Tacked to the outside wall of a government office building in Zimbabwe, the warning served notice to all who could read English that Mudzi district is in the throes of a major public health crisis.
Like wildfire, hot spots of cholera—a waterborne diarrheal disease that can kill quickly if not treated properly-- continued to erupt in late January in this rural northeast region on the border with Mozambique. I heard about the spikes—and the challenge of stopping their spread—at the morning meetings at Kotwa hospital, where aid groups and government health officials gather to coordinate each day’s attack on the disease. Oxfam and its local partner, Single Parents Widow(er)s Support Network, or SPWSnet, are among those responding to the crisis.
Fanning out from the hospital grounds, a small team of nurses, water engineers, and public health promoters hit the road each day, traveling up to two hours to reach the more remote areas where people need everything from clean water to basic information about cholera prevention. And they return each night—sometimes long after dark—to prepare their reports for the next morning.
The news they deliver, along with their statistics, is often unsettling: Reports of people drinking from a stream in which others are washing dirty clothes and dishes; shortages of oral rehydration salts and disinfectant; an ox cart toting a patient who died before reaching a clinic. All of it paints a picture of a country crippled by hyperinflation and failing water and sanitation systems. In Mudzi, less than a third of the households have access to proper latrines, according to one estimate.
Already cholera has sickened close to 85,000 people across Zimbabwe, killing more than 3,900 of them as of Feb. 6. The World Health Organization has called it one of the largest outbreaks ever recorded. And Mudzi, poor and far from central areas of commerce and government activity, has been one of the hardest-hit districts.
Here, in Mudzi, fear of the disease is palpable. Fist bumps have replaced handshakes as people worry that palm-to-palm contact could transmit cholera. Some people are even afraid to eat, though of course they must, one man tells me.
“We are not settled,” says the man, Wonderful Nyatsuto, as he helps a SPWSnet engineer repair a deep well, known as a bore hole, about a mile and a half from his home. About 15 people in his village have contracted the disease, he says, and a third of those have died. Cases of cholera started to erupt when people began fetching their water from a nearby river after the bore hole stopped functioning. Across Mudzi, many of the region’s 600-plus boreholes no longer work and communities are too poor to repair them. But without a supply of clean water, residents face a growing danger from the disease.
“We are trying to maintain the rules they tell us,” Nyatsuto adds. “Boil water. Clean hands before you eat. Clean the toilet.”
Still, in a region where many locals supplement their meager incomes by panning for gold in a network of streams and drink the contaminated water as they labor, people are continuing to get sick.
But getting to a clinic is no easy matter. Functioning ones are few and far between. Some have no medicines. Others have no medical equipment. And so sick people trudge great distances to get the care they need. Roads are rough, sometimes barely more than tracks through the bush, cars are scarce, and fuel is both dear and hard to find—even for aid workers who have access to outside resources to buy what they need. Sometimes, aid groups have to send vehicles all the way back to Harare, the capital, a two-and-a-half hour drive from the Kotwa hospital, to scrounge for a small supply of fuel that they can port back to keep their trucks in Mudzi running.
One day in late January, 49 patients packed a clinic in Makaha, a ward in Mudzi where cases of cholera were suddenly spiking. A series of tents and one dimly lit concrete room served as wards for people stretched out, limp and mostly silent, on cholera cots—beds with large holes cut in the middle beneath which buckets are placed.
Snaking between the tents and the out buildings was a narrow path of mud bricks powdered, here and there, with flecks of white—the remnants of the dried lime-chloride used to disinfect contaminated surfaces. Mixed with water, a jug of it sat at the exit of the clinic, a reminder to all visitors to give their hands a thorough dousing.
As she finished hosing down an empty cot with the chloride solution, a nurse, her face flat with exhaustion, described some of the misery she had witnessed in the last few days. A mother, six months pregnant and very sick with cholera had managed to get herself to the clinic only to lose her baby. The next day, her husband arrived with their five-year-old son whom he had carried more than 16 kilometers from their home in search of help. Weak with cholera, the boy had died en route. And now the husband was gravely ill, too. The nurse was uncertain whether he would survive.
