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On the cholera frontline
IRIN News
March 09, 2009

http://www.irinnews.org/report.aspx?ReportID=83378

The number of cholera deaths in Zimbabwe has crept past the 4,000 mark and case numbers are receding, but for those on the frontline of the epidemic it is business as usual, and much too soon to talk of victory.

The World Health Organisation (WHO) said on 9 March that 4,011 people had succumbed to the waterborne disease since the outbreak began in August 2008, and the total number of cases recorded had reached 89,018.

Signs that the disease is abating, with cholera infections down by about 50 percent to around 4,000 cases a week, are lost on those fighting the disease.

Stella Moyo, 40, a nurse working for Doctors Without Borders at the Beatrice Road Infectious Diseases Hospital, about 5km southwest of the capital, Harare, told IRIN she was "distraught at the number of cases that we have seen over the past week, at a time that we thought we were winning the war against the cholera outbreak."

One of Africa's most deadly cholera outbreaks in recent history has been fuelled by the collapse of municipal services, including water, sanitation and healthcare.

"We thought we had gone past the peak of the epidemic, and statistics given indicated a downturn, but judging by the number of patients we have been admitting in the last few days, the storm seems far from over," said the nurse, who declined to give her real name.

"There is hardly any clean water throughout the city [Harare] as we speak, and that should explain the renewed spread of cholera."

The establishment of a unity government on 11 February 2009, when Morgan Tsvangirai, leader of the Movement for Democratic Change, was inaugurated as prime minister, has yet to bring any change in the material conditions that contributed to the cholera epidemic.

A check by IRIN of the water availability in many of Harare's high-density suburbs found that the city council had disconnected piped water to homes, schools, recreational and shopping centres, as well as police stations.

Residents were thronging wells, boreholes and the few municipal taps in industrial and residential areas to collect water, but the impatient were drawing water from the Mukuvisi River, known to be contaminated with raw sewage and industrial effluent.

"Because of our desperation we are collecting water for washing and cooking from the river. Most of us are boiling the water before we use it, but those that are lucky are putting anti-cholera pills in them," Bridget Fokoyo, 27, who lives in the high-density suburb of Mbare, in the capital, told IRIN.

Beatrice Road is a referral hospital where 5,360 cholera patients have been treated, of which 268 have died, according to WHO. "Even though the wards designated for such cases are less than half full, it is only a matter of days before all the beds are claimed if the water situation does not improve," Moyo said.

Entire family killed by cholera

"It is not surprising that we have a high number of school children coming for treatment. With no water at home and in the schools, there is a high possibility that the children are picking up the disease at school and passing it on at home, where hygiene is poor."

Relatives and friends, many holding containers of the salt-and-sugar solution recommended for the rehydration treatment of cholera victims, brought those suspected of having the disease on wheelbarrows, or in the back seats of private vehicles.

Many patients arrived and first went to be tested for HIV/AIDS and then to the cholera desk a few metres away. "I requested staff at the testing centre to give my sister priority and place us at the front of the queue because I also suspect that she has cholera," Givemore Kabhachi, 48, from Mbare, told IRIN.

"It looks like she has the HIV, but then she started having diarrhoea that I have been told could be due to cholera. I am not leaving anything to chance," he said.

Kabhachi has every reason to be cautious: cholera recently killed a whole family in one of Mbare's neighbourhoods. "First to die was my neighbour's son. Before he could be buried, the father, mother and remaining child were rushed here [Beatrice Hospital] but, unfortunately, they were too late," he said. "They are all still in the mortuary because there is no money to bury them, and the house has since been locked up."

Justice Chasi, an advocacy officer for the Combined Harare Residents Association (CHRA), told IRIN that investigations by the organization showed cholera was spreading to areas that had previously escaped the disease and cited Glen View as an example, which recorded 87 cases last week.

"Our survey indicates that there is some sort of an upsurge in the number of cholera cases reported in the city, and that increase coincides with the critical shortage of safe water in suburbs, a situation which has left residents relying on sources such as rivers, wells and boreholes that have been proved to be unfit for human consumption."

Chasi said the water shortages were caused by a lack of water-purifying chemicals, a breakdown in pumping infrastructure and "administrative hiccups" after the transfer of responsibilities from the Zimbabwe National Water Authority (ZINWA), the water parastatal, to Harare municipality.

"We have also received reports of dead bodies that have been found in water sources and we are still investigating this," Chasi said.

At another referral centre in Harare's working-class suburb of Budiriro, a nurse who also declined to be named said his application for leave had been turned down by his superiors because of the "overwhelming number" of cholera cases.

According to recent report commissioned by the WHO, all water sources in Budiriro, including borehole water, were found to be contaminated and unsuitable for human consumption.

No rest for medical staff

"Since October last year, I, like my other colleagues at this clinic, have not been able to take time out to rest. I was due to go on leave in the second week of March but have been told that I could not do so, since the outbreak that had shown signs of decreasing is now spreading again," the nurse said.

Some medical staff were transferred to satellite clinics, like the one in the neighbouring suburb of Glen View, where patients were given initial attention before being referred to the Budiriro clinic or Beatrice Road for hospitalization, he said.

"We are recording at least five deaths a day, and even though the figures are not as high as what we experienced when the epidemic broke out last year [2008], it is a cause for concern. I wonder why municipal authorities are cutting water supplies now, when we are still struggling with cholera," he said.

The nurse said unhygienic practices were still prevalent in Budiriro, which has recorded 8,458 cases and 200 deaths.

The Harare City Council has not clamped down on vendors selling food in the open. "These vendors are not helping our case because they are selling fish, meat and fruits in open places," the nurse said. "They are creating breeding grounds for cholera."

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