By Julia Newton-Howes, the chief executive of CARE in Australia. She is currently visiting CARE projects in Zimbabwe. The cholera epidemic in Zimbabwe so far has affected 70,640 people and caused the death of more than 3,400 persons (WHO figures, as of February 9th, 2009).
Flies, faeces and hand washing
Visiting a cholera camp in Zimbabwe can be frightening. Housed in a small, colonial era hospital, temporary barriers of orange plastic netting have been set up everywhere to make sure I have to go through foot dips and hand spraying with chorine solution as I pass through the different parts of the hospital.
‘I was here on my own’ said the head nurse, ‘all my colleagues have left for South Africa or other places.’ His uniform is immaculate with impressive epaulettes on the shoulder, he looks almost military. He describes how he recently had so many maternity cases that he delivered three babies in twelve minutes.
The first three Cholera cases he saw all died because he did not have enough intravenous fluid.
We go into the hospital, dipping our shoes in chorine solution and having our hands sprayed. In the treatment wards he shows us the equipment received from NGOs like CARE and MSF. Buckets, special but very basic beds, IV fluid, sprays operated by hand pump, are all shown to us, over the past two months the tiny hospital has had 118 admissions.
On maps of the area they have tracked the movements of the cases and pinpointed where they contracted it – mostly at funerals or from collecting water. Many more women than men caught cholera because they are the ones who collect water from the river.
The reduction in the number of patients attending the clinic is testament to the hard work of a young community educator. As the hospital tracked where the people who had come to the clinic had been, he went to the areas on a motorbike, and talked about cholera. With considerable passion he described how flies feed on faeces and then can fly up to two kilometers before landing on someone’s food, vomiting on it, before flying on, small messengers of illness and death. Warming to the topic, he told me to keep my fingernails short, because cholera can survive under them for two weeks.
Traditional funerals involve viewing the body, but in cholera cases this has to be prevented, causing resentment in some families. He was clearly exhausted by trying to deal with bereaved families, explaining how infectious the body was. He personally was attending funerals to make sure the body bag was not opened before burial and the pressure of being at the centre of this tragedy showed in his face.
Travelling around the rural areas, it is really impressive how people have taken on board the messages of cholera – in most places I went to people have stopped shaking hands and instead touch their clenched fists together. Despite this huge success in raising awareness of cholera transmission, there is a desperate need to improve water supply and sanitation in these rural areas; while people are drinking out of the river and using the bush as a toilet, they remain at risk.
The urban areas have been worst hit, particularly when the water in parts of Harare has not worked for months and the water treatment in many places is simply not happening. Economic hardship has made people very mobile, so the entire country is now at risk from cholera.