Everything is carefully done. Clinicians put on their gloves, masks, protective coats and boots as they prepare to attend to patients in a cholera treatment camp at Bwaila Hospital in Lilongwe. The camp is enclosed by a small fence, keeping out all non-essential personnel. There is a mat drenched in chlorine by the camp entrance, and a bucket full of disinfectant for handwashing to make sure anyone leaving or entering the camp is safe. The solemnity of the entire exercise points to the severity of the disease being dealt with. The paradox of cholera is that, while it can kill within three hours, it is fairly easy to prevent and treat.
Preventing cholera is a seemingly simple matter of having basic sanitation facilities, safe water supply and practicing good hygiene. But these facilities and practices are lacking, not only in rural Malawi but also in densely populated urban areas. In early 2018, the capital city Lilongwe was hit by a major cholera outbreak. Now, a UNICEF mapping exercise that includes drones is enabling communities to get involved by identifying problem areas and taking action to fill the gaps in sanitation and hygiene.
Booming business, deteriorating hygiene
In another part of Lilongwe is a busy market. Here you can find anything from vegetables, firewood, spare parts for motor vehicles, shoes, clothes, charcoal, kitchen utensils and much more. It is a one-stop-shop set up haphazardly by the road, with no sanitation facilities or safe water for the hundreds of people who visit the market every day. With food on the ground, and open defecation nearby, the risks of cholera spreading are clear.
Luckily, help is at hand. A white van from Centre for Development Communication, a UNICEF partner, is going around such market places. Facilitators hand out flyers and tell people about the dangers of cholera and what to do to prevent it. This is an interactive exercise as the facilitators provide some information, then go around asking questions to see if the crowd understands the message. The process was initiated by UNICEF and its partners.
In Lilongwe, UNICEF is going a step further by using unmanned aerial vehicles (UAVs), or drones, to improve sanitation and prevent cholera. As the van goes around teaching people the dangers of cholera, the facilitators also inform people about a drone mapping exercise in high-risk areas of Lilongwe, which will enable communities to take action.
Drones are used to take aerial images and these are processed into maps, which are brought back to the community to facilitate discussions on sanitation and hygiene, leading to action. The drone imagery is linked to on-the-ground information provided by students and volunteers, in collaboration with LUANAR University and the Malawi Red Cross, with all the information entered into an online database.
Bringing technology to the people
In Chigwirizano township, residents are gathered to see the results of a drone mapping exercise conducted in their area. There is an excited mood as men and women crouch over the maps laid out on the ground. As they point out some key landmarks — shops, a church, someone’s house — they also see piles of garbage in the market area, close to restaurants.
One of the residents, Angela Masoambeta, says the images from the drone have fleshed out some problems they were already aware of and highlighted others that were not previously obvious. “There is no latrine at the market. Most people just relieve themselves in the open behind the market, she says. “From the drone images, you can see that the chances of rainwater carrying faeces into the food sold at the market are very high since most traders have no benches. They just lay some cloth on the ground and arrange their commodities there.”
Angela points to a structure on the map. “The only source of water for traders in the market is an open well,” she adds. “The water is not safe. The traders use this water and then handle the food that we buy from them.”
Another participant, Frederick Magombo, agrees that the images taken by the drone have enabled residents to clearly visualize important issues and reflect on how their own behaviour affects sanitation in the area. “It looks like people just decide to put up a latrine wherever they want to, as long as they own the land,” he says. “But now someone’s latrine is facing the neighbour’s cooking area. I think the authorities can use these images in allocating plots to ensure everyone has enough room and that sanitation facilities are well positioned.”
Partnering to end cholera
Cholera is a recurring phenomenon in the southern districts of Nsanje, Chikwawa and Mwanza. But the current outbreak in Lilongwe is the first in seven years. Madalitso Nkhata coordinates disease surveillance and response at the Lilongwe District Health Office. “We are closely monitoring the situation and investigating the probable source of contamination for the individual cases reported,” he says.
Water quality is certainly an issue. UNICEF Malawi’s Chief of Water, Sanitation and Hygiene (WASH) Paulos Workneh says drinking contaminated water exposes people to cholera and other diarrheal diseases. “Contaminated water has far-reaching consequences for the health of children and for the economic and social development of communities,” he adds.
With support from UK Aid, UNICEF has provided water bowsers (trucks) and water treatment kits to Government of Malawi for use during emergencies. The equipment is now being used to bring safe water to at-risk communities in Lilongwe to prevent the further spread of cholera. UK Aid support has also enabled UNICEF and its partners to procure cholera treatment supplies, set up cholera treatment camps and step up community mobilization activities to change behaviours around cholera prevention.
“We need innovative ways to deal with some of the challenges we encounter in our work to improve the lives of children,” says UNICEF Associate Director for Data and Analytics Mark Hereward. “Drone technology has been developed well here, particularly with a view to help children and bringing what the technology does back to the people. Elsewhere, drones are being used to track the movement of people in emergency situations, and Malawi can share lessons from its own experience.”
UNICEF has been leading the use of drones for development and humanitarian assistance in Malawi since 2016, starting with a feasibility and cost study on the transportation of blood samples for early infant diagnosis of HIV. In 2017, UNICEF deployed drones to respond to flooding in Karonga, Salima and Lilongwe, and trained the government on integrating drones into an emergency response.
Also in 2017, the Government of Malawi and UNICEF launched a humanitarian drone testing corridor in Kasungu to provide companies with a controlled platform to test the use of drones for the benefit of children and marginalized communities.
As Angela and Frederick can attest, UNICEF Malawi’s expertise in drone technology is now making a tangible difference to communities as they battle the deadly disease of cholera. Together with other interventions, drones are quite literally contributing to saving children’s lives.