At the beginning of 2009, Helen Hawkings spent six weeks in Zimbabwe as part of the British Red Cross mass sanitation emergency response unit. While there, she kept a diary about her hygiene promotion work with communities affected by the cholera crisis. The situation in Zimbabwe was critical, cholera claimed almost 4,000 lives and the total number of cases was more than 87,900.
Wednesday 14 Jan 2009
©InfoHaving closely followed the current economic crisis in Zimbabwe, and now watching the country suffer from the largest cholera outbreak in Africa for over 15 years, I am excited to have the opportunity to see first hand what is really happening on the ground.
I will be here for a month with three colleagues from the British Red Cross mass sanitation emergency response unit (ERU) supporting the Zimbabwe Red Cross with their cholera response programme.
From the beginning of the outbreak last August to our arrival in Harare, 1,912 people died of cholera and 37,837 cases were reported. In urban areas where the epidemic first hit, people are suffering for long periods without their water supply, which limits access not only to drinking water but also makes flush toilets unusable. The sewage systems are in a state of disrepair and the health service has collapsed, leaving just core teams of dedicated but exhausted staff to work with extremely limited, inadequate resources. The needs here far outreach the scope of what we can offer. We have the capacity to reach just 20,000 people with emergency latrines and hygiene promotion. We will be working in one of the three priority provinces – the Midlands, home to over 1.5 million Zimbabweans.
Before leaving Harare and driving to Gweru, we stop at a restaurant where a simple meal cost Z$ 50000000000000! Last August 10 zeros were removed but this has had no impact on inflation rates. Now the South African rand and US dollars are commonly used but the majority of Zimbabweans are paid in Zim dollars which are practically worthless.
It’s raining hard when we arrive in Gweru, our home for the next month. There’s no electricity at the moment but the lodge where we are staying is comfortable.
Thursday 15 Jan 2009
©InfoToday we are going to Gokwe North, the worst-affected district in the Midlands. On the way we drive past a trail of people. Some have walked for many miles while others came in ox-drawn carts to a food distribution. Zimbabwe is in the unenviable position of having the highest rate of inflation in history.
Crop failure and the dire economic situation have led to widespread food insecurity. Trouble with electricity and water supply has led to problems with irrigation and inflation means fertiliser is too expensive for most Zimbabweans. It is thought that over 50 per cent of Zimbabweans need food aid. Also, an estimated 1.3 million Zimbabweans are living with HIV/AIDS – with their compromised immune systems they are also more susceptible to cholera.
After six hours, we finally stop in the middle of a field in Masemu, a rural, very dispersed village. We are here accompanying the Norwegian Red Cross who are putting up a cholera treatment centre (CTC). We work with local volunteers to put up latrines for the cholera patients. We also agree to organise a workshop for local community health workers who will raise awareness about cholera in their communities.
This is the first time the ERUs have been deployed to Zimbabwe. Foreign medical staff are not allowed to practice here without first completing a six-month internship and the majority of experienced Zimbabwe medical staff are working overseas, leaving young graduates with little experience to work in the cholera treatment centres.
Water and sanitation coverage is low here. Ninety-five per cent of people do not have toilets and most people get their water from the river. We pass people collecting the brown river water in 20-litre buckets to take home. Once cholera gets into a community it spreads easily through contaminated water and from person to person. We are told of a woman who had cholera, was treated and felt better but the cholera bacteria were still in her system. She came to celebrate her health with her family and passed cholera on to them. Her sister was living with HIV so her immune system was weak. She died from cholera and at her funeral more people were infected.
As cholera can be spread by shaking the hand of someone with cholera bacteria on their hands, when we meet the healthcare teams and community members, they greet us by touching forearms rather than shaking hands!
Monday 19 Jan 2009
©InfoI had a meeting with the Ministry of Health public health team this morning. The provincial nursing officer is a wonderful, devoted woman who just shines. When we went to help put up the cholera treatment centre yesterday she was there intravenously re-hydrating patients who had arrived and were lying under the trees.The meeting proves to be really fruitful. They ask for protective clothing, boots and gloves, and disinfectant and tell us that hygiene promotion must be our priority. One nurse is already sick with cholera.
People cannot afford to travel to work or eat at work so many have stopped going. Transport fares rise so quickly that when workers travel back to see their families in another town, many do not have enough money for the bus fare to return to work. Food is needed for nurses and patients at the cholera treatment centres – people come to the clinics with cholera but they have no food and the nurses have not been paid and are hungry. Many health workers including nurses are on strike.
Wednesday 21 Jan 2009
©InfoThis morning I sat under a tree outside the rural health centre in Denda (there are currently 23 cholera inpatients here), to have a co-ordination and planning meeting with the local environmental health officer and technician. We are in a field deep in the Zimbabwean countryside.We plan three training sessions with local community health and Red Cross volunteers. The logistics of planning a training session here are quite different from London. A lack of cell phone coverage means that I cannot phone to organise a meeting. Instead I have to drive for hours and hope that the person I want to see is where I think/ hope he/she will be! Then there is the issue of catering. People here are hungry. I need to provide the volunteers with lunch. There are no local shops or catering facilities. I leave money for a goat and some vegetables and I will buy a sack of maize meal and a local soft drink in town 2 hours away. The volunteers will bring their own plates and we will pay someone nearby to bring pots, make a fire in the field behind the vacant school where we will hold the workshop and prepare the meal for us.
