“The destruction across the capital was stunning, and the sight of countless camps crowded with families gave me a powerful sense of how devastating this earthquake has been for people,” says Oxfam writer Coco McCabe, who recently returned to Boston from Haiti.
The camps are spontaneous, makeshift neighborhoods, marked out by plastic tarps, cardboard, and bed sheets strung between whatever’s there. Posts to hang materials on are in short supply, so people are scavenging wood from the wreckage of buildings.
“I saw one man with a flat, wide board, working hard with a small hand saw to cut the board into narrower pieces that could serve as poles for sheets, plastic, scraps of clothing—anything that might offer the semblance of a wall or roof to give families privacy,” says McCabe.
Plastic sheeting strung from poles may seem like a minimal shelter solution, and it is. But at this moment in the emergency, it’s something that works. Colored tarps keep off the sun and rain and, unlike tents, can be made to fit whatever space and terrain is available – or whatever other purpose they’re needed for on a given day.
Over the next two months, Oxfam aims to boost the supply of sturdy plastic sheeting, providing enough for at least 4,000 families (20,000 people) – a project that includes a cash-for-work component: we are employing local people to cut giant rolls of the material down to size. Families will get two pieces, each six meters by four meters, along with two 10-meter lengths of rope.
Meanwhile, we’re making plans to assemble and distribute home-repair kits to help those whose houses need patching up, not rebuilding.
But when it comes to figuring out if what’s left of your house is a danger to your family, no one should have to rely on guesswork. Oxfam will assemble a team of structural engineers to survey the damage to homes in Haiti and share their knowledge and suggestions with local residents, builders, and officials.
How long will it take for survivors of the quake to make their way from camp sites to temporary houses to real, permanent homes? For many, it will be years. But if donors continue to support the aid effort generously, Haitians will get the support they need every step of the way.
“Building back all that was lost in just a few seconds,” says McCabe, “is going to require a sustained commitment from us all.”
Farmers in Cusco are reporting irregular rains and intense heat. This is affecting their potato and corn crops: in recent years, production has fallen by at least half. The Peruvian Ministry of the Environment corroborated this information in its 2009 National Environmental Study, which revealed that 80,000 hectares (about 195,000 acres) of potato and 60,000 hectares (148,000 acres) of white corn have been lost in the last 12 crop years due to climate change. Livestock farmers also report that new diseases are affecting their animals.
Cirilo Quispe Latorre, mayor and resident of the district of Cachimayo. “Eighty percent of the farmland is seasonal. In other words, if there is rain, we plant. If there isn’t enough rain, we can’t keep planting. I’m a native of this region. When I was a child, there was quite a lot of water in this region. There were toads and frogs that you don’t see any more. It’s a big worry. And if I go up to the mountains around Urubamba, I see that they’re almost black now. I worry and tell my children that those mountains used to be white with snow. Now that I’m a bit older, they’re black. What’s happening? A big change is taking place on our planet. I don’t know who’s going to come and sort out this situation. It’s worrying. The rains used to start in October, and we would plant broad beans, wheat, and potatoes. Now the rains begin around mid-December, and we lose more than a month and a half of growing time. Now, by the end of March the rains are over. It used to rain throughout most of April, with the dry season only starting in May. So, the rain has decreased at the beginning and the end.”
Teresa Rocca Mismi, communal farmer in the community of Chacacurqu. “I have potato and corn crops. There isn’t as much rain. The hail that’s fallen (we don’t normally see hail in this region) is what’s affected us. It hailed in mid-February. For example, the potatoes that should be big by now are just seeds. I don’t know why we’ve had hail this year. The rain used to start in October, now it’s December. This has been happening for five years. We want the authorities to help us.”
Local residents in rural Piura report that changing rainfall patterns are damaging their mango and cassava crops. They also have noticed public’s health problems, specifically the emergence of diseases such as dengue fever (spread my mosquitos) and leishmaniasis (spread by sand fleas). A Ministry of Health employee corroborated this information, confirming the appearance of dengue in populations where the transmitting agent (the Aedes aegypti mosquito) never had existed previously.
