Fighting Cholera in Somalia

“Don’t let the gunfire bother you; it’s usually nothing. However, don’t linger near windows, but if you do find yourself near one when gunfire breaks out, duck!” explained Amadou Phillipe, a doctor at Banadir Hospital in Mogadishu, Somalia.

A three-member icddr,b team had reached the hospital on 11 September to treat cholera patients along the Kenya-Somalia border and were embedded with a team of local doctors and aid workers who were already stretched for supplies and short on skilled manpower.

Phillipe’s advice was nothing new for team leader Dr PK Bardhan, for whom this was the fifth international trip (after Zanzibar, Zimbabwe, Pakistan and Haiti) to deal with cholera patients in a potentially volatile area.

“In Pakistan, we were given training on how to deal with earthquakes, which was usually to run for open space at the slightest sign of a jolt, so I was pretty confident I could handle gunfire as well,” explained Dr Bardhan with a straight face; Dr Azhararul Islam and Nurse Momtaz Begum, the other members, grinned and nodded. Suddenly being dubbed icddr,b’s ‘cholera warriors’  by journalists seemed very apt after all.

Setting up shop in Kenya

The icddr,b team had originally left Bangladesh for Mandera, a province in eastern Kenya, on 1 September. Once settled in Mandera, the team by reviewing the existing control and prevention guidelines in the region to help prevent cholera and other causes of acute watery diarrhoea (AWD) diseases, along with training health personnel and auxiliary staff from about 70 NGOs and government organisations.

“Training to combat and cholera and AWD was something that we at icddr,b have almost perfected from decades of research and practice. This is what we are now globally known for,” explained Dr Azhar.

Across the Somalia-Kenya border, their skills were in dire need. According to UNICEF, almost five million people in famine-stricken southern Somalia are at risk of cholera and other causes of due to malnutrition, lack of access to clean water, sanitation and hygiene, population movements and crowding in displaced sites. The training that the icddr,b team were imparting to their local colleagues could save thousands of lives.

As Dr Bardhan explained, the region was the perfect training ground for a team that was equipped with the type of specialised skills that icddr,b prides itself with: “Our team specialises in the management of cholera outbreaks and epidemiology and thus our priority was to train local people so that the region’s health authorities are equipped with the skills and knowledge necessary to manage and curtail any serious cholera outbreaks in the region. Hopefully the result would be better clinical case management of cholera and diarrhoea by local experts even after we had been long gone.”

Across the battle lines

On 11 September, the team travelled to Somalia to begin a 10-day training programme in the country’s war-torn capital, Mogadishu, where they would be based in Banadir Hospital. The team knew they had their work cut out for them: years of civil war have torn Somalia’s health infrastructure apart, leading to extremely poor sanitary conditions.

“I am used to working under constraints and in situations where I had to make do with whatever resources I have in front of me. In earthquake-affected Haiti, basic hygiene requirements which we take for granted in Dhaka Hospital on a daily basis were totally absent. Thus the challenges presented in Mogadishu were nothing new for me,” explained Nurse Momtaz.

Once set in Banadir Hospital, the team started their training by targeting health professionals, including nurses and community health workers. Together with malnutrition and malaria, AWD has also become a major health threat in the famine-stricken country, with the hospital receiving around a 100 patients a day with strong symptoms of AWD.

“The biggest casualty of the regional war here has been complete breakdown of health related infrastructure which in turn has an adverse effect on health and hygiene. Cholera is an aftereffect of the regional strife,” explained Dr Bardhan.

In Mogadishu, the icddr,b team also visited the offices of various relief organisations such as Muslim Aid, UNICEF, and Islamic Relief, where they shared their experiences with staff and discussed opportunities for collaboration in the future. The team capped off their visit to the region by visiting a camp for internally displaced people. Here, malnutrition and poor hygiene are rampant and exchange of best practices with camp leaders and volunteer health workers make a big difference.

“We have worked in camps before, both in Pakistan and Haiti, so this is nothing new for us. What is crucial though is to pass on some of our skills and expertise to our colleagues at the camp since the condition here is very poor and a small effort goes a long way here,” explained Dr Azhar.

The warriors return

The team returned back to Dhaka on September 22. “Our efforts were very well received by the local doctors and patients,” explained Dr Bardhan. “In fact, we have received several offers from UNICEF to return soon and continue with our medical treatment and training, since there is a serious shortage of skilled personnel in the region.” For now, icddr,b’s ‘cholera warriors’ await their next mission.