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The public was recently shocked to hear of the loss of life due to cholera in the Hammanskraal area. Panic swiftly fanned the flames of discontent as efforts were made to find evidence that cholera was lurking in other parts of the country. We now have a confirmed death rate of 32, with two coming from the Free State, proving that the cholera crisis is wider than Hammanskraal. |
But, at the time of writing, no clear linkage has been claimed by any investigating authority.
The news cycle has passed, so maybe the hope is that public interest will fade before demands are made for a clear pronouncement on the discovery of the epicentre.
READ: UPDATE: Hammanskraal residents have warned about cholera since at least 2018
Let me expand on this by using a tool accepted in the procedure and science of investigation.
That tool is known as Occam’s Razor, and it basically says that when solving a complex problem with competing hypothetical solutions, the most probable solution is the one with the least number of assumptions.
Stated differently, it tells us that the simplest explanation is statistically likely to be the correct one.
How does this apply to the 2023 cholera crisis?
Let us start with fundamental facts that cannot be disputed. In 1831, a new and yet unknown epidemic hit London.
It triggered panic that spread like wildfire. This led to the discovery of cholera as a new disease, alongside typhoid and scarlet fever.
Doctors were unfamiliar with the new disease, adding to the sense of panic.
In 1837, an outbreak of influenza, followed a year later by an outbreak of typhoid, wreaked havoc in the crowded slums of London.
This resulted in the publication of a paper titled The Sanitary Conditions of the Labouring Population by Edwin Chadwick in 1842. This caused Chadwick to be appointed to the board of the Sanitary Commission of London.
A new theory started to emerge, challenging the dominant belief in miasma, which gained traction in the Middle Ages after it was observed that illness was associated with smelly conditions.
The new theory was based on the observation that disease was transmitted from person to person and became known as contagion theory. Sanitation engineering was based on these two theories.
It was believed that by removing the source of foul air associated with miasma, and restricting the movement of people with infection rooted in the experiences of the Black Death, the impact of disease could be limited.
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In 1849, there was a second outbreak of cholera, followed by a larger event in 1854, showing weaknesses in the prevailing sanitation engineering approach.
John Snow, a physician, published a paper in 1849 titled On the Mode of Communication of Cholera, in which he proposed that it was not transmitted by miasma (bad air), but rather by water.
Armed with this idea, he used the 1854 cholera epidemic to conduct a statistical survey of all known casualties.
He was thus able to isolate the source of the outbreak to one water point – a well with a hand pump – in Broad Street. Further investigation revealed a sewer carrying untreated human waste that was leaking into the well.
However, as with all new scientific discoveries, there was scepticism from William Farr, in his capacity as head of the General Register Office.
Farr challenged Snow’s statistical finding, thereby preventing proposed restoration work for the entire sewage system.
With this fact now established, it took another catastrophe to bring about change. In the summer of 1858, the smell of sewage in the Thames River became so bad, that Parliament was forced to close.
This event came to be known as the Great Stink and it catalysed the desire of the political leadership to intervene with policy that enabled the launching of what became the greatest engineering project of the era – a modern sewer system for London.
READ: Laboratory confirms no traces of cholera in Hammanskraal water
That task fell to Joseph Bazalgette, Chief Engineer of London’s Metropolitan Board of Works.
The new sewage system was commissioned in 1865, three decades after the first cholera outbreak that caused massive loss of human life.
We therefore know, without the need to reinvent the wheel, that cholera is caused by sewage in the rivers.
Green Drop Report
Let us now apply Occam’s Razor to this known fact by taking the next leap in logic. In 2013, the last Green Drop report allowed by Nomvula Mokonyane, in her capacity as minister of water and sanitation, indicated that 248 of 824 WWTWs (30%) were in critical condition.
She chose unilaterally to suppress reporting of this reality as it might impact negatively on the public perception of the ruling party in an election cycle.
In April 2022 the reinstated Green Drop Report indicated that 334 out of 850 WWTWs were in critical condition. That was a total of 39% of all WWTWs in 90 municipalities. The situation has significantly deteriorated.
READ: Anthony Turton | Our slow onset sewage disaster
We know that we collectively discharge over five billion litres of sewage daily into our rivers. We also know that about 15% of that is treated to a satisfactory standard, the rest of which comes from the 334 dysfunctional WWTWs.
However, we now also know that 41% of our drinking water systems (Blue Drop Watch Report) are non-compliant with microbiological parameters, with a further 9% being in poor condition. This means that 50% of the drinking water is non-compliant with microbiological standards. A red flag indeed.
So, to summarise, we have almost 40% of all WWTWs dysfunctional, and 50% of all potable water non-compliant in terms of parameters associated with risk of infection of one sort or another.
Let us now apply Occam’s Razor to reach a plausible conclusion as to the source of the problem. We know that on 16 February 2001, Exception No 1918B was issued in response to a crisis at Rooiwal.
This provides a clear indication of a crisis needing priority management, as well as naming names of who knew what and when they knew it.
On November 3 2011 DR6041/2011 was issued by the department of water and sanitation. This is entitled Request for Deviation from the official procurement process. This enabled procurement of services to bypass the normal tender procedure.
What we learn from the history of cholera
We can therefore say with confidence that the procurement procedures for engineering services arising from a situation so grave that a state of emergency had to be declared, lies at the heart of the 2023 cholera crisis.
We also know that water was being provided by tanker services, so the most logical place to investigate the cause is the source of water from which those tankers were filled.
Now we jump into the unknown because the investigation has been focused on the drinking water supply.
But we know from observed cases in KwaZulu-Natal, that tankers are operated by syndicates who get paid per bowser delivered, and they often source their water in the river rather than waiting for hours in a queue at the municipal standpipe.
We know of course that Rooiwal WWTW has been discharging thousands of tons of sludge into a wetland along the Apies, the very same river from which the tankers have probably been sourcing their water.
What we learn from the history of cholera is that resistance to implementing fundamental human health management practices, first learnt in London in the 1800s, costs human lives.
Instead of waving their hands and feigning incredulity by focusing only on the drinking water system, investigators ought to look at the tankers sourced via a corrupted procurement process. Remember Occam’s Razor tells us that the simplest solution to any complex problem is most probably the correct solution.
* Prof Anthony Turton is a water expert in the Centre for Environmental Management, University of Free State.
