EDITORIAL COMMENT: Cholera can be defeated, we have to act responsibly

The present cholera outbreak in Zimbabwe broke out just over six months ago and despite some major efforts to finish off the chains of infection it is still with us, although the public health efforts have cut infection and death rates.

Almost every year there is the odd case reported from Manicaland border areas, but usually this is isolated very quickly and does not spread.

This year it did, with an epicentre developing in the Murambinda area of Buhera District, with the worst affected population being a large community that for religious reasons does not accept medical treatment, vaccination or even natural causes of many diseases.

Buhera has almost a third of the cases in the outbreak.

This has made control very difficult. In theory, under the Public Health Act, when a listed serious communicable disease breaks out the Government has the powers to enforce treatment and hospitalisation, along with vaccination and quarantine if these are pertinent.

Cholera is listed in the Act, but other diseases can be added, as we saw when Covid-19 was added to the list three years ago and then a lot of measures were put in place to slow and stifle transmission rates.

But the problem of heavy-handed enforcement, especially within a large community of like-minded people, is that they will refuse orders, and may even go into hiding if they feel their religious rights are being infringed.

So persuasion and provision of services, such as safe water, have been found to be the best solutions.

While 41 districts have now had cases, in most it has been tightly contained and in most cases was one or two steps from the Buhera outbreak.

The saddest thing about the present outbreak, with 63 deaths and 2 411 cases in easily the worst affected province, Manicaland, is that cholera is curable with antibiotics and no one need to have died if they received treatment promptly.

It is also easy to prevent. The only means of transmission is through drinking water or eating food contaminated by faecal matter of an infected person.

Contamination is not just that contaminated matter flowing into a well or river, or covering food, there is also possible transmission if an infected person with poor hygiene has this contaminated matter on a hand that then transfers it another person who does not wash before preparing food or a drink.

Prevention is largely making sure water is safe, either because it comes from a protected source, is chlorinated water from a local authority, or has been treated.

Even a few drops of bleach in a bucket of water will render it safe. Food can washed, hands well washed and generally good hygiene maintained.

This week the campaign is being stepped up. Eight more boreholes are to be drilled promptly in Buhera, more medical staff are being sent into the district, including more doctors, and the education on hygiene, which does not infringe beliefs, is being stepped up.

Gatherings are largely banned, with funerals to be supervised, the supervision probably extending to the ensuring any water or food is safe.

At the same time cultural practices which include open defecation, the use of rivers and streams as toilets, and religious leaders ritually washing sick people in a river, especially the Save, have to end.

There is a sort of deadline looming, with the rains coming and that will mean better flows in rivers and streams, bringing water to many, but also allow germs to spread. It would be better if there was no cholera when that happened.

Infection occurring outside a single family home in somewhere like Harare, and there have been cases initiated by someone infected outside, should not happen.

That means that the water supply, the sewer system and the removal of rubbish and waste has be sorted out, measures the Government is now moving in to have done if the council cannot do it itself, as legally it is supposed to do without interference.

This is how cholera was defeated from most parts of the world from the later decades of the 19th century and into the 20th century. It used to hit most cities in almost all countries during hot weather, and was mistakenly thought to be caused by a miasma rising from the ground and so there was nothing that could be done.

A more intelligent group of medical scientists thought the theory bosh, and that cholera was a waterborne germ arising from mixing contaminated sewage with drinking water. They were ignored, but won through.

In one famous London case a young doctor, noticing that water companies pumping water from upstream of the city, had healthy customers while those taking water from next to the city had sick ones. He smashed the tap feeding water supplies to what he reckoned was the epicentre of the infection, and stopped it dead.

Within a few years in a great feat of Victorian engineering huge trunk sewers were tunnelled and dug through the great cities of the world, sewers that are still operational today, and a lot of money was spent on ensuring that clean and uncontaminated water was piped into first public taps and then homes.

Now the Second Republic is doing the same. The Presidential borehole programme has already made major advances to have safe water in every village, even with the diversion of a rig into Harare because the city council cannot cope, and public health education campaigns have been pressing for some years for proper sanitation. Even the poorest rural family is supposed to have a decent latrine.

It is these basic steps, plus the implementation of emergency programmes such as the one now ordered for Buhera, that will wipe out cholera forever in Zimbabwe, but we still have a hard struggle and we still need to take precautions, and follow the advice.