Zimbabwe's cholera rages out of control

Despite Zimbabwe President Robert Mugabe's claims in December that “cholera had been arrested,” the numbers of patients being diagnosed with and dying from cholera continue to grow. More than 65,000 cases have been recorded in Zimbabwe, and more than 3,300 people have died since August.

“The cholera epidemic is not yet under control,” the World Health Organization (WHO) warned in its weekly epidemiological bulletin. The report went on to warn that the death rate remains high — on average, more than 5 percent of those infected have died. In what epidemiologists call a “well-managed outbreak,” only 1 percent of those infected will die.

Although Mugabe instituted a ban on foreign aid activities in Zimbabwe last summer, he recently rescinded that order. Now the country is dependent on help from abroad in managing its cholera epidemic.

United Nations Secretary-General Ban Ki-moon announced on Feb. 2 that Mugabe has agreed to allow a delegation of experts into the country to study ways to control the epidemic. It is increasingly clear that international assistance is needed.

The strain of cholera in Zimbabwe has spread to South Africa, Mozambique, Zambia and other neighboring countries.

Of Zimbabwe's 235 cholera treatment centers, more than half are run by a consortium of international organizations under the auspices of the WHO. These organizations have brought in supplies and are treating the bulk of the country’s cholera patients. Medecins Sans Frontieres (Doctors Without Borders), one of these organizations, has treated more than 40,000 patients in their centers throughout the troubled nation.

“When we arrive, people are lying dead on the ground,” said Marcus Bachmann, the emergency coordinator for MSF’s effort in Zimbabwe. “You step over dead people to get to those you can still help.”

And before the doctors and nurses of MSF arrive, 15 percent to 20 percent of people are dying in these rural healthcare centers that lack the sanitary facilities or the needles to administer intravenous fluids. In most cases, there are no doctors or nurses either: Many have walked off the job after months without pay.

Within 24 hours, however, the situation is dramatically reversed. Only 1 percent to 2 percent of those sick with cholera die of the disease under MSF’s care.

Such a reversal is possible because the treatment for cholera is so simple. The treatment is not even a drug — it is just hydration.

The diarrhea typical of cholera is so severe that people become dehydrated to the point that kidneys shut down, along with other organs, and they quickly die. People can die in less than a day — or in Zimbabwe, in less than the amount time it takes to reach a treatment center.

The WHO estimates that 69 percent of the dead in Zimbabwe’s outbreak have died outside of treatment centers, not surprising in a country where the nearest facility may be 20 miles away.

If patients can reach a treatment center, doctors treat cholera patients with oral rehydration therapy — an amped-up version of a post-gym Gatorade, in much larger amounts — which patients can drink in water if they are well enough, or received intravenously.

“In practice, the treatment is rather simple, but the patient needs to reach a cholera treatment center in time,” Bachmann said.

Deaths due to cholera are particularly tragic because they point not to a medical or scientific failure to find a cure, but to a government’s inability to deliver basic services to its people. Cholera flourishes in states where essential services are impossible to come by.

The situation in Zimbabwe is desperate. Raw sewage runs down the streets because of broken sewer pipes, municipal water supplies broke down long ago and rampant inflation means that few Zimbabweans are able to buy basic goods like food or water.

“There’s no water to flush the toilet. There’s no water to wash your hands,” said Bev Clark, a Zimbabwean blogger who lives in Harare, in an email. “The place where rubbish [is] put from all the offices and the restaurant in our block builds up and stinks. Children play nearby. Lately we have been told to bring in bin liners and remove our own rubbish. But where to?”

The WHO reports that many holes made in the ground to access water are contaminated, even those connected to the cholera treatment centers that the organizations have set up. Clean water is hard to come by for everyone.

In her blog, Clark describes seeing people standing in long lines outside of those houses that have water-holes, hoping to collect enough for the day. “I drove past a sign on Enterprise Road recently. It caught my eye because in big red letters the word BEWARE jumped out at me,” Clark wrote. “The sign advised that most bore hole water in Harare, and the rest of Zimbabwe, isn’t as clean as we need it to be.”

The lines of people at the holes remained, regardless of the warning.

More GlobalPost dispatches on health issues:

Anatomy of Zimbabwe's cholera outbreak

 (This article was updated on Jan. 9 to show the increased number of people treated at MSF clinics.)

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