Zimbabwe: Cholera Keeps a Low Profile

IRIN – A year ago Zimbabwe was immersed in one of the continent’s worst ever cholera outbreaks, and more of the same was expected in 2010, but the waterborne disease has so far kept a low profile.

The cholera epidemic that began in August 2008 and lasted for a year before it was officially declared at an end in July 2009 caused the deaths of more than 4,000 people and infected nearly 100,000 others.

The 2008-09 outbreak was attributed to dilapidated and broken sanitation and water infrastructure, much of which is still in the same state, raising the fear that the 2009-10 rainy season would bring a resurgence in cases.

Cholera, a waterborne bacterial disease, infects the gastrointestinal system, causing vomiting and diarrhoea that can lead to acute dehydration; left untreated, the disease can kill within 24 hours.

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Cholera returns and kills five, so far

Photo: Médecins Sans Frontières (MSF)

Cholera is making a comeback

(IRIN) – Five people have died from cholera at two different locations in Zimbabwe, and 30 other people are undergoing treatment for the waterborne disease, raising the spectre of another epidemic.

The permanent secretary for health, Gerald Gwinji, told the state-run newspaper, The Herald, on 20 October that three people had died from cholera in Mashonaland West Province, in the northeast of the country, while two other deaths were recorded in Midlands Province, in central Zimbabwe.

Gwinji attributed the deaths in Gokwe North, Midlands, to “religious objectors who for a long time have been reluctant to seek medical attention. We are still trying to come up with ways of addressing this special group.”

A cholera outbreak that began in August 2008 and lasted for a year before it was officially declared at an end in July 2009 caused the deaths of more than 4,000 people and infected nearly 100,000 others.

The cause of this epidemic was dilapidated and broken sanitation and water infrastructure, much of which is still in the same state as a year ago, so the coming rainy season is likely to facilitate the spread of the disease.

“We have received confirmation of the cholera cases from the government and this poses a new challenge, in the sense that there is need to educate and sensitise some communities which are resisting prevention and medication for cholera,” said Tsitsi Singizi, a spokesperson for the UN Children’s Fund (UNICEF).

“Our education teams are already out in full force, and we hope that this time the effect of cholera will not be as it was last time,” she commented.

Samuel Sipepa Nkomo, the minister for water resources development and management, told IRIN that repairing the water and sanitation infrastructure in the capital, Harare, was the main priority, as this had been the epicentre of the previous cholera outbreak.

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DRC: Cholera kills at least 100 in east

Photo: microbiologybytes

The cholera causing germ, Vibrio cholerae

At least 100 people have died of cholera in parts of eastern Democratic Republic of Congo (DRC) since January, say medical sources.

South Kivu Province is the worst affected, with at least 75 people dead and 6,392 infected, said Eugene Kabambi, who is in charge of communications at the UN World Health Organization (WHO) in DRC.

The South Kivu governor, Louis Leonce Muderwa, said the 10 worst-affected health zones in the province included Fizi in the region of Baraka, Nundu, Uvira, Kadutu, Ibanda, Bunyakiri, Katana, Minova, Nyantende and Kabare zones. Two deaths have been reported in Kadutu and one each in Ibanda and Katana.

Muderwa declared a cholera epidemic there on 14 September.

In neighbouring North Kivu Province, 48 deaths had been recorded and 4,609 people infected by 13 September, according to a WHO report.

Five health zones have recorded cases, including the main town of Goma, Karisimbi, Masisi, Mutwanga and Rutshuru areas. Other eastern regions have also recorded cases, with Katanga listing 199 new cases and two deaths.

The North Kivu provincial medical inspector, Dominique Bahago, blamed the cholera outbreaks on poor hygiene. “The majority of the population’s supply of cooking and drinking water is from Lake Kivu where all kinds of waste is dumped; cholera is endemic in that zone,” said Bahago.

Cramped living conditions in displaced persons camps, as well as the inconsistent use of latrines, had exacerbated contamination, he said.

An estimated two million people are displaced in eastern DRC, some of them repeatedly since the start of conflict there in 1996.

