Cholera: 'This is a human being and should not be treated this way'

"We are refugees in our own country," said Blessing, a young Zimbabwean man as he stared around the field in front of Bindura’s Chiwaridzo Clinic. Lying in the dirt under a scorching sun are 71 cholera patients who local authorities have left outside in the courtyard rather than bring into the empty polyclinic building, right in front of them.

Some patients have found a couple of broken down benches to lie across, while others hide under the side-flaps of some small tents set up. The one open-aired tent that is set up is overcrowded and filthy. But most have no shelter either from the blistering sun or the periodical torrential rains that frequent this time of year.

The cholera crisis in Zimbabwe is far from over. Though, the case load in the capital, Harare, has decreased, outbreaks in mid-sized cities and rural areas continue. The prediction that Zimbabwe would reach the 50,000 mark of cholera cases has been surpassed months ago and the epidemic still rages throughout the country infecting more than 89,000 people, according to WHO estimates from March 8.

MSF has been treating roughly about 56,000 of those patients through its mobile units and by setting up and running dozens of Cholera Treatment Centers (CTC) around the country.

One of the latest outbreaks is in the city of Bindura, in the northeast of Zimbabwe. A week earlier, the local health authorities had considered closing down the small CTC that MSF had helped them set up in front of the clinic. MSF was able to dissuade them, since there were still new patients getting care at the site.

On February 22, the MSF mobile unit came by to check up on the small CTC and discovered that there was a spike in cases, with 56 patients admitted in the camp. In two days there were 71.

The local authorities have refused to allow the patients to be moved inside the available - and empty - clinic building in front of the camp, claiming difficulties of cleaning and disinfecting the premises once the crisis is over. MSF considers that such a number of patients can not be adequately and humanely treated out in the courtyard.

At that time, neither the patients nor the government nurses had any food in this makeshift CTC. Some patients’ relatives are able to bring food but this adds to the dangers of infection since the food is being cooked back at the sites where cholera has broken out. Those patients, though, are the lucky ones since others do not have anyone to bring them food, or their families simply do not have food themselves.

In addition, the food situation is affecting the health staff.

"The morale of the nursing staff is quite low," commented one of the district health officers in a health partners meeting. It is no wonder. Not only has the government nursing staff not been paid for months but now they do not even receive food at their workplace. Despite this, the Zimbabwean government nurses work tirelessly day and night to try and ensure that patients are kept alive.

Case management is difficult under the bad conditions of the site. A woman, 50, died a couple of days after MSF arrived in Chiwardizo, but in the crowded corner none of the staff noticed she was dead until hours later. The deceased was lying among other inert and exhausted cholera victims. The MSF Environmental Health Officers (EHO) had to disinfect and wrap the body in front of the other patients; there was nowhere else to do it.

"How can you treat someone like this," said one of the MSF EHOs. There is no mortuary either in the clinic or, of course, in the camp’s field. The body was set to lie in the corner of the camp next to the patients under the boiling sun. There was nowhere else to store it. Eleven hours pass before it is taken away.

"This is a human being and should not be treated this way," she said, shaking her head sadly.

Since this article was written, local authorities have cooperated in making a football field in the area available for MSF to set up a new CTC there. Ministry of Health authorities have also promised to respond faster to emergency situations and ease bureaucratic constraints.