Unpacking Cholera Risk in Goma: It’s More Than Just Water

Hey there! So, you know how sometimes we think a problem is simple, like, “Oh, just fix the pipes and everything will be fine”? Well, when it comes to something as serious and persistent as cholera in a place like Goma in the Democratic Republic of Congo, it turns out it’s way, way more complicated than that. We recently took a deep dive into what’s really going on there, beyond just the lack of clean water, and let me tell you, the story is fascinating and heartbreaking.

Goma sits right by the beautiful Lake Kivu, which you’d think would be a blessing, right? Plenty of water! But here’s the kicker: most people don’t have access to *clean*, treated water. And cholera, bless its terrible heart, absolutely thrives where safe water and sanitation are missing. Goma’s been a major hotspot for this disease for decades, facing outbreaks that just won’t quit.

We wanted to understand the *social* side of this. What are the real-life dynamics, the daily struggles, the community perspectives that influence who gets sick and why? So, we put on our researcher hats (well, our local team did the heavy lifting on the ground, speaking Swahili and French, doing interviews, walks, and workshops) and spent time in six different areas of Goma between 2021 and 2022. We talked to all sorts of people – community members, leaders, health workers, even folks in the prison and military camp. We weren’t just counting cases; we were listening to stories, mapping out risks, and trying to see the world through their eyes.

What we found really hammered home that cholera risk isn’t just about a germ in the water. It’s woven into the fabric of daily life, influenced by everything from poverty and politics to natural disasters and how communities are (or aren’t) empowered to help themselves.

The Water Woes: A Daily Struggle

Okay, yes, the lack of safe water infrastructure is absolutely the big one, the main character in this sad play. Lake Kivu is right there, but getting clean water from it is a massive hurdle. The public water company, REGIDESO, distributes treated water, but only to a lucky few. For the vast majority, it’s a choice between untreated lake water, or maybe chlorinated water if they can afford it or if aid groups are around.

It’s wild, but people have different beliefs about this water. Some know the untreated lake water is risky; others feel their bodies are used to it, or they just don’t have another option. One person told us, “People have no choice, they take knowing that there is dirt but we take it like that. And that’s okay!” Others even refuse chlorine tablets, thinking it makes them *more* vulnerable later if they run out!

Paying for water is a huge barrier. Even where there are standpipes with treated water for sale, many simply can’t afford the cost per canister. Boiling water? Forget it – the cost of firewood or embers is too high. People are forced to use water they know is dirty, just to survive.

Access points are a whole social drama in themselves. At community tanks (Bitanké), there’s a hierarchy. Police manage them, and sometimes their friends, the “capable”, cut the line, leading to fights. It’s a daily battle for this basic necessity.

Water also comes from NGO trucks filling local tanks, but even this is unreliable. Infrastructure gets damaged by volcanic eruptions (hello, Nyiragongo!) or conflict. And who knows if these private tanks are even clean or properly chlorinated? As one person put it, “Here it’s the tanks first, because there is a water cut on the taps… we just see the car that comes to pour water and we do not know if they wash the tanks and if they put the medicine [chlorine].”

Piped water exists, but mostly in the city center, serving only about 30% of households. And promises of expanding this? Often just political talk that never becomes reality.

Who’s Most Vulnerable? Certain Groups Face Higher Odds

Beyond the general lack of clean water, our conversations revealed that certain groups in Goma are seen as being at much higher risk of getting cholera. It’s a mix of individual factors, behaviors, and the environment they live in.

The most commonly mentioned were:

• Children, Women, and the Elderly: Kids, especially younger ones, are vulnerable because of play, putting things in their mouths, and needing help with hygiene. Women are at risk because they are often the primary caregivers for sick family members and handle laundry. The elderly might keep water longer, increasing contamination risk.
• People with Health Issues: Folks with chronic diseases like HIV or diabetes, or those who are malnourished, are believed to be more likely to get severely ill if they contract cholera.
• Occupational Risks:
  • Market Sellers: Markets are seen as hotspots due to lack of toilets, open trash (sometimes with feces!), flies, and the consumption of ‘quick food’ that might not be prepared safely. Food left on the ground during rain and contaminated by runoff is also a concern.
  • Fishermen: Spending all their time on the lake and often drinking untreated lake water puts them at high risk. They might also lack latrines and eat risky market food.
• Socio-Economic Status and Living Conditions: Poverty is a massive driver. Poor households often can’t afford clean water or don’t have proper waste management. Building latrines is hard on volcanic rock, and renting land often means no access to a toilet, forcing people to defecate in the open. Overcrowding, especially in places like the Katindo camp and the Munzenze prison, creates incredibly unhygienic conditions where disease spreads rapidly. Prison septic tanks aren’t emptied often enough, and sheer numbers overwhelm the system.

The Bigger Picture: Conflict, Disasters, and Growth

Cholera in Goma doesn’t happen in a vacuum. It’s deeply intertwined with the city’s tumultuous history and ongoing challenges.

Ongoing armed conflict forces people to flee rural areas and crowd into the city, putting immense pressure on already strained infrastructure like water and sanitation. Roads get cut off, making it hard to get medical care or supplies. Displaced people living in camps around Goma are particularly vulnerable, facing major outbreaks.

Natural disasters are also part of the story. Volcanic eruptions, like the one in 2021, cause mass displacement and disrupt services, including water pipelines. People fleeing the volcano might even abandon treatment centers while still sick, potentially spreading the disease.