The International Committee of the Red Cross (ICRC) and partners are helping to distribute water to affected locations in North Kivu, chlorinating water, disinfecting premises and conducting hygiene awareness, among other activities, according to a 25 September press release. The cholera treatment centre in Virunga was also reopened on 14 September to deal with the outbreak.

“As the rainy season [arrives] in this cholera endemic zone, it is very important to take measures that will allow for the spread of this epidemic to be contained,” said Catherine Savoy, ICRC health coordinator.

More than 10,000 cases have been recorded in the Kivus since the beginning of the year, according to Kabambi of WHO.

Paying the water bill prevents cholera

Photo: WHO/Paul Garwood

Checking on cholera

(IRIN) – Zimbabweans have been given the good news and bad news about their water supplies. First, the government declared the end of the devastating cholera outbreak; then, residents in the capital, Harare, were told to expect widespread cut-offs of water supplies over unpaid bills.

When the last case of the waterborne disease in the Harare township of Budiriro was recorded on 3 July 2009, the cholera epidemic that began in August 2008 had claimed the lives of more than 4,200 people out of about 100,000 known cases.

Health and child welfare minister Henry Madzorera told local media: “The nation experienced the worst cholera outbreak between August 2008 and June 2009, but the epidemic has been successfully contained and has ended.”

Zimbabwe’s dilapidated water reticulation system and decaying sanitation system were widely blamed for Africa’s worst outbreak in 15 years. The collapse of infrastructure mirrored the country’s rapid economic descent, when routine maintenance of the water and sanitation networks was neglected and the scarcity of foreign currency meant water treatment chemicals could not be imported.

The Zimbabwe National Water Authority (ZINWA) was unable to provide clean water – or any water at all – so residents took to digging shallow wells, which were contaminated by the raw sewerage spilling into the city’s streets. The responsibility for water provision has now reverted to local municipalities.

Analysts link the fading away of cholera to the onset of the dry season, which reduces favourable conditions for the waterborne disease to spread, and to widespread education programmes.

“All districts, provinces and cities will conduct post-mortems of the epidemic in their areas, evaluating their responsive strategies, and plan forward for future outbreaks, which have a strong likelihood of recurring in view of continued sewerage and water problems,” Madzorera said.

Raw sewage still spills onto the streets of some suburbs, providing a dank reminder of the danger that cholera could return with the coming rainy season, but work on restoring the city’s water and sanitation systems has begun.

No free water

Harare’s municipality this week placed a slew of adverts in the local media, warning residents that the water supply would be disconnected if they did not settle US$23 million in outstanding accounts, and has since made good on their threats.

“Harare Water would like to inform its valued customers that with effect from Monday, 27 July 2009, there will be a massive disconnection of water in the low-, high-density, commercial and industrial areas to all those consumers with outstanding water bills,” the adverts said.

The mayor, Muchadeyi Masunda, dismissed complaints by residents and insisted that all monies owed be paid. “I have not received water at my house for more than four years but I still pay my bills. No one is going to be relieved of their obligation to pay their dues to council,” he told IRIN. “What we may consider is to reduce the amounts, but not total waiver.”

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Aid money almost too tight to mention

The international humanitarian community’s most important tool for raising resources for action in Zimbabwe, the Consolidated Appeals Process (CAP), is out of date and in need of revision. The question is whether appealing for more funds to keep pace with worsening conditions will actually translate into enough money to remedy them.

The CAP 2009 was launched in November 2008, but “the situation in [Zimbabwe] has obviously moved on,” Catherine Bragg, UN Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator, told IRIN.

Photo: ReliefWeb

Zimbabwe and surrounding countrie

Discussions were underway to ensure the CAP 2009 document better reflected the current humanitarian crisis in Zimbabwe, Bragg noted after leading a UN assessment mission to the country at the end of February. “The cholera epidemic is still ongoing and the humanitarian situation has gotten much worse.”

By early March cholera had claimed more than 4,000 lives and nearly 90,000 Zimbabweans had been infected since the outbreak began in August 2008.

The food security situation is still deteriorating rapidly: the original CAP 2009 projected 5.1 million Zimbabweans depending on food aid in the first quarter of 2009, but that number is now closer to 7 million.