Friday 23 Jan 2009
I arrive at the CTC at the same time as a very thin stricken man being wheeled in, draped over a wheelbarrow.
©InfoWe spend the day training 17 Red Cross volunteers about the cause, symptoms, prevention and treatment of cholera. These volunteers will organise meetings and events in their communities to share this information with the nearby villages. We then start the long drive back to Gweru.
While we have been training, my colleague Theo has been at a soap distribution. A large part of our work is encouraging people to wash their hands with soap at key moments but many people cannot afford soap during these difficult times.
Tuesday 27 Jan 2009
Gweru has a strong group of Red Cross volunteers. Today we spend a full day training 42 Red Cross volunteers on cholera, disinfection and how to erect emergency latrines! The drama group showcase their new cholera drama, which will form part of our cholera road show.
Wednesday 28 Jan
At a food distribution in Shurugwi, I meet Beauty. Both her parents died of AIDS and she is the head of her household. She lives with her alcoholic grandmother and cares for her two younger siblings. She is just 10 years old, and has come to collect food and soap.
Sunday 1 Feb 2009
The Norwegian team have been asked to set up a CTC (cholera treatment centre) at Mbezo Health Centre. We accompany them to provide latrines, disinfectant and cholera awareness.
The scene we met as we walked into the health centre was unforgettable. The room with four beds, one in each corner, was filled with 28 patients lying next to each other mainly on blankets on the floor, the healthier ones sat leaning up against the walls.
In the centre of the room were two bodies wrapped in black bin bags taped with brown tape and a paper luggage label as if they were ready to be mailed to the mortuary, an adult lying next to a small child. In between two other patients, there was another corpse covered with a red blanket. The nurses were overwhelmed. The team carried the two bodies out, swiftly followed by the third that they had put in a body bag.
All the cases at the centre have come from Tiger Reef mine, 19 kilometres away, so we drive over there to see if we can do a cholera awareness session.
The situation at Tiger Reef was worse than I expected. I sat down with a group of women who talked about their living conditions. They have had no running water for months, and they all get their water from the river or from two pits full of rainwater. It is possible that the metal factories upstream poison the water. The public toilets they used to use are flush toilets, so with no running water they are full of excreta. There have been 131 cases of cholera reported here in the last five days, and eight deaths. Some of the women have started boiling the water but with no electricity all cooking requires extra time searching for firewood.
After giving a senior village member a loudhailer he walked around inviting people to gather at the bus stop to hear us talk about cholera. I counted over 500 men and women gathered. People are hungry, the mine is closed so they have no work, no latrines or water or electricity, and so their questions turned into a venting of their frustrations at us. I could not promise things I didn’t know whether we would be able to deliver, I just stressed that we were there to give them information that could save their lives over the next few days and that even in their desperate situation there are measures that they can take to protect themselves and their families from cholera.
Tuesday 10 Feb 2009
We travel along a dirt road for what seems like forever until in the middle of deep woodland, we arrive at Menene Hospital in Mberengwa. We go to a local school which currently is home to more cows than children. The teachers have not been paid so children have not attended since last year.
The group of Zimbabwe Red Cross volunteers that we had expected to attend our workshop did not appear, so our drivers went in search of the community health workers, some of whom were out working in the fields. Eventually over 30 people came to the training but their knowledge is much lower than the Red Cross volunteers who we usually train. They learned that cholera is not an airborne disease and that hospital treatment is usually not necessary. The day ended with plans of how they would take the information they had learnt back to their communities.
Wednesday 18 Feb 2009
Back at Tiger Reef, after our initial visit much has changed. Some of the temporary latrines we provided are being used, the rest will be erected in the next few days.
The mine management brings drinking water in every day by truck, and today we distribute soap and jerry cans so that people can wash their hands and store their drinking water safely. I talked to one of the guys I had met 10 days ago at the Mbizo clinic. The last time I saw him he had a drip in his arm – he had been very weak and had spent a week at the clinic. He is now looking happy and healthy and wanted to say thanks to the Red Cross for helping him.
Saturday 21 Feb 2009
I have been here for six weeks, and while the number of cases of cholera does finally seem to be decreasing, the outbreak is not over yet. The original worst case scenario of 60,000 cases has already been exceeded.
To date there have been 83,631 cases and 3,879 deaths reported. We have trained 437 Red Cross volunteers and health personnel in cholera response. The trained volunteers have since reached over 28,000 people with hygiene promotion activities including road shows, community cholera talks with practical demonstrations, home visits, church visits and school cholera awareness sessions.
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