LIBERIA: Less cholera with better hygiene

Faced with unsafe water and poor sanitation systems, aid groups in Liberia are encouraging people to wash their hands, put bleach in drinking water and find safe ways of disposing of human waste.

"We're trying to prevent outbreaks of waterborne diseases before they happen... It's fairly clear that the Ministry of Health does not have the transport and logistical facilities to improve the country's provision for water sanitation," Kabuka Banba, UN Children's Fund (UNICEF) project officer in Liberia, told IRIN.

Less than 25 percent of Monrovia's 1.5 million people have access to safe drinking water, according to UNICEF. "So the thrust of [our] intervention is to build capacity through training and education," Banba said.

Education in New Kru Town, a neighbourhood in the capital Monrovia, would seem to be paying off. Two rainy seasons ago there were nearly 300 cases of cholera out of a population of 40,000; this year fewer than 20 cases have been reported.

Water and sanitation experts say when a community undergoes an epidemic, as New Kru did, people there are naturally more receptive to prevention messages.

Liberian NGO Foundation for All Ages (FALL) says it has carried out a hygiene scheme that taught residents about the importance of using toilet facilities, washing their hands afterwards and collecting fresh well-water every day rather than letting water sit in buckets for long periods.

"People have been taught some basic hygiene skills they didn't know before," community leader Augustus Seongbae II told IRIN. "After the training the number of running stomach cases and cholera cases has sharply reduced."

Dirty or expensive

Still old habits die hard. "The general perception is that hand washing wastes water," UNICEF's Banba said.

Since the civil war ended in 2003 the Liberian Water Sewage Corporation (LWSC) has been slowly restoring services – sewers and piped drinking water – to Monrovia but the costs are prohibitive for most people living in places like New Kru Town.

The start-up fee is US$35 while the average monthly income is US$55.

"If people pay the water registration fee what happens to food? What happens to schooling?" asked community leader Seongbae. "Pipeline water is so expensive that we have to rely on wells," he said.

But wells in low-lying areas are subject to contamination by human waste, especially during the rainy season when there is flooding.

The limits of knowledge

Under such conditions experts say that changing habits is not enough. People need the basic infrastructure of toilets and clean water.

"It is one and the same thing," said Francisco Gonzalez, West Africa water and sanitation coordinator for ECHO, the humanitarian aid arm of the European Commission. When it comes to sanitation systems and healthy habits, he said it is not a question of one being more important than the other. "Any [anti-cholera] approach absolutely must include both."

But all the experts say rebuilding Liberia's sanitation infrastructure will take time.

In New Kru Town there are only a few blocks of toilets and they overflow in the rainy season. Residents are forced to return to their former habits of defecating in wastelands and on the nearby beach.

This and poor hygiene in general are the principal causes of cholera and diarrhoea outbreaks in Liberia, the UN said in a 2006 report. At least 20 percent of deaths in children under five are caused by diarrhoea resulting from poor hygiene, according to UNICEF.