— Some residents of the South Sudanese capital are heeding the call of health officials and taking extra measures to fight cholera as the number of cases of the diarrheal disease continues to rise.
But others are ignoring messages from health officials and continue as before -- not washing their hands and not treating the water they drink.
Asumpta Talata is one of the people who are listening to health officials' warnings about cholera. She wakes up early every day to buy water from the tanker trucks that ply the streets of Juba, paying 5 South Sudanese pounds for a plastic 100-liter container of water -- enough for her family of six.
Since the cholera outbreak was first declared in mid-May, Asumpta says she has been purifying the water she buys, just to be doubly sure that it is safe.
“When I get water from those people who are selling it, I first put aside drinking water in a pot and I mix it with chlorine so that the water can become clean and to avoid diseases like cholera,” she says.
Asumpta then pours the purified water into bottles for her two young daughters to take to school.
A nurse at a Doctors Without Borders cholera treatment center in Gudele, near Juba, inserts an intravenous drip to a woman infected by the diarrheal disease. The number of cases of cholera has risen steadily since the Health Ministry declared an outbreak
Her neighbor, Flora Keji, says she heard about the cholera outbreak on radio and television but did not take the message seriously until a month ago, when her aunt came down with the disease and was rushed to Juba Teaching Hospital.
Since then, Keji, who works in a small barbershop, has been very careful about her personal hygiene and that of her family. She even washes her hands after touching her clients' hair.
Every evening, before the family sits down to share food from the same big tray, as is the custom in South Sudan, she makes sure that everyone has washed their hands.
Boda boda rider James Malish also tells members of his family to wash their hands thoroughly with soap and water before they eat and after using the toilet. Like Keji, he worries about many people eating from the same bowl.
"When you eat with someone who doesn’t wash their hands, of course you will be affected because your food is going to get contaminated," he says.
Cholera is caused by a bacterium found in contaminated water or food. Large outbreaks are often related to fecal contamination of water supplies or street vended foods, according to the U.S. Center for Disease Control and Prevention.
The outbreak in Juba has already impacted food stalls,
many of which have shut down in recent weeks.
Very quickly after the outbreak was declared on May 15, the Ministry of Health developed a cholera response plan and established a Cholera Response Task Force, which coordinates both health and Water, Sanitation and Hygiene (WASH) activities.
Among other activities, the Task Force coordinates public health education and awareness activities. Its WASH program has been promoting hand washing, proper disposal of solid and liquid waste, and household water chlorination.
Children wash their hands in Juba, South Sudan, during a campaign in October 2013 to promote the habit.
People like Asumpta, Keji and Malish are heeding the health messages put out by the authorities. But Dr. Lul Riek, director of the Task Force, says that in spite of the massive information campaign launched by the Health Ministry, some South Sudanese still drink untreated water or fail to wash their hands before meals or after using the toilet.
“When we tell them to wash their hands before you prepare your food or before you eat, some people keep forgetting," he said. "They are in a hurry, they want to just eat, they don’t want to wash their hands. It's a problem."
The World Health Organization (WHO) says another problem hampering the fight against the diarrheal illness is that some people in Juba still defecate in the open.
Thirty-seven people have died of cholera so far in Juba, and WHO says more than 1,700 cases have been reported, including 50 among internally displaced persons sheltering in a UN camp.
The Health Ministry and NGOs have opened six cholera treatment centers in and around Juba to tackle the outbreak, and Riek says Juba residents are being provided with free chlorine tablets by the ministry.