Patients suffering from cholera rest in a tent ward at Budiriro Polyclinic in Harare.

©Reuters/Philimon Bulawayo

In front of the entrance, a white tent serves as a ward for critically-ill cholera patients, who lie in their beds with intravenous drips attached to their arms. A man with a tank of chlorinated water strapped to his back walks through the tent spraying the floors and walls to disinfect them. Inside the clinic, the antenatal, maternity and other wards are all housing cholera patients.

The outpatient waiting area is overflowing with patients. Some lie on benches or curled up on the floor, while others sit awkwardly, evidently in pain. Those with a little more strength sit up, sipping solutions of oral rehydration salts (ORS) while a nurse talks to them about cholera and hygiene. Meanwhile, two health workers hand out ORS to yet more patients. In front of their table, a man awaits his turn with a bag of intravenous fluid hanging from his neck and a tube connected to his arm.

The ward is lined with benches, all packed with cholera patients attached to intravenous fluid bags hanging from makeshift stands. Some patients are writhing in pain, some are vomiting, while others just lie there, helpless. According to a nurse, "The situation is getting worse. We have a shortage of gloves and other supplies and the number of cases continues to increase." Another member of staff tells us about the upswing in cholera cases. "The clinic screened about 200 patients suffering from diarrhoea yesterday between 5 p.m. and midnight. We treated most of them with rehydration fluids, but we had to admit 57 for treatement." Humanitarian agencies in Zimbabwe report over 9,000 recorded cases of cholera and more than 350 deaths since September.

Medical personnel attribute the resurgence of cholera to a lack of safe water in many parts of the city. Residents in some areas have to fetch water from shallow wells and other potentially contaminated sources. Another factor is the rain. It is the rainy season in Zimbabwe, and while rainwater that has been on the ground is risky, it is also readily available.

At Budiriro polyclinic, the ICRC is providing intravenous hydration fluids, oral rehydration salts, cleaning materials, protective items such as gloves, and other supplies. The organization is also supplying food for the health staff. Since the epidemic began at the beginning of November, the ICRC has provided the eight polyclinics it supports with about 1,000 litres of intravenous fluids, 20,000 doses of ORS, more than 2,500 refuse bags and enough food to sustain 50 health staff for four weeks.

The lack of safe water is affecting the clinics, so the ICRC has drilled two boreholes, at Budiriro and Glen View polyclinics, to provide a long-term solution. Pumps will be installed at the boreholes this week but as a temporary measure the ICRC is delivering water by truck to the polyclinics it supports at Budiriro, Glen View and Rutsanana. Each clinic has been receiving over 5,000 litres of water twice a week since the beginning of November. The polyclinics in Rutsanana and Mabvuku already had boreholes, and the ICRC is renovating them in order to get their water supply systems going again.

Zimbabwe Red Cross Society volunteers are working in the clinics, washing and helping the patients. The ICRC is cooperating closely with the ministry of health and the City of Harare Health Department, and remains ready to support the authorities and coordinate with other humanitarian organizations.

Toilets, blankets and clothing are being sprayed with a chlorine-based disinfectant.

"We are spraying the homes to break the transmission cycle of cholera bacteria. We want to make sure that the disease does not threaten those who are not infected," said Benjamin Jombe from Beatrice Infectious Diseases Hospital.

In addition to disinfecting the homes, the ICRC staff and city health workers advise the families of patients and neighbourhood residents on how to avoid catching the disease. They also identify people who have contracted cholera and take them to treatment centres. In the coming days, they will distribute water-purification tablets, buckets and soap to promote sanitation in affected communities. The ICRC is providing protective clothing, other supplies and transportation for the personnel involved in this work.

On Wednesday the ICRC donated pumps, water-testing equipment and spare parts to the Zimbabwe National Water Authority (ZINWA) at the main water-treatment plant serving Harare and the surrounding area. "The donated equipment will go a long way towards improving the plant's efficiency," said ZINWA Chief Executive Albert Muyambo. Since November 2007 the ICRC has provided support for ZINWA's efforts to stem the spread of water-borne diseases such as cholera through improvement in the quality and quantity of the city water supply.

