to provide further technical assistance on response efforts.
She praised the work of local community leaders and said “I know you are doing everything you can for your people here.”
A tough life
Johannes Frederick, the chairperson of the CDC for the Samora Machel constituency highlighted the many challenges in combatting the outbreak in informal settlements, and said the community leaders are doing their best to educate and create awareness on minimising risks to exposure.
Nevertheless, he said life in informal settlements is tough, and people are continually at risk of becoming infected because of the lack of toilets and water points.
“Our people's health is at risk here, and they are affected by the virus as they live close to it. They might go to hospital, but then they come back to these areas, so it is difficult to keep them healthy.”
He noted that the outbreak has spotlighted the larger issues affecting the poorest of the poor, who not only struggle without access to toilets and water, but services in general.
“There are no bus stops, no taxi ranks, no clinics, and no police stations. Everything is far from us,” he said.
JANA-MARI SMITH