Marco Sandoval García, president of the Santa Catalina Peasants’ Association. “When I was a lad, I remember that there would be two harvests a year in the lower rice-growing area. Now there’s only one. I also remember that in my community, we had drinking water 24 hours a day. Now it’s just two or three hours, depending on the rain. All the drinking water for Patachaco used to come from a single spring. Now we have to take it from two springs... There’s a shortage of water... The springs aren’t the same any more. Some of them are drying up. The elders say that the cassava never used to rot and could be harvested throughout the year. Last year, no one harvested cassava because it all rotted. My orange tree was full of blossoms, but then we had a sharp frost and all the flowers fell off. There’s instability. The climate is strange. For example, although it’s winter, we’ve just had seven days of strong sun. Some farmers think this is because there’s been a lot of deforestation of the hills. They don’t know that climate change is affecting the whole world. We’ve caused so much damage ourselves, with deforestation and pollution.”
Katerine Rosillo Quispe, Ministry of Health employee in charge of Health Center 1 in La Huaquilla (Morropón, Piura). “We’ve got high numbers of dengue transmitting agents in the region, which hadn’t been seen before. Those dengue mosquitoes are new for us. In La Huaquilla, the whole population is exposed: children, adults, the elderly. Climate change greatly affects health, especially as other types of pathologies appear, such as diarrhea, respiratory infections, but above all, the dengue mosquito.”
]]>I flew into Mogadishu in a plane full with nine tons of Oxfam aid. We took blankets, mosquito nets, medical supplies, and plastic sheets for families to build temporary shelters. We also took 3,500 buckets: Many of the families who have fled the fighting have lost everything they had, so they can use the buckets to carry clean water and store milk for their children.
At Mogadishu airport, I was met by some of our local Somali partners who quickly unloaded the aid for distribution. We carry out all of our work in the country through partners like them.
People are still fleeing the capital. Every day more buses, vans, and donkey carts carry families out of the city along a road called the Afgooye corridor. In the past few weeks, tens of thousands of people have fled down this road to escape the violence. They are settling in camps nearby, where about 400,000 people have taken refuge in the past two years.
The living conditions in the camps in Afgooye are some of the worst I have ever seen. Families are sheltering in tiny huts, pieced together from plastic bags and sticks. When the rains come, the huts are washed away. Oxfam is about to provide 10,000 new shelters, which will improve the lives of about 70,000 people.
The most urgent need is for shelter, but people also desperately need clean water, food, and medicine. The fighting has had an enormous impact on children's health. One doctor told me that there is so much gunpowder in the air in Mogadishu at the moment that it is making children sick.
When people leave the city and arrive in camps—which are so basic and overcrowded—diseases can quickly spread, and there are few health services. I saw young children lying on the floor of the shelters, too ill to move. Many children are suffering from diarrhea and cholera. Oxfam has helped set up an oral rehydration treatment center where mothers can bring their children for help. Oxfam has also distributed mosquito nets to mothers to help them protect their children from the spread of malaria.
To help address the critical need for water, Oxfam recently expanded its water system—which features large, circular holding tanks—to reach an additional 78,000 people. In total, we now provide water to more than 200,000 people in Afgooye—and we hope to increase the supply in the coming months. Despite these efforts, the need for water remains huge. People line up for hours to get clean water.
But it was the terrible condition of people's shelters that struck me most.
"Our biggest problem is shelter," Halima Abdi, a mother of six children, told me. "If people see this house and the conditions that we live in they will be shocked. It is raining heavily during the nights. Without shelter it is a disaster for us. My children are sick and I'm worried what will happen to them. They don't have enough water or food either.'"
]]>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.
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.
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.
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.
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.
]]>Working closely with Sri Lankan partner organizations, Oxfam is providing primarily clean water, sanitation and public health assistance to families arriving in government-controlled areas, as well as cooked food and other essential relief items. Plans are in place to assist up to 60,000 more.
However, over 50,000 civilians may still remain trapped in a small, heavily crowded rebel-held enclave in northeast Sri Lanka, where humanitarian conditions are now catastrophic. Hundreds have been killed or injured in the past few days. Children are dying of untreated wounds as well as a lack of clean water and unhygienic conditions.