Growing hunger, growing needs

Halfway through 2008, the humanitarian community in Zimbabwe estimated it would take around US$350 million to address immediate needs in the country; by November the figure in the CAP had grown to US$550 million.

The new numbers were mainly a reflection of rising food insecurity – the food component shot up from US$173 million at the beginning of 2008 to US$411 million by the 2008 mid-year review. “A 137 percent increase,” Luke McCallin, the Flash Appeal Coordinator of the Consolidated Appeals Process (CAP) at the UN Office for the Coordination of Humanitarian Affairs (OCHA), told IRIN.

In January 2009 the sharp increase in the number of emergency food aid beneficiaries led to a halving of cereal rations, which were already cut in late 2008 in the face of donor funding shortfalls.

By March 2009 the collapse of Zimbabwe’s health sector and the unprecedented outbreak of cholera caused the CAP to balloon to well over US$570 million. Expectations are that the latest revision will lift the required amount beyond that, but the exact figure remains unclear.

“It is difficult to tell at this stage. There is an agreement to conduct inter-agency assessments that will inform the CAP Review,” said Muktar Ali Farah, the Officer in Charge at OCHA in Zimbabwe.

Asking for money is one thing; getting donors to shell out is another. As of 12 March 2008, commitments to the 2009 CAP covered a mere 18 percent of requirements.

CAPs are notoriously underfunded, particularly early in the year. The average level of funding for all CAPs worldwide in 2009 so far is at 25 percent. “Zimbabwe is not far off the pace in terms of other African CAPs, either percentage-wise or in dollar amounts,” McCallin said.

Having the money at the right time is often crucial. “One of the problems we have in general with CAPs is that donor financial years vary widely, and so their decisions on when and how much to fund do not always correspond to the needs as we identify them. For example, we often get increased funding towards the end of the year as donors look to spend their annual amounts.”

‘Lifesaving’ semantics

Competing priorities mean the spread of limited finance across the various sectors of intervention has reached a critical point. “Zimbabwe is facing a multisector crisis. Food, health, water supply and Sanitation, and protection remain the main priorities at the moment,” Muktar noted.

“The problem in Zimbabwe … is that funding has not been going to sectors of the emergency which critically need it, such as agriculture and economic recovery,” McCallin said. Sectors usually not perceived as ‘life-saving’ had long been downplayed due to their developmental nature.

The CAP is a strictly ‘humanitarian’ financing tool, and thus traditionally restricted to short-term emergency needs, but does make provision for including support to communities requiring emergency early recovery to strengthen coping mechanisms and sustainable livelihoods – this is a grey area between humanitarian and development work.

The CAP 2009 document noted the need to bridge the gap between what is humanitarian and what is developmental: “Support to development sectors and activities in Zimbabwe has traditionally been poor.

“Considering that the CAP remains one of the few funding frameworks for donor engagement in Zimbabwe, and despite the prevailing political uncertainty, it will require more donor support to essential sectors that were critically underfunded in 2008.”

Getting the message out

The humanitarian community has consistently advocated emergency funding for agriculture, watsan [water and sanitation], education, and HIV and AIDS.

“Although they represent underlying causes and require mid- to long-term approaches, they also fall under emergency needs. For example, in Zimbabwe an estimated 2,300 persons die per week due to HIV/AIDS, and on an average only 250 persons die due to cholera,” Muktar said.

According to Bragg, “there are a number of sectors in particular that we need to revise. Water and sanitation and health are obvious, in terms of trying to contain cholera as well as other infectious diseases. The breakdown of the health sector had not been to such an extent when we did the consolidated appeal [in November 2008],” she commented.

“Traditionally we don’t include a lot of agricultural activities in a humanitarian appeal but in this case we have to look at this as life-saving, in the sense that if we don’t do it, next year we will continue to have seven million people requiring direct food aid,” Bragg said.

“We think, and we hope, that we will be in an environment where we can carry out some of our traditional protection activities … We think there is now a slight opening for that.”

Development sectors would include emergency agriculture and education, health, water and sanitation, assistance to victims of politically motivated violence, and sustainable return and reconciliation in affected communities. “Any delay in addressing these needs will only result in a greater humanitarian caseload,” the CAP 2009 document warned.

