Briefing by Minister on Cholera

Meeting report

HEALTH PORTFOLIO COMMITTEE
16 February 2001
CHOLERA: BRIEFING BY HEALTH MINISTER

Chairperson: Dr S A Nkomo

SUMMARY
The Minister of Health examined the national statistics on cholera and explained why a disaster zone had not been declared in heavily affected areas. Sanitation problems, health worker volunteers, rehydration centres and funding were some of the pertinent issues discussed.

MINUTES
Minister's Briefing
The Minister stated that her October 2000 visit to cholera-infected areas (where a total of 2 603 cases and 12 deaths had been reported) had revealed that the situation was under control. Health workers had set up rehydration centers and it was evident that there was good case management. In addition the death toll was only 1,28% of those infected whereas statistics showed that when a cholera outbreak occurs the death toll usually exceeds 50% of those infected. The Minister said the death rate between October and the present has not risen above 0, 22 percent in KZN. The Minister commended the staff in KZN on effective management even though they had not informed the Minister at the outset of the epidemic in August 2000.

The Minister then read out the national statistics for provinces other than Kwazulu Natal as of 14 February 2001:

The total cases nationally (including KZN) is 47 558 and the total number of deaths is 107 as of 14/02/01. One death that was reported in the Northern Province was not included as it was discovered that the compounding factor in this case was anaemia.

In KZN the Amakhosi are working with the Department of Water Affairs and Forestry, the private sector and the South African National Defence Force (SANDF) in trying to bring awareness to the people about the disease. In addition, bleach and Jik have been distributed to the affected areas.

In mid October 2000 cases were reported in KwaDuduza, Port Shepstone. In mid November cases were reported in Ulundi and later in Durban. On 25 January the Minister had returned to KZN to assess the situation and decided that the area was not a disaster zone.

Reasoning for not declaring this a disaster zone was that :
- the government had been able to provide everything that the Department requested so far in dealing with the epidemic
- the reported deaths had occurred in inaccessible areas where it had been difficult to rehydrate those who had contracted the disease.
- the World Health Organisation had commended the government for its management of the epidemic. Its only criticism was that other departments are not involved in the process.

A survey conducted in KZN concluded that cholera is caused by lack of sanitation. In addition there is a relation between cholera and poverty. On 25 January Minister Tshabalala-Msimang attended a meeting chaired by the Minister of Provincial Affairs and Local Government, Mr Sydney Mufamadi, to draw up a strategic plan.

On 7 February a meeting was convened to assess the situation. At this point the Minister felt that it was necessary to clarify the figures being reported. She stated that every person who tests positive does not end up in hospital. They often are just re-hydrated and then sent home. It is only in the more serious cases that patients are admitted to hospital.

Minister Kasrils from the Department of Water Affairs and Forestry, has made resources available to build toilets. To date 9000 toilets have been built.

The Minister again stressed that the visit to KZN was merely a show of solidarity for health workers and it did not mean that KZN is a disaster area. Provinces are mobilising Environmental Health Officers to visit the area as well. Re-hydration centres will be established closer to the communities. The private sector has also made resources available.

Support to health workers, in the form of redeployed health workers, has been provided swiftly from Gauteng and the private sector. The Minister argued that Local Government needs to be strengthened as they are responsible for environmental issues. She had recently visited Potgietersrus due to reported incidents of cholera in that area. Here she was shown where the contamination could have originated.

In what she described as a "stark reminder of the past", she had noted that what separated the traditionally "white" town from the poorer township was an open sewer. To her horror, she had witnessed faeces floating on the water and stated the smell had been overwhelming. It was evident that the seepage had obviously resulted in the contamination of the water of the poorer village. The result of this visit is that negotiations are taking place with other Departments about the action to be taken.

Discussion
Ms C Dudley (ACDP) commended the Department as their actions had resulted in a relatively low death rate. She went on to state that 75% of cholera sufferers show no symptoms of the disease. Twenty percent showed mild symptoms. She wanted to know whether educational programs were in place in the high-risk areas in Gauteng.

Dr Chetty of the Department stated that one has to examine the water. The Environmental Health Officers are currently in the process of checking which rivers are high risk by testing the water. Rivers in the Eastern Cape are currently being checked.

