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reported by Nigel Marsh, World Vision East Africa Communications Manager
 SALAGLE, Somalia--An NBC documentary team was on the spot today to follow World Vision's response to an outbreak what is believed to be cholera.
The team spent two days filming World Vision projects for “Dateline,” to be aired in about a month. They canceled further travel after reviewing a health team assessment indicating serious trouble was ahead in this arid, rocky outpost at the north of World Vision Somalia's operating territory.
Salagle, a small town on the Juba river, is a difficult four-hour journey from World Vision's offices at Bu'alle. Approaching the town this morning, three families were seen digging graves outside their homes. Twice people ran despairingly toward vehicles, imploring help for the sick in their homes.
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An unfinished World Vision health clinic on a hill overlooking Salagle was converted into an isolation facility. By noon today, 43 patients had been admitted; 12 are already dead.
"My husband died two days ago after four days of sickness," says widow Batulo Mukhtar, who has just watched as her daughter's body was lowered into the latest of a number of graves hurriedly dug at the bottom of the hillside. "She was sick for two days. By the time we brought her here, it was really too late. We have not seen sickness like this befor; we are used to malaria and jaundice, but never deaths like this. Some people get sick and die the same day. Apart from this place, there is nowhere else to go to get help around Salagle."
Mukhtar has neither time nor energy to grieve. She starts back up the hill to the clinic to tend to her nephew, Aden Nuh. He is lying still and unseeing as his grandmother Hawo Idow mops away the "rice-water"-colored diarrhea, a typical symptom of cholera, as it pools around him. He has been taken off his IV, and Batulo carefully feeds him some more oral rehydration fluid. World Vision nurse Evelyn Luna cautions her to repeat this every few minutes.
"He seems to be doing better," says Bob Arnot, NBC's correspondent and a medical doctor who lent a hand with the emergency. "His chart shows he is improving." Later, looking around the hell-like scene of heat, rocks, and sick humanity, he adds, "This situation is serious."
Somalia program officer Enzo Vecchio is ordering supplies needed to set up an immediate response to cholera. These items will arrive by nightfall from Bu'alle. Enzo's efforts to get community assistance building pit latrines are less successful.
"We cannot help," says a grim local authority leader. "We are too busy digging graves. Some people are dying as they walk back with their cattle from the Juba river. If the bodies are not found quickly, the hyenas drag them away."
The Juba river is critically low after a long dry spell which also has left the population weakened from hunger. Large numbers of people who fled fighting in Sakow to the south and the Bay region to the east are particularly at risk. In the midst of the outbreak, people are still drawing water from the Juba or from the stagnant remains of rain catchments. Cattle, camels, and small children wade out into the sluggish, depleted river. They pollute it, while others collect the water in plastic containers and gourds and take it home.
"There have been 62 deaths in the past two days in Salagle and the satellite villages," says Hassan, another local leader, who is looking after a patient in World Vision's isolation unit. "It is impossible to say how many are sick. People believe this sickness has floated down the river from Bardera; but it is the only water supply, so they must continue to drink it."
The locals are probably right about the source of the outbreak, even if they misunderstand the means of transmission. Bardera, 37 miles to the north on the Juba, had a serious outbreak of cholera. United Nations agencies helped bring that under control, but it is possible nomads and displaced people have carried it to Salagle. The infection is spreading--perhaps through the catchments, stored water in homes, and the dirty, slow moving river.
"I have seen 20 bodies this morning, wrapped in shrouds for burial," says Omar Mukhtar, who has buried a brother and a niece in the past week. "Wherever you go, people are getting sick."
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