According to McCallin, donors have picked up on the need: “Health, in the specific context of Zimbabwe, has done better this year [2009], probably because of the attention to the cholera outbreak.” The health requirement was 8 percent funded in 2006, 30 percent in 2007, and 57 percent in 2008, he noted.

“On a related issue, for WASH [water, sanitation and hygiene] – which is inextricably linked to the health crisis and cholera outbreak – the funding over the same few years has been 17 percent, 60 percent and 90 percent respectively. There is a trend there, which is probably improved donor response to a growing crisis.”- IRIN

On the cholera frontline

(IRIN) – 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.

Photo: ReliefWeb

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.”

We must not forget Zimbabwe’s cholera victims

By Nicholas Young

At some point in the past three weeks Zimbabwe passed a grim milestone. On one day in January Zimbabwe registered cholera case number 60,001.

A week before Christmas 60,000 was considered the worst-case scenario. Now, humanitarian organizations working in the country fear that the toll could climb to 100,000 or beyond. Whatever the final number, Zimbabwe is now in the grip of the worst cholera outbreak on this continent in 15 years. In six sickening and painful months, Zimbabwe has surpassed Africa’s continent-wide annual average of cases and deaths.

And yet despite the constant media focus and the pledges of solidarity from around the world, efforts made by the humanitarian community to arrest this slide are being undermined because we are rapidly running out of funds.

In a typical case in Kadoma, there is a Red Cross cholera treatment centre. There, a football pitch had been co-opted by tents and aid organizations and is a refuge for 100 people suffering from this awful illness.

A young woman arrived on an oxcart. As her details were recorded, she lay on a tarpaulin, shivering with exhaustion and dehydration.

As the situation unfolded a man approached a Red Cross worker. He explained that his village had lost 10 people in recent days to cholera. He pleaded to arrange some transportation as, just like the girl, all the cases in his village had to be brought in by cart or wheelbarrow. Ten kilometres, he said, is a long distance with that kind of load in this type of heat.

His request was taken to the nurse in charge. “What vehicles?” she asked. “There are not that many unused trucks or cars, and besides, where would we get the money for the fuel?”

The girl outside will be ok. Cholera is not a difficult illness to treat. But then she will go home and there’s no guarantee that the cholera can be kept at bay. We can picture her village. If it is typical of rural Zimbabwe today it will most likely have no running water, no sanitation, no food. She will be encouraged to practice basic hygiene and to drink from clean water sources. She and her family will be visited by Red Cross volunteers and this message will be reiterated.

But what would you do if your only water source was a muddied river, and if you could only carry what you and your family could drink?

In an attempt to escape their desperate situation thousands of Zimbabweans have fled the country. Some have made it to the UK where they have sought asylum only to find themselves faced with a new set of challenges.

An estimated 11,000 Zimbabweans have had their claims for asylum rejected but remain in the UK too frightened to return to Zimbawe. Although the British Government is not forcing them to return home because of the current situation in the country, it has not granted them any type of leave to remain here. This throws them in a limbo – unable to seek employment and barred from accessing benefits or key services.

Many of these vulnerable refugees face isolation and exclusion from any sort of normal life here. Often they are skilled and motivated people who would much rather pay their way and contribute to the society in which they have sought refuge. However they find themselves experiencing humanitarian suffering and hardship as a result of the current policy.

The Red Cross offers help to Zimbabwean people at both ends of the immigration process. In the UK, the British Red Cross helps destitute asylum-seekers who invariably have nowhere else to turn for help; while our current Zimbabwe and the region appeal is supporting the country through its cholera crisis.

But so much more needs to be done. The truth is that Zimbabwe’s economic and infrastructural collapse sits hand-in-hand with this cholera outbreak. None of this is to say that organizations like the Red Cross don’t have a key role to play. The infrastructure issues must be addressed, but they are longer-term concerns.

The Red Cross Red Crescent Movement is doing a lot, and the impact is clear. For starters, we are producing millions of litres of clean water and digging sanitary latrines. We are supporting over-worked and under-resourced clinics with drugs and expertise, and our volunteers are in the remotest villages explaining to people the simple steps they must take to identify and avoid the illness.

