Dealing With Cholera Joints: What’s The Best Approach?

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I stumbled upon them last weekend in, surprisingly of all places, Victoria Island one of the most “highbrowed” neighborhoods in Lagos. Rows upon rows of street food vendors with patrons hustling to get the attention of the food seller and jostling for a place to sit with their plates of indescribably cheap food. Welcome to what I would call “Cholera Alley” or “Cholera Cul de Sac”. Not the most enviable place to have your lunch except you are amongst the many Lagosians living below the poverty level of less than a dollar a day.

Popularly called Cholera Joints, they are familiar sights in this country, especially in urban centers. Preparing and selling food under the most unhygienic circumstances, these roadside food vendors have gained notoriety as public health menaces, perhaps the number one public health menace in our urban society. Sometimes late last year four persons died in Lagos, from what the Lagos State Ministry of Health confirmed to be cholera, after patronizing roadside food vendors like these.

I was told that the term “Cholera Joint” was coined on Nigerian University and Polytechnic campuses many years ago to describe those low life cafeterias with plank and plywood walls and pot-holed concrete floors situated on the fringes of campus society where food is sold cheap and usually patronized by those students who couldn’t afford the opulent restaurants located in the Student Union Building.

These dodgy canteens were aptly named cholera joints by students because except you are extremely lucky you stand the chance of bagging a dose of vibrio cholerae, the causative agent of cholera, in addition to the cheap meal you pay for. As it is “Cholera joints” are not limited to campuses, the entire society is dotted with them, encouraged and spurred on by the high poverty levels in the land and further enhancing the public health burden of food-borne illnesses.

The public health problem of street food vendors is not limited to Nigeria, it’s a phenomenon common to developing countries. The question is how should this problem be addressed here in Nigeria?

Should there be an outright clamp down on them? I don’t think this strategy will work for three simple reasons:
1. These vendors are so widespread that it is next to impossible to locate them all to implement any effective clamping down exercise, and because they are very mobile with few fixed assets it will be easy to avoid being detected.
2. Secondly clamping down outrightly may cause social upheaval no matter how minor it will be anyway. It can be viewed as the rich again taking it out on the poor, a regular sentiment in our classed Nigerian society because majority of the poor depend on street food as restaurants are beyond their reach.
3. Street food vending has significant economic relevance. It occupies a large portion of Nigeria’s informal business sector and may be too important to outrightly clamp down on for this reason.

Another option is to legislate and regulate their activities. This would have been an effective strategy if the appropriate government commitment especially at the state and local government levels is present and also if there is availability of resources to monitor compliance to regulations and legislations. The first is very questionable and the second is doubtful because of how widespread and ubiquitous these food sellers exist all over the urban areas.

A third option is to reach out to these street food vendors and engage them in awareness campaigns, teaching them basic food hygiene practices that will protect their patrons and themselves, helping them to understand the benefits of improved hygiene and sanitation and where possible providing basic infrastructure for them such as food warmers, brooms, napkins, soaps, etc. Now this approach will naturally be painstaking and requires patience and persistence. Each roadside food vendor needs to be convinced and convinced thoroughly of the need for change and there are hundreds of thousands of them dotting the landscape. But it can be done, resulting in a win-win situation for government, the food vendors themselves and their customers.

This third option can be effectively pursued by NGOs with adequate fundings and grants and this is part of the objectives of Food-Borne Illness Prevention Initiative to reduce the public health burden of food borne illness in the society.

Surmounting Nigeria’s Food Borne Illness Problem.

Thinking about it, the food borne illness problem in Nigeria is not an insurmountable problem. All it needs to be surmounted is first and foremost an acknowledgement of its existence i.e that we have problem of food borne illness in this country and secondly a full commitment on the part of the government at all tiers (federal, state, local) to deploy resources required to deal with this matter.

When I consider the situation in the country as per food borne illness, many times I wonder and ponder “what is on the mind of the government concerning the public health burden of food borne illness in this country?”, “is the government even aware of the severity of the problem?”, “has the arm of government responsible for health matters in this country, the Federal Ministry of Health, taken any concrete steps in recent times (or should I say in living memory) in the direction of addressing the problem of food borne illness”, “what will it take for the government to upgrade food borne illness to the status of a public health issue that needs to be attended to like HIV/AIDS, Malaria, Tuberculosis”.

