David Adachi, a farmer and resident of Amachi-Igwebuike village, Agba, in Ishielu Local Government Area of Ebonyi State, lost his father, mother and brother to cholera within a few hours.
The 50-year-old man watched helplessly as six members of the family started stooling and vomiting in the dead of the night.
According to him, the family had eaten a dinner of rice and stew before going to bed on the night of July 6.
“At midnight, my parents complained of stomach ache, then my elder brother, his two daughters and wife also woke up writhing in pain as their stomachs rumbled.
“My parents and my brother died before daybreak,” Mr Adachi told PREMIUM TIMES, sobbing.
Two days later, the Ebonyi State Government confirmed cholera as the cause of death.
They were among about 1,000 people who have died of cholera in Nigeria this year.
The Nigeria Centre for Disease Control (NCDC) said 31,425 suspected cases had been recorded in 22 states and the Federal Capital Territory (FCT) as of August 1.
But the official data appears to understate the realities PREMIUM TIMES found in states visited by its reporters.
Blaming the deceased
Richard Nwabu was acting health commissioner in Ebonyi State where Mr Adachi’s family suffered its calamity. He said 12 cases were recorded in Mr Adachi’s village, telling the News Agency of Nigeria (NAN) that the patients had refused to go to the hospital.
Mr Nwabu’s claim was angrily refuted by the bereaved family. Mr Adachi said the short time between the manifestation of the symptoms and their death means they could not have been taken to the nearest hospital about 14 kilometres away.
Mr Adachi said Agba general hospital, the only health facility in the area, is a 25-minute journey by motorcycle and 55 minutes by car, due to the poor state of the road.
He said the community residents helped in evacuating the three members of the family who survived the attack to the hospital in the morning, where he said they received treatment and were discharged a few days later.
He had administered local herbs to his parents and brother in their desperation. “But there was no relief until they passed away painfully.”
A commercial motorcyclist, Sunday Aroh, who took PREMIUM TIMES’ reporter on a 25-minute journey from Nteji junction at Agba community to Amachi-Igwebuike, said he was one of those who took the survivors to the hospital.
“The village does not have a good road,” Mr Aroh said.
And just as he said, it was a tortuous journey along the bushy, narrow path.
The chairman of the village’s association, who resides in a neighbouring village, Peter Agunkwo, also confirmed the incident.
He said state health officials visited the village after the incident to sensitise the people on the need to keep the environment clean to avoid contracting diseases.
But Elizabeth Adachi, the wife of Mr Adachi’s late brother, blamed the government for her becoming a widow overnight because of lack of access to potable water.
She said she cooked the deadly rice meal eaten by the family with rainwater she had collected through the roof of their house.
“During the rainy season, that is how we source water because the only other sources here are the streams. So I cooked with the rainwater, and that was all,” she said.
Mr Adachi said politicians always promise to provide amenities such as potable water when they visit the village to canvas for votes but forget the promises as soon as elections are over.
Hospital confirms more cases
Meanwhile, a health official at the Agba general hospital, who asked not to be named because only the state’s health ministry could give an official response, said many cases from four other villages in the area were presented at the hospital.
State confirms more cases
When contacted, the then acting health commissioner directed our reporter to his successor, Daniel Umezurike.
But Mr Umezurike hung up on our reporter as soon as he introduced himself and his inquiries on the phone. The new commissioner did not pick subsequent calls or reply to short messages sent.
However, on August 10, Mr Umezurike confirmed another round of cholera outbreaks in Onweonwiya and Mgbalukwu communities in Izzi Local Government Area of the state.
He said those affected were taken to the general hospital in Iboko, Izzi council headquarters.
“No record of deaths has been reported in the area,” he said.
Like Ebonyi like Enugu
A few days after Ebonyi State confirmed the cholera outbreak, the capital of nearby Enugu State was hit by the epidemic with health officials confirming 14 deaths within three days.
The outbreak was recorded at the densely populated and filthy New Artisan Market, close to Goshen Estate in Independent Layout along the Enugu-Port/Harcourt expressway.
Traders in livestock and other dairy products dominate the market, but many other businesses, such as beer parlours, brothels and batcher houses are also in various corners.
On July 18, the Enugu State Commissioner for Health, Emmanuel Obi, who announced the outbreak, said seven people died and 19 persons had “presented with sudden onset of passage of loose stool and vomiting.”
Eyesore
On July 20, a witness and patent medicine shop owner at the market, Augustine Uzoigwe, told PREMIUM TIMES how he had received many customers complaining of running stools and vomiting on the evening of July 16.
Mr Uzoigwe said he suspected cholera and simply referred them to hospitals after recommending Oral Rehydration Salt (ORS) as a stop-gap remedy.
“The ORS pack is sold for N100, so I gave each of them to mix in a bottle of clean water, and told them to visit the hospital in the morning,” he told PREMIUM TIMES.
Mr Uzoigwe, who had operated in the market for over a decade, said the complaints were not surprising to him because of the filthiness of the environment.
The market is a slum beside a trapped pool of floodwater near a large canal demarcating the market from a residential area.
Septic pipes from public toilets near the market’s mosque at the east end of the neighbourhood are channelled into the canal.
“Everything is channelled into that canal. When they kill animals they pour the blood and other contents into the drench. They still bathe in that same water and some even drink it,” Mr Uzoigwe said.
Our reporter captured a man taking his bath in the floodwater.
Heaps of garbage also littered the residential area of the neighbourhood while animal dung and remains litter the squalid livestock market area.
Officials speak
The director, public health and disease control at the state’s ministry of health, Boniface Okolo, told this newspaper that as of July 19, more than 80 cases had been recorded and 14 deaths.
Mr Okolo said many of the cases were presented at Enugu State University Teaching Hospital while others were taken to unidentified private clinics. However, he said, most of the infected recovered after treatment.