And yet, despite the desperate needs, and despite the very real impact that the Red Cross Red Crescent Movement is having across the country, our cholera operation is scarily under-funded. Unless this changes we will be forced to revise our plans. And this is simply untenable. The resources needed for battling cholera on the frontlines must be provided and we urge people to give whatever they can to support our appeal.

In the UK, to ease the deadlock over the status of rejected asylum-seekers, we recommend that the Government should consider giving Zimbabwean asylum seekers whose claims have been rejected leave to remain in the UK allowing them permission to work here and support themselves and their families.

Wherever Zimbabweans may reside, they deserve to be part of a supportive community, to have access to health care and to be empowered to contribute positively to their own future. Whether living in a remote rural community in Zimbabwe, or living in destitution in Peterborough, no one should go through a crisis alone.- The Telegraph

Sir Nicholas Young is CEO of the British Red Cross

An anatomy of cholera

Cholera is a waterborne disease that has surfaced in almost all parts of the world, and the mere mention of its name is often enough to induce panic in communities. IRIN answers frequently asked questions about the disease that has killed nearly 3,000 people in its latest large-scale outbreak in Zimbabwe since August 2008.

What is Cholera?

Vibrio cholerae is a rod-shaped bacterium. It has two major biotypes: classic and El Tor. El Tor is the biotype responsible for most of the cholera outbreaks reported from 1961 to the present.

Photo: Tim McKulka/UNMIS

Cholera at home in water

Cholera is a diarrhoeal disease caused by infection of the intestine. In most cases, infection causes only mild diarrhoea or no symptoms at all. In 5 percent to 10 percent of cases, however, patients develop severe watery diarrhoea and vomiting from 6 hours to 5 days after exposure to the bacterium.

The initial symptoms of the disease are queasiness, nausea and abdominal gurgling, followed by acute diarrhoea. The loss of large amounts of fluids can rapidly lead to severe dehydration. In the absence of adequate treatment, death can occur within hours. Those who are malnourished or already have intestinal parasites can be at especially high risk of death.

How did cholera get its name?

The disease’s name was coined from the Greek word, Khole, meaning “flow of bile”. Cholera’s watery diarrhoea is often referred to as “rice-water” stool, as it contains flecks, which are mucus and epithelial cells. The diarrhoea causes victims to lose huge amounts of potassium ions, which can also lead to cardiac complications and circulatory failure.

Where did Cholera originate?

The first known cholera outbreak was recorded in the Indian sub-continent in 1817. Since then at least seven distinct cholera pandemics have been recorded, the first six from the Ganges Delta, viewed as the “ancestral home” of the disease.

How did cholera travel to other parts of the world?

It is thought that cholera was inadvertently transported from India to the shores of the colonial power, Britain, in the bilge water of English ships. The contaminated water was dumped on arrival at home ports, and the disease moved rapidly to Europe and then to Russia. Emigrants to the New World were thought to have taken the disease to the Americas.

In 1832 a cholera epidemic swept through New York, killing 3,515 of the city’s then population of 250,000.

In 1991 a Chinese registered freighter discharged bilge water into a Peruvian harbour, sparking a cholera pandemic that affected 322,562 people after a nearly 100-year hiatus of the disease in South America.

By 1994 there were more than 1 million cases recorded in South America.
In the aftermath of the Rwandan genocide in July 1994, cholera struck Goma’s refugee camps in the neighbouring Democratic Republic of Congo. There were about 70,000 cases and 12,000 deaths.

How is cholera spread?

A Ukrainian parliamentarian remarked during a 1994 outbreak of the disease in his country that “the spread of cholera and other infectious diseases is the calling card of an economy in trouble.”

The spread of cholera and other infectious diseases is the calling card of an economy in trouble

Cholera infects humans through the consumption of infected water or contaminated food. The consumption of raw or poorly cooked seafood, raw fruit and vegetables, and other foods contaminated during preparation or storage can lead to infection. Bacteria present in the faeces of those infected are the main source of contamination. The bacterium can also survive in brackish rivers and coastal waters. The disease spreads rapidly where sewage and drinking water supplies are inadequately treated.

When was the disease identified?

