Water and sanitation improvement is an essential step to stop cholera, a waterborne disease.

In Mozambique, where a current outbreak has killed 46 people and affected over 5.000 people according to official statistics, MSF's teams are working to improve the situation. But it takes more than a quick, technical fix.

“What is it that you want? Build a water treatment station, or have people use it?”, asks Eveline, an MSF health promotion officer.

Cholera patients are treated at the MSF Cholera Treatment Center in Tete.Photo: Luca Sola
Cholera patients are treated at the MSF Cholera Treatment Center in Tete.Photo: Luca Sola

The rough rubber boots and the already dusty MSF vests may not be screaming “diplomatic mission”, but it's more or less what this morning is about: understanding, talking, explaining, and convincing local leaders on how to defeat cholera.

In the Tete cholera treatment centre, there has been an increasing influx of patients from Chimadzi, a large ‘bairro’ midway between urban slum and big village.

Cholera outbreak means unsafe water supply and poor hygiene and sanitation; so the ‘watsan guys’ like Mihail Papageorgiou, a water and sanitation specialist, play a key role in the response.

He already knows what should be set up in the area: a water treatment unit that will soak the water from the nearby river, clean it, and deliver it, for free, to the 3000 families.

Gabriela, MSF counsellor, health promotion team, gives a speech in Dégué village, to explain to the local population how to prevent cholera. Photo: Luca Sola
Gabriela, MSF counsellor, health promotion team, gives a speech in Dégué village, to explain to the local population how to prevent cholera. Photo: Luca Sola

“This centralized water treatment system is designed for rapid response. We could have come with 20 guys, and within three hours we would have been done; bang, bang; in and out.”

This hardware component of the response, setting up the most appropriate water treatment system, indeed is mainly a technical issue and can go quick.

But the real challenge lies in trying to improve the users’ understanding and correct use of this system, or the ‘software’ component.

“You might be producing the cleanest water in the world, but if the community you do it for doesn’t trust it or uses it wrongly, the net health impact of your response is small. There, the health promotion teams play a key role.”

“We want to leave information and education behind us, not a mess, so we have to take more time”, he says.

While Mihail and logistician Iain Watermeyer examine the area's water pump – a possible source of contaminated water - MSF health promotion officer Eveline Cleynen talks to the local leaders, a neighbourhood toddler stuck on her hip.

Manuel Faquero, the local leader, agrees to hold a meeting to talk things through with the community. “I'll try to convince them, but it's difficult to change habits”, he says.

Cholera is a waterborne disease; a person who has cholera has been drinking dirty water or disregarding personal hygiene measures such as hand washing. Avoiding contracting it seems simple: stop drinking dirty water, and wash your hands regularly.

But many factors are at play. Habits. Practicality. Lack of information. Distrust of the messenger – be it NGO people or government people. There is a huge difference between telling people what to do, and showing them that you're willing to try and understand the situation.

In the Tete cholera treatment center there has been an increasing influx of patients from Chimadzi, a large ‘bairro’ midway between urban slum and big village. Photo: Luca Sola
In the Tete cholera treatment center, there has been an increasing influx of patients from Chimadzi, a large ‘bairro’ midway between urban slum and big village. Photo: Luca Sola

It’s important to taste and drink the water when setting up a point-of-collection water treatment system, like bucket chlorination. This to demonstrate clearly that the chlorine that we’re adding is not unhealthy or even giving you cholera, as is sometimes believed.

We climb down towards Chimadzi river that runs about ten meters away from the pump. It is large and low: a few hundred meters wide, but barely a foot deep of water running along sand ridges.

Women are cleaning their laundry; kids jump in stark naked; a donkey cart passes by. The river bed is poked with holes where people take their water from: the sand acts as a natural filter, and the water in there is crystal clear but open to all kinds of contamination from run-off water or dust.

Mikhaelis finishes his samples collection and asks what water people prefer to drink... Now it starts to make sense: the water from the pump is slightly salty; the one from the hole in the river tastes like... water. No wonder people prefer it. Something to keep in mind when the water treatment centre is finished.

Once the first litres of treated water start coming out of the system, the ball is on the side of the health promotion team and the local leaders. There will be meetings, there will be questions. Hopefully, there will be change, at least until the outbreak is over.

Find out more about MSF's work in Mozambique.