There’s a debate here. Some see positive changes – urbanization, people becoming more aware of hygiene, a “change in mentality.” Others are more pessimistic, pointing to increasing food insecurity, less land for farming, and relentless population growth that outstrips any development in infrastructure. New buildings pop up without latrines because owners don’t want holes dug on their plots, especially if they don’t own the land securely.

Unemployment, particularly among young people migrating to the city, contributes to insecurity in peripheral areas. This insecurity discourages investment in homes and infrastructure, leaving areas undeveloped and sometimes used for dumping waste.

Even the lake itself is a source of concern beyond just lack of treatment. People believe it’s contaminated by laundry, bathing, defecation, and even corpses. Lake waves are thought to bring more dirt to the shores, increasing pollution. The dry season is seen as riskier because heat leads to water shortages, pushing more people to use the lake directly. Climate change is messing with farming, leading to famine, which weakens people and makes them more susceptible.

Barriers to Care: Getting Help Isn’t Easy

Even when someone gets sick, getting effective treatment for suspected cholera in Goma is full of hurdles.

First off, there’s a strong culture of home care and using traditional remedies. People often try herbs, coffee, or other methods first, only considering modern treatment or going to a cholera treatment center (CTC) if things get really bad. One person described trying herbs first, and only if “these herbs do not relieve you and if the diarrhea continues then you have to go to the hospital quickly.” There’s also the belief that illness might be due to witchcraft, leading to spiritual practices before seeking medical help.

When they *do* decide to seek care, cost is a major factor. Families have to balance the need for treatment with their limited income. Transportation can also be a nightmare. Motorbike taxis, often the only way to get around, might refuse to carry someone suspected of having cholera for fear of contamination. Traveling at night is risky due to insecurity.

And even if they reach a CTC, the quality of care can be inconsistent.

• Lack of supplies, especially intravenous fluids for rehydration, is common when NGOs aren’t actively supporting the center.
• NGO support is often temporary, tied to outbreaks. When the outbreak ends, staff might not be paid regularly, and services suffer.
• Many CTCs lack electricity, making nighttime care difficult.
• There’s often insufficient personal protective equipment for staff and community health workers.
• Shockingly, some CTCs themselves have poor water and sanitation! Patients might share water, and hygiene can be terrible, creating a risk of further spread *within* the treatment center. Imagine going for help and finding the place you’re supposed to get better is dirty.

The Prevention Puzzle: Critiques of Current Approaches

Finally, the way cholera prevention is currently handled in Goma also contributes to the ongoing risk. There’s a lot of skepticism and frustration among community members regarding the effectiveness and sustainability of existing programs.

Many different NGOs operate in Goma, which sounds good, but it can lead to a lack of coordination and duplication of efforts. More importantly, their interventions are often seen as partial and temporary, focused on emergency response rather than long-term development. When an outbreak hits, NGOs rush in, provide support (like paying staff or supplying materials), but when it subsides, they pull back, leaving local structures unable to cope.

Building toilets is great, but if people can’t afford to empty them when they’re full (a common problem), the benefit is temporary. Hygiene promotion might happen during a project but isn’t sustained. This short-term focus makes it hard to build lasting change.

Community health workers (relays) play a crucial role in referring cases and educating people, but they are often volunteers, only supported financially during short project periods. This lack of consistent support is discouraging and hinders the development of a strong, sustainable community-based system.

Even vaccination campaigns face challenges. While large campaigns have happened, community members expressed concerns about lack of information, poor follow-up for second doses, and rumors about side effects (like infertility – a common fear with vaccines). Whether these concerns are fully accurate or not, they are real to the people and can limit the effectiveness of these interventions.

There’s also a feeling that local health centers and communities lack power in decision-making. Decisions about how and where organizations intervene are often made at higher levels, not by the people on the ground who understand the real needs.

What We Learned (and What’s Needed)

So, what did this deep dive tell us? It confirmed that while lack of clean water is central, cholera risk in Goma is a complex web of interconnected social factors. It’s about who you are (age, gender, health), what you do (job), where you live (poverty, housing, access to sanitation), and the larger environment you’re in (conflict, disasters, population pressure).

It’s also about the challenges people face in getting help when they’re sick and the limitations of current prevention strategies that often focus on quick fixes rather than lasting solutions.

This means that tackling cholera in Goma requires more than just emergency responses or distributing chlorine tablets. We need strategies that:

• Prioritize the long-term development and maintenance of safe, reliable water infrastructure across the entire city, not just parts of it. This is non-negotiable.
• Involve the affected communities directly in planning and implementing prevention measures. They know their realities best.
• Address the specific vulnerabilities of high-risk groups.
• Improve access to and quality of care, ensuring treatment centers are well-equipped and hygienic, and that transportation isn’t a barrier.
• Move beyond short-term NGO projects towards sustainable, locally-led initiatives.
• Recognize and address the impact of conflict, displacement, and environmental factors.

Ultimately, reducing the chronic nature of cholera in Goma isn’t just a public health task; it requires political stability, regional cooperation, and a commitment from the government and international partners to invest in the fundamental needs of the population, starting with clean water.

It’s a tough situation, but by understanding the full picture – the social dynamics, the daily struggles, the community’s own insights – we can hope to find better ways forward than just reacting to the next outbreak.

Source: Springer