British doctor and epidemiology pioneer John Snow, and Robert Koch from Germany, the 1905 Nobel Prize recipient for Physiology or Medicine, are credited with unlocking the mysteries of cholera.

In 1831 England experienced its first cholera outbreak, where the disease was attributed to “miasma [pollutants] in the atmosphere”. Another outbreak occurred in 1854 and on 31 August the London district of Soho suffered what Snow was later to call “the most terrible outbreak of cholera which ever occurred in the kingdom.”

Within three days 127 people living close to Soho’s  Broad Street succumbed to the disease; by 10 September 500 had died and nearly three-quarters of the residents had fled their homes.

Snow suspected cholera was a waterborne disease and zeroed in on the Broad Street pump which served the area. He convinced the authorities to close the pump down and immediately deaths in the area were rapidly reduced.

Can cholera be prevented?

Yes. People living in high-risk areas can  protect themselves with good hygiene and safe food preparation, such as washing their hands before preparing food and eating, by thoroughly cooking food and eating it while it is hot, by boiling or treating drinking water, and using sanitary facilities.

The simple rule is: boil it, cook it, peel it, or forget it.

What treatments are available?

The most important  treatment is rehydration, which consists of prompt replacement of the water and salts lost through severe diarrhoea and vomiting. Early rehydration can save the lives of nearly all cholera patients. Most can be rehydrated quickly and easily by drinking large quantities of a solution of oral rehydration salts. Patients who become severely dehydrated may need to receive fluid intravenously.

Packets of oral rehydration salts are available from most city pharmacies and health care facilities. If you have diarrhoea – especially severe diarrhoea – and are in an area where there is cholera, seek treatment immediately from a physician or other trained health care provider. Begin drinking water and other non-sweetened fluids, such as soup, on the way to getting medical treatment. – IRIN

Sources: World health Organisation, MedicalEcology.org, University of California, Los Angeles Department of Epidemiology, International Public Health and Human Rights in the Developing World (A Case Study in Peru), Tropical infectious diseases, principals, pathogens and practice.

Worst-case cholera scenario getting worse

Zimbabwe’s worst-case cholera scenario, as predicted by the World Health Organisation, is likely to be surpassed within a few weeks and there are still about two months of the rainy season left.

Photo: WHO/Paul Garwood

Treating cholera

In December 2008 the WHO said cholera cases could balloon to 60,000 before the rainy season ended in March 2009, but Gregory Härtl, spokesman for the organisation’s Epidemic and Pandemic Alert and Response office in Geneva, told IRIN that as of 25 January, 53,306 cholera cases and 2,872 deaths had been recorded since the outbreak began in August 2008.

Cholera, an easily treatable waterborne disease, thrives in poor sanitary conditions and is expected to remain a feature until Zimbabwe’s rainy season subsides.

The Herald, a state-owned daily newspaper, trumpeted in its 26 January edition that cholera was on the “retreat” in the capital, Harare, but cautioned that “Cholera is still present in the city, especially the southwestern suburbs, and any relaxation in our guard and our efforts will see the caseload explode.”

However, Härtl said the conditions causing Zimbabwe’s cholera outbreak remained in place. “The systemic underinvestment in water and sanitation infrastructure and the health system … These conditions will not change overnight.”

Zimbabwe’s cholera death toll has now exceeded the number of people who have died from the disease in the entire African continent over several years: in 2001 (2,590 deaths), 2003 (1,884), 2004 (2,331) and 2005 (2,230), according to the WHO. Figures for 2006, 2007 and 2008 were not available.

Africa had 4,610 cholera deaths in 2000, and 4,551 in 2002.

Cholera Spills into the region

The disease has also spread to neighbouring countries. South Africa’s Health Minister, Barbara Hogan, told a local television station that the country’s cholera outbreak was a consequence of the spread of the disease from neighbouring Zimbabwe.

According to local media reports, between 15 November and 24 January, 5,696 cases were diagnosed in South Africa and 36 people died.

The South African National Institute for Communicable Diseases (NICD) notes on its website that the disease strain in both South Africa and Zimbabwe is Vibrio cholerae O1 serotype Ogawa biotype El Tor.

The United Nations  Office for the Coordination of Humanitarian Affairs (OCHA) said in its regional update on 23 January 2009 that nine countries in the Southern Africa region were reporting cholera cases: Angola, Botswana, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe.

