ON A RECENT afternoon in Freetown, Sierra Leone’s capital, Jonathan Abass Kamara, a spokesman for the country’s health ministry, spoke to Baobab about the latest cholera statistics. As of August 28th, Sierra Leone had recorded over 14,000 cases and 232 deaths. In terms of numbers infected the outbreak is the worst ever in the small west African state. August marks the high point of the wet season, but rain will continue for another month. The water-borne disease, which kills through acute diarrhoea and vomiting, is likely to spread further.
Cholera dominates the national conversation. The Airtel mobile-phone network bombards its customers with advisory text messages: “Always wash hands with soap and water after using the toilet, before eating and after caring for a sick person” advises one. Radio and the local press are similarly focused. “Cholera taking over,” screamed the Politico newspaper. The rival Awoko put it more bluntly: “Stop this runny shit,” read one headline.
International attention has increased since the government declared a national emergency on August 16th. Britain has pledged £2 million ($3.1 million) to help. But both the domestic debate and growing international coverage seem to have glossed over a couple of important factors.
The first is the economic basis of Freetown’s slum quarters. On a recent visit Baobab splashed through the Susan’s Bay slum in torrential rain. It is easy to see why these waterfront communities are baring the brunt of the cholera outbreak in the capital. Pigs rooted betweens shacks of corrugated zinc and children played in the filth. Clean water is scarce, lavatories are largely non-existent; cholera spreads fast.
But the slums are, in their own way, prime commercial real estate. Straddling the sea on one side and Freetown’s central business district on the other, they provide ideal brokerage points for the commodities that descend the Sierra Leone River from the interior or arrive from islands offshore, notably timber and palm oil.
On a trip late last year to Kroo Bay, another Freetown slum, Baobab found the stench so bad it was difficult not to gag. Yet in between the fetid huts were neatly stacked short lengths of firewood. Longer branches, still with the bark on, were destined to be used as scaffolding in Freetown’s booming construction industry. The palm oil itself was stashed in reused 1.5 litre plastic water bottles. A local woman said she preferred living in KrooBay where she could trade than in outlying areas with better sanitation. Slums close by ministries and banks are better able to siphon off electricity than the cleaner areas further out. In Susan’s Bay Baobab spied a large television flickering inside a shack as the rain pummelled down outside.
Another underreported aspect of the outbreak is the underlying cause of cholera. Attempts to encourage hand washing and establish treatment centres in the slums are laudable. But fundamentally, cholera in cities is a disease of poor urban planning and weak civic administration. Freetown, while topographically stunning, is overcrowded and dirty up close. This is partly due to wartime migration of people—the slums swelled during Sierra Leone’s 1991-2002 civil war when people fled the bush to the relative safety of the capital. Partly it is a function of limited resources—Sierra Leone is a very poor country. But weak leadership also plays a big role. There is little excuse for drifts of rubbish in a city with massive underemployed manpower, nor for water shortages when the annual rainfall is over three metres.
If basic administrative procedures are not improved cholera will remain a persistent problem, no matter how much hand-washing is preached. Much of the responsibility for this failure lies with Sierra Leone’s ruling class, which has stolen from its people for decades. But there should be an onus on the broader population too to demand better for themselves.
Hence the aid community’s recent emphasis on "civil society" and advocacy. In Sierra Leone, a small nation inundated with NGOs, the culture has approached the level of parody. Almost everyone seems to self-identify as an "advocate" or "activist" of some stripe. But the basic idea is good one.
Unhappily, attempts to persuade people to hold their leaders to greater account have made little headway. Repeatedly, as the cholera outbreak has spread, Baobob’s mind has drifted back to a scene that played out earlier in August in a cavernous, wood-panelled courtroom in central Freetown.
Sierra Leone’s much-maligned Anti-Corruption Commission had secured a conviction against Freetown’s mayor in a graft case. A packed chamber awaited the sentence. Half a century after independence the paraphernalia of British judicial proceedings remain, wigs and the judge’s scarlet gown included. With no apparent irony, despite the cholera stalking the grubby city outside the courtroom, the mayor’s lawyers pointed to his achievements in waste management as a mitigating factor for the judge to consider.
The judge duly eschewed a custodial sentence for a fine that, while sizeable, was a slap on the wrist compared with Freetown’s Pademba Road prison. Overjoyed, the crowd in the courtroom leapt to their feet rapturously. “Thank you Jesus, for what he has done today,” a woman told Baobab outside. “They free our mayor—innocent.”
Many of those present were the mayor's supporters; some were probably paid or at least part of his patronage network. But the broader point stands. As long as Sierra Leoneans continue to acclaim corrupt and inept politicians, their country’s sclerotic administration will not raise its game. And the citizens of this long-suffering state will continue to die unnecessarily of nineteenth-century diseases.
via Baobab http://www.economist.com/blogs/baobab/2012/09/cholera-sierra-leone?fsrc=gn_ep
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