Once again, Cholera is with us

Cholera is a bacterial infection caused by a spiral bacteria called Vibrio cholerae, which is typically spread through contaminated food, water, or human faeces. For us in this part of the world this is not a new kind of disease. Some nine years ago, when there was a similar outbreak in Lagos, and a few other states we had cause to look in detail at the causes of this peculiar illness.

We examined the common causes of this disease and its implications for the populace. Between then and now, different types of infections have afflicted our country, which together, brought to the fore the key importance of basic sanitation, the availability of clean potable water, decent living conditions, the treatment of sewage and adequate ventilation. However, most people learn new habits when there is an infection in town, and then they quickly forget them as soon as the infection recedes. On this page over many years, we have dealt with cholera, typhoid, Ebola virus disease, the COVID-19 pandemic and gastroenteritis. The common thread running through all of this has to do with basic hygiene, the habit of making adequate use of soap and water to clean our hands after going to the toilet before and after eating, and after handling any kind of object that is not edible.  Yet, people have quickly forgotten those lessons once the danger is no longer evident.

The causes of cholera are contaminated food, water, or ice. From a public health perspective, the main cause of this infection is contaminated water supplies. The bacterium can be found in surface or well water. And we all know that well water is the most common source of potable water in many of our communities. Such contamination of public water supplies represents a very important and frequent source of large scale cholera outbreaks. This was very much the situation in 1830s Europe when a similar epidemic caused the deaths of many thousands of people. In an epidemic in Britain in 1832, as many as fifty-two thousand people died. In the city of Sheffield, in the West Midlands, where more than 500 people lost their lives the City Council elected to build a cholera memorial as a tribute to all the people who died there. It has subsequently been turned into a national memorial, which serves as both a constant reminder and as a reference point to a bygone era. It is also a constant reminder of how a city confronted and overcame the ravages of cholera. It is very different from what we do in our own country, where diseases come and go and people simply do not pay attention until the next one strikes. And that is what we are reeling from at the moment.  Other causes of cholera are the consumption of raw or undercooked seafood and living in close contact with an infected person.

An individual who is infected will not pass the disease directly to another person but crowded living conditions will guarantee that his vomit or stool will at some point contaminate what the healthy individual will put in their mouth, thereby helping to ensure the propagation of the infection. On this page as well, on several occasions we have discussed about the importance of adhering to strict building codes such that there will be public works control over the treatment of sewage, its flow and over the distribution of potable water. The provision of adequate drainage in our environment ought to be the responsibility of the government but it is common to find all kinds of community development associations making ludicrous attempts to construct shallow open drains that end up breeding mosquitoes and other organisms that ultimately harm us. On the contrary, what do we see? In our towns and cities, we find evidence of people who basically erect their buildings anyhow they want to, and turn their various compounds into veritable local governments. They provide their own security. They handle their sewage by constructing septic tanks and soak-away pits. They will then sink a well or a bore hole in the same compound perhaps with a decent amount of distance from either of these utilities. However, these water sources may lie within a few feet of a soak away pit, or a septic tank in the neighbouring compound just a few feet away across a diving fence.

When these sorts of mistakes are made, it means that untreated sewage would occasionally find its way into sources of portable water, and mix with flood waters in the open drains which frequently accommodate the pipes that carry clean water to people’s homes from the various water works. These abnormal developments are compounded by the fact that heavy rainfall, which today is exacerbated by the effects of global warming progressively causes both clean and dirty water to mix together and become potential sources of gross infection to human beings in that environment. Right now it is cholera that is the infection of concern across many states. In the background, there is gastroenteritis happening in children under five and in the elderly, there are concerns over endemic cases of typhoid and also malaria and tuberculosis. But because we have refused to adhere to some of these very basic tenets of urban design, we will continue to have outbreaks of diseases like cholera.  Cholera is not a new disease. More than a century ago, it was a major problem in many European countries. There was a concerted effort in many of these countries to improve sanitation when they realized what was responsible for the outbreaks. Proper attention was given to the supply of clean potable water to residents and appropriate attention was given to environmental health. Here at home, governments are looking for escape routes to explain away the tragedy.

