Team Battles Zimbabwe Cholera Epidemic With Training

By Dr. Annie Sparrow and Michael Hill

As part of Catholic Relief Services' response in Zimbabwe to the outbreak of cholera—which has spread to over 60,000 people and killed over 3,000 according to the World Health Organization—Dr. Annie Sparrow from the agency's Emergency Response Team traveled from her base in Nairobi and spent two weeks in January in the southern African country.

A pediatrician and public health specialist for CRS, Sparrow's mission was to educate people on how to avoid and treat the disease. Her visit complemented CRS' other cholera response efforts, which include the distribution of water purification tablets, covered water pails and soap; and the provision of water purification systems to the country's eight dioceses. This is Sparrow's report on her time in Zimbabwe:

People don't realize that cholera, as devastating as an outbreak like this can be, is actually fairly easily avoided and treated. In fact, I brought my 11-month-old baby with me to Zimbabwe because I'm still nursing and could not leave him home for two weeks. We traveled all over the country together. I wasn't concerned because I knew how to keep us safe. And that's what I tried to teach several hundred people during my two weeks in Zimbabwe.

We traveled across Zimbabwe in all directions, teaching three basic principles: personal hygiene, water purification and home-based rehydration for those who do get the disease. We often trained people who would in turn teach others. The idea is to build up a network of people who understand what to do and can spread that information. CRS is the perfect organization to do this because we already have a base of thousands of volunteers, mainly through our work with HIV and AIDS home-based care services.

Unusual Outbreak

You usually see cholera in certain situations—when there is a sudden influx of refugees or bad flooding, in places where everyone is getting water from the same contaminated source. Because that's what causes cholera: dirty water and food that is contaminated with the cholera bacteria. It is quite unusual to see the kind of outbreak that you see in Zimbabwe that goes across a country, from major cities to rural areas.

Zimbabwe is considered a developed country by African standards and ironically that is one of the causes of the outbreak. This is not a crisis of poverty or underdevelopment. This epidemic is a result of the failure to maintain the water and sanitation infrastructure. When water stopped coming out of the taps in Harare and the toilets became blocked, people had no idea what to do to keep themselves free from cholera and other waterborne diseases. Informal solutions to the problem of personal hygiene, based on a lack of information, led to widespread contamination of water sources. In less developed countries, where wells and bush toilets are more common than they are in Zimbabwe, people often know how to make sure their water is safe, keeping their water source well away from latrines, and so on.

Zimbabwe's development contributed to the epidemic in another way. Cholera doesn't usually spread so fast, but in Zimbabwe the roads are very good, people are more mobile, and that contributes to spreading the disease rapidly across the country from major cities to rural communities.

Another factor contributing to the deadliness of this outbreak is the large number of high-risk people in Zimbabwe. The country has an HIV prevalence rate of 15 percent, or perhaps higher; malaria and other diseases are also present. On top of that, catastrophic food shortages are leading to malnutrition. And in recent years the health system has collapsed. Facilities that do remain open are too expensive or too distant for most people. And there are simply not enough health care workers. So this is a very vulnerable population.

One problem we faced was that some people are poorly informed about how to deal with cholera. Another challenge is that, in some places, people with the disease have been stigmatized, treated like lepers, because people don't understand how the disease is spread. The government and nongovernment organizations have set up treatment centers for the disease that have saved many lives. Unfortunately, these often makeshift, tented camps have become known as "cholera camps." Some people avoid them because of the stigma, and then they don't receive treatment that could save their lives.

Defending Against Cholera

Zimbabwe has quite a sophisticated and educated population with a very high rate of literacy. But they have never faced these problems before. They really want to know how to look after themselves. So that's what we try to teach them—how to make their water safe, and keep it safe. At this point, they cannot control what comes out of the tap, or from the well or the river, but they can control what goes into their mouths. Therefore we teach them how to disinfect water using either water purification tablets or home-based solutions such as boiling, bleach, even lemons. Also, teaching people how to wash their hands properly becomes incredibly important.

People don't die from cholera, they die from the dehydration that it causes. So we teach them if they do get cholera, what they can do about it, how to make rehydration solutions out of food that they have access to. Although sugar-and-salt solution is being widely promoted, most people simply cannot afford sugar, so they need to be taught this practical and lifesaving treatment using maize and rice.

When you see cholera in something like a refugee situation, it is usually contained and short-lived. But this is different. It is so widespread that it is likely to become endemic, and indeed is probably going to get worse with the onset of the rainy season that lasts until the end of April. The education that these CRS volunteers can now provide is crucial to saving many, many lives.

Dr. Annie Sparrow is the health and nutrition technical advisor on CRS' emergency response team based in Nairobi, Kenya. Michael Hill is CRS' communications officer for sub-Saharan Africa. He is based at the agency's headquarters in Baltimore.