Frequent Cholera Outbreaks Could Be Pointing To a Dysfunctional Health System in Kenya

Picture: A woman does eatery joint chores oblivious of the free 
flowing sewage along the road (Picture Courtesy of Nation Media

(Picture Courtesy of Nation Media)

The recent cholera outbreaks in several parts of Kenya pointed to some dysfunction in the health system yet the Constitution of Kenya Article 43 recognizes sanitation and hygiene as a “… right to a clean and healthy environment” to all Kenyans. The less than desirable performance of Kenya’s health system could be attributed primarily to lack of concerted effort in managing crisis. From early to mid-2015  to mid-2017 the health system failed to deliver a most basic health service like containing the cholera outbreak. It spread to more than 10 counties, over 3500 cases, about 70 people died. http://www.who.int/csr/don/21-july-2017-cholera-kenya/en/

Let us consider four incidents conveniently titled- wedding buffet, seminar treat, who was who and full force:

Wedding buffet

In mid-May 2017, about 400 guests had attended a garden wedding party at Karen, Nairobi. They were drawn mainly from counties in western Kenya but also from Nairobi and its environs. A few came from Eldoret and Mombasa. They also included two Germans who happened to be first-time visitors to the country. An outside catering firm had been contracted to handle the meals. They served delicacies: fish, meatballs, spinach, and rice etc. In less than a week after this, there was a cholera outbreak which claimed 3 persons with several hospitalized. Efforts to track down all those who had attended the event were made http://www.the-star.co.ke/news/2017/05/18/cholera-outbreak-five-hospitalised-in-nairobi-after-a-wedding-feast_c1564146

Quotes from some of the affected: ‘I remember one of the cateresses was diarrhea-ing a lot but was allowed to continue preparing food’. ‘Hiyo dish iliniactia serious’.  Sheng dialect perhaps to refer to the symptoms – she was down with severe effortless diarrhea, abdominal pains, and dehydration. Isolated cases had since then been confirming cholera all the way to June 2017.

Seminar treat

In late June, 33 out of the 400 medics (mainly doctors) attending the 4th International Scientific Lung Health Conference in a Nairobi hotel were admitted to hospital after contracting what was believed to be cholera. The Ministry of Health which had sponsored the event was at pains to deny the outbreak. Again an outsourced catering outfit that had brought in packed lunch was blamed for the contamination. Rapid tests tested positive, the victims themselves shared their results on social media as they were convinced it was cholera. One doctor was put on dialysis secondary to renal failure from severe dehydration. A week or so later cases of cholera were reported in several estates in Nairobi including Huruma http://www.the-star.co.ke/news/2017/06/22/50-hit-by-cholera-outbreak-at-weston-hotel-health-conference_c1584996.

The response to contain the outbreak was less than desirable. The Ministry of Health for some time toned down the matter as food poisoning. It took time to reach the decision to quarantine the whole hotel, get to the bottom of possible contacts and source(s) etc. The then Nairobi governor ordered a probe almost 10 days after the incident. The decree also included activating 4 out 6 cholera treatment units in the city. Apparently, public relations (PR) and politics worked in cohort to overrun public health. The situation was complicated by the possible link to a senior politician to the hotel and, 2017 being an election year certain quarters tried to gain some mileage out of the incident.

Who was who

This episode happened on July 14th about a month after the seminar treat above. The list read like who was who involving at least 2 cabinet secretaries, 1 principal secretary, and dozens of senior government officials alongside other patients (including some reputable hotel staffs). All of them happened to have attended Kenya Trade Week/Trade Fair at Kenyatta International Convention Centre (KICC) in Nairobi city’s central business district. They were admitted with what was suspected to have been cholera http://nairobinews.nation.co.ke/news/two-cabinet-secretaries-hit-cholera-like-disease-kicc-meal/ .

Official figures released on 14th July 2017 by Nairobi County health department indicated 33 cases of cholera had been in the month of July brings to 96 cases and 4 fatalities in two months. Unofficial figures were diverse and also much higher.

On 17th July the county government canceled all food handlers’, water vendors’ medical certificates and ordered fresh medical examinations. Hawking of food and outsourcing of food by event organizers and hotels was also banned. Distribution of chlorine to treat drinking water and hand washing to the affected areas was done.

By 19th July, 67 patients were admitted to Kenyatta National Hospital (KNH), 4 at Mukuru Kwa Ruben Health Centre and 12 in other health facilities within Nairobi County. Many of the casualties came from the slums of Mukuru Kwa Njenga, Mukuru Kwa Ruben, Kibera and Imara Daima estate among others. An alert was issued, cholera centres were activated in many counties.

Kisumu was the next city to be hit, the victims included 34 prisoners from Kodioga GK Prison. They were discharged from hospital on 27th July 2017 after treatment. There were some cases reported from Garissa with 10 other counties on high alert. These included Tana River, Vihiga, and Murang’a. Some of these had traditionally been cholera hotspots. By 3rd August 2017, Nakuru had reported 7 cases in 2 weeks.

Full force

On September 3rd, about 92 police officers who were being accommodated at Multi-Media University (MMU) in Kajiado County were suspected to gotten cholera. 54 of them were admitted. The food was said to have been sourced from the Nairobi Area Police Canteen. An officer who sought anonymity “… this thing started from the canteen. I wish you visit the place; the sewer is burst and effluent deposit near the kitchen”[1]. Around this time 22 members of the National Youth Service, Bura camp in Tana River County were being treated for cholera. http://www.nation.co.ke/news/Police-officers-admitted-in-hospital-with-cholera/1056-4080916-kkpa11z/index.html

We look at lessons learned in the next post. But just before you go, do you see cholera outbreak as a problem? Asking for your help in the way forward and spreading the word.

Please leave a reply