And, the more the population of Hammanskraal has grown and the more the infrastructure has NHLS Jubilee Laboratory With its broken sewage and failing water treatment plants, South Africa has the perfect conditions for diseases such as cholera to thrive Sheree Bega The kettle has just boiled and Johanna Maphingane is sitting down for lunch thick slices of bread smeared with jam in her home in Hammanskraal, north of Pretoria. The tea the 74yearold is drinking has been brewed with water from the municipal tankers that sporadically deliver drinking water to Maphingane's neighbourhood of Temba. She won't dare drink the foulsmelling water in the tap. But when the tankers don't pitch, Maphingane has to use her meagre pension to buy bottled water. "That water from the tap is too dirty, you can't drink it or cook with it. It stinks," she said, wrinkling her nose in disgust. Maphingane is not surprised by the outbreak of cholera in Hammanskraal that, by Thursday morning, had killed 20 people. "It's painful. This dirty water in Hammanskraal has been a problem for years and years. We will all die from this water." Her goddaughter, Matlakalala Tshabalala, said her uncle is one of the cholera patients admitted to Jubilee District Hospital last week. "The government is failing us," she said. "They don't care about us. That's why people are dying." Several cholera cases have been recorded in Limpopo and the Free State in the past week but Hammanskraal, where residents have been consuming contaminated water for nearly two decades, is the epicentre of the current outbreak. By Wednesday, the Gauteng health department said 17 people, including two children, had died in Hammanskraal, with 165 patients being treated for the acute diarrhoeal infection at Jubilee and 18 transferred to other health facilities in Tshwane. The number of laboratoryconfirmed cholera cases stood at 29. This week, Water and Sanitation Minister Senzo Mchunu blamed the poor water quality in Hammanskraal on the failure of the Rooiwal wastewater treatment works, run by the City of Tshwane, to meet the desirable final effluent quality for discharge to the Apies River, which in turn, flows into the Leeukraal Dam. In 2011, the department declared the Apies River a disaster area. Rooiwal is situated upstream of Hammanskraal and the discharge of untreated and partially treated sewage and sludge has polluted the Leeukraal Dam, where the Temba water treatment works abstracts water for treatment and distribution to residents as potable drinking water. Water tankers now supply potable water to affected areas that were initially supplied by the Temba plant. "The department has been continuously carrying out water quality tests at the Temba water treatment works and at water distribution points in Hammanskraal; the latest tests indicate that the drinking water quality from the Temba water treatment work does not meet minimum drink of water, I must stress that we haven't received any tests that the actual water supply has been contaminated so the taps from Temba are not the source of the cholera ... If you speak to people in Hammanskraal, they will tell you it's along time that water has been an issue." He did not want to make "wild promises" for delivery that weren't within his control. "But what is clear to me is that plodding along the way we have up to this point is not going to work. We have to do things differently. "I'll be candid, I don't trust Tshwane's supply chain management system, and I've said this openly to the city manager. I think whatever solutions we devise, we must try to bring in outside partners, if only to serve as a check on the city's own supply chain management system." In 2021, a report by the South African Human Rights Commission found that the primary reason for the unacceptable levels of pollution in Tshwane is its failure to manage and maintain wastewater treatment works. Tshwane's freshwater sources the Apies, Tolwane, Pienaar and Hennops rivers and the Roodeplaat and Leeukraal dams are being contaminated with untreated and partially treated sewage and sludge. "People and animals who drink the water are vulnerable to illnesses such as bilharzia, cholera and hepatitis. Such exposure renders those most vulnerable like the elderly, children, and those who are ill, even more at risk of adverse health conditions," the report noted. The city rejected the report's recommendations. Zamantungwa Mbeki, the commission's acting Gauteng provincial manager, said: "Outside of the cholera outbreak, why must the people of Hammanskraal drink the water that they're drinking?" Cholera is endemic in South Africa, said water governance expert Carin Bosman, who wrote a guideline on dealing with cholera outbreaks in 2002 while employed by the water and sanitation department. "It's an acute intestinal infection caused by the ingestion of contaminated water and or food containing the bacterium Vibrio cholerae. Most of the over 100 strains of Vibrio cholerae are natural inhabitants of the aquatic environment, and do not cause epidemic cholera. However, some of the strains can cause sporadic cases of diarrhoea similar to gastroenteritis." Bosman emphasised the need for proper sewage treatment and water ing water quality," Mchunu said. "The water quality challenges are therefore, in central Hammanskraal, from water supplied by the city." Since 2011, the department has issued several directives and, when the city failed to comply, instituted legal action against the city for the failures at Rooiwal. A frustrated Tumelo Koitheng, the chairperson of Hammanskraal Residents Forum, said of Rooiwal: "There is no political will to sort out this mess ... the source of the contamination is Rooiwal," he said. "They must fix it, rehabilitate the Apies River and dredge the Leeukraal Dam because of all the sludge. "Instead, we're getting water tankers permanently. An