On the grounds of a school in Mudzi, a northeast region of Zimbabwe, where a cholera outbreak has now hit more than 30,000 people across the country, a crew of men hop out of a truck, unload their equipment, and within a few short hours have the defunct well they have been dispatched to repair gurgling with clean water once again.
"It was like Superman," says Miriam Aschkenasy, a public health specialist for Oxfam. "They came in. They looked at the problem. And a couple of hours later they had a working pump."
"They" are members of a local organization known as the Single Parents Widow(er)s Support Network, a group Oxfam has joined forces with to combat the waterborne epidemic that has claimed the lives of more than 1,600 people so far.
But the network's concentrated attack stands in stark contrast to the scope of the problem. For Aschkenasy, who has recently returned from a week in the country assessing conditions, a visit to a "sanitation alley" reveals just how widespread the decay of the country's infrastructure is—a collapse that has allowed cholera to sweep through whole neighborhoods.
In Harare, Zimbabwe's capital, Aschkenasy drove by one of the sanitation alleys—a litter-strewn lane into which people sneak at night to relieve themselves now that the toilets in their homes no longer work since the municipal sewage treatment systems have failed. The corrosion of those systems, coupled with poor maintenance of water supplies across the country and a lack of the most basic tools for good hygiene have all contributed to the explosion of the disease.
"In urban environments, people go into alleys like these at great risk to themselves," says Aschkenasy, noting that it is absolutely against the law to defecate in public. They stand the chanced of being arrested.
"But what choice do they have?" Aschkenasy asks. And with no other options, inevitably disease will follow. "It's so clear there is going to be cholera if you're pooping in the streets."
Between now and February, Oxfam will be working closely with the Single Parents Widow(er)s Support Network during this acute phase of the emergency in Mudzi, which also coincides with the rainy season. Among the steps we will be helping the network to take is the rehabilitation of bore holes—wells drilled deep into the ground and lined with casing—so that people can have access to clean water, a critical component in combating the spread of the disease. We will also support the network in monitoring water quality and working to protect open wells from contamination.
In rural areas, poor sanitation can contribute to potential outbreaks of disease. Only 28 percent of Mudzi's population has access to latrines. Many people use the bush as their bathroom, and flooding consequently adds to the danger by washing human waste into water sources, such as rivers.
Additionally, we will be supporting the distribution of soap and water purification tablets to about 30,000 people in Mudzi, and conducting public health education using volunteers. We'll help the network spread the word about the importance of good hygiene via plays and music and through churches and schools.
"One of the problems with water in Mudzi is that it is saline—and scarce. People often resort to using water scooped from river beds," says Aschkenasy. "With such a limited supply of water, it's hard to convince people to follow good hygiene practices, like using water for hand-washing, when there is so little to consume."
Following the emergency response, next steps will focus on preventive measures, including the possibility of establishing a diarrhea early warning surveillance system to catch cases of the disease before it becomes epidemic. The plan is to model the system on one Oxfam has already established in Ethiopia to detect early signs of drought and the severe problems it can trigger for families. The Ethiopia model relies on regular check-ins with households and a list of questions that reveal exactly how they are doing.
"The network is looking forward to doing something pro-active and preventative once this emergency is over," Aschkenasy says.
Clinics in tents
But for the moment, all energy is being focused on stopping cholera from spreading further. And two of the clinics Aschkenasy visited in Mudzi left her feeling hopeful. Both were set up in tents. "They were very well run," says Aschkenasy. "They were set up appropriately with disinfectant stations, hand-washing stations, and feet-cleaning stations."
But still, it was clear that some of the people the disease has struck have a long road ahead, particularly in a country where food shortages are rampant. Some aid workers expect that come January, about five million people—nearly half of Zimbabwe's population—will be in urgent need of food. People already weakened by hunger will have a harder time fending off the cholera outbreak.
In one clinic, Aschkenasy snapped a picture of two young boys sitting on the floor of the tent in which they were recovering. Both were thin, and neither smiled when she pulled out her camera—a troubling sign.
"Kids always smile when they have their pictures taken," Aschkenasy says. "These ones didn't. And that's a sign of how sick they were."
Adding to her concern was what she saw on the drive from Harare to Mudzi.
"One of the things I noticed were the acres and acres of unused farmland," says Aschkenasy. "This used to be the bread basket of Africa. They used to export food to other areas of Africa."
The decline in commercial farm production has added to the profound hardship Zimbabweans are now experiencing because of hyperinflation and massive unemployment.
With a severely weakened economy, the infrastructure crumbling, and hunger looming, no one in Zimbabwe is free from worry about the cholera outbreak.
"Everybody is susceptible," says Aschkenasy. "If you drink the water and it has cholera and it has a big enough load, it doesn't matter who you are or where you are, you'll get sick."