Behind her, on a shelf, stood a plastic barrel—a mini storage tank for the mixture of oral rehydration salts that were helping to keep the clinic’s patients alive. But the barrel had barely two inches of liquid left in it—nowhere near enough to sustain all those who desperately needed the sugar-and-salt mixture. And there was no more solution anywhere else in the clinic. Fortunately, we had a small supply of rehydration packets in our Oxfam truck and immediately gave them to the nurse. But that’s not all she needed. The clinic had just two doses left of ciprofloxacin, an antibiotic used to treat a variety of bacterial infections including severe cases of diarrhea.
Beyond the tents, was the observation area—a patch of dirt in the shade of a large tree. Here, patients waiting to be admitted slumped on the ground and those who had improved continued to rest before making the journey home. Outside the gate to the clinic, family members huddled around small cooking fires, the smoke curling around them. They were preparing food for the patients inside—a kindness that was also a cause of concern to nurses who feared cholera could soon sweep through the family support network.
Compounding the challenge of treating cholera is the widespread hunger many people in Zimbabwe are now confronting in the months leading up to the next harvest. Hunger has left people weak and more vulnerable to the disease.
The World Food Program plans to feed more than five million people in February, the greatest number in a single month since 2002. But because more people need food, the program is reducing ration size so that it can stretch its stocks far enough to accommodate everyone.
For some families, even coming up with the basics to fight cholera—such as sugar for a rehydration solution—can be daunting. Dutchman Matika tells of having to borrow sugar from a neighbor to make his wife the solution when she came down with cholera. As he speaks, two of his young sons listen intently, their hair tinged with orange—a sign of malnutrition. With 11 children and three wives in his household, Matika says mealie meal—a local staple—is in short supply.
“When you walk around, you see it,” says an aid worker about the malnutrition that has followed on the heels of several poor harvests and that’s affecting people most acutely in the interior of the country. “Poppy tummies. That’s one of the very clear indications. It’s mainly in kids. And you get wasting away in adults.”
But this year, in Mudzi, there are signs the next harvest may be better. While there is never enough fertilizer to guarantee robust crops, the rains during the current wet season have been unusually plentiful. Where corn and sorghum, millet and ground nuts have been planted, green shoots abound—slivers of hope for the future.
]]>The agency has had to hand over its laptops and communications equipment to the government. This will adversely affect its ability to carry out its work, which was reaching some 600,000 people across Darfur, in Khartoum state and the east of the country.
Oxfam GB estimates that its supply of clean water and other programmes can continue to be run by local communities and Oxfam-trained volunteers for a number of weeks but if its appeal to the government fails then its programme will have to close.
Oxfam GB's work in Darfur is its biggest emergency program in the world. It has operated in northern Sudan since 1983 and currently has 450 staff, 90 percent of whom are Sudanese. Oxfam is an independent, impartial non-governmental organization, with absolutely no links to the International Criminal Court. Oxfam does not have an opinion on the Court's activities, and our sole focus is meeting humanitarian and development needs in Sudan.
]]>The agency said it is appealing the decision and hopes the matter can be resolved quickly. The agency urged the government of Sudan to allow it to continue its vital humanitarian efforts, which affect hundreds of thousands of lives.
Penny Lawrence, Oxfam's international director, said, "If Oxfam Great Britain’s registration is revoked, it will affect more than 600,000 Sudanese people whom we provide with vital humanitarian and development aid, including clean water and sanitation on a daily basis. 400,000 of them are affected by the ongoing conflict in Darfur, where people continue to flee from violence, and the humanitarian needs remain enormous. It will also affect another 200,000 poor people in the east of the country and Khartoum state."
Oxfam Great Britain has operated in northern Sudan since 1983 and currently has 450 staff, 90% of whom are Sudanese. Oxfam is an independent, impartial non-governmental organization, with absolutely no links to the International Criminal Court. Oxfam does not have an opinion on the Court's activities, and our sole focus is meeting humanitarian and development needs in Sudan.
]]>On this day, it seemed highly symbolic: a clean sweep. It was a day which many Zimbabweans were praying would bring them change, after months of political deadlock, an ever-worsening economy, and a humanitarian crisis as the country battled its worst-ever cholera epidemic and serious food shortages.
It was the day Morgan Tsvangirai, the country's main opposition leader, was to take office as the country's prime minister in a new unity government.