The official decried the unhygienic practices, particularly the improper disposal of domestic and human wastes in the area.
Some of the residents said they defecate in polythene bags and throw them into the open trenches “because we don’t have toilets.”
But the chairman of the association of livestock traders in the market, Danladi Abubakar, could not see a nexus between the dirty environment and the cholera outbreak.
Instead, he said tanker owners supplying water to the neighbourhood should be blamed because the market relies on them for water.
“As part of measures to curb further spread of the disease, we are now monitoring tankers that bring water for us. The water we use could have been contaminated from source,” he said.
Mr Abubakar said the 14 dead persons were already buried according to Islamic rites.
Measures taken
Meanwhile, Mr Okolo, the health ministry director, said to forestall recurrence of the unfortunate development, the state had put on standby epidemiologists and other health officials.
He added that the state government had launched an aggressive sensitisation campaign for residents to take precautionary steps against further spread of the disease.
During the visit, PREMIUM TIMES saw officials of the World Health Organisation (WHO) handing out soaps, detergents and hand sanitisers to residents of the area.
From Enugu to Benue, Plateau
Benue is one of the few states that reported cholera outbreaks at the beginning of the year.
According to the state’s commissioner for information and orientation, Ngunan Adingi, over 200 suspected cases and 20 deaths had been reported as of January 15.
The head of the NCDC’s National Rapid Response team working in the state, Ikechukwu Oradu, said the infections originated from communities near the Benue River. She said preliminary investigations linked the outbreak to contaminated water.
The affected communities are in four local government areas – Guma, Agatu, Gwer-West and Makurdi, which surround the popular river.
Victims narrate ordeals
Ali Sani, a 28-year-old fisherman and resident of Abinsi village in Guma Local Government Area, plies his trade at the Benue River.
According to him, he was at work when his wife called him that his two-year-old daughter was vomiting and stooling.
“I rushed back home and took her to the health centre but she was dead when we got there,” Mr Sani said.
“We cook, drink and bathe with water from the Benue River despite warnings that the water is contaminated,” he admitted after recalling being told at the hospital that the disease that killed her daughter was water-borne.
“But do we have any alternative?”
But while many adults suffer from cholera in the local government, half of all the infections in the area occur in children, said Caleb Aba, the chairman of Guma LGA.
He said more than 50 children had been infected as of the time of our visit.
Similarly, Janet Adzuu, the chief nursing officer at the Abinsi primary health centre, said about 120 suspected cases had been reported in the facility this year.
She said the majority of the children that were infected also showed symptoms of Severe Acute Malnutrition (SAM).
Husseni Saliu, a survivor, told this newspaper how he developed cholera symptoms shortly after drinking water from the river.
He said he noticed the water was not as clean as before when he drank it that fateful morning.
“I felt my stomach rumbling loud, then I started vomiting and stooling. But for the community’s health centre, maybe I would have died,” he said.
Another survivor, Aminu Isah, 24, narrated how his daughter was the first to complain of stomach upset and then began to stool profusely.
Mr Isah said hours later, he also began to exhibit similar symptoms.
NCDC said as of August 1, about 600 suspected cases and 12 deaths had been recorded in Benue State. Residents said the actual numbers may be higher.
About River Benue
In the absence of scientific research, PREMIUM TIMES cannot authoritatively link the spread of cholera in Benue to the Benue River.
However, a visit to the river banks by our reporter showed that its brownish water was largely caused by mudslides during the rainy season. The stench of human faeces and animal dung that oozed from the neighbourhood suggest the other causes of contamination of the river.
Residents said they do not have potable water and toilet facilities.
“The only borehole in this community was built by an individual after the cholera outbreak. The state government is yet to fulfil its promises,” Yakubu Abu, a resident, said.
Open defecation
According to Garaba Yakubu, assistant leader of Kabuwa community, another village in Guma LGA, about 15 people died from the disease in the area.
He attributed the outbreak in the community to rampant open defecation, especially along the river banks.
He said residents practice open defecation because the area does not have adequate toilet facilities.
“Apart from the bad source of water, this community has over 5,000 people and the majority of them lack latrine, so they practice open defecation,” he said.
The assistant disease surveillance and notification officer in the local government, Aba James, said since the outbreak in Gbajima, a neighbouring community, five fatalities had been recorded from almost 100 cases.
“From investigation, it shows that the source of water which is the River Benue is contaminated,” he said.
Like Guma, communities in Agatu, a neighbouring LGA also located on the river’s bank, are affected by the outbreak.
Anna Adebo, the director of health, Agatu LGA, said the outbreak started in Adache-Obagaji, a thickly populated community before spreading to other communities.
Ms Adebo also explained that residents in the affected communities defecate anywhere, including near their water wells.
“The people drink and cook with water from uncovered wells. Some even defecate very close to the well, which makes the water unhealthy for consumption,” she said.
Ms Adebo said health workers in Agatu LGA were running a sensitisation campaign to prevent a future outbreak of the disease.
“We have sensitised the people on the importance of keeping their environment clean and also boiling water before drinking,” she said
“But the problem is that the communities lack access to good water, making it impossible to prevent an outbreak.
“We are pleading with the state government and donor agencies to provide a good source of water for the communities,” she said.
According to Adebo Oloche, a medical officer with the general hospital in Obagaji village of Agatu LGA, 286 cases of cholera and 16 deaths were recorded in the six wards within the LGA.
“These casualties were cases that died at home due to distance to the health facility,” he said.
John Ikwulono, vice chairman of Agatu community, said efforts were being made to provide potable water for the communities.
“We reached out to the government to provide potable water for the people to prevent future outbreaks and they promised to dig some boreholes but nothing has been done,” he said.