“Trans-border infections have been recorded and cholera is becoming endemic (recurrent throughout the year) in most of the affected countries,” OCHA said. – IRIN

What this year’s Christmas meant to the Zimbabwean Diaspora

By Sarudzayi Chifamba-Barnes

In Shona, we have a saying that a mother with a child strapped on her back is burning on her backside, while the child is burning on the stomach. Amai vatsva musana, mwana atsva dumbu.

This has been the case with this year’s Christmas and New Year for many Zimbabweans in the Diaspora, who have been providing financial and medical assistance to families and relatives left behind in Zimbabwe. Christmas is a time of celebrating the birth of Jesus Christ with friends and relatives and buying presents for one another, but this year’s Christmas has been tough for many Zimbabweans back home and in the Diaspora. With the cholera epidemic and  hunger, coupled with the  credit crunch  gripping our host countries and first world economies  sliding into recession, surely it was not easy, and can not be easy for Diasporas to continue repatriating funds and food to starving relatives in Zimbabwe.

Many Zimbabweans in the UK admit that this year things have been very difficult for them, and they have not been able to celebrate Christmas as they have done in the past. With job cuts and rising costs of living, it is difficult to look after themselves and their families in the UK, let alone relatives and families left abroad. It is even worse for people waiting for their asylum cases to be decided, and those whose claims have been refused, as most of them lead a life of destitution and survive on handouts from friends and churches.

This year the Zimbabwe Association (ZA), which is a charity working for Zimbabwean asylum seekers and refugees in the UK, organised an event called Singing for Our Supper on the 13th of December 2008. “After years of being stranded in the limbo of a seemingly endless asylum process, hundreds of Zimbabweans in the UK are now destitute and without support… Zimbabweans will sing a combination of well known carols….throughout the UK”, read their  press release statement for December 2008.

Molly, a Zimbabwean living and working in Surrey, works in a nursing care home for the elderly. She said this year’s Christmas was a hollow event , and instead of sitting around with friends and celebrating, she went to work to ease away the pain of not being able to send money to relatives in Zimbabwe as she has usually done. Rather, she worked for five long days, 12 hours per day for the entire Christmas period. She blames the UK government and other western countries for failing Zimbabweans here and those back home..

“I think instead of talking about sending aid to Zimbabwe, this government should help the situation by giving all the Zimbabweans in this country the permission to work. Every Zimbabwean in this country looks after more than three families in Zimbabwe. That way, it will be a new form of aid, that will reach the people, and not this bilateral aid which goes through the government and ends up lining up the pockets of corrupt political leaders,” she said.

Chipo is a Zimbabwean freelance journalist based in the UK, and  works in old people’s homes. She says this year’s Christmas was a  nightmare, as she could not afford to send money to her parents and siblings in Zimbabwe.  She has been the bedrock of the family since she came to the UK in 2000, remitting money, clothes and food to her extended family members, but this year’s credit crunch meant that like many people in Britain, she has to revise her expenditure by tightening her purse. She  feels guilt for letting her family down at a time when they need her most. She failed to secure them  maize seed and fertiliser for this planting season, meaning  another year of economic hardship for her since without a good harvest, the burden of feeding the family in Zimbabwe can only be worse for her in 2009.

“With this year’s winter  being  the  coldest in Britain, buying gas and electricity alone has become a priority, and  takes a lion’s share of our [my husband’s] earnings. We spend £50 per week on electricity, compared to £20 we spent per week in the summer. Things are now very expensive in the shops, and we have resorted to buying only necessities. We have had to pull out our children from nurseries and make do with cheap unregistered care, which is a risk on its own,” she said.  This year she did not buy Christmas cards for her neighbours and colleagues, something she has never done before, and had to wait for the Boxing Day bargains to buy her children clothes. She lost a family member to cholera just before Christmas, and to her Christmas was a mourning period. Worse still , she can not afford to buy the medicine that helps to control her ageing mother’s blood pressure, something she has always done.

