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Would you eat that?

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The Story of Cholera - Krio - Sierra Leone
Before leaving Atebubu - a cholera affected community in Ghana - we screened the wonderful animation from Global Health Media "The Story of Cholera" at a community meeting. The general ‘WASH’ environment - shown in earlier posts - is fairly typical of cholera ‘hot spots’ that I’ve observed across West Africa this year – a semi-urban slum, with very little sanitation, lots of open defecation, use of ‘flying toilets’, and reliance on unprotected shallow wells for drinking water.
Representatives of various community groups were invited to a meeting on a Saturday morning. These included representatives of: market women, hairdressers, beekeepers, the Ghana Red Cross, Youth Groups as well as the Cholera Task Force of the local authority. A preliminary discussion revealed that very few people had a real understanding of the causes of cholera, although many could ‘repeat’ the behaviour, such as hand-washing with soap, which could prevent it.
“The story of cholera” was screened followed by more discussion. Despite most of the audience not understanding the English narration, the group were able describe all the key messages in the film; about how cholera was transmitted, and what the boy - who is the ‘agent of change’ – had done to help his community rid itself of cholera. All agreed that their community should be capable of doing something similar for themselves. However, there was also some conflict obvious between the “authorities” and the “community” about who should do what for whom. Never-the-less, the seeds of a community based solution were sown, and all were agreed that if they had more exposure to tools like the cholera film, and other visual materials, they could work together to spread knowledge about cholera and good hygiene around the community, and decide on what actions they could take to clean up their environment. I shared this experience with the film's producers who gave permission to translate into any local languages that would be useful in the fight against cholera.
From Ghana I was called to Sierra Leone where the Cholera outbreak, which had started in some rural areas back in January, had hit Freetown and flared up into a major epidemic that had reached over ten thousand cases and was growing at 1,000+ a week, prompting the Sierra Leone Government to declare a national emergency in mid August.
My Unicef & other colleagues on the cholera task force agreed that Krio and other local language versions of the film would fit with the Social Mobilisation programme and we commissioned Talking Drum Studios to produce the local language versions.
This Krio version of the film is now being shown on national TV and field tested by social mobilisation teams in various Cholera affected communities across the country - who are captivated by it.
Teach your children well :) http://www.youtube.com/watch?v=EkaKwXddT_I
'Children are our future' is often quoted and we are increasingly investing in them as agents of change. But we have to create an enabling environment for good hygiene behaviour to become habitual. The simple addition of a hand-washing station outside a public toilet in Atebubu, the site of a major cholera outbreak in Ghana, 'enables' a teenage mother to teach her child hand-washing with soap! Small ting deh grow na big ting oo!
Atebubu is small town of about 100,000 people. They have had no piped water since April '12 when cholera first appeared this year. There have been some 280 cases of cholera since and at least 8 deaths. This woman told us she had had cholera. The well she is drawing water from, has been disinfected but is still unprotected, and can be easily recontaminated - if only by the rope and bucket which lie around on the ground. When it rains the streets flood, washing rubbish and faeces into the wells.
What is remarkable - to me - is that I can blog this situation using my 'stick' modem - from a town that has virtually no sanitation or safe water!
Men - Public Toilet Atebubu, Brong Ahafo, Ghana
Back in the field at last after 2 weeks in Accra. Yesterday evening we drove through Ashtown in Kumasi, the scene of my thesis research on household sanitation and alternatives to public toilets last year. It was a strange feeling to be driving through streets familiar to me - I walked them for a couple of months - but not to my two Ghanaian companions - who were somewhat surprised that I knew where I was. So I'm starting my report on cholera in Atebubu with a picture from the men's side of a public toilet.

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Canoes beached in a creek on Khunyi
I'm in Accra Ghana just now - and it took me a whole night to get here by plane from Dakar via Ouagadougou - I think a Fanti canoe would have been more comfortable. There's not a lot new in this bustling growing metropolis other than it seems bigger and more congested every time I come here. There have been a few thousand cases of cholera over the past few months but most of the people I meet in the central district of Osu are blissfully unaware of it. I was musing on this and missing the beauty of these simple craft.
Nomads of the Sea - Fanti Canoes from Ghana in Bonfi Port Conakry Guinea.
I spoke to the Captain - who said he had come from Accra - how far is that by sea, albeit in several stops? Fantis in Monrovia had told me that that was 7 days from Takoradi, so I figure 3 weeks to Conakry? My admiration and fascination with these marine nomads is growing. Days at sea, off the continental shelf, in a 15m dugout canoe, with no compass, charts, or radio - let alone GPS! Follow the fish and bring home the money!
Khounyi 'town' yards from the beach - some drinking water can be collected in the rains - but how to stay clean in this environment?
Khounyi on Kabak - Forecaria Guinea.
I had wanted to tell more of the story of Cholera in Guinea over the last couple of weeks, but the various frustrations of working in an environment that is challenging, even when you are living way above street level, rather hampered that idea. However - last weekend I visited Kabak Island where the Cholera epidemic started this year. Happily on the island it's more or less under control now - thanks to sterling hygiene promotion activities by the Guinea Red Cross, distribution of chorine for household water treatment and a rather controversial trial vaccination campaign.
I was left with a puzzle though - what can be done at a practical level to protect this semi-itinerant population of fisher folk from Cholera and other WASH related diseases? There's no sanitation at all and no 'sweet' water and no apparently easy options for addressing these issues. I showed this picture to a colleague - who said "See - that child is exposed to everything!" and that summarises my impressions perfectly.

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The small fishing ports around Conakry are the entry point for Cholera which has spread along the coast.
We can encourage people to wash their hands with soap before preparing food and feeding their kids, and treat their water with chlorine but it's not exactly an 'enabling environment'.
Bonfi Market, Conakry Guinea - a cholera 'hot-spot' - conditions are perfect for spreading the disease, fruit, flies, mud and shit.
Fresh Roasted Peanuts - is that Mrs Percy Dalton overseeing operations?
Cut away right down to the bilge pumps - ships of steel recycled.

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Le Port de Conakry - "pirogues" amongst the rotting hulks of the modern age.