Both sides must pause in their battle to allow trapped civilians to leave safely and for humanitarian workers to reach the sick and wounded, said Oxfam.
"For each day that passes without at least pause in fighting, civilian families are paying with their lives," said Joan Summers, Oxfam Country Director in Sri Lanka.
Oxfam calls on both parties to the conflict to fulfill their obligations under international humanitarian law by permitting safe civilian evacuations and humanitarian access, respecting the lives and neutrality of all non-combatants.
Oxfam urges the Sri Lankan government to fulfill its obligations under national laws and international humanitarian law by ensuring the humanitarian relief effort is increased rapidly and significantly, allowing both national and international aid workers safe and unhindered access to affected families.
Oxfam also urges the international community to help affected civilians by pressing for a humanitarian pause in the fighting by and supporting efforts to provide the 250-300,000 Sri Lankans displaced by the war with both adequate emergency relief and longer term recovery assistance.
Oxfam has been working closely with local partners to provide safe drinking water, sanitation facilities such as latrines and hygiene kits, emergency shelter, and other essential items to thousands of displaced civilians. Our relief activities have been targeting the most vulnerable civilians such as women and children.
]]>Trees provide shelter from the blazing sun, traditional medicines, building materials, firewood, and food. So, it was fitting that a group of 30 women chose to gather beneath a tree in Welgeval village, South Africa, in 2002 and decided they had to take action.
"When we became aware of the deadly effect of HIV and AIDS in our community, we realized we had to do something," says Itumeleng Modimola. "It was not easy when we started; people were not used to the idea of caregivers and because of the stigma around HIV and AIDS, people would pretend they were not at home when we came to visit."
But the women persevered, and in 2006 their efforts were rewarded when the local traditional council offered them land and a building as a base for their organization. Today Modimola is the manager of Pholo Modi Wa Sechaba, a thriving community-based HIV/AIDS project in Welgeval in South Africa's North West Province. The organization—whose name means "health is the root of the nation" in the local language, Setswana—is dedicated to overcoming the devastating impact of HIV/AIDS in the local community.
South Africa has the world's largest number of HIV infections—an estimated 5.5 million of the country's 48 million people live with HIV. Women are hardest hit. In 2005, one in three women in South Africa aged 30–34 were living with HIV.
Every day the Pholo Modi Wa Sechaba site is alive with activity as children from AIDS-affected families crowd into the small day care room and spill out onto the dusty playground. In the afternoon, they are joined by their elder siblings and other schoolchildren for a healthy meal and supervised afterschool activities where they learn life skills—such as how to prevent HIV/AIDS. The once-barren garden is now green with tidy rows of vegetables. The foundation and walls of a new community center are taking shape nearby, the material and labor provided by members of the organization.
Pholo Modi Wa Sechaba runs a support group for people living with HIV/AIDS and has 20 caregivers who provide home-based care services to almost 300 families in four villages. It is a member of the AIDS Consortium, a South African national umbrella organization that helps community groups struggling to provide services for people living with HIV/AIDS. A grant from Oxfam America is helping the AIDS Consortium extend its reach to the North West Province, where Pholo Modi Wa Sechaba and some 100 other community organizations will get additional training to raise and manage money, design and carry out better community programs, and train their staff.
With the AIDS Consortium's help and growing awareness about HIV/AIDS in the community, Modimola says her organization is making progress.
"The situation has changed for the better; people are more aware of HIV and take informed decisions to protect themselves and their families. But we still have a long way to go. Government and other partners need to increase access to anti-retroviral [ARV] treatment and health services in our area," says Modimola. "While we are doing the best we can with limited resources," she admits, "training and retaining caregivers...is an ongoing challenge."
Modimola has built strong partnerships with the local clinic, tribal authorities, and government departments. Pholo Modi Wa Sechaba receives an annual grant from the provincial government to provide food to 60 families and a monthly stipend for the caregivers. Once this grant is depleted, however, Modimola predicts many caregivers will be forced to quit; they cannot afford to work without pay.
Local caregivers provide a vital service to the community and fill the gaps in the national health care system. Often they are the first to identify members of the community who may have become infected with the HIV virus and the last line of care for those with AIDS. While ARV treatment and hospital care is the responsibility of the state, there are not enough doctors, nurses, and hospitals to cope with the spread of the disease.
