Residents of Machinjiri in Malawi stand on their doorsteps, watching, in a mixture of curiosity and awe, as their traditional leader goes from door to door, visiting families in the village. It's an unheard-of event.
"We always go to the Magombo, and only when summoned, or when you have a serious issue that needs solving. The Magombo never comes to our doors. It has never happened before," whispers a resident.
But for the traditional leader, Alice Ntemera, desperate times call for desperate measures.
"As you know, the country has been greatly affected by cholera and people have lost lives," she said.
"The situation will not change if we do not follow hygiene. I need to ensure every house has a latrine and sanitation is good. This is all we, as traditional leaders, can do to assist in this battle."
Besides inspecting sanitary facilities, Ntemera encourages households to put chlorine in water and avoid careless defecation.
"As I walk, I sensitise our people about the disease, its causes, how it spreads and how it can be prevented. But we also have committees that deal with this."
Machinjiri is among the areas with the highest number of cholera cases in Blantyre. At the end of last year, their small health clinic, Makhetha, was overwhelmed.
"The tents you see here were not enough as we were receiving many cases daily," nurse-in-charge Unikani Mthipela said.
"What was more worrying was that some of the people who brought cholera patients to the clinic also contracted the disease soon after."
The head nurse acknowledges that the door-to-door campaigns by the Magombo and other health assistants and distributing chlorine to households have helped tame the spread of the disease.
"Of course, many people complained that it [chlorine] changes the taste of water. But sometimes it is important to take a little pain to avoid a bigger one," she said.
Cholera has, indeed, been a big pain in the country. Since the outbreak in March 2022, Malawi has recorded more than 50,000 infections and at least 1,500 deaths, according to the UN.
With hospitals stretched thin, lacking basic supplies and many people seeking help only after falling ill, emergency cholera tents like the one at Makhetha clinic popped up nationwide.
Unsafe drinking water and poor sanitation, which are significant problems in cities like Lilongwe and Blantyre, have contributed to the high number of cholera cases.
As traditional leaders in Malawi transverse villages to fight against cholera, midwives in Nigeria are renovating community boreholes and distributing water purifiers to protect their people.
An unmatched case-control study in northern Nigeria found that "cholera outbreaks were often attributed to rain, which washed sewage into open wells and ponds, where people obtain water for drinking and household needs".
The 2022 Nigeria Cholera Situation report by the Nigeria Centre for Disease Control (NCDC) indicated that more than 57 per cent of cholera cases occurred between September and October. These periods were marked by intense flooding.
"The flood was a great concern to this community. We had problems with water supply," said Zainab Musa, a midwife at the Family Support programme (FSP) Clinic, Odaki, Koton-Karfe, a coastal community in Kogi, northern Nigeria.
The community was on the brink of a cholera outbreak, which was already the case in similar northern regions that had experienced flooding.
At the FSP clinic, the midwives were witnessing an increase in cases of acute diarrhoea and vomiting as the repercussion of consuming contaminated water emerged.
However, without a medical laboratory in the community, they could not confirm that the cases were, indeed, cholera.
Without any aid on the horizon, the midwives mobilised quickly to avert a potential cholera outbreak in the community.
"Through the Basic Health Care Provision Fund, we renovated the borehole in the facility," Musa said.
This intervention helped locals access clean water, but it would be short-lived as the cost of running the borehole pump to serve the entire community began to stretch the clinic financially.
Subsequently, the midwives focused on educating locals about water purification methods.
"We distributed water disinfectants to pregnant women and educated them on the need to purify their water before drinking," Musa said.
Water purification is now an important talking point during the weekly antenatal clinics held every Thursday.
The NCDC’s 2022 Cholera Situation Report showed that only one cholera case was recorded in Kogi State, a massive decline from the 151 cases reported in 2021.
Gloria Adaji, a nursing mother and one of Musa's patients, said she uses both water purification methods.
"I use WaterGuard, but when it finishes, I switch to boiling until I can buy another one," she said.
Beyond the clinic, the midwives partnered with the community's Red Cross Society to popularise several water purification methods.
"We expect disease outbreaks and other health challenges after the floods," said Umar Mahmud, Disaster Management Officer, NRCS, Kogi Branch.
"So we collaborate with health workers to sensitise community members. The FSP Clinic is among our partners."
In Malawi, Amref Health, an African-led international organisation, provides training and health services.
Country director Hester Nyasulu said they support district health offices with critical medical supplies, conduct community sensitisation campaigns and coordinate cholera response.
"Our support is mainly aimed at reducing cholera deaths by ensuring treatment supplies are available in [hospital] facilities," Nyasulu said.
He cited chlorine for household water treatment, gloves, hand sanitisers, cotton wool, buckets with taps, intravenous fluids [lingers lactate], oral rehydration salts and cannula needles.
At the national level, Ministry of Health spokesperson Adrian Chikumbe says they are also working hard to contain the disease.
"The will to fight cholera is even in the Office of the President and Cabinet, where there is a Presidential Taskforce on Cholera," he said.
"Government is playing a supervisory role in ensuring that all activities in the fight against cholera are coordinated."
The spokesperson said although the disease is reduced in some areas, there is no change in others, while several new locations have reported an increase.
"Again, as the cases increased, there was a shortage of human resources. We hired temporary staff to assist," he said.
"But the most important thing is to ensure that chlorine is available and accessible to people, especially those in areas where cases are high."
He said they are doing this because of a shortage of cholera vaccines.
The country's water boards reconnected many water kiosks that they had previously disconnected due to nonpayment of bills.
Because of the dry taps, many people drank from untreated wells and dirty rivers.
To prevent this, the government ordered water connection to all water kiosks.
The World Health Organisation (WHO) has also reported cholera cases in Burundi, Cameron, the Democratic Republic of Congo, Ethiopia, Mozambique, Kenya and Somalia.