Cholera Policy in Zambia Suffers from Collective Amnesia

Zambia’s fight against cholera must not be simplistic. If anything, the current cholera epidemic epitomizes the need for urgent reforms in public health.
These reforms should foster the science and art of preventing cholera, prolonging life, and promoting overall health by improving social and political systems in Zambia.
Improving socio-cultural norms is critical to cholera prevention. For example, what is our national psyche in relation to littering? How do we react to garbage?
Re-educating our political milieu so that we are not always in political lockdown and chaos will enable our country to undertake cholera-prudent environmental, economic, technical, educational and legislative measures.
At the crossroads of these urgent reforms should be a rigorous epidemiological and evidence-based approach to interrogate the plethora of determinants of cholera, to plan effective solutions through innovative public health and cholera policy, legislation, advocacy and outreach.
Away from the current situation where soldiers are fighting this new war- the war against cholera- the country should establish a well thought-out public health mind-set that focusses on cholera preventive programmes for populations, communities and individuals.
Anchored on qualified personpower consisting of inclusive, non-tribal national skills and expertise- not Americans or Israelis- the objective of this new national public health paradigm should be to foster a fresh thinking necessary to develop, enhance, and disseminate effective cholera preventive services, programmes, and policies that ‘wholistically’ improve the health and quality of life for all Zambians.
Our own experts should guide the nation to critically evaluate and implement practical public health solutions that are tailored to our environmental and socioeconomic landscapes.
Genuine experts, not politically-correct scholars and hare-brained political party cadres armed with pangas and insults, should help us gain a critical understanding of how and which factors including culture, personal behaviours, social, economic and environmental circumstances incline our people to cholera.
The country should improve cholera surveillance mechanisms, to gather and analyse data from public health scenarios, demographics, epidemiology and other sources to determine population wellbeing and health in relation to cholera.
Key among these is the need to understand our people’s lifestyles and processes that affect the evolution and spread of cholera at both individual and population levels.
Stated differently, Zambia should embark on a new journey of applied public health programmes that focus on the application of multidisciplinary policies and practices which speak to the breadth of issues surrounding the breeding ground for cholera.
To permanently defeat cholera, we need to go deeper, not just fighting symptoms. A long-range view of cholera is needed.
Sadly, the current cholera crisis is reflective of a much deeper and perennial national crisis, a crisis in political and public health leadership.
Whichever way you look at it, this cholera epidemic is a stinging rebuke of the country’s leadership.
In mitigation, Zambians should evaluate the political, social and economic frameworks within which policies influencing public health and cholera are developed and implemented.
Leadership with pale vision suffocates qualitative and quantitative skills and core competencies necessary to undertake and evaluate interventions against annual epidemics such as cholera.
Beyond the current military and fire-brigade type of cholera management, our country yearns for a formidable leadership which should spur a deeper reasoning and efficient management of risks to cholera, especially risks arising from waste, food, and water.
But this cholera crisis also reminds us that we have failed to learn from the past. This cholera epidemic in fact shows that Zambia is a dead and failed state in terms of public health. The reason is simple.
Cholera policy in Zambia suffers from collective amnesia.
Zambians do not learn from history. We are a nation that is so impervious to professional public health advice, so much so that we have individually and collectively refused to re-learn the contexts and policy priorities that constantly shape and bring about cholera.
That we are now in the jaws of this deadly cholera epidemic is because we have been feeding meat to the crocodile hoping to be eaten last.
There is a silver lining, though. And the silver lining is that pain is the best incentive for change.
So, as we bury and mourn the dead, we need a paradigm shift towards a participatory, evidence-based, and innovative public health system that provides relevant and engaging learning experiences for role players whose work must include the reversing of determinants to perennial epidemics such as cholera.
To control cholera will require practical municipal outreach programmes that establish and maintain linkages with key stakeholders including street vendors.
We need a fresh strategic thinking and systems approach which advocates for the development of integrated, cost-effective public health solutions. Appropriate surveillance and community consultations and informatics standards can also foster cholera prevention and treatment.
Comprehensive epidemiological data and communication of these data especially to hard-to-reach populations in areas such as Kanyama which represent latent cholera reservoirs should be central to our cholera prevention strategy.
Interventions for cholera including fiscal, food, water, sanitation, town planning, and trading policies should focus on entire populations and communities, not just pandering to the whims of political party cadres.
A new cholera preventive public health order, infrastructure and systems thinking is urgently needed before the whole nation wakes up dead.

An award-winning scientist, Chinsembu is a Professor of Microbiology at the University of Namibia. Views in this article are personal.

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