Bringing critical care directly to communities impacted by cholera

AN innovative community-based campaign against cholera in Zimbabwe focuses on “oral rehydration” and door-to-door awareness raising about protection from contaminated water and food.

In the heart of Hopley Farm in Harare, a silent threat looms large — cholera.

Zimbabwe was hit hard by a significant cholera outbreak that started in Chegutu town and quickly spread across the country in 2023.

By November 7, over 6 000 suspected cases and 136 deaths were recorded, with weekly cases surpassing 500, marking the highest rate since the outbreak began.

In response, the Zimbabwe Red Cross Society swung into gear, leading a comprehensive strategy focused on prevention, containment, and upscaling efforts at the community level in the most hardhit places.

One of the cornerstones was the establishment of oral rehydration points (ORPs) strategically placed in Hopley Farm, providing vital oral rehydration therapy to those in need.

Manned by dedicated volunteers, who also live in the community, these points of care became crucial in the fight against cholera.

The recurring cholera outbreaks in informal settlements like Hopley in Harare underscore the peril of poverty and inadequate urban planning.

With Hopley’s population estimated at around 100 000 people, it is critical to have timely interventions and access to clean water to prevent cholera-related fatalities.

“Initially, the community did not believe that there was cholera,” says Fortune, a Zimbabwe Red Cross Society volunteer leading the team at the ORP site in Hopley.

“Even setting up the ORP site was a problem. But when the community started hearing about and seeing cases of cholera, the ORP site is where they would come to get information.”

Cholera is an acute diarrhoeal illness caused by infection with vibrio cholerae bacteria.

Approximately one in 10 people who contract cholera will experience severe symptoms such as watery diarrhoea and vomiting.

This rapid loss of body fluids leads to dehydration and shock, and without treatment, death can occur within hours.

That’s why water — mixed with other ingredients that help the body retain water — is a critical element in treating those infected with the cholera bacteria.

Bringing rehydration to hardest hit places

The ORPs serve as the primary points of care and the first line of defence for community-level cholera case management through administration of oral rehydration therapy.

Research has shown that 80% of suspected cholera cases (mild to moderate) can easily be managed at community ORPs and may not need to visit a local health facility.

This effectively decongests health facilities, reduces the transport burden on patients and save lives by providing quick treatment.

It also saves lives because people from poor communities sometimes succumb to cholera due to delayed treatment as they often must travel long distances to health centers to get care.

Lack of access to rapid treatment is particularly acute when the healthcare system is stretched thin by outbreaks and facing shortages of supplies and personnel.

The impact has been tangible. Over 1 400 patients have been served at the ORPs in Harare, with many more receiving timely referrals for further treatment.

Lives were saved, not just through medical intervention, but through the spread of knowledge and awareness.

Information also saving lives

Besides providing oral rehydration therapy, the ORPs also serve as information and reporting centres where patients get critical information about stopping cholera transmission and treatment and provide critical reports to health facilities about levels of infection and community readiness for response.

The Zimbabwe Red Cross Society is looking at deploying more ORPs in Harare and beyond as they plan to scale up their response in-country.

The project has also emphasised community involvement and empowerment.

Volunteers conducted door-todoor visits, engaging residents in risk communication and education efforts, turning the community into active participants in their own health.

Communities across the country struggled with limited knowledge and resources, fueling stigmatisation, and making certain groups more vulnerable to the disease, especially in areas like Harare, Mutare, and Buhera.

Knowledge about cholera prevention can also save lives and, again, water also plays a major role.

Exposure to contaminated water or food is a leading cause of transmission while access to safe water — and safe use of water and proper hygiene practices — is the best way to stop the spread of cholera.

At Hopley Farm, this combined approach — called the “Integrated Strategy for Cholera Risk Elimination and Mitigation” — is supported by the European Union and the Finnish Red Cross and serves as a model for effective cholera risk mitigation beyond Hopley Farm.