We can’t continue to treat cholera as ordinary infection

THE most worrying aspect of the present cholera outbreak in Zimbabwe is its persistence, with the first case recorded almost a year ago and after it spread it has now reached a stage where, while not getting much worse each day, it is definitely not getting any better.

So far 18 623 cases have been recorded, both confirmed and highly likely, with 333 deaths, again not all confirmed as being caused by cholera, but that bacteria the most likely cause in the opinion of medical professionals.

This is serious, and while spread out over 11 months it is still a major cause of preventable serious illness and death.

While only four districts in Zimbabwe have reported zero cases, with the other 60 having had at least one, there are two focuses of infection. The original outbreak was largely in Manicaland centred on Buhera District and the latest figures show this is still an area of concern, with a belt of districts across that province and stretching into the Lowveld with above average infection rates.

But it is also apparent that the efforts of the Ministry of Health and Child Care, backed by borehole drilling at clinics and other measures by other ministries, have gradually tamed this original outbreak and while the infection rates are still a cause of concern progress is being made on reducing them.

This has been managed despite the original problem that the initial outbreak was centred on a community that followed religious practices that did not allow members to seek medical attention.

The Health Ministry has, over the years, built up contact between village health workers and families within these communities to cope with vaccination programmes and other public health issues, and some sensible practices have emerged that seem to allow families to both follow their religious beliefs and to stem the spread of bacteria and viruses.

A lot of the effort on cholera, for example, must have stressed personal hygiene and the need to make sure drinking and cooking water was clean and that raw food, particularly vegetables and fruit, were washed before cooking and eating.

The particular communities do not have any religious strictures on washing hands and food, and so basic public health education will do most of the work.

The second major focus of infection, and now easily the largest with more than 43 percent of new cases, is Harare Metropolitan, and that fraction rises closer to half of all cases once the surrounding rural district councils are counted in.

Here we have a different problem, or set of problems.

A lot has been spoken and written about the breakdown of basic services such as water supply, garbage removal and sewage systems, or even the lack of these services in a swathe of new housing areas created largely by land barons.

That obviously has an effect when people need water to wash their hands, maintain personal hygiene and wash their food before preparation and eating.

There would also be cases of contaminated and rotting waste in those illegal informal dumps that are now being cleared, with the present heavy rains and the breakdown or non-existence of storm water drains allowing the bacteria and bacteria-laden waste to be washed into unprotected wells, or over otherwise clean vegetable gardens and the like.

There does not appear, from the Health Ministry figures, to be a single point of extreme infection in Harare, as we saw in 2008 and 2018. This time the infection is more spread out, and the modest preponderance of cases in the southern and western suburbs is simply because that is where the vast majority of the population lives.

It seems that there are multiple sources of infection within the city and its surrounding towns with every day more than 100 people being diagnosed with cholera and starting the very rapid and effective treatment offered at several health centres.

The central Government did want Harare City Council to bring the huge population of vendors under control, or at least those selling food. The council has done almost nothing, saying it needs to establish the more formal market places before it can stop people trying to earn a living.

That could be fair enough if the choice was between putting vendors out of business or only allowing them if they were in a supervised market with functioning public toilets and running water.

But there are a lot of intermediate steps that could be taken, for a start making sure that public toilets were all functioning and were open, and making sure that some sort of clean water supply was available, even if only from tankers or bowsers with people using buckets.

A campaign could have been mounted to ensure that vendors had access to public toilets, had buckets of water, and had those cheap purification tablets or even a bottle of bleach to keep the water free of germs.

In some ways this might be creating temporary market spaces, and might cause problems later, but at least it would ensure that the main distribution channel for fresh food remained, but a great deal safer.

A side benefit would be that food vendors would be listed and would start learning to work with officials rather than against officials and safer conditions were created and enforced.

At the same time fixing the public toilets would help slow the spread of disease.

A major symptom of cholera is acute diarrhoea and this means that the sufferer will use open space if they cannot find a proper toilet very quickly. That is just a recipe for spreading the bacteria.

There has been little in the way of the sort of public health campaigns we saw in earlier outbreaks, but almost everyone knows how cholera spreads, and knows how to avoid infection.

What they need are the means to avoid it. It is difficult to wash your hands and food if there is no water handy, and presumably that is why health experts are lobbying for water bowsers to be deployed.

A major city in the 21st century should not have cholera, or at least nothing more than the occasional case when a rural relative drops off some contaminated vegetables, and this continual several score a day in Harare Metropolitan, which could easily explode into something far more severe, just should not be happening.

A serious effort by the council and the public could back what is already being done by the public health authorities and the central Government and beat back cholera in greater Harare, just as it is being beaten back in far harsher conditions in Manicaland.