Cholera is alive, well and still a killer at large. Epidemics ravaged the UK in the Victorian era but these are now consigned to the history books following significant investment into the provision of clean water, and sanitation services. And yet the WHO estimates cholera still kills an estimated 95 000 people and affects 2.9 million more every year. Over 2000 cases and 98 deaths in Lusaka, Zambia late 2017 were reported. It prompted a huge public health response including delivering 2 million doses of vaccine; increased chlorination of the municipal water supply; providing emergency water supplies; water quality testing; and training health care workers.
The Logie Legacy www.logielegacy.com is a charity set up to support the twinning link between NHS Borders in Scotland with St Francis Hospital in Zambia that goes back to 1991 when Dr Sandy Logie, a medical Consultant from the Borders General Hospital went to volunteer there. In the course of his medical duties he contracted HIV and sadly died 9 years later. For many years a wide range of staff including medics, nurses, midwives, pharmacists and IM&T have been going there to volunteer support projects with training and education. More recently however Chris Faldon, a Health Protection Nurse Consultant, has been monitoring progress with projects in tuberculosis, water and sanitation. He was shocked initially to see that this large mission hospital with over 350 beds struggled with an intermittent and unsafe water supply.
“…the hospital has literally no running water from taps, causing an outcry from staff and departments. It is a daily nightmare to all residents and departments. Some staff resident at St Francis claim that they have not had running water at their houses from their taps for almost 1-2 months now and are very desperate about the situation” – St Francis Hospital Senior Administrator (November 2014)
With over 22,000 admissions and 93,000 outpatients attendances annually this needed some serious attention. Hospital management just could not find the hospital budget to meet the costs of such a venture. For example, staff salaries fall into arrears and essential drugs and medical supplies cannot be procured. A ‘Water for Life’ project was therefore initiated. Approximately £100,000 has been raised back in the UK and the 3rd and final phase of the project is approaching completion in 2018. This will see a new system implemented of metering household and business properties on the large site in order to introduce for the first time a charge for water usage and thus provide a source of sustainable income to maintain the supply.
Sights are now set on addressing the considerable sanitation challenges across the compound. A grant of £12,000 from the Scottish Government (International Division) has funded a sanitation feasibility study to provide evidence needed to make decisions about providing a reliable, sustainable low-cost sanitation and wastewater treatment solution. It will require some major financial investment but the public health benefits to flow from this are likely to save many lives and significantly reduce the burden of disease.
There is a bigger picture. Consider the following:
- More than 1 in 3 health care facilities in low-resource settings do not have any access to water at all. When the reliability, safety and distance of the water supply is taken into account, that ratio increases to 1 in 2.
- Nearly 1 in 5 of these facilities does not have toilets and more than 1 in 3 does not have soap for handwashing
Source: WHO and UNICEF report, “Water, sanitation and hygiene in health care facilities
Poor water and sanitation services are casualties of an underfunded healthcare financing system. Such a system should be capable of raising adequate funds and yet Zambia relies significantly on donor funding (Freedom to Create, 2016). Does this compromise long- term planning for health? Whilst the political debate goes on, the facts remain that about 8,700 Zambians, including 6,600 children under 5, die each year from diarrhoea (about 90% directly attributed to poor water, sanitation and hygiene). The Logie Legacy has chosen not to sit on the fence and instead has worked with our partner to identify and implement sustainable developments to benefit thousands and avoid the tragic consequences of a deadly disease outbreak within a treasured hospital that too celebrates its 70th anniversary in a country seeking to provide, like the NHS, good healthcare to all, regardless of wealth… or the lack of it.
Chris Faldon | Nurse Consultant | The Logie Legacy – Secretary
ST FRANCIS HOSPITAL, ZAMBIA TWINNING PARTNERSHIP WITH NHS BORDERS [SCIO]
Known as: ‘The Logie Legacy’
Scottish Charitable Incorporated Organisation: SC047148