[This article was written by Fran Siebrits and a version of it was published in The Big Issue Magazine, #169, and Toast, 2010] 

Capetonians and tourists alike find solace hiking one of the many routes on Table Mountain. But have they drunk in the beauty as well as the danger?

Sweet smells tickle your nostrils awake. The slightest of breezes nips playfully around your face. A soothing sun comforts your overworked body as you head onto a tranquil mountain trail for a couple of hours, breaking from the mundane. A stream, refreshingly cold, blissfully quenches your sand-like throat.

In winter especially, natural streams gravitate down from all sides of the mountain like custard over a pudding. Delicious water comforts many a mountain enthusiast. But, how many enthusiasts would there be if this unassuming water was contaminated with a parasite which causes severe diarrhoea for weeks on end?

The parasite known as Giardia is a major cause of intestinal disease. It is responsible for 24% of cases of diarrhoea worldwide, depending on socio-economic levels, community health and individual lifestyle. This protozoan (minute unicellular organism) parasite infects the gastrointestinal tract. It can lead to giardiasis, causing severe diarrhoea and abdominal cramps.

The highest prevalence of giardiasis occurs in the tropics and subtropics. In the United States, however, giardiasis is the most commonly reported pathogenic protozoan disease.

For the non-medic multitude, this little parasite means business. Its tongue-twisting name echoes the way it will twist your gut like a course-soaked towel. Not pleasant!

For the sake of our sanity and an easier-to-read article, let’s call this little protozoan parasite PP for short (and Pooh Pooh might be more appropriate in this case too).

PP can survive for months in moist environments due to a never-say-die personality and hard outer casing, not unlike the suit of an ass-tronaut (poetic license, excuse the pun … couldn’t hold it in). Once he enters the mother ship i.e. your unassuming digestive tract, he loses his suit and makes himself right at home. But it doesn’t end there. He is a master of disguise, making it almost impossible for your immune system to detect and eject him. This sneaky trick reveals why PP infections are extremely persistent. However, with or without sci-fi character analogies, the basic biology of this parasite is poorly understood.

The Council for Scientific and Industrial Research (CSIR) did a three-year study on selected water samples in South Africa. According to the study (Studies on the Prevalence of Giardia Cysts and Cryptosporidiom Oocysts in South African Water) only about 87% of the treated water samples were parasite free, while about 12% were riddled with PP. Yip, PP managed to sidle his way through the security systems of water treatment facilities.

Dr Laurie Nathan, from the Environmental and Geographical Science (EGS) Department at UCT, was diagnosed with giardiasis in 2009. “I contracted Giardia as a result of drinking the water on Table Mountain on one of my many jogs there,” says Laurie. “I got violently sick, went to my doctor, was diagnosed immediately with giardiasis, was stricken in bed for seven days and disabled for a total of about 10 days. I had chronic diarrhoea and fatigue, and was unable to do anything but lie down.”

PP’s perfect holiday destination is a polluted water environment. In South Africa, habitation along rivers and dams increases the levels of pollution in drinking water sources. So for PP, it’s a constant party, especially as settlements are informal and without infrastructure. “Of course, what this doesn’t explain is why Giardia is found on Table Mountain in the first place,” says Dr Kevin Winter, Laurie’s colleague. “It is usually associated with conditions of poor sanitation, sewage pollution, etc.”

Think again about that image of water down a mountain running like drizzled custard over a pudding. This run-off heads for the lower slopes and flats, which forms a large populated area in Cape Town. But how many people does this water affect? This question remains unanswered.

The potty-plot thickens… As far as the City Council Scientific Services is aware, no research has been done on PP on Table Mountain. Other water research companies in Cape Town were not even aware of this parasite.

Microbiologist Wouter le Roux from CSIR’s Water and Human Health Department shed some light on this mucky matter. He explains that infected humans and animals can contaminate any unprotected water. “They excrete Giardia cysts in their faeces,” he says. “Birds and other wild life can carry these parasites.”

The information that should be skid-marking an impression on you is that anyone can be affected by PP. People who use contaminated water for drinking, washing, even for swimming, can become infected. Le Roux explains that “the Giardia parasite spreads when a person accidentally swallows it.”

In terms of prevention, the Centre for Disease Control and Prevention suggest practising good hygiene and avoiding water that might be contaminated.

Even though Table Mountain water is not part of the domestic-use quota, water treatment facilities should follow the recommended procedures for limiting parasites. In a developing country such as South Africa, it is imperative that water quality guidelines are formulated and adhered to. Letting PP slide undetected down our mountain could keep Capetonians running for the wrong reasons.

It’s not that every drop on Table Mountain is contaminated with the PP. But enthusiasts enjoying the many activities on the mountain should be aware of it. If giardiasis was life-threatening, something would have been done about it already (we hope). PP’s leaking affects are not worth that one sweet sip, so rather carry your own supply of water next time you venture to the hills.

“I don’t drink the water on Table Mountain any longer, which is a great pity,” says Laurie, but it has not stopped him and his family from spending many a recreational hour enjoying Table Mountain.

Giardiasis – Additional Information

Infections last 2 to 6 weeks, but they can last longer. Medications can help decrease the amount of time symptoms last.

What are the symptoms of giardiasis?

• Diarrhoea

• Gas or flatulence

• Greasy stools that tend to float

• Stomach or abdominal cramps

• Upset stomach or nausea

These symptoms may lead to weight loss and dehydration. However, some people with Giardia infection have no symptoms at all. Giardiasis is not associated with mortality (death) except in cases of extreme dehydration and malnourishment, primarily in infants.