The letters on the printed warning were small, but the string of exclamation points that followed shouted with alarm: Cholera outbreak!!!!!!!!!!
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.
Fist bumps replace hand shakes
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.
A clinic in Makaha
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.
Haunted by hunger
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.