In Zimbabwe

In Zimbabwe
By Sarika Desai (Epiet Cohort 12, Merlin, Harare, Zimbabwe)
I arrived in Harare at the end of March to a blazing sun, a virtually empty international airport and the all important photo of President Mugabe welcoming me into his country. I admit I’m not nearly as patient as I would like to be so to find myself waiting in an unending queue for visas and then to discover that the Zimbabwean rugby team’s luggage took precedence over mine so that my luggage was left languishing in Johannesburg airport until the next flight in was hugely frustrating. Obviously, this is no big hardship but the thought of my spanking new work laptop lying in one of the suitcases was worrying especially when the stories of theft and robbery in Joburg airport emerged during the next few hours. To my great relief I was spared the embarrassment of explaining the loss of the laptop and possibly more importantly the large pile of EU posters and stickers I had been entrusted with and in the process I had already learnt two very valuable lessons – things happen in their own time in Africa and never leave a laptop in hold luggage.
Since then I have been working on the cholera response for Merlin, a UK-based NGO which has recently begun operations in Zimbabwe. From the media, I had expected to find myself in a humanitarian disaster situation and had I arrived two months earlier this would have been true but by April, cholera was mostly under control with small pockets of disease remaining. It is those very hotspots which have largely preoccupied me. Although based in Harare, the capital, I have spent countless hours in 4x4s experiencing first hand Zimbabwe’s roads, which are riddled with potholes and which turn into dirt tracks in rural areas that are impassable in the rainy season. But these have also been some of my best hours in Zimbabwe. Not only did I have the opportunity to see the beautiful Zimbabwean countryside but I also learnt a lot about cholera.
We were making these trips to assess and monitor the cholera situation in rural Zimbabwe. On one such trip we were in Gokwe North, a district about 5 hours from the capital and heard of an increase in cholera in a nearby village. During Easter members of the apostolic faith had travelled on a church trip to a town a few hours away and when they came back there were reports of diarrhoeal illness.
Unfortunately, because these apostolics belonged to the branch which does not believe in medical treatment, four deaths had also occurred. The district medical staff took drastic action by taking police with them to visit the community and convince them that they should seek treatment because taking oral rehydration salts (ORS), the mainstay of cholera treatment, was nothing but sugar and salt. We responded by visiting the same community the next day, meeting the headman and agreeing to set up an oral rehydration point (ORP) in his homestead. ORPs are basic medical posts where mild or moderate cholera cases can be treated with ORS; these sites reduce the burden in cholera treatment centres (CTCs) and improve access to treatment especially in remote areas. Setting up an ORP only takes a few hours – it’s a matter of setting up the buckets and equipment, recruiting two volunteers and training on infection control methods, case definition, dehydration assessment, treatment and data reporting. The impact was instantaneous and substantial – people including apostolic men, many of whom only came under the cover of night, sought treatment and the case load reduced rapidly. Rural ORP set up in the community in response to the cholera outbreak in Gokwe North
Over 98,000 suspected cases and 4000 deaths have been reported from across the country since August 2008. During the peak of the outbreak, this was over 7000 cases each week but now numbers have dropped to below 100. I am now occupied with working with the Ministry of Health to retrospectively dissect the outbreak. Very few studies have been conducted during this outbreak and one of the many remaining questions is why community deaths were so high with some districts reporting over 75% of deaths as community deaths. Although response is still an important component of the Merlin strategy, the focus is shifting to preparedness and risk reduction. This entails training of all cadres of health staff and prepositioning of CTC and ORP kits in preparation for the next outbreak because it is likely there will be another one in the coming rainy season. The underlying causes of this outbreak, the weak water and sanitation infrastructure, although being slowly addressed still remain causes of concern.
Outside work, my life is very enjoyable. Harare is a lovely and pleasant city to live in – I’ve never seen so many tree lined streets. People’s friendliness and openness is a refreshing change as is the relaxed pace of lifestyle. What has been special about my stay is witnessing Zimbabwe’s transition. Even in my short stay here the quantity and variety of food has improved and the number of cars on the road have multiplied so much that we even experience traffic now! Even though there is a long way to go before Zimbabwe can reclaim being one of the most developed countries in Africa, there is optimism in the air that a positive change can and will come about.