Up to 1.4 million people are endangered if the outbreak continues to spread.

Up to 1.4 million people are endangered if the outbreak continues to spread.

In Zimbabwe's capital, Harare, Médecins Sans Frontières (MSF) is responding to a cholera outbreak of cholera, which the local Ministry of Health has declared "the biggest ever in Harare". MSF has set up cholera treatment centres (CTC) in Budiriro Polyclinic and Harare Infectious Diseases Hospital, where 500 patients have been treated to date and, on average, 38 new patients are admitted every day. About 78 percent of the patients come from two densely populated suburbs in the south west of Harare, Budiriro and Glen View, which have a combined population of approximately 300,000 people. The outbreak has also affected people from the neighbouring suburbs of Mbare, Kambuzuma, Kwanzana and Glen Norah. Up to 1.4 million people are endangered if the outbreak continues to spread. Since being asked to assist with the outbreak in Harare, MSF has been providing staff as well as medical and logistical resources at both CTCs. Amongst a growing team of over 40 national staff are nurses, logisticians, chlorinators, and environmental health workers. The latter perform an important role in reducing the spread of cholera in the community by disinfecting the homes of those affected; following up contacts of patients; and supervising funerals, where the traditional practice of body washing, followed by hand shaking and eating, is a significant factor in the spread of cholera.

Medical teams are overwhelmed

"At Budiriro CTC, things are getting out of hand," said MSF Water and Sanitation officer, Precious Matarutse. "There are so many patients that the nurses are overwhelmed. In the observation area, one girl died sitting on a bench. The staff is utilising each and every available room and still in the observation area patients are lying on the floor. "A man came to the clinic yesterday for treatment. His wife had just died at home and that is what made his relatives realise this is serious, and they brought the man to the clinic. They wanted to know what to do with the wife's body. People are concerned about catching cholera from others. Health education must be intensified to inform the population." MSF teams face many challenges in the CTCs. "It is a constant challenge to keep up with increasing patient numbers. We are running out of ward space and beds for the patients," said Vittorio Varisco, MSF logistician. "Today patients at the Infectious Diseases Hospital are lying outside on the grass and we are setting up tents with additional beds as an overflow for the wards." Human resources are vital in order to effectively treat patients and contain the outbreak. "Patients need constant supervision to ensure adequate hydration, without which they will die," said MSF doctor Bauma Ngoya. "As patient numbers continue to increase we must continue to recruit and train nursing staff."

A new urgency

Cholera is no new phenomenon in crisis-shaken Zimbabwe. In some of the rural areas of the country cholera is endemic and occurs every year. However, until recent years cholera was relatively rare in urban areas of the country where treated, piped water and flush toilets exist in most homes. With the ongoing economic crisis and the constantly deteriorating living conditions these urban areas are more and more affected. The disease is water-borne and transmitted by the oral-faecal route, and thrives in unsanitary conditions. Run-down infrastructure, burst sewage pipes and water cuts are mainly responsible for the outbreak, as they force people to dig unprotected wells and to defecate in open spaces. During the rainy season from November to March, heavy rains effectively flush standing sewage into unprotected wells. That the recent outbreaks of cholera have started before the rains are a clear indication of the deteriorating sanitary conditions and shortage of clean water, and a worrying sign with the rainy season just starting.