Cleo is a Zimbabwean who works in Angola. He admits that this year has not been easy for him either, and  he says the amount of money  he spent sending to Zimbabwe this year alone was five times more than he did in previous years. He lost a  cousin’s child to cholera, and his nephew and nephew’s wife are currently in hospital because of cholera. “So I can say this Xmas is the worst ever because the amount that I have spent sending home is more than 5 times I used to send ,because of the ridiculous prices being charged in Zimbabwe. Previously, sending hard currency was great but now we have to send groceries plus cash because ma one (it’s tough)” he says.

Sarudzai Mubvakure, a UK based Occupational Therapist and writer of the debut novel, A Disappointing Truth, The Tragic Story for Sarah Witt, said it is becoming difficult to look after loved ones in Zimbabwe   without putting a strain on herself, because of the US dollarization of the Zimbabwean currency.  “For instance I paid £100 pound sterling for a bag of mealie meal, a bag of rice, a bag of beans, a bag of sugar, a bag of flour, five bottles of cooking oil and three small bags of matemba. I thank God that I was able to provide however, I still believe that   £100 should have gone further than it actually did,” she said.

Tinashe Mushakavanhu is a PhD student (literature) at the University of Kent, and for him, this year’s Christmas was filled with sad memories of a grandfather who succumbed to the cholera epidemic. Even an invitation to celebrate Christmas with friends in Wales did not ease the pain as he found it strange to celebrate Christmas in the time of cholera, and  often wonders if cholera will not strike another family member again. “It’s strange to celebrate Christmas in the time of cholera, to celebrate when there is pain and sadness in your heart. For me, Christmas, was a time to reflect on the year, the struggles I went through while in Zimbabwe and that triumphant moment when I arrived at Heathrow Airport, because I knew I was free to dream again….Christmas in this year of cholera was never the same for our family. We lost our grandfather, the great patriarch of the family to cholera, a few weeks ago. He was in his late 70s. This was a man who was supposed to live up to 84, or even beyond, and enjoy the privileges of old age but lack of sanitation, lack of clean of water, lack of drugs in hospitals has certainly not helped the situation,” he said.

Viola is a Zimbabwean nurse working in the UK. For her, Christmas passed in a blur as she sat with her patients consumed with guilt and pain, since this year was the first year, in the  fifteen years of her working life, that she failed to buy groceries for her elderly parents in Mhondoro.

Thandiwe, a law student and self employed Zimbabwean living in the UK says that the dollarization of the Zimbabwean currency and the high prices charged by people in Zimbabwe has meant that instead of sending the usual £100 per month to her parents, this year she has had to send on average £300 per month, putting her life here on-hold. “It’s difficult to cope with the cost of living in Zimbabwe. How can a president declare himself a president when he sits and watches his currency and financial system overtaken by the Rand and the American dollar, and yet he continues to pay people in the useless Zim-dollar? Certainly this year has been very hard for me, and I can not envisage what 2009 will be like” she said.

Mathew lives and works in Coventry. He said  this year was difficult for him to even manage to buy himself a bar of chocolate, because his mind was with the people suffering in Zimbabwe. He remitted over £1000 to relatives this month alone, as they all look up to him for financial support. This also includes cousins who fled the political and economic meltdown in Zimbabwe to South Africa in search of greener pastures, but found the pastures dry because of the asylum process in South Africa.

Emmanuel Sigauke, a Zimbabwean writer and lecturer of English at  Cosumnes River College in California, says that although all his  Christmases tend to be low-key, this year things are also hard for him as  it has become increasingly difficult to help everyone who needs help back home. He now prioritises between those relatives who are completely dependent on him, and has recently asked one relative to move from Harare to the rural areas “since I will not be able to continue paying her rising rent. Of course, she informs me things would be worse in the rural areas.   I have also begun to dread that phone call from Zimbabwe that comes in the middle of the night when I am asleep. I just can’t afford to help everyone who calls me,” he said.

Given such a situation and the current predictions that the UK and USA economies will shrink further this year, one is left to wonder who will extinguish the fire burning both the mother and the child on her back . Even the old adage  kutsva kwendebvu varume vanodzimurana (when one man’s beard catches fire, another man is ready to extinguish it)  is now hard to contemplate since it will  now be a situation of each man for himself and God for us all. – The Harare Tribune

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