Like the tree beneath which Pholo Modi Wa Sechaba was founded, Modimola and local caregivers serve as symbols in their community. Their steady commitment in the face of challenges has given strength to many.
]]>That was 15 years ago. Today, clean water in the small communities of El Recuerdo and Agua Zarca is as precious as ever—and still hard to get. There's no turning on the tap over a kitchen sink and letting the gallons gush. Here, many people trudge to a communal source, fill their jugs, and lug the heavy load home again. But seasonal flooding—sometimes hugely destructive and, with climate change, possibly becoming more severe—contaminates many of the area's hand-dug wells, exposing people to waterborne illnesses.
But now, with the help of Oxfam America and its local partner, PROVIDA, the well that Cruz worked so hard to dig on the school grounds in El Recuerdo is pumping enough clean water to satisfy the drinking needs not only of the students but of about 80 families in the surrounding area. The well is one of five "healthy wells" in southern Zacatecoluca province PROVIDA lined, surrounded with a filter, capped to ensure its cleanliness, and outfitted with a pump that sends water to a large tank for chlorination and storage.
"The families in this area are living in extreme poverty, living as subsistence farmers or low paid day laborers in the nearby sugar cane plantations," says Karina Copen, an Oxfam humanitarian program officer. "They face numerous challenges in having to adapt to the increased frequency and intensity of the flooding in their area. With access to a healthy well, they can at least know that in the next flood, they will have a safe source of water for their families and the good health that comes along with it."
Adaptations, such as these healthy wells, are essential for Salvadoran families living in the department of La Paz in the lower region of the Lempa River where seasonal rains, tropical depressions, and hurricanes, make it one of the country's most flood-prone areas.
Coupled with those natural hazards is the fact that communities in the region have significantly less access to improved water sources and sanitation than other parts of the country. The "healthy wells" along with 27 new composting latrines have been a boon to families in the area.
"Kids are getting sick less; families are healthier," says Santos Efrain Coto, one of the local leaders in El Recuerdo. "When they drank contaminated water they got diarrhea and parasites."
The improved wells are based on a model that's new to El Salvador and designed by an organization called Swiss Labour Assistance. Besides having their tops sealed with cement to prevent polluted flood waters from slopping in, the wells are lined with a type of plastic pipe, known as polyvinyl chloride, or PVC, that extends down into the aquifer. Packed around the outside of the lining is a filter of volcanic rock that prevents contamination from seeping through underground.
At the El Recuerdo school one day recently, teacher Ana Elsa Cubias describes how students used to bring their own water from home to drink during the school day. Now, the refurbished well guarantees them a clean supply right on the spot.
"They're drinking water from a protected source and the kids have water right in the classroom," says Cubias.
A short distance from the classrooms sits a large plastic tank, sky blue and able to hold 1,100 liters of water pumped fresh from the well. Chlorinated, the water from the tank flows to two taps standing just outside the gates to the school. They're accessible to whoever is driving or walking by. And to ensure the stored water stays safe for drinking, the water committee arranges to have the tank cleaned every couple of weeks—a task that falls to a child small enough to wiggle inside and scrub the interior walls with a brush and bleach.
"We make sure he bathes before he gets in the tank," adds Coto, the local leader.
In Agua Zarca, a few communities over, Jose Luis Funes Cruze says that before PROVIDA and Oxfam installed the new well, most of the local residents depended on their own backyard wells for drinking water—and that was a problem.
"The household wells take on a lot of rain water and a lot of filthy water when there's flooding," says Cruz, pointing in the direction of the polluted San Antonio River, which spills its banks during big storms. "The things people throw in—there are pigs up river. And the cheese factory is up river."
In the past, when their drinking supply has been contaminated, families in Agua Zarca have had to rely on the government or aid groups to truck in drinking water for them.
But now, with a new communal well their supply of drinking water is much improved.
"We're very grateful—the whole community is—to have that water," says Blanca Lidia Jiménez, who lives close to the well makes about six trips a day to fetch enough water for the seven people in her house. "We don't get sick so much when we drink the water from this well. The little kids would get swollen bellies, but with the new well that problem has been solved."
