14 September 2018

Zimbabwe: Race Against Time to Curb Cholera

Stewart Murambiwa's snow-white teeth appear too big for his mouth; his arms and limbs look like they belong to a little boy and not the 27-year-old man he is.

Propped up on an iron bed in a tent at Glen View Polyclinic, he laughs and claims he has always been slim.

But he is visibly dehydrated.

A furniture maker at the popular Glen View small-scale complex, Murambiwa arrived at the clinic on Tuesday with his colleague, also suffering from severe watery diarrhoea: a tell-tale sign of cholera.

He has recovered incredibly but his colleague did not make it, dying just hours after admission.

A nurse at the clinic told the Zimbabwe Independent she believed the two got sick from the same water source, a nearby borehole which clinical tests confirmed was contaminated with faecal matter.

Zimbabwe, a country ravaged by an economic crisis which has condemned many to acute poverty amid dilapidating social services, is now facing the worst cholera outbreak in a decade.

As of Wednesday, more than 2 500 cases had been reported, claiming 21 lives, according to conservative official figures. Health workers are adamant the figure of those dead is much higher.

In any case, the number is growing with each passing day as the vicious disease spreads across the country like a raging wild fire.

The acute, diarrhoeal illness is caused by infection of the intestines with the bacterium, vibrio cholerae, that can kill within hours if left untreated. Waterborne, it thrives in unsanitary conditions.

It is caused by ingesting food or water contaminated with the bacterium. It primarily affects developing areas that lack adequate water treatment or sanitation, according to the Centres for Disease Control and Prevention and the World Health Organisation (WHO).

Cholera is preventable and easily treatable with the proper resources. In Zimbabwe, however, the collapsing health infrastructure has cut off an estimated over half of the country's population from regular access to clean and safe water, increasing the likelihood for the disease to spread, according to latest information by UN Water.

The government has, as usual, been too slow to react to the calamity which has now engulfed the country.

On Tuesday, it declared a state of national emergency, albeit far too late. The situation had already deteriorated to epidemic level.

"That is the sad part about it. This crisis is man-made in the sense that the city lacks the very basic services like clean potable water. It reflects badly on the image of the country that we are affected like this by a medieval disease which should have no place in the modern world," said Combined Harare Residents Association director Mfundo Mlilo.

Harare Residents Trust director Precious Shumba said: "City of Harare is criminally liable for the death of people in Harare since the beginning of the cholera outbreak. The Harare Residents Trust (HRT) has been to different communities interviewing the residents about the cholera outbreak that has befallen the residents in Glen View and Budiriro. It has been noticed that residents have placed their reports for sewage but nothing was done as the sewage is all over the streets posing a danger to the community."

Amid the crisis, the blame game is underway. Government, through newly appointed Health and Child Care minister Obadiah Moyo, says the city council is squarely to blame as it failed to provide adequate services to residents.

Outspoken deputy Information minister Energy Mutodi was even blunter, tweeting in a rather unhelpful pre-election tone: "MDC councils are the breeding ground for cholera, typhoid and other waterborne diseases. It's happening in Harare of all towns, councillors are sleeping on the job and it is high time residents say enough is enough and boot them out."

The City of Harare has, in turn, responded in kind, with mayor Herbert Gomba blaming central government for not helping the overwhelmed metropolis. Gomba, speaking during MDC leader Nelson Chamisa's tour of the two cholera hotspots Budiriro and Glen View on Wednesday, said the war on cholera has until now been left to the understaffed, under-resourced and plainly incapacitated local authority.

Fortune Nyamande, a spokesperson of the Zimbabwe Association of Doctors for Human Rights, blamed both government and council.

"It is deeply worrying that the central and local government authorities have not moved with speed in allocating time, human and financial resources towards finding a lasting solution to the persistent outbreak of diarrhoeal illnesses in Zimbabwe," he said.

But while brick-bats are being traded in the corridors of power, the urban poor continue to perish in the pitiless wrath of the unforgiving bacteria.

A visit to Glen View and Budiriro by the Zimbabwe Independent this week revealed that there has been no significant headway in efforts to keep the disease in check.

There appears to be no emergency at all on the ground as one drives into Glen View; little kids playing in the dusty streets and everyone appearing to mind their own business. It is otherwise a fine environment but, as they say, appearances can be deceiving.

Driving towards Glen View Primary School, which has been shut down after cholera claimed the lives of two pupils, a huge pool of sewage effluent suddenly appears, as if beckoning one to dive into its enigma.

Slender sewer streams branched off in different directions, parallel to a ditch overflowing with wastewater which cruelly assaulted the news crew's olfactory nerves.

The place now resembles a monument to a primitive menace.

Three or so metres downwards is located the now decommissioned borehole from which people were drawing and drinking their own effluent.

The unsanitary conditions provide the perfect ingredients for cholera.

Kennias Magodo, a Glen View resident who counts himself so blessed to have escaped infection -- maybe just for now -- says the sewer has been flowing for at least three months, resulting in it leaching and contaminating the groundwater where the borehole is located.

"We informed council about this problem many times but no one came to fix it. It's tragic. I have seen neighbours being ferried to the clinic and have never returned," he exclaims.

Despite the purported declaration of a state of emergency by new Health minister Obadiah Moyo, there is nothing on the ground to suggest a sense of official urgency.

Along the way to Glen View Polyclinic, the Independent news crew encounters a group of six volunteer health workers carrying out door-to-door educational campaigns to help raise awareness about the disease. It is the only sign of any form of commitment to fight the disease outside the medical facility.

"We are doing all that we can to help and we won't tire. We do not want to lose more lives," says a leader of the group who identified herself as Lucia Nyazuva.

Inside the clinic yard, a young female nurse donning protective clothing is seen addressing dozens of patients already waiting for treatment.

"You did well to come early for treatment. We will do our best to assist you. We want all those worst affected to be served first," she is heard saying in a voice so weary it is clear she has been talking this way all day long.

In the backdrop of a lethargic official response to the devastating disease, there are fears the cholera scourge will spread rapidly to more areas in the country. Already, cases have been reported in Manicaland, Midlands, Masvingo and Mashonaland East provinces.

This evokes dreaded memories of the 2008 cholera epidemic which is still widely regarded as the worst such disease outbreak in the country's history.

The severity of the 2008 episode has been attributed to a combination of societal factors including poor access to health care and poor health care infrastructure.

From August 2008 to June 2009, an estimated 95 531 cases and 4 282 deaths due to cholera were reported.

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