Dr Rabinowitz (IFP) also referred to the low death rate and stated that the Department had managed well in the situation. However, she commented that Local Government has to work together better in order to prevent this situation from recurring. There appeared to be confusion at this level as to who accounts to whom. She also mentioned the absence of involvement of the Amakhosi (Chiefs).

The Minister replied that Cabinet had taken a firm decision that Water Affairs and Forestry would deal with sanitation. She was sure that the Minister of this Department was not confused about that fact as Dr Rabinowitz seemed to suggest. On the question of Amakhosi, the Minister said that they are very much involved at meetings and they had even requested additional pamphlets about cholera.

Dr Rabinowitz stated that she had never said that the Water Affairs Minister is confused. She said that the confusion was at local government level as people at this level did not know who is accountable to whom.

With regard to the issue of sanitation, she recommended that the area be declared a disaster area so that special funds can be made available to the Department. Women could be mobilised to assist in building the toilets.

The Minister replied that this is unnecessary as there is no lack of funding. At no stage had they approached government for funds and been refused. The Departments of Health, Water Affairs and Local Government are dealing with it with the Health Department leading the process. With regard to the involvement of women, the Minister stated that women are in fact very involved in the building of toilets, but added that this could be encouraged on a greater scale.

Ms M Njobe (ANC) suggested that an awareness campaign should be launched even in the areas which have not been affected by the disease.

Dr Chetty pointed out that this had already been done especially in KZN. The campaign included issuing each child with one poster depicting the importance of washing hands and general cleanliness. The rationale is that by reaching the child, one reaches the family.

Ms Njobe (ANC) commented on the problem of makeshift toilets and suggested that people should be educated on the minimum standards required for construction of toilets. She was particularly concerned that toilets should not be too shallow as flooding and excessive rainwater could result in toilets overflowing.

Ms M Malumise (ANC) asked if the health workers who volunteer help in KZN would be remunerated. If so, from which budget?

The Minister has requested health workers to show solidarity to fellow health workers and has appealed to their patriotism. They will not be remunerated, but will receive accommodation, meals and transport. The Ministry of Water Affairs and Forestry has contributed funds in this regard.

Dr S Cwele (ANC) commented that water does not seem to be the problem in KZN. Instead the only weak point is sanitation. He stated that social factors and cultural values should not be disregarded as this directly affects the way in which toilets are used and built.

The Minister agreed that the program for supplying water is on track and that the current focus of the Department is on sanitation.

Dr Rabinowitz suggested that the Department should look at projects in other developing countries where water tables is an issue with regard to sanitation.

The Chair interrupted by saying that the issue raised by Dr Rabinowitz should be researched further as it is more an engineering issue than a health issue.

Ms Njobe asked how the extra manpower, such as retired health workers, would be recruited and how interested persons could be involved in assisting in KZN.

The Minister replied that the Provincial Ministries and MECs are coordinating the project. Alternatively people can contact the National Department of Health directly.

The meeting is adjourned.

Appendix :
UPDATE ON CHOLERA IN KWAZULU-NATAL as of 18/02/01

Total Cases currently in hospital: 676
Cases reported in 24 hrs: 783
Total cases to date: 52 405
Deaths confirmed in past 24 hrs: 0
Total deaths to date: 112

Area: Lower Umfolozi Districts

Cases currently in hospital: 81
Cases reported in 24 hrs: 112
Total cases to date: 14 344
Deaths confirmed in past: 24 hrs: 0
Total deaths to date: 22

Area: Ulundi

Cases currently in hospital: 102
Cases reported in 24 hrs: 226
Total cases to date: 8 478
Deaths confirmed in past 24 hrs: 0
Total deaths to date: 26

Area Eshowe/Nkandla

Cases currently in hospital: 132
Cases reported in 24 hrs: 183
Total cases to date: 18 304
Deaths confirmed in past 24 hrs: 0
Total deaths to date: 18

Area: Ladysmith

Cases currently in hospital: 1
Cases reported in 24 hrs: 0
Total cases to date: 7
Deaths confirmed in past 24 hrs: 0
Total deaths to date: 0

Area: Durban

Cases currently in hospital: 58
Cases reported in 24 hrs: 0
Total cases to date: 313
Deaths confirmed in pa