The ICRC is coordinating its response to the cholera epidemic with partners within the International Red Cross and Red Crescent Movement and other humanitarian organizations. Since September the ICRC has been supporting eight clinics in Harare's densely populated suburbs and 18 other health facilities in rural areas. In addition to improving access to clean water in those facilities, the ICRC has flown in 13 tonnes of medical supplies from Kenya and arranged for two cholera experts to travel from Geneva. Nearly 1,000 lives have been claimed by the disease and about 18,500 cases recorded since August.

Document printed from the website of the ICRC.
URL: http://www.icrc.org/web/eng/siteeng0.nsf/html/zimbabwe-feature-261108

	December 15, 2008
MSF responding to worst cholera outbreak in Zimbabwe in years
Because MSF has been in the country since 2000 running HIV programs, it has been able to react from the ground and quickly bring in emergency cholera response units.
MSF has seen more than 11,000 patients since August in Zimbabwe's worst cholera outbreak in years and has opened dozens of cholera treatment centres throughout the country. Cases have been found in nearly all the country's provinces. More than 500 national and international MSF staff members are working to identify new cases and to treat patients in need of care. Harare, the capital city, has been the center of the outbreak. MSF has treated more than 6,000 people in the densely populated city. A second location, Beitbridge, a town on the border with South Africa, has also been hard hit. MSF has provided care to more than 3,000 people with suspected cases of cholera. "The scale and the sheer numbers of infection especially in Harare is unprecedented," said an epidemiologist for MSF who has worked periodically in Zimbabwe for the past seven years. He explained that the key reasons for the outbreak are the lack of access to clean water, burst and blocked sewage systems and uncollected garbage overflowing in the streets. "The fact that the outbreak has become so large is an indication that the country's health system can't cope," he said. A town on the border with Mozambique, Nyamapanda, also has been affected. When MSF arrived in early November the team found about 150 cholera patients and helped set up one cholera treatment center in the town, as well as four others with the Ministry of Health in the surrounding areas. In total, 1,600 patients have been seen in Mudzi District. Zimbabwe has had major outbreaks of cholera before - it is endemic in certain rural areas - but until the last few years it has been relatively rare in urban areas. The outbreak is particularly worrying as it began well before the rainy season. A major concern is that once the heavy rains start, unprotected water sources will become contaminated, causing the further spread of cholera. The rainy season normally starts in November and continues through March, although the heavy rains have yet to be seen in some areas. Because MSF has been in the country since 2000 running HIV programs, it has been able to react from the ground and quickly bring in emergency cholera response units. MSF is working in two cholera treatment centers (CTCs) which are located in existing health facilities in Harare. In total, the two main CTCs saw more than 2,000 people with cases of suspected cholera in the first week of December. An MSF emergency coordinator in Harare described the situation: "Imagine a cholera ward with dozens of people under the most basic conditions. For instance, there is only a little electricity so there is hardly any light. It is difficult for the doctors and nurses to even see the patients they are treating. The nurses have to monitor multitudes of IV bags to make sure they don't run dry which is also difficult to do in the dark and when there are so many patients." In Beitbridge, MSF has set up CTCs run mainly by MSF staff using supplies shipped in from all over the world. The peak of the emergency was unusually early in Beitbridge, which resulted in a high mortality rate within the first couple of days of the severe outbreak in the town. By the fourth day, however, MSF had established a CTC and the mortality rate eventually dropped from 15 percent to less than one percent. An additional challenge has been that government health workers in certain areas, particularly in Harare, are on strike. This has required MSF to rapidly recruit hundreds of nurses and other staff to handle the influx of cholera cases. Significant time and energy is needed to train the new staff, adding considerably to the workload of the existing staff. MSF has also conducted exploratory missions in rural communities and responded to scattered reports of cholera cases. Low numbers of cases have been found in a number of small villages; MSF established small cholera treatment units (CTUs) where necessary. MSF has eight CTUs in five districts spread over the Manicaland and Mashvingo provinces in the eastern part of Zimbabwe and treated more than 770 patients. MSF will continue to monitor the situation and treat people in the most affected areas, as well as send emergency staff and supplies to various locations in Zimbabwe where new cases arise. "A cholera outbreak of this proportion usually continues for several months," the MSF epidemiologist says. "MSF expects to be caring for cholera patients in Zimbabwe for some time to come." http://www.msf.org/