BONGOR, 19 January 2011 (IRIN) - Temporary thatch-walled latrines marked "Oxfam-GB" in green letters line a schoolyard in the southern Chadian town of Bongor. The NGO put them up as part of an interagency response to a cholera epidemic: along with emergency beds and intravenous equipment are temporary toilets, because most public schools have no loos.

Cholera, though easily preventable, is one of the most deadly diarrhoeal diseases. Once someone is infected through contaminated food or water, the vibrio cholerae bacteria are present in faeces for one to two weeks, and without proper sanitation are likely to infect others.

But proper sanitation facilities, as well as safe drinking water, are out of reach for most Chadians. And tackling this, experts say, must be the priority post-emergency. With the rate of infection slowing as of mid-December, Chad had 6,369 documented cases of cholera with 180 deaths, according to the UN Office for the Coordination of Humanitarian Affairs.

"Once an epidemic is over, the government must work on improving basic water and sanitation infrastructure and promoting hygiene for the long term," said Abakar Mahamat, director of Intermón Oxfam Chad.

"This is the way we can tackle cholera in a definitive way, as well as other infectious diseases caused by the lack of potable water and proper hygiene," he told IRIN. "It is difficult to effectively teach proper hygiene to students when schools do not even have adequate washroom facilities."

Among schools in the capital N'djamena Intermón Oxfam workers have visited, one had no toilet for 785 students, another had one toilet for 623.

A Chadian education official said building plans for public schools now include toilet facilities. "Knowledge and awareness have evolved quite a bit," Houdeingar Menodji Félicité, director of basic education and literacy, told IRIN. "It was also a problem of means, but with oil revenue the government can now ensure that schools are built with everything students need."

She said teachers are increasingly including hygiene in their curriculum. "More and more we are aware of the importance of educating families about preventing infectious disease."


Chad has the lowest coverage of safe water (44.7 percent of the population) and adequate sanitation facilities (12 percent) in all of West and Central Africa, according to UN Children's Fund (UNICEF). Nearly 90 percent of the population defecate in the open, says UNICEF, which is working with the government and the Netherlands-based PRACTICA Foundation to improve water and sanitation in the country, including putting boys' and girls' latrines in schools. The agency said just 14 percent of schools had lavatories.

At the Médecins Sans Frontières (MSF)-run cholera treatment centre in Bongor, included in the hygiene kits families receive when they leave are `dabas' (traditional hoes) for clearing and disposing of children's faeces. "The children defecate on the ground, often close to the home," one local aid worker said.

MSF nutrition and cholera coordinator Issoufou Salha said: "Many Chadians live in quite precarious conditions. It is important to address this - particularly those living in slum areas, where there is no access to safe drinking water. In the rainy season especially, any kind of infectious disease usually spreads rapidly because hygiene conditions are not as they should be."

Poverty

Beyond basic infrastructure, in households proper hygiene is a question of money. People in Bongor told IRIN they could not afford to keep soap and bleach in the house regularly, once that distributed by aid groups had run out.

"It varies from family to family," said a woman sitting with her child at a cholera clinic in Bongor. "Many can buy such things only on the rare occasion there is extra money."

Year-round awareness

Aid workers and Chadians told IRIN the time for hygiene and prevention education is year-round, not only in the midst of a cholera outbreak.

"In the dry season, before we see a drop of rain, hygiene and prevention education must be ongoing," said Benoudji Macaire, a local MSF worker who has long worked on cholera treatment and prevention.

"Once latrines and water sources are already flooded, that's not the time to come round telling people about protecting their latrines and water, or cleaning up rubbish." He said he has seen Chadians get angry when aid workers come talking about prevention after a family member has died of cholera.

"Besides, once the flooding started there were many areas health workers were not able to reach to spread their prevention messages."

He noted that in recent years the rains in Chad had been unpredictable - another reason hygiene education should not be tied to a rainy period. "The messages must be constant - repeat, repeat, repeat."

More regular prevention messages might be a welcome thing for people like Martine, who lost her five-year-old daughter to cholera after floods forced her and her family out of their Bongor home. "I heard about the importance of washing hands with soap and disinfecting water after my girl had died."

This is sad for the country.