As Epidemic Ravages Acholi, Govt Dithers

The Monitor (Kampala) / NEWS 27 April 2008 / Posted to the web 28 April 2008

By Tabu Butagira and James Eriku (Kampala)

Since last October, a viral disease that the World Health Organisation says has no cure has been silently killing people in the northern district of Kitgum in Acholi sub-region, near the frontier with Sudan.

Residents and their political representatives say Hepatitis E epidemic, which initially struck Madi-Opei sub-county of Lamwo County is now intensifying. Government-provided figures show that current fatalities stand at 24 out of 1,109 cumulative registered cases.

Some of the affected people, however, have a bigger estimate of deaths - three times higher than the official count - from the contagion that causes inflammation of the liver.

Dr Samson Okware, the commissioner for community services in the Ministry of Health disagrees even as the infection spreads to the sub-counties of Agoro, Paloga, Padibe and now Muncwini in the neighbouring Chwa County. On Friday, Dr Okware said the spread of the already worsening epidemic is yet to peak amidst forecasted heavier downpour over the Acholi sub region in coming months although efforts are underway to contain it.

"The problem," he said, "Is that when it rains, run-off water ferries human waste downstream and this contaminates wells and streams from where sections of the local community draw water for domestic consumption."

Hepatitis E, just like its cousin infections - cholera and dysentery, is transmitted through ingestion of food and water contaminated with human waste.

Its symptoms listed on the WHO website include yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools, loss of appetite, an enlarged, tender liver - a condition otherwise called hepatomegaly in medical parlance; abdominal cramps, nausea as well as vomiting and fever.

At the last official count in February, there were a total of 19 boreholes in Madi-Opei that hosts thousands of Internally Displaced People, uprooted from their homes by the Lord's Resistance Army insurgency that has ravaged the wider northern Uganda since 1987. By the time the epidemic broke out in November 2007, only a handful of these boreholes were functional. Those that were damaged, and had for long been neglected for repairs, were fixed only in recent weeks.

This perhaps exacerbated the problem since environmental health experts from the Ministry of Health headquarters have since confirmed that all water sources in the affected areas, except the boreholes, are contaminated. The clay pots where villagers store drinking water were also found to be harbouring the virus that causes Hepatitis E, which mainly kills pregnant women - in part owing to diminished immunity.

As a panacea or was it? The health ministry in February this year recommended the mass destruction of clay pots in areas where the epidemic was reported. But a combination of lack of alternative water storage facilities and traditional preferences has impeded implementation of this decree among an impoverished population that barely has the means to even put food on the table.

"[Health officials] are just telling our people to get rid of [clay] pots and use what?" wondered MP Livingstone Okello-Okello (Chwa, UPC), the chairman of the Acholi Parliamentary Group. "Government should give the people alternative utensils." "The situation is getting more desperate by the day, we are disappointed that it was not controlled earlier," he said, "We demand that government takes quick action to avoid further loss of lives."

Luckily, health agencies such Unicef, WHO and Medicines Sans Frontiers (MSF)-Holland, Oxfam, Avsi and Amref have given out thousands of eco-sanitary facilities, including jerry cans to the needy people.

Dr Emmanuel Otaala, the State minister for Health officially announced the outbreak of Hepatitis E in Kitgum on Dec. 4, 2007, two months after the index or first case was registered on October 25. At that time, three other epidemics; ebola, cholera and meningitis had simultaneously erupted in the western, mid-western and northwestern parts of the country. All except hepatitis E have been defeated.

Since the reported cases of Hepatitis were few then, local health workers say the Ministry of Health only briefly intervened and then withdrew suddenly. But what seems to be at the heart of the matter is that the Shs25 million that the ministry earmarked for the anti-Hepatitis E campaign was allegedly first wired to a different account before the district leaders provided the central government authorities the right account number on which the money was deposited as recently as April 17.

The lack of money, as expected, de-motivated stakeholders. "I don't know how this government behaves; when you give them information, they take it lightly and begin to run around only when it is already too late," Mr Okello-Okello said. Mr Okello-Okello said he petitioned Dr Otaala this week to dispatch senior health officials from Kampala to carry out an assessment. Dr Okware said there are already three core sub committees of water, social mobilisation and case management working together to fight the epidemic. Chlorine tablets are also being distributed to purify drinking water.

In spite of the interventions - that local leaders deride as dismal - a disturbing trend of increased infections is emerging as a sense of hopelessness convulses Madi-Opei, Agoro, Paloga, Muncwini and Padibe sub counties.

In a seven-page document (October 25, 2007 - April 21, 2008), nine NGOs that are helping Hepatitis E the long term solution lies in a "sustained health education campaign to improve basic hygiene at household level in a collaborative and participatory approach with district partners with the ultimate aim objective of reducing the risk of diarrheal disease outbreaks."