Cape Town prides itself on its record of delivery. But in Khayelitsha, one of the poorest, most densely populated areas of the city, there appears to be no significant improvement in the annual tragedy of infant deaths caused by diarrhoea-related infections.
The Mail & Guardian struggled to obtain statistics to establish a trend, but doctors said the situation was getting worse, although the city claimed that this week was “quieter” than the same period last year.
In response to questions from the M&G about the past two years, the city supplied information only for 2010, which showed 58 deaths from diarrhoea of children under five in Khayelitsha.
Another city report suggests that there were 60 deaths in the same area in 2009, though the document is undated.
One well-placed source said that the city was publicly downplaying the situation but health officials were “extremely concerned” that “death and illness is on the increase” in Khayelitsha and its informal areas, but that they were “constrained to admit this publicly”.
The city’s own health data shows clearly that Khayelitsha has by far the highest number of diarrhoea-related infant deaths of any district in Cape Town — its figures are double the city average and more than 10 times worse than those of the affluent southern suburbs.
Public health experts are warning that such disparities within districts is alarming and “inequitable” and can be explained partly by a lack of resources and neglect of sanitation
infrastructure and maintenance, and partly because of “the blame game”.
Although the city said this week that diarrhoea was a seasonal problem, this was criticised by local doctors and public health specialists.
Professor Louis Reynolds, a paediatrician with the People’s Health Movement, said: “The diarrhoea season has been with us for decades. The fact that one can predict it and it then happens every year is an indictment on the health system and the state. Everyone knows it will happen and that children will die and everyone seems powerless to stop it.”
He also said that an “intersectoral response” that addressed people’s living conditions and sanitation access was needed. “For children to die of diarrhoea, a preventable disease, in the year 2010 is something to be ashamed of.”
In a submission to the Human Rights Commission two years ago, Reynolds said that “both diarrhoea and non-diarrhoea admissions are increasing in Cape Town health facilities and the rates of increase of both have been greater since 2005 than they were before 2003 … conditions that make children sick persist. As a result Cape Town’s children are getting sicker and the load on the health system is growing.”
This week Mayor Dan Plato did not answer detailed questions sent to his office.
Of the several units responsible for informal areas, health, reticulation and sanitation in Cape Town, only the city’s health unit responded to questions (see “City health unit responds”).
The Social Justice Coalition (SJC), the members of which are residents of informal areas in Khayelitsha, said this lack of response was part of a broader pattern of the city and mayor ignoring a public health crisis and sanitation problem in informal areas.
Gavin Silber of the SJC said that in their single meeting with the mayor last year he was defensive about the problems in Khayelitsha’s informal areas and told the SJC that people “squat where they shouldn’t squat” and in doing so “aggravate their own situation”.
Professor Leslie London, head of the Public Health and Family Medicine School at the University of Cape Town, said: “It is quite clear that the city needs to invest in infrastructure … we need an engineering solution for a public health problem.”
The city did not answer questions about its budget allocations for sanitation.
Sanitation of problems bedevil residents
Khayelitsha is at the centre of Cape Town’s diarrhoea storm and samples taken of run-off water at the RR section in Khayelitsha demonstrate one reason.
The samples were taken by Stellenbosch University in September 2010 from a basin at a communal tap, from toilet overflow and from open waste water and they revealed “extremely high pollution by raw sewage”, said Jo Barnes, a researcher at the university.
They also revealed alarmingly high levels of E.coli bacteria, which arise from poor sanitation and are the underlying cause of most diarrhoea cases.
Last week the M&G spoke to several residents in RR section about their sanitation problems.
“Nosake” is a grandmother who cares for eight minors. There are two waste-water manholes in the front of her house. She said that she regularly had to take her children and grandchildren to health clinics, often for treatment for “diarrhoea or gastro infections”.
One of her grandchildren was admitted to hospital last year for eight days and had to be placed on a drip. She said the manholes often over-flowed with “dirty water, pads and worms”.