The end result of all these efforts has been the development of social amenities in those societies that have become the healthiest in several centuries. But we at least have the advantage of learning from the mistakes of all those countries. But rather than do so in a comprehensive fashion, we have tended to follow the mistakes that they made and even compounded them. What this means is that, at the time of those earlier cholera epidemics, humanity did not have to be hampered by the prevalence of plastic bottles and containers and Styrofoam cups. In our towns and cities today, even impressive open drains that have been constructed to deal with perennial flooding have become clogged with these materials that are not biodegradable. These substances mix with human waste, which results from Nigeria being host to the second largest open toilet in the world. A combination of all these is a sure laboratory for all kinds of disease conditions. It is no wonder then that cholera, and other water-borne diseases are certain to remain with us for many more years to come. The sad effects of this failure to plan are all too evident today in the features of cholera that we are witnesses to. It is a violent disease characterized by profuse diarrhoea that is frequent, watery, and looking like rice water. There is usually associated vomiting which is also frequent and severe leading to rapid and severe dehydration if both are combined.

Electrolyte imbalance rapidly supervenes leading to shock in severe cases and death can quickly result within a few hours if left untreated. Clearly, therefore, it is reasonable to assume that within the context of our urban communities now being ravaged by cholera, many more people are dying quietly at home without the benefit of getting hospital care. You only need to take a drive around these cities. To see or to witness the eyesore that open drains, and flood drainage channels have become. There is no way such a baffling accumulation of human negligence and irresponsibility will not lead to outbreaks of serious disease. The prevention of these problems is assured by drinking safe water that is boiled, filtered, or bottled. Avoidance of raw or undercooked food is a must. So is the adherence to the washing of the hands frequently with soap and water. Use proper sanitation and hygiene and avoid close contact with infected people. Vaccination is available for travellers to those regions and high-risk groups. Treatment involves fluid replacement with oral rehydration therapy or intravenous fluids in those who are vomiting. Electrolyte replacement with potassium, sodium, and chloride must be given with the drips. Antibiotics that are known to be useful in the treatment of this disease must be given in addition to adequate, rest. Hospitalization is required in severe cases.

Complications that are associated with cholera are dehydration and shock. Electrolyte imbalance quickly follows. Kidney failure, septicaemia (blood poisoning) rapidly follow suit and death results if no treatment is obtained. The bottom line is that our towns and cities increasingly resemble ghettos.

Questions and answers

Good day, doctor. Please my 13 year old daughter has been complaining of headache for several days now. She said the headache is dull, but it is persistent and is worse in the evenings. We have not been able to do any tests. But this morning, she said she was also nauseous. What do you advise us to do?  0803********

Well, it is understandable if you are unable to afford the cost of laboratory investigations. Since she is not vomiting, it is advisable to get her an antimalarial medication, as these complaints seem like she has the early stage of malaria. There are many various brands to choose from but let the attending pharmacist at the point you eventually get the drugs from to guide you on their usage.

Good day, Sunday doctor. I am a 27-year-old single woman who has been taking malaria treatment at a private hospital. I was placed on daily injections for three days and today is the second day of it but the problem now is that there is so much pain in my tummy between the navel and the chest. The pain is like worms are running around inside and I am not able to even tolerate water; I keep on vomiting. One injection is being given in my buttocks and the other in my vein. The doctor said it is Omeprazole. What should I do please? Should I take a worm medicine?  0803********

The fact that your tummy rumbles does not mean that you have worms! It is more likely that you are suffering from one among a variety of stomach disorders ranging from gastritis to pancreatitis. You should go back to that hospital for a proper re-examination and further testing. If you are unable to take even bland things like pap or water without vomiting, then you are a candidate for hospital admission so that these injections can be administered the way they should be given and you can get some intravenous fluid therapy as well to ensure you get some energy replenishment. These will cost you some more money, an important consideration in the country today, but there is no true alternative to good health.

Good evening, Doctor. Thank you for your selfless service to the general public, may the good Lord reward you. Please, I’d like to know the causes of sudden stroke, the indications and possible precautions to avoid it sir. Kindly enlighten us on this, sir. May God’s protection continue to be upon you and your family in Jesus Name.    +23481********

Thank you very much for your kind words and prayers. I appreciate you and want you to know that it is the readers like your good self who make it all worthwhile. A stroke is caused by either of two major events. The first possible cause is a blockage in one of the blood vessels supplying oxygen and nutrients to a part of the brain. When such a vessel gets blocked, nothing passes through that obstruction and the brain matter beyond that point gradually dies. The same thing happens when such a vessel bursts thereby disrupting the blood and oxygen supply to the relevant part of the brain. To avoid these events from happening, it is important to keep your blood pressure in check, maintain a healthy weight, avoid cigarette smoking and stop heavy alcohol consumption. In addition, you should keep your blood sugar within healthy limits and conduct an annual health check once you are over the age of forty years.

