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Emergency Preparedness And Response: It’s Time For Cameroon 

By Denis A. Foretia, MD*

In the last month at least 200 men, women and children have died in northern Cameroon according to reports from the Ministry of Public Health.The cause, a fledging cholera epidemic, has continued to ravage the three northern regions of Adamawa, North and the Far North. With more than 3000 confirmed cases as reported by CNN, this epidemic is by far the most devastating yet.

The bad news is that Cameroonians, especially residents of the three northern regions, are very familiar with cholera. In the last decade alone, there have been multiple cholera outbreaks in Cameroon the last of which occurred in these same regions in October 2009 and was responsible for hundreds of preventable deaths.

With such a high recurrence rate of cholera outbreaks, one would expect a more comprehensive and strategic response from the government and the Ministry of Public Health. Instead, what has happened is nothing more than a fragmented, half-baked, and timid response largely spearheaded by international aid agencies such as the World Health Organisation, UNICEF, the Cameroon Red Cross and the local health departments in the northern regions of Cameroon.

Not surprisingly, the government has continued to depend on international organisations to take care of its citizens, to provide basic health needs and clean drinking water supplies. While scores of Cameroonians continue to succumb to preventable deaths, the government is yet to find plausible reasons, in all these years, to substantially increase the budget earmarked for public health and by extension confront public health emergencies.

The budget for public health as of 2009 was a dismal 4.9% of the national Gross Domestic Product. John Snow, the 19th century British physician, was the first to link contaminated water supplies as the main cause of cholera outbreaks and spread. The conditions in northern Cameroon are not different.

The cyclical nature of this epidemic, usually in the rainy season, has been directly attributed to our despicable water supplies. Poor infrastructural networks, especially a mundane water supply system and few hygienic toilets, have greatly exacerbated the situation.
Government’s response has been abysmal at best. The current death toll and absence of an appropriate response highlights the lack of timely medical interventions and the infrastructural support to facilitate the delivery of care.

Government, therefore, must use this crisis as an opportunity for a strategic re-structuring of the emergency response paradigm. It must now, more than ever before, adopt and implement an aggressive emergency preparedness and response system that anticipates, coordinates and directs the national response to both natural and man-made disasters within the country.

It is critical to create the Center for Emergency Preparedness and Response – CEPR, to be directly responsible for the active implementation of this system. This Center will permanently replace the ad-hoc committees that have been hastily put-together after a crisis or disaster in order to help in the relief effort.

With direct supervisory control from the Ministry of Public Health, the center should be composed of an interdisciplinary network of epidemiologists, researchers, policy makers, physicians and other healthcare professionals. To adequately fight the healthcare and public health battles of the Cameroonian people, the operating budget for the Ministry of Public Health must, at the minimum, be doubled to 10 percent of the Gross Domestic Product (GDP).

In order for the center to function properly, it must have expanded responsibilities in dealing with natural disasters such as floods, toxic exposure as was the case in Lake Nyos in 1986, famine conditions especially in northern Cameroon, the active volcanic mountain range of Mount Cameroon and other health disasters.

The creation of mobile medical units together with a strategic medical laboratory unit, preferably in the economic capital of Douala, will greatly complement the center. Though aid and other relief agencies are critical in the aggressive response to such epidemics, the government must take the lead in establishing working frameworks and investing heavily in the publicity and educational campaigns.

With recurrent cholera outbreaks threatening safety and security in most of the northern regions, neighboring Chad and Nigeria and with the prospects of Chadian conflict forcing refugees into northern Cameroon, the time has come for definitive solutions to an easily fixable problem. A government that watches its citizens succumb to preventable deaths as a result of contaminated water supplies without springing into action has certainly ceased to be a government for the people.

Creating the Center for Emergency Preparedness and Response will ensure that catastrophes like the current cholera epidemic are easily targeted and quickly contained. The time for inaction is over. We Must Act and Act Now.

Dr. Denis A. Foretia is a Resident in Surgery at Emory University School of Medicine and is a Masters in Public Health degree candidate at the Bloomberg School of Public Health, Johns Hopkins University in Baltimore
dforetia@jhsph.edu

 

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