Tsvangirai won the first round of last year's presidential elections by a small margin. But he withdrew from the run-off, citing violence against his supporters. In September, though, he agreed to a power-sharing arrangement with Zimbabwe's president, Robert Mugabe. However the deal had been stalled for months amid political disagreements.
While there are skeptics who say the new political arrangement is a sell-out and unlikely to achieve much, many Zimbabweans beg to differ. They view the new political arrangement with optimistic caution. Many told me things couldn't get any worse, and that the formation of a new unity government gave them cause to hope again. They believed it could mark the start of change in their country, which has seen thousands killed from cholera—a curable and preventable disease—and where up to seven million people, more than half the population, are dependent on food aid.
Later in the day, after being officially sworn into office, Zimbabwe's new prime minister addressed thousands of supporters at a packed showground in Harare.
Some attending told me they'd sold household goods—a TV set; an iron; some clothing—to get enough petrol to come to Harare to listen to Tsvangirai address the crowd as the country's new prime minister.
He promised to end political violence and Zimbabwe's culture of impunity; to work for a society where people were no longer living in fear of reprisals or repression for their views. He said Zimbabwe would not be a pseudo democracy, but a functioning democracy, where the rule of law could be re-established.
A second top priority of the new government, he said, was to tackle the humanitarian crisis, to stem the cholera epidemic which has gripped the country, and to ensure that those who needed food got help—regardless of their political or tribal affiliations.
He also promised to appoint a senior cabinet member to coordinate humanitarian efforts; to remove tax duties for humanitarian food aid, and to organize a food summit to try to ensure that in the future, Zimbabweans would not go hungry again.
And he vowed to stabilize the country's economy—characterized by crippling hyperinflation; to get children back to school, hospitals to reopen, and civil servants to return to work.
All music to the ears of the crowd and—possibly good news for international governments that have said they will carefully monitor change in Zimbabwe before making serious commitments of financial help.
The crowds in the stadium cheered, danced and waved flags. Even a reporter from a government-controlled newspaper seemed happy.
"We used to be dead," he said. "Now we are alive. This is the start of change."
]]>"We hope the government of national unity can prioritize the humanitarian crisis and mobilize all the resources it can to make swift recovery possible while working to bring broader stability to the country," said Oxfam's country director in Zimbabwe, Peter Mutoredzanwa.
Oxfam also urges the new government to create the space for the active engagement of civil society in partnership to rebuild Zimbabwe. Civil society has a critical role to play in the current humanitarian crisis and the longer-term development of the country. Oxfam also asks the new government to ensure that beyond access to basic needs, people's rights to freedom of expression, movement and security are respected and protected.
"We're calling on the new government to remove all constraints and enable our staff and staff of other civil society organizations to be able to carry out their work on the ground freely and effectively" Mutoredzanwa said.
As a direct result of the deteriorating socio-economic conditions in the country, Zimbabwe is currently struggling to control the worst- ever outbreak of cholera in its history, fuelled by the collapse of the country's public health and water systems. The cholera epidemic has claimed more than 3,000 lives, and infected more than 69,000 people. In addition, nearly seven million people, more than half the population, are relying on food hand-outs because of serious food shortages. Seriously weakened, they are more vulnerable and therefore unable to fight cholera.
Hyperinflation and the dollarization of the economy has meant millions have been unable to access basic food staples, increasing the number of people needing food aid in both urban and rural areas.
This year's harvest is predicted to be even worse than last year's and food shortages could continue into 2010. As well as dealing with immediate needs, Oxfam believes the new unity government and donors must examine ways of providing longer-term help, including inputs for farmers to prevent future food emergencies and food insecurity; and ensuring communities have access to clean water.
Oxfam calls for specific attention to be paid to the impact of this tragedy on women and girls—who bear the brunt of the HIV epidemic—are most affected by the deterioration of basic services and the lack of farm inputs.
While several governments have said they will only restore substantial aid to Zimbabwe when there is concrete evidence of political and economic reform, Oxfam urges donors to explore innovative ways to channel emergency resources to people who urgently need help and for existing pledges of aid to be translated into funds on the ground.
Oxfam supports calls for the creation of transparent mechanisms with clear benchmarks, supported by regional bodies like the African Union (AU) and Southern African Development Community (SADC), to monitor the implementation of the power-sharing agreement and policies of the new government. One key benchmark will be an open environment where civil society organizations can freely engage in a wider dialogue with the government as part of longer-term efforts to seek a resolution of Zimbabwe's problems.
