IRIN
VIETNAM: Grappling with renewed cholera outbreak
29 April 2008


HANOI, 29 April 2008 (IRIN) - In the face of yet another outbreak of 
cholera, Vietnam's capital city is closing down dog meat restaurants and 
unhygienic street food stalls, but not enough is being done to address 
Hanoi's decrepit sanitation system, a major source of the illness, 
according to health officials.

"The sewage from septic tanks flows into the lakes," Nguyen Huy Nga, 
director of the Ministry of Health's Preventive Medicine Department, 
told IRIN. "When people use the lake water for different purposes, such 
as washing food, they are helping to spread the disease."

Hanoi's sewers date back to French colonial times when the city was 
relatively small. Today, it teems with more than three million people 
yet the sanitation infrastructure is largely unchanged from the late 
1800s.

According to the World Health Organization (WHO), 2,490 cases of acute 
diarrhoea were reported in Vietnam between 5 March and 22 April. A total 
of 377 people tested positive for vibrio cholerae, mostly in Hanoi.

Cholera is an infection of the intestinal tract, which is contracted 
through contaminated food or water. It can result in dehydration and 
kidney failure, which if untreated can result in death. So far no 
fatalities have been reported.

In response to the recent outbreak, the third since October, Hanoi's 
health department has closed dozens of dog meat butchers and restaurants 
in the capital. Because the dogs are not reared for consumption, the 
meat is often contaminated. In addition, it has urged people to avoid 
street food stalls. A ban on using excrement to fertilise crops has been 
put in place as well. Health authorities have also repeatedly warned 
people not to wash fruit and vegetables in the highly polluted lakes and 
ponds.

But Hanoi's public health officials concede they can only do so much. 
"There are more than 260 inspection delegations at all levels throughout 
the city every day," said the frustrated director of the Hanoi Health 
Department, Le Anh Tuan. "We have shut down dog meat restaurants that 
failed to meet the food safety and hygiene requirements.

"We are trying to raise the awareness of all people, including 
restaurant owners and customers, so they understand about food safety 
hygiene. [But] we can't do anything if customers just ignore basic food 
safety."

Treating the lakes

Tuan said the 30 lakes in Hanoi that tested positive for the presence of 
cholera bacteria are now being cleaned. More than a tonne of chlorine 
was dumped into Linh Quang Lake after six people living nearby 
contracted the illness.

However, the real problem is a sewage system that dates back to the 19th 
century, says Ngo Trung Hai, vice-head of the Institute for Urban and 
Rural Planning at the Ministry of Construction. Rainwater run-off mixes 
with untreated sewage, exacerbating the problem.

"Hanoi has no water treatment plants," says Hai. "It's crazy. It all 
goes into the lakes without being treated. It's easy to understand why 
the lakes are infected with cholera because the sewage flows into them."

The good news is that a water treatment plant is under construction, 
says Hai. It will be able to process 200,000 to 300,000 cubic metres of 
sewage a day. But Hanoi's houses still need to be connected to an urban 
sewer system, a long-term project.

Meanwhile, WHO and local public health officials are stepping up their 
campaign to warn people of the dangers of eating uncooked vegetables, 
using unhygienic food outlets and drinking contaminated water. They also 
warn that warmer temperatures are likely to bring an increase in 
infections.

Vietnam's state-controlled media is also ratcheting up the rhetoric, 
using "cholera" instead of "acute diarrhoea", in a move that health 
officials hope will encourage the public to take the threat more 
seriously.

Some people are getting the message. Many say they are paying more 
attention to sanitation and are washing their hands before meals. But 
there is little evidence that people are actually changing the way they 
eat.

"Eating on the street and at pavement stalls is unclean and is 
destroying the city's image," said 21-year-old Pham Tien Quan. But at 
the same time she was buying sugar cane juice, a virtual cholera 
cocktail, from a local vendor in Hanoi.

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