Nosake’s battle to get the city to raise the level of the manholes took several years and was successful only after recent assistance given to her by the Social Justice Coalition (SJC).
A trail of correspondence between Nosake, the SJC and officials confirms the extremely long turn-around time for the city to attend to overflows and broken or damaged water pipes and manholes.
According to the SJC, “just working out who was responsible for what and getting them to do their job proved to be a nightmare”.
Residents said that water sources in RR section could be infected because of the lack of adequate and safe toilets.
They said that children and adults were often forced to relieve themselves near a swamp filled with garbage or on other pieces of vacant land, resulting in an environment with excessive human sewage.
Children often played in contaminated water puddles that accumulated near leaking or broken water pipes.
In RR section several families share communal toilets, including chemical and concrete toilets, some of which do not work properly. Families also share communal taps from which they collect water. About 100 people share one tap for washing and cooking.
Professor Louis Reynolds, a local paediatrician, said: “For frequent and effective hand washing, you need ready access to clean water. It is a bit hypocritical to blame people for inadequate hand washing if they have to walk 50m down the road to a tap at the best of times. There are many obstacles to access, including lack of security in areas where crime rates are high.”
During a visit to RR section, the M&G witnessed leaking taps, stagnant pools of water at communal taps and conduits built by the community to redirect the flow of effluent from leaking manholes and pipes.
Some of this was flowing into a swamp alongside the N2. Several concrete and cubicle toilets were unfit for use.
“Eric”, a resident of RR section, complained about irregular garbage collection, lack of sufficient garbage bags and of dustbins, the overwhelming stench of sewage, the seething heat in the plastic toilet cubicles and the overflow of water from toilets and broken pipes and taps.
But his main complaint related to his inability to access easily one office that could attend to his community’s sanitation and waste-collection problems, which he said were getting worse.
Three of the companies contracted to provide sanitation services said they would have no objection to dealing with residents’ complaints directly and that they had the ability to respond within less than 24 hours.
But the SJC complained that many of their members had difficulty in making the city exercise proper oversight of these companies and that they often had problems with lengthy turnaround times.
City health unit responds
“Informal settlements are visited weekly, checked for water, sanitation and refuse collection problems that might lead to health hazards. These problems are referred to the relevant departments and city health monitors the situation.
Adequate access to water and sanitation and effective solid waste removal is paramount to maintain health and hygiene standards that prevent the spread of diarrhoea.
We have not identified water-borne health-related problems [in Khayelitsha] but rather personal hygiene (hand washing), poor housekeeping practices (which impacts on water contamination at storage and use levels) and the preparation of formula feeding.
Poor sanitation can be addressed only in partnership with the community. As the city strives to install (very expensive) new infrastructure, there is a need for the community to use it properly. But instead extensive vandalism occurs.
A recent pilot project provided evidence that a janitorial system is a good contribution to improve the situation with water and sanitation in informal settlements and its expansion will be explored.
Toilets: This is an emotive issue easily manipulated for political gain. But the reality is that certain informal settlements are too dense to allow installation of water and sewerage, while others are situated in areas where the surface water level is too high to allow waterborne toilet systems.
Communication of such technical facts to communities is disputed and disregarded by people ill-advising them and undermining trust in city departments.
Solid waste: The community needs to be sensitised to the dramatic impact and cost of littering and refuse obstructing stormwater systems.
Water: Even when supplied pure at the tap, water can easily turn into a source of contamination and disease if not appropriately stored and used.
The city’s cost of providing services for informal settlements is very high, but service delivery continues to be frustrated by lack of cooperation between residents and providers.
Solid-waste contractors provide weekly refuse collection to informal settlements but access to areas is often denied and bagged household refuse is sometimes not left out to be picked up.”
This article was produced by amaBhungane, investigators of the M&G Centre for Investigative Journalism, a nonprofit initiative to enhance capacity for investigative journalism in the public interest. www.amabhungane.co.za.