]]>What is most surprising is not all of Mississippi is poor, or last in every development category. There are regions in Mississippi that rank on par with the richest state in America (Connecticut), and there are regions that rank on par with the least developed countries in the world.
This study illuminates the sharp disparities in opportunity between regions and between races within the state. The report forces us to acknowledge who is thriving, and who is being shut out. It is clear that we cannot forge ahead while leaving so many people behind.
"In Mississippi, where we work with 13 state and local organizations such as the NAACP, this report clearly illustrates the conditions residents were struggling with even prior to the hurricanes of 2005—limited access to education, lower incomes, and shorter lives—and argues for a comprehensive solution for recovery," said Raymond C. Offenheiser, president of Oxfam America.
Given the profound economic and social challenges facing Mississippi, and more broadly working families in the US today, this report comes at a crucial time to help policy makers use precious resources to ensure all Mississippians have access to the American Dream.
]]>Oxfam America congratulates you on your inauguration as the 44th president of the United States. This historic moment provides an occasion to reestablish the role of the US as a global leader in fighting poverty and social injustice. And we believe you will make the most of this opportunity.
We ask that you take decisive and early action to shape how we engage in the international community. At a time when the US economy is in trouble and Americans are understandably concerned about their own economic well-being, we must not forget the needs of vulnerable populations around the world. If the US leads in the fight against global poverty, we can create positive long-term change that will result in a more just, prosperous, and secure world for all.
As your administration moves forward, you face an excellent opportunity to restructure US Foreign Assistance. Our current aid system is broken, which undermines American leadership and standing in the world. We ask that you work with foreign policy leaders in Congress to fix US foreign aid—a move that will fight poverty more effectively with no additional cost to taxpayers.
We encourage you to take bold action on climate change. The world?s poorest people—who are least responsible for climate change—are often the hardest hit by its consequences. Climate change is likely to increase economic and social instability, migration and refugee crises, and conflict over natural resources, and is quickly becoming a major driver of poverty and instability around the world. It is essential that your administration re-engage in international negotiations for a post-2012 agreement that includes significant cuts in emissions and additional funds to assist developing countries adapt to climate change. World leaders cannot create the next international climate agreement without US leadership. We also urge you to help bring about strong US legislation that not only dramatically cuts US emissions, but also provides significant assistance to poor and vulnerable communities.
Internationally, numerous conflicts continue to ravage civilian populations. We ask that you serve as a leader in prioritizing the protection of civilians in foreign assistance programs and cooperating with allies to remove obstacles to peace and stability. Yours is a unique opportunity: to build a 21st-century State Department by doubling the number of core diplomatic personnel and moving more personnel to potential and ongoing conflict zones. We know that we can rely on you to work closely with Secretary of State Clinton to achieve this vision.
In the US, we encourage you to turn your attention to the failed recovery of the Gulf Coast following Hurricanes Katrina and Rita. The inadequate US response to the desperate calls of her own citizens must not continue. Your administration can restore faith in government by helping to provide quality jobs and affordable housing for the low- and moderate-income families still unable to return to their former lives.
We look forward to working with you and members of your administration. We firmly believe that your leadership can help to improve the plight of millions of people who suffer from hunger, injustice, and violence around the world.
Sincerely,
Raymond C. Offenheiser
President, Oxfam America
The song,"Cholera—Chenjerawo," which translates as "Cholera—Beware," will be played on radio stations across the country every 30 minutes. Performed by a group of musicians calling themselves Artistes for Health, it's the brainchild of some of Zimbabwe's top performers including Tanga Wekwa Sando and Oliver and Sam Mtukudzi who wanted to do something to help stop the rapid spread of the epidemic—the country's largest recorded outbreak. Cholera has now affected every province in Zimbabwe. More than 33,000 suspected cases have been reported and the disease has taken more than 1,600 lives.
The first cholera case was reported in August in a suburb of Harare. This week, at a meeting attended by government ministers, provincial governors, traditional chiefs, health experts, the commander of Zimbabwe's defense forces, diplomats, and the media, the government announced what it called a nationwide blitz to control, cure, and eliminate the disease.
