UN warns Ebola could infect 10,000 people per week—unless we act now

A journey to Zimbabwe with Emile Hirsch

By Miriam Aschkenasy
Miriam Aschkenasy and Emile Hirsch attend a community meeting in Mudzi, Zimbabwe.

In April 2009 Oxfam Ambassador Emile Hirsch traveled with Oxfam's Miriam Aschkenasy and Lyndsay Cruz to Zimbabwe to see first-hand Oxfam's response to the cholera crisis that has hit the region. Aschkenasy, Oxfam's public health specialist, wrote this account of their five-day trip.

Day 1: In Transit to Harare

My gift, according my father, is that while most people look at a 15-hour flight as torture, I look at is a time to get some rest. And he is right. My flight went by in a flash. I got some reading done, some work done, and slept the rest of the way curled up in my seat with my neck pillow and noise-cancelling earphones (best birthday gift ever).

My first hours in Zimbabwe were filled with contradiction. As I walked out of the airport in Harare I was greeted by clean, cool evening air. I was then welcomed by Oxfam's humanitarian program coordinator, Ransam, with a hug and a joke. But as we drove to my hotel the empty streets were shocking. It was only 10 pm, but there were almost no other cars on the road and very few people walking. We pulled into the hotel and as we walked up to reception the crickets were singing. I could tell, even in the dark, how beautiful the landscape was. But as a sign of the times in Zimbabwe, when I checked in I learned the hotel wanted me to pay cash—in advance—for my room and it preferred US dollars or Euros.

After checking in, I met up with Lyndsay, Oxfam's public figures liaison. She worked to put this trip together and I could tell she wanted it to go well. She has a lot of respect for Emile after their trip to the Congo last year. He gets it, she said, and really wants to learn. As for me, I couldn't wait to meet him and made her knock on his door at 10 p.m. to introduce us. He was tired but cheerful and very excited about the trip. We kept the meeting short: tomorrow would be the car ride to the rural area and we could get acquainted then.

Day 2: The Pumpkin Hotel in Mudzi

I am always so tired at the end of the day in Mudzi, a region in the northeast part of the country where Oxfam has been working on the cholera outbreak. After a two-hour car ride from Harare we arrived at the Pumpkin Hotel—the only hotel in this region. We settled in (Emile got the suite with the waterbed, and I got the one next door) and had some lunch: Eggs and sadza—a finely ground cornmeal boiled in water.

After lunch, we headed out to look at a bore hole—a narrow well drilled deep into the ground. Mudzi has hundreds of them. They're the source of drinking water for many people in this rural region. This one was a half-hour-drive away on a bumpy, dry road—and when we arrived, we found hundreds of community members waiting for us.

Sitting in two large groups, they had prepared a speech and gifts: beautiful hand-crafted baskets and several large bags of fresh peanuts tied in large burlap bags with "product of USA" stamped on their sides. These bags had been recycled from earlier food distributions. The villagers wanted to show their gratitude for the work Oxfam and our local partner, Single Parents Widow(er)s Support Network, or SPWSN, had done together: teaching communities about hygiene , providing them with basic goods like soap, and repairing their bore holes.

Emile confessed to me that he thought the word was "boar" hole. And why not? if you were not a water engineer or public health person or someone dependent on these holes for water, how would you know what they were? It made me realize how little the developed world knows or understands about those who still fetch water by hand and don't have access to flushing toilets—or even pit latrines.

Back at the meeting, Emile addressed the village, thanking them for their hospitality and acknowledging their strength as a people and as a community. He was nervous and I could tell he had really thought through what he wanted to tell his hosts.

That is why this trip is so important: To get the word out. Yes, the number of cases of cholera might be less each week, but what about next year? How do we stop an outbreak from happening again? This year in this village this outbreak left 25 orphans. This is a staggering number of children who have lost their stability—all because they and their families could not access clean water.

As we drove back to the Pumpkin Hotel, I thought again, with amazement, about how so much devastation can happen in such a beautiful setting, and how the people can keep going with such optimism and positive attitudes. I realized it had been an important day for Emile, too: He was beginning to understand the context of people's lives, how they cope, and the importance of supporting them when their options run out.

Day 3: Cholera public health education campaign

We spent another long and dusty day in the field. Today we watched as nearly 2,000 people gathered to learn about cholera. They sang, laughed, and watched plays all about a deadly bacterial disease that can kill a person in a matter of days with diarrhea and vomiting. We listened to health promoters from Oxfam and SPWSN as they talked and sang about feces, and watched as they faked illness and dying—all to teach the audience about cholera.

Emile was amazed at the teams' drama and acting capabilities and at the community's ability to laugh about something so devastating. My favorite part was the singing—so lyrical and powerful. I found myself singing along (not nearly as well, of course) and envious that they could make such beautiful music with nothing but their voices.

We spent the second half of the afternoon driving to a cholera treatment center. The number of cases had finally started to wane but it was hard to know if it was just because the rains had stopped or if all our hard work was paying off. I am sure it was a combination of both—but we will know for sure next year when the rains come again. That is why we are going to continue our work after the outbreak is over: We'll introduce clean water at the level of the household using sand filters. We are going to try and break the cycle of yearly diarrheal outbreaks—lofty goal, but worth shooting for.

Day 4: Early warning and seeds

The day started out with a 9 a.m. meeting at the local hospital and a report on new cases. Yesterday, the cholera early warning surveillance system Oxfam put in place with SPWSN detected new cases. For the past several weeks there were only sporadic cases, but yesterday, following a funeral the day before , 19 cases were detected. It was amazing to be there and see our early warning system working—and to learn about the response. All 19 patients were brought to the health center and the response featured bore hole repairs, the delivery of supplies to the health center (including a salt and sugar solution for oral rehydration, disinfectant, tents, and beds) and the launch of a public health education campaign for the affected community. Amazing! By getting the patients to the health center so fast the hope was to avoid more deaths—and more funerals.

As we were listening to the report, I looked over at Emile, who was absorbing all the details and asking thoughtful questions. I was glad he was there so he could return home and share what he had learned about the seriousness of the situation in a way other people might be able to understand.

Oxfam had jumped in to supply ever-scarce fuel and supplies for the response. While everyone hopes this epidemic is winding down, no one was surprised that that there were still cases erupting. The infrastructure in Zimbabwe is so broken down it will take years to build a safe water system for all to use. Our biosand filters—a water treatment method that is used in the household—will provide more long-term protection for families and hopefully prevent diarrhea for them in the coming year.

The filters arrived the other day—thanks to UPS, who shipped them from the US for free—and we swung by the warehouse to look at them: large blue buckets with very little tubing. Their simplicity is amazing. I had drawn a picture for Emile the night before and explained how they worked. When he saw them in person, his eyes lit up: it all came together. I was happy to see someone who was just as excited as me about these blue plastic buckets and their potential to save lives.

Day 5: Final night in Harare

We spent the night talking about the trip—all the things we saw and experienced. I pulled out my computer and we had a discussion, using a power point lecture, about the role of evidence in humanitarian response: How do you set up an early warning surveillance? Why is it so complicated? Why is it so important? I could see that Emile was synthesizing all the things he had learned over the past week, putting them together and grasping the complexities that make up Zimbabwe.

I am looking forward to reading what he writes. I am sure I will learn something from him and can't wait.