I know a National Food Safety Committee (NFSC) was set up two or three years ago but this committee has very little or nothing to do with solving the public health burden of food borne illness in the country, it’s terms of reference is largely focused on managing the process of ensuring Nigerian food products meet international safety standards for exports. So it’s more of an economic outfit than a health related body.

Even at that, one is yet to see any visible and tangible work that this enigmatic committee (I refer to it as an enigma because the names of the members of the committee or at the least the chairperson heading the committee are/is unknown in the public domain, no report or recommendation has been published by the committee since it’s inception, type “National Food Safety Committee of Nigeria” in any of the search engines and you will draw a blank or at most be  referred to some blogsites commenting about it being setup three years ago) has done. It truly has a lot of ground to cover if it truly wants to justify its creation.

It is also concerns me that when I check the websites of the Federal Ministry of Health, there is nothing about food borne illness in all its categories, the same applies to NAFDAC (National Agency for Food and Drug Administration and Control) although kudos needs to be given to the later for creating at least a level of public awareness about the fact that food can be dangerous to health. However the agency is more engaged in registering manufactured and finished food products and regulating their manufacturing process as well as combating fake and adulterated drugs and medicines in the country. When it comes to food from kitchens in hotels, restaurants, hospitals, boarding schools, prisons, cafeterias, hostels, fast food outlets etc. NAFDAC has no visibility.

I have heard of NACA (National Agency for the Control of Aids) and MAPS (Malaria Action Program for States), government agencies in this country that are visible to the public and in the media and with up-to-date and robust websites and calendar of activities addressing these two health issues. But concerning food borne illness in Nigeria, all we have is a worrying silence on the part of Federal, States, and Local Governments yet the casualty counts of food borne and water borne illness keeps mounting periodically in the country.

An example of a government with the will and commitment to deal with food borne illness is the United States. Three years ago President Obama signed into law the Food Safety Modernization Act which is aimed at minimizing food borne illness risks to the American consumer using a science and risk based approach.

I believe we need to have a similar level of government commitment in Nigeria to address the public health burden of food borne illness in this country.

More Than Meets The Eye

“there is more to food borne illness than the frequent commute to the toilet or to the local pharmacy down the street.”

In many quarters in this country, the outcome of a person with food borne illness is simply viewed as having the nasty and unpleasant symptoms of diarrhea, vomiting, nausea, tiredness, stomach upsets for a period of time after which recovery sets in with or without medical treatment and the victim gets back on with life. Or, less acknowledged, outright death and fatality of victims.

But there is an ominous and little known aspect of food borne illness that began to be considered some five years ago which may aggrandize the public health burden of food borne illness globally, Nigeria inclusive. This is the Long-Term Health Outcomes of Selected Foodborne Pathogens.

The Center for Foodborne Illness Research & Prevention (CFI), a US based non profit research and advocacy organization, released a report in 2009 that placed the spotlight on the long-term health consequences of five foodborne illnesses pathogens: Campylobacter, E. coli O157:H7, Listeria monocytogenes, Salmonella, and Toxoplasma gondii.

According to the report, serious life-long complications like hemolytic uremic syndrome (HUS), the leading cause of acute kidney failure in children; paralysis; seizures; reactive arthritis; hearing/visual impairments and mental retardation have been associated one way or the other with these food borne pathogens.

To read the full report click here: CFI LTHO REPORT

Even though the authors of the report acknowledged that “this long-term health burden of foodborne disease is not well understood” and “additional research is needed to improve our knowledge about these diseases”. The study counters the common public perception that food borne illness is basically limited to the symptoms previously mentioned above and in rare cases fatalities.

That is to say there is more to food borne illness than the frequent commute to the toilet or to the local pharmacy down the street.

A 2012 case of a 7 year old girl that was left brain damaged and paralyzed from food poisoning in Australia sort of validates the hypothesis raised in the CFI report. To read the full story of this incident click here: Girl Paralyzed By Food Poisoning Traced To KFC Chicken

The implication of this for Nigerians is that our public health system, inadequate and already getting overwhelmed as it is, will yet have to cope with additional burden if the food borne illness problem isn’t addressed as a matter of great priority.

A pragmatic preventative approach to address the problem of food borne illness in this country through enforcing existing food safety legislations, Local Governments rising up to their statutory responsibilities of food business inspections, and most importantly continually creating public awareness about the food borne illness problem to counter the dearth of public awareness of this problem will spare our public health management system additional burdens that it simply cannot bear at this moment.