Will just have to let Britain's leading medical journal know it was the World Bank, not the IMF, which set the stage for cholera to break out.
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Prevention fails to halt South Africa's well-treated cholera epidemic Editorial by Kelly Morris
The Lancet - January 27, 2001
WHO officials have lauded South African health workers for achieving perhaps the lowest ever case-fatality rate in a cholera epidemic. But the praise is hollow comfort for many thousands of people now at risk from the disease in Johannesburg, after the first urban river tested positive for cholera last week.
The country's largest cholera outbreak for almost 2 decades has has caused at least 25 500 infections and 73 deaths since August, 2000, mostly in AIDS-stricken KwaZulu-Natal province. The WHO team that reviewed epidemic management there reported on Jan 15 that "successful case management" accounted for the "exceptionally low" death rate, estimated at 0á29%. However, the opposition Democratic Alliance counters that people are dying in remote Areas before cholera is diagnosed. And cases have steadily increased since the end of 2000, with KwaZulu-Natal still recording at least 500 new infections a day. Five of nine provinces are now affect ed, including Gauteng, where authorities are on full alert since cholera was detected in the Jukskei River on Jan 18.
Cholera now threatens many thousands of informal settlers along the river, because, despite emergency education, some residents continue to use the contaminated river as their only source of water. This situation is familiar to the majority of residents living below the poverty line in affected areas throughout the country. The government claims it has provided 6á4 million people with clean water, but the epidemic has demonstrated shameful inadequacies in rural development in South Africa: at least 8 million people are still without tap water and inadequate roads are hampering water delivery. WHO has also encountered shortages of health-promotion workers, ineffectiveness of education programmes, lack of community involvement in education efforts, and over-pressurised hospitals.
But water and sanitation remain the key issues. In the Sunday Independent on Jan 21, Ebrahim Asmal of the South African Human Rights' Commission noted that about 60% of households in affected areas had inadequate sanitation and, in one province studied, up to 90% of new water connections were not fully functional. He also alluded to last year's assertion that the epidemic started after water supplies were cut because users could not pay newly introduced water fees. Community cost-recovery programmes, promoted by the International Monetary Fund, are a key component of the government's much-criticised macroeconomic policy. Yet, Asmal notes that the country spends approximately R4 billion (US$ 500 million) treating diarrhoea and dysentery a year, whereas only about R750 million was spent on water in the past financial year.
Kelly Morris