Bissau // In an effort to halt a worsening cholera epidemic, the Guinea-Bissau government has banned tribal burial ceremonies, which last for days and involve handling corpses as well as slaughtering animals for communal feasts.
These ceremonies are "one of the main reasons for the spread of the epidemic", according to a report by the UN Children's Fund (Unicef), which is helping the government address the crisis. The epidemic has killed about 100 people and infected at least 4,000 throughout the country since mid-May. In June, it spread to the capital, Bissau, and the rate of infection is steadily increasing. Silvia Luciani, Unicef's country representative, said she doubted the temporary ban would be effective in stopping the spread of the disease.
"The people continue to do their traditional ceremonies, but they do it underground, for instance in more rural locations," she said. "The ceremonies continue to happen in the bush, which increases the risk of contamination." People in remote areas have little access to health care and find it difficult to ask for help once their communities have been contaminated, Ms Luciani said. Augusto Paulo Silva, secretary general of the public health ministry, said the government was powerless to stop people from performing traditional funeral rites.
"It's completely impossible," he said. "It's rooted in their behaviour. Tradition is tradition." Seven main ethnic groups populate this tiny former Portuguese colony, which is nestled along west Africa's coast on the southern border of Senegal. Many adhere to animist beliefs that prescribe prolonged funerals with large social gatherings - a recipe for disaster when it comes to deadly and highly contagious diseases, such as cholera.
According to tradition, the body of the deceased is taken to its native village to be washed by close relatives. The relatives then wrap the cadaver in shrouds of cloth before sharing a meal. Ceremonial rites are performed on the body for up to five days before burial. In the morning, women enter the funeral house and make offerings of food by eating rice and sprinkling it on the floor. During the day, the body is taken outside, where male relatives wrap it in additional funeral shrouds.
The funeral also includes a community feast that usually involves the ceremonial slaughter of an animal, which is then eaten. "It's not hygienic," said Dr Marilene Meneses, the ministry's director general. "When they kill the animals, blood gets all over the floor, and people don't wash their hands before they eat." At Bissau's national hospital, health workers struggled with their country's crumbling health system as new patients streamed into an overcrowded cholera ward. Skeletal figures lay listless on cots in the hallway and on the veranda, which runs the circumference of the small colonial-era building. Other patients are shuffled into an overflowing tent provided by Unicef.
Many cots were split down the middle, and had been stitched together to prevent the victims from falling through. Some cholera victims slept on blankets spread out on the floor of the veranda. Ward attendants emptied buckets of vomit and diarrhoea. The smell of bleach permeated the air as workers constantly disinfected the floors. Cholera is one of the fastest killing illnesses, causing severe dehydration and circulatory collapse. Victims can die within days or even hours if they do not receive proper treatment. The disease is spread through ingesting contaminated water.
Cholera is endemic to Guinea-Bissau, one of the world's poorest countries where the vast majority of the population does not have access to clean water. In rural areas, people tend to get water from wells that may be located too close to latrines. During the rainy season, gutters often overflow, flooding the streets and contaminating water sources with sewage. "Almost every year there is an outbreak, but some years it becomes an epidemic," said Ms Luciani of Unicef.
The country was hit by its first epidemic of the 20th century in 1987, and the large-scale outbreaks have occurred consistently since then. In 1997, cholera killed almost 900 people and infected more than 20,000. Aside from a lack of infrastructure - all hospitals and clinics lack dependable electricity, for example - the country's health care system suffers from unmotivated staff who are poorly trained and barely paid, Ms Luciani said.
This undermines the efforts of organisations attempting to disseminate information to the public to help them understand how to fight the epidemic. "You can develop all the communication materials, all the protocols you want," she said. "You need someone in the field to operationalise all of that." To make matters worse, this year's outbreak coincided with a political crisis that paralysed the government.
Parliamentary elections scheduled for April were postponed until November, because the government said it was not ready. In August, a month after one of the main parties quit the coalition government, Joao Bernardo Viera, the president, dissolved parliament. That same month, the military accused the head of the navy of plotting a coup. The country was rocked by another scandal in August when a judge freed three alleged cocaine smugglers, one of whom was wanted on an international arrest warrant.
"All of these situations have diverted attention needed on the cholera issue," Ms Luciani said. "If we were all fully engaged, I believe we could stop this epidemic within a few weeks." Meanwhile, people are becoming infected at an increasing rate. In the week leading up to Sept 1, there were 859 cases reported, compared with 768 the previous week. Ms Luciani said that cholera will continue to be endemic to the country until the root causes are addressed.
"We cannot continue to respond to epidemics every time an epidemic occurs," she said. "We need to resolve the problems of water and sanitation in this country and we need a massive public education campaign." @email:firstname.lastname@example.org