"Information is the greatest tool in fighting this epidemic," declared Dr. Edward Mabhiza, permanent secretary at the Ministry of Health and Child Welfare.
The plan is to recruit as many as 20,000 volunteers to help spread messages about good hygiene. Radio jingles and messages in the papers and on television will be used in the campaign. Pamphlets and posters carrying information on how to prevent cholera are to be distributed everywhere, from beer halls to church entrances, and everyone, from provincial chiefs to soldiers, is being urged to play a part in the national effort.
Theatre groups will be also enlisted. Oxfam is already using drama groups to promote key health messages as it distributes hygiene kits to vulnerable communities across the country.
Using music, theatre, dance and humor, the groups entertain the crowds. But it's entertainment with a message, as the shows also highlight the need for careful hand washing and food hygiene.
Yet even the government, which acknowledges there is still some way to go before it can declare the epidemic under control, concedes that it needs more than educational messages to fight the cholera epidemic.
The country's sewage systems have broken down. Rubbish is no longer collected and piles up rotting on streets. Hyperinflation has caused many health workers to stay away from work, unable to live on their salaries which are paid in rapidly devaluing Zimbabwean dollars. More boreholes need to be drilled to provide clean water sources for communities. And many Zimbabweans are struggling to feed themselves.
There are worries that the epidemic could spike with the approach of the peak season of heavy rains which could spread contamination to shallow wells. There are also concerns about flooding and the movement of infected people within Zimbabwe and to other neighboring countries.
Education, though, can go a long way. And the call for action to mobilize the nation is an important step forward.
]]>2008 was an especially grim year in Zimbabwe—and prospects for the coming year seem little better. The fact that Zimbabweans were celebrating the new year at all might seem surprising. But many people, or at least those with some money living in the cities, were in the mood to party, if only for a night and to forget their worries.
Zimbabwe is gripped by economic collapse. Hyperinflation, the worst in the world, has seen prices skyrocketing, making it hard for many to access food and fuel. Last month, the country's central bank introduced a 10 billion Zimbabwean dollar banknote, but its actual worth, about $10 US dollars on the black market, is rapidly decreasing day by day. Most shops now only accept foreign currency not Zimbabwean notes.
On top of the economic meltdown, which has seen doctors, teachers, and most government staffers staying away from work because their pay in local Zimbabwean dollars won't even cover their crippling transport costs, there is a serious and worsening humanitarian crisis.
A cholera outbreak in August has now affected more than 30,000 people, and claimed the lives of more than 1,600 people, with cases now being reported across every province in the country.
Cholera is an easily preventable and treatable waterborne disease. But its spread in Zimbabwe is being fuelled by the collapse of health, sanitation, and water services. There are limited medical supplies and many don't have access to clean drinking water or proper sanitation. The onset of heavy rains this month is worsening an already alarming situation.
A second humanitarian crisis, still under-reported, is the worsening malnutrition and food shortages. There have been several years of failed harvests; a serious shortage of seeds and fertilizers; and driving hunger is forcing many to eat seeds instead of planting them for next year's crops.
The UN has warned that around five million people, more than half of the population, will soon rely on food aid.
The country is also facing political deadlock. Efforts to form a power-sharing government between the ZANU-PF party of President Robert Mugabe, who has been in power since 1980, and the opposition Movement for Democratic Change, have stalled.
I got a somber insight into many of the problems the country was facing as I visited Kadoma city in central Zimbabwe, about 112 miles west of the capital, Harare.
Oxfam has been working in the area, drilling wells so that communities can access safe drinking water, distributing hygiene kits, and undertaking health promotion work.
The health authorities have reported nearly a thousand cholera cases since mid November, with 29 deaths. Unofficial statistics put the figure even higher.
Two people had died that day; and I was shown a tent containing the wrapped corpses of seven bodies, several of which had lain there for several days and were swelling. Fuel shortages and rocketing prices meant that there were no vehicles available to take the bodies to the local cemetery.
"Things aren't stabilizing," said one nurse. "They're getting worse. We're seeing more patients every day."
With early access to treatment—intravenous fluids and oral rehydration—patients can recover quickly and be discharged within days.
But a visit to a nearby housing estate—described as a cholera "time bomb" by a senior health official—made clear why the epidemic is sweeping across the country.