Still, the situation in Agua Zarca points to the challenges of providing clean water in this area. The community's new well was built on the only land available: next to a cow pasture—an arrangement that could be problematic during the wet season when rain sloshes manure about and allows it to seep into the groundwater.
The deep plastic lining on the well and its volcanic-rock filter help, though, says Guillermo Morán, a professor and researcher at the University of El Salvador's Earth Sciences Institute. He worked with Oxfam America and another of its partners, the Harvard Humanitarian Initiative (HHI), to evaluate the effectiveness of the wells while studying the health practices of families who use them.
The study is an important component of Oxfam's public health work: It promotes accountability and offers a different model for aid groups by linking their work with that of universities.
"We have the field experience and they have the technical expertise," says Miriam Aschkenasy, Oxfam America's public health specialist. "Together we're able to evaluate programs at a higher standard and at one that increases accountability."
In its draft report, HHI said that individuals who live in communities with "healthy wells" were less likely to have diarrhea and reported fewer cases of the illness during the time of the study. But the draft report also revealed that in two of those communities, some people were still using hand-dug wells for their drinking water while other people from places without "healthy wells" were making the trek to a community that had one to fetch their water.
"The study gives us insight in a way we couldn't have anticipated," says Aschkenasy. "It gives us an idea of where to focus in the future. We now know we need to find a way to encourage people who are still relying on the hand-dug wells to use the healthy ones instead. And it gives us great incentive to build more of them."
]]>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.
]]>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."
]]>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.
]]>On this hot August morning in a small fishing village on Sri Lanka's southern coast, he is probing locals for a full understanding of what well-being means to them. He remains serene as they squabble a bit, call each other liars, and offer up whole new categories no one has mentioned before. When a group of men can't agree on a set of criteria, he announces a tie and allows both points to become part of the findings.
Such is the life of a researcher engaged in the ebb and flow of a study that allows its authors to enter into a direct dialogue with the community they are focusing on. The approach is called participatory action research—a method Weerackody believes in deeply. He is applying it to a piece of research intended to expand the understanding of mental health issues in Sri Lankan communities affected by natural disasters or long-term conflict. Funded partially by Oxfam, the study is part of a large, four-year project conducted by investigators from McGill University. This piece is being carried out by the People's Rural Development Association, McGill's local partner.
"People are never given a chance to participate in the decision-making process," says Weerackody. "And this is what we need"
That lesson became all too clear in an earlier study he had helped to conduct on the impact of the aid system on communities affected by the tsunami. People received goods that weren't relevant to their lives, that were of poor quality, that weren't useful, says Weerackody—all because no one had bothered to consult with the communities themselves.
"It's about attitude and the way the colonial system was established," he adds. That system says decisions should be made by technical experts or politicians. "They think people don't know what they want."
Weerackody thinks otherwise.
"If it is decided by someone else, people don't have any feeling it is part of their lives," he says. And aid agencies have enough experience building roads, community halls, culverts, and the like to know quite well what will happen if beneficiaries aren't involved from the start: As nice as the facilities are, they won't be maintained, says Weerackody.
A relocated fishing village in which he has been conducting research recently offers a case in point. The hillside homes, sturdy but small, now house 55 families formerly living near the sea, and a newly built community center at the top of the hill serves as gathering place for all.
"They have a house but they're not happy," says Weerackody. "That house was not spacious. They can't entertain their relatives. They don't have enough place to sleep. One woman said she can't even make love with her husband. The lesson we learn from the study is you may design houses, but what's needed by development workers is to take into consideration other aspects of well-being."
From a rural community himself, Weerackody, who has been working in participatory development since 1982, says he takes pleasure in meeting with local people to learn about their opinions and needs—an important perspective to understand since so much of the country's population is rural. About 80 percent of Sri Lankans live in rural areas, Weerackody points out. And whenever he's got a free moment, he heads out of Colombo, Sri Lanka's capital and his current home, to visit the village in which he was raised.
"I have a strong belief in community consultation," he says. "Development workers should respect the communities and should win the trust and confidence of communities."
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