I recently learned the details of events from Cameroon that reminded me of a modern day Broad Street pump. If you work in public health, you’ll remember that in 1854, John Snow removed the handle from the Broad Street water pump in London and – in all likelihood – stopped a cholera outbreak that had killed over 600 people. In Cameroon, the lessons learned from John Snow reverberated loudly.
This story takes place on a remote island in Lake Chad, an area that is both remote and under threat from Boko Haram and local bandits. In October 2014, a team from M.A.Sante, an NGO in Cameroon and a partner with the DOVE project (Delivering Oral Vaccine Effectively), was dispatched to investigate a cholera outbreak that had sickened 10 people that month. By the time they arrived, the only medical person at the local hospital was a nurse; others had fled the island. The team met with the nurse to assess the situation, obtain samples from 13 patients in the hospital who appeared to have cholera, and collected water samples from nearby sites. Some of the samples came from large bodies of water such as the lake, while others came from drinking wells. Because of security concerns, the team returned to the mainland the same day, but they took the samples with them for testing.
The next day, the team used the modified dipstick test to confirm the cholera diagnosis from the patient’s samples. They also found that, among 15 water samples tested, water from site #8 was positive for V. cholerae. This was a well that supplied drinking water for many families in the area, some of whom had contracted the disease. Using a cell phone, the team immediately notified the local authorities who then locked the well. It took two more days for the team to return to their base of operations where they could confirm the dipstick results using standard culture methods. This took another two days.
The modified dipstick test the team used was developed through the DOVE project, a project funded by the Bill & Melinda Gates Foundation to facilitate the appropriate use of oral cholera vaccine. Prior to the development of this test, detecting cholera was expensive, highly sophisticated and time intensive – and that’s when you’re close to a lab, much less a remote area in Cameroon. With the new dipstick test, the team was able to confirm the outbreak, identify the contaminated well, and close it within a day, staving off numerous additional infections. Testing water samples from a remote island would not have been possible previously, and obtaining results from patient samples from such a hospital would take more than a week, assuming the samples could somehow be sent to a reference laboratory.
We have come a long way since John Snow visited Broad Street in 1854, but cholera remains a threat to millions worldwide. Fortunately, we have life-saving vaccines to keep people healthy, and innovative diagnostics like the modified dipstick that enable us to quickly and effectively identify threats. We must continue to ensure these tools are readily available whenever and wherever they are needed.