The sewage system had broken down, and residents were disposing of human and other waste in the narrow lanes around their homes.
Those images haunted me as I sat in the jazz bar that night. Zimbabweans might have little to celebrate, other than surviving another difficult year; but they are still pinning their hopes that the coming year might bring some change for the better.
]]>— Padmanaban, farmer of Sengapadai
The farmers of the village of Sengapadai, India, make it their business to know what's coming. They are fortune-tellers of sorts, who look deep into history in order to forecast the future. Using methods that have evolved over thousands of years, they watch the movement of the stars, notice the feel of the wind on a given day of the month or year, and carefully observe the behavior of plants and animals. At the heart of the mysteries they set out to unravel each year is this: When will the rains come?
If they miscalculate, the consequences can be grave. In years past, it has meant families postponed not only weddings but also medical care. Sons and daughters have dropped out of school, ending their formal education. They've pawned their jewelry, which represents their savings—even the necklaces that symbolize their marriages. And, says 51-year-old Jakkammal, "In a bad year, there's only one meal a day."
The specter of bad harvests looms larger than ever these days because, as one farmer put it, "We are not getting proper rain."
Rains are coming when they shouldn't and not coming when they should, and the traditional forecasting methods, unable to adapt to the speed of change, are losing their power to predict.
"There's been a vast difference in rainfall patterns in the last 10 years," says Jeeva Rathinam, another farmer. "Before that, we used to plan properly and plant one kind of seed in the fields. Now we have to mix them together and see what comes up."
"The rainfall variations these farmers are seeing now are defeating their knowledge of the way nature functions," says Hari Krishna, Oxfam's research program manager in India.
Climate change, in other words, has come to Sengapadai.
The DHAN Foundation's ACEDRR, an Oxfam partner, has set out to help communities adjust to the changing climate landscape. Researcher B. Arthirani, herself the daughter of farmers, gathered and analyzed 40 years' worth of local rainfall data, and on a sweltering day in May 2008, the farmers of Sengapadai came together to learn the results.
Rains that once fell here predictably in July, she told them, can now be expected to arrive in late August. Then she made a proposal: delay sowing peanuts until between Aug. 10 and 16.
A heated discussion followed. Shifting to accommodate the rains could make some crops more vulnerable to infestations of weeds and pests, and the farmers argued pros and cons of various plans. But an hour later, everyone had come to agreement: the best way to balance all the factors would probably be to plant corn in September.
This is not research as it's conducted at universities, where academics carry out studies at a comfortable distance from actual farmers, and where recommendations are conveyed to the villagers in top-down fashion. That day's discussion, which began with Arthirani's educated guess about what to sow when, ended with a practical plan that drew on knowledge from both inside and outside the community. The ACEDRR study, says Arthirani, "is not a one-way process."
Community members are not simply considered beneficiaries of the study, explained Hari Krishna. "Here, they are partners in the research. They know best about their soil, their sky, their water, and what crops suit their needs."
Outside the meeting place, a heifer nosed along the roadside looking for something to graze on, and a bullock cart passed by with a load of fodder. Women headloading firewood and water walked along the dusty main street in the fierce midday sun, and in the distance, a man stood knee-deep in a pond, splashing water on his team of bullocks after what had probably been a morning of hard labor in the fields.
Fossil fuels and all their labor-saving pleasures seem to have bypassed this village entirely. There were no cars or tractors in sight, and despite the scorching temperature, no one was heading home to air conditioning or refrigerated drinks. It is a painful irony that many of those who have done least to bring about climate change are the most vulnerable to its effects.
DHAN is tackling that vulnerability on two fronts: the disaster-oriented research of ACEDRR is helping ensure that changing rainfall patterns don't lead to catastrophic crop losses, while DHAN's development programs are building resilience in other ways—helping those same farmers organize themselves into self-help groups that enable savings and investment; creating federations that have clout in the marketplace; and helping farmers gain access to high-quality seed, affordable insurance, and lenders that charge two percent interest instead of ten.
It is an approach that is working. By November it was clear that the shift from peanuts to corn was a big success. But there are signs everywhere of the growing security of this community—most convincingly in the confident smile of Jakkammal. The days of one bad harvest plunging the community into debt and hunger, it seems, are over. "After joining DHAN," she says, "we are able to have three meals."
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