daniel chigunwe
Recent cholera outbreaks in Harare, Marange and Buhera highlight the fact that this disease can break out unexpectedly almost anywhere, but also that health authorities can bring it under control, especially when they have the co-operation of the communities where it appears.
Cholera is a highly-infectious diarrhoeal disease that spreads when infected faeces contaminate water sources, fruit and vegetables or other food, and sometime even by physical contact.
It is easily curable by suitable antibiotics and correct nursing care can keep a patient out of danger while they are under treatment.
The response by the health authorities has followed standard procedures, stopping or at least minimising contamination, making sure that people do not eat unwashed, but potentially contaminated food, and trying to get those who are infected into a suitable health centre where they can be swiftly treated.
The Harare outbreak was largely caused by the shoddy water supplies within the largest urban area in Zimbabwe and the inability of the Harare City Council to supply enough treated water to all areas, or at least to most areas all the time.
Dodgy sewers do not help, but the main problem is that people take risks in getting water from unsafe sources, or cannot get enough water for full health needs.
The Ministry of Lands, Agriculture, Fisheries, Water and Rural Development, using its responsibility over national water supplies, did convene a recent meeting to isolate on scientific grounds just what were the problems of Harare water.
The list was not short. There is enough raw water in the two main supply dams of Chivero and Manyame, but because the sewer treatment works have had indifferent maintenance and have not been expanded to meet population increases, these two dams are badly polluted. Harare sits within the catchment area of its water supply dams.
The water treatment plants have serious issues of maintenance and replacement of worn equipment, and the polluted raw water means that more chemical are needed driving up costs.
The city council does not spend enough to start with. Many of the mains pipes are corroded or leak or are blocked, so some areas get no water, and a lot of treated water is wasted.
There are even attempts to get residents in suburbs where pipes are in a bad state to pay a lot extra for the repairs or replacement, although this is supposed to come out of the water rates, with consumers only responsible for what happens on their side of the meter.
We are possibly moving towards the point where yet another disaster will have to be declared so that the central Government can move in and at least stop everything getting worse.
The Buhera outbreak, the latest, has been the worst with 157 recorded cases and 12 deaths.
Here there is an extra problem, that the source was a meeting at a shrine used by a religious community that does not believe in seeking medical treatment, seeing prayer as the only response to illness.
Other religious communities also use prayer, but see the prayer being answered indirectly by enabling a decent doctor or nurse to give the right treatment. Here there was an additional problem of contamination of a river.
To show the sort of dangers that can arise, there were a couple of cases in Hwedza, but these two were of people who were at the Buhera shrine. Hopefully they were found in time before they infected anyone else.
The problem of religious communities that refuse medical treatment has always been tricky. Zimbabwe guarantees freedom of religion and even atheists, or at least adult atheists, are allowed to refuse medical treatment.
But there are problem when they religious beliefs put others outside their communities are risk, through a refusal to vaccinate children or a refusal to seek medical attention for a highly infectious disease.
The Ministry of Health and Child Care does have the law on its side for compulsory vaccination and compulsory treatment in these circumstances, where a person’s refusal can endanger the lives of many others, but has been reluctant to use the powers fully, preferring persuasion.
At least that stops people fleeing an area and spreading the infections, or going into hiding and becoming a new source of an outbreak. The problem does not have simple solutions.
At the centre of this persuasion effort are the community health aides, those remarkable women who not only can talk to their neighbours but who can see infections very early in an outbreak and warn the district health authorities.
It is Government policy to continue strengthening these community services and considering the work they are now doing that is a very good policy.
The second reaction to cholera outbreaks is to redeploy borehole drilling rigs to the worst areas, as was seen in the Marange outbreak and to a degree in the Harare outbreak, to ensure that there were safe water supplies in the area.
This is the longer term solution and when all villages have their borehole, an achievable target in a very few years at the rate the boreholes are being drilled, a lot of the risk will be over.
No doubt the central area of the Buhera infection is also getting more boreholes.
Urban areas can have their water problem ameliorated by the extension of the village scheme to urban areas, but in the end getting the city and town councils to do their jobs and supply the water would be more effective with urban boreholes just being a useful back-up.
The very high density of populations in urban areas means that piped water and water-borne sanitation are essential. This is how major cities in the 19th century around the world ended cholera in many countries.
We can do the same, but this requires that we build the infrastructure, which the central Government is doing, and maintain the infrastructure, which Harare for example is not doing.
Eradication of cholera needs to be a regional, continental and global effort, but at least we can do something in out own country.
Online Reporter