area can go three weeks to a month without receiving water. They're forced to drink the tap water. There are many households where no one is working and they are relying on grants so how do you buy water?" degraded, the more expensive this project has become." He said the budget allocation will need to be combined with a project loan from a funding institution such as the Development Bank of Southern Africa or partnership with the water and sanitation department. According to ActionSA, a forensic report by the city showed how a R295 million tender was awarded to two companies belonging to state captureimplicated Edwin Sodi for the upgrade and refurbishment of Rooiwal, but neither of the companies had any experience. The contract was cancelled in August and Brink said the disciplinary process against the officials involved is "well underway". He said Sodi's group did 60% of the work for phase one. "That can be completed within the following financial year. But phase two of that project is crucial and that is valued at R2.5 billion. "The R450 million over three years is much more than has ever been set aside for this but it's still not enough, so those engagements with other lending institutions, with the department ... are going to be crucial." On getting potable water into Hammanskraal's taps, Brink said: "So many promises have been made about this issue in recent years and as much as this recent tragedy has focused our attention on the quality Cholera country Hammanskraal outbreak Cholera is transmitted through contaminated water but the source of the infection that caused the Hammanskraal outbreak is unidentified Contaminated water can carry pathogens such as cholera and hepatitis that infect people when they consume it or come into contact with it by brushing teeth, bathing, washing dishes or cutlery and laundry in it 4.. Hartebeespoort Dam Cholera facts One in 10 people who get cholera develop severe symptoms. In these people, death can occur within hours due to rapid loss of body fluids. Cholera can be treated by immediate replacement of fluid and salts Roodeplaat Dam R.573 Mamelodi iGraphic:JOHN McCANN Data sources: SAHRC, US CDC, WHO Compiled by: SHEREE BEGAN4 GAUTENG Apies River Mabopane Ni Atteridgeville N14 Tshwane CBD 411 Soshanguve M39 Rooiwal waste water works NORTH WEST happen anywhere in the country IIMINIMMONHOMMININsmummil Sludge: With dysfunctional sewage plants and failing water treatment plants such as Temba above South Africa has the perfect conditions for diseases such as cholera to thrive. Photo: Delwyn Verasamy purification works. Those who died in Hammanskraal are the poorest of the poor, who get the poorest services. "Cholera is an emotional word because it's a communicable disease but people have been dying at high rates for the longest time in Hammanskraal and Temba because of the poor water quality." So much emphasis is placed on finding the source of the outbreak, but "you're never going to find the source. In 2005, I was involved in managing the cholera outbreak in Delmas, you're not going to find the source, you might find the cause. What is the most likely cause? Untreated and unchlorinated sewage from Daspoort and Rooiwal that goes into the purification works at Temba." She prepared the water use licence application for the Temba plant in 2009. "We made recommendations then, including that the water quality that Temba has to abstract from the Apies River to then treat to potable standards is ridiculously poor because the effluent from the Rooiwal sewage works discharged into the Apies upstream from Temba does not meet acceptable standards, and that Rooiwal requires upgrade'." She warns, too, against overchlorinating the water produced for potable purposes at Temba: "You can get the formation of trihalomethanes THMs , which is carcinogenic cancercausing , if you overchlorinate your water. Cholera will kill you within three or four days, THMs will kill you 20 years from now." She said it was therefore necessary that the city urgently look at modular treatment plants to ensure pota ble water is available for the citizens of Temba, until the Rooiwal sewage works can be upgraded. Jo Barnes, a senior lecturer emeritus at Stellenbosch University's department of global health, health systems and public health, said the cholera outbreak is bigger than Rooiwal's failures. "It's not just these huge wastewater systems, it's the massive mess inside the settlement. The chances are excellent that the infection came walking into the poor area. In other words, a person brought it in. Solid waste surprisingly has a big connection to sewage because people empty their chamber pots in these places." Whenever someone turns cholerapositive it appears in their faeces and urine and "the body excretes masses, millions, of those organisms so wherever that stuff runs it contaminates". People underestimate the effects of cockroaches, flies and rats, rife in impoverished, underserviced areas. "They have it on their feet as they run over this mess, they run over the floor, inside the shack or humble house and that's where children play and where they prepare food. Water takes it everywhere and from then onwards, it spreads like wildfire because of our general lack of proper sanitation and that includes solid waste removal in our poor areas." Barnes is "utterly surprised" that Mchunu's department has now put together a team to hunt for the origin of the outbreak. "It's too late, it's already here ... they jolly well know they're going to spend months on end and not come up with a clear answer. By now it's almost starting to become rife in the area, so how will they determine where it came up first? It's a standard ploy for shifting blame a smokescreen." Failing infrastructure means that "everywhere we're running a risk of having another Hammanskraal," Barnes said.

Source: Mail & Guardian