Good morning, doctor. I read your recommendation about getting a two-hour post prandial blood sugar done in the last edition of Sunday Punch.  My fasting sugar this morning was 5.2. After a breakfast of three slices of wheat bread with some peanut butter, I took my prescribed Panfor SR 1000[1 tablet]. Exactly, two hours after, my blood sugar was 9.4. What’s your opinion, Doctor? Gratias. Secondly, doctor, what is your take about the chart approved for diabetics by the [American Diabetics Association] ADA?    +234 803 389 8785

Good evening sir. Thank you very much for your feedback. A reading of 5.2 milimoles per litre is equivalent to about 95 mg/dl which is normal. However, one error in your medication is that the Panfor SR should be taken before your meal, not after. Secondly, a 2-hours post prandial result of 9.4 milimoles per litre is about 170 mg/dl which is clearly above the recommended threshold of 135 mg/dl.

That result shows the deleterious effect wheat is having silently on your blood sugar. Just 3 slices of wheat bread and it raised your blood sugar so much! As for this American Diabetics Association, just know that the Americans have led the medical field with their unique classifications over a wide range of specialities. You should imbibe their recommendations.

Doctor good day, Sir. I must commend you with emphasis on your insightful medical information and advice that have been invaluable to your esteemed readers and fans. I am one- of such beneficiaries. I read your Sunday edition of 23rd June 2024 where I understood that sugar is the chief culprit in cancer cases, I lost my father to cancer last year.

You explained ketogenic diet but didn’t give examples of such food. Please can you give examples of ketogenic diet so that your readers and I can know, adhere to it, and inform the wider populace? Keep up the good work doctor. Thank you.    [email protected]

Good afternoon to you. Thank you very much for your contribution and kind words. Sorry to learn about your father’s death. Sugar is not the main cause of or main contributor to cancer; other factors like cigarette smoking, family history and environmental conditions also play a role. However, the role of sugar, which was not properly understood before is coming into a sharper focus as an important contributor to the incidence of cancer. The keto diet, short for ketogenic diet, is a low-carbohydrate, high-fat diet that aims to put the body into a state of ketosis, so that the body is forced to burn fat for energy instead of carbohydrates.

The diet involves drastically reducing the intake of carbohydrates and replacing them with fat, which forces the body to switch from relying on glucose (sugar) for energy to relying on ketones, which are produced by the liver from fat.

The percentage of carbohydrates is 5-10 per cent while that of fat is 70-80 per cent while that of proteins is 10-20 per cent. Such foods will typically be made up mainly of cheese, butter, nuts, berries, legumes, and avocado pear. Other pears are also useful. You can compose these foods by yourself at home or place an order for them from companies that make such meals. I hope this is informative enough.

Dear Dr. Ikhisemojie, I stumbled on a movie about five years ago on the effectiveness of the Keto diet in curing seizures/epilepsy, and I felt bad that nothing of it was mentioned in my pharmacology class in pharmacy school. Surprisingly, this knowledge has been around for about 80 years now. Please find the link to the YouTube movie titled: First Do No Harm. Regards.    [email protected]

Answer: Thank you very much for that contribution Pharm. Ola. It introduces a new dimension to the growing notoriety of sugar as a precursor of several systemic illnesses, and the efficacy of the ketogenic diet to mitigate some of these deleterious effects. I was also unaware of that link until a few minutes ago. I will check it out. Bless you.

Good morning, doctor. I went to see our family doctor yesterday with complaints of mild headaches, bad sleeping patterns, cough, and foul odor when urinating particularly in the early hours of the morning. A series of tests (blood and urine) was carried out and the results were no traces of malaria or typhoid; not anything in my urine but that my blood sugar level was low.

The major recommendation was for me to take more sugar and antibiotics and few drugs were given to me. I asked the doctor if there was no drug for sugar level booster and he said no but that I should take a bottle of Pepsi in the morning and the night. Please doctor I need your advice. Thank you and God bless you, sir.   080********

Good evening. Unfortunately, you neither told us your age nor your gender, but you will still be able to get some useful advice. The recommendation you were given concerning the consumption of Pepsi is not appropriate advice. Low blood sugar could have been an occasional finding. It is not likely to be your regular status, especially if at the time of these tests, you had not taken any meal.

So to guarantee a constant blood glucose level, eat regular meals, no matter how small. Taking Pepsi is not the solution because, in each bottle 50 cl bottle, you could be taking the equivalent of 16 cubes of sugar. Your urine can smell in a bad way if you are dehydrated due to inadequate water intake during the night. As soon as you can take enough water, that smell should recede.