Choléra, Choléra!

Today Dennis is awake and sitting up. Gogo is happy to see me, while Dennis can not take his eyes off the notebook and pen I brought him together with some crayons. I do not understand until later why these are so important to him.

Photo: J Stavropoulou, MSF. | Grandmother

Juliette, the MSF head nurse is here as well. She is the kind of nurse you would want if you are sick. Kind eyes, beautiful face and always with a smile. Dennis is obviously feeling much better today. He had been quite a severely dehydrated case when he came in and had to be put on a drip, which he was still on today but which Juliette hoped they could stop later on. “He’s finally drinking his ORS,” says Juliette with a smile.

Dennis is small for a 10-year old and now he is so thin it makes him look even smaller. He is quiet and polite. I ask him what it feels like to have cholera. “I had a burning in my stomach,” he says rubbing his abdomen just at the memory. “How do you think you got it?” I ask and Juliette helps me with the translation. He is thoughtful for a moment, then says that he thinks it wasn’t anything he ate, but, “because I was playing outside in the rain in muddy water.” I am surprised at his perceptiveness and think that he is probably right – sewage runs openly through the neighborhood and rain would be a great disseminator of the bacteria. “When I go back, I will tell the other kids not to dig through the rubbish,” says Dennis quietly.

Dennis tells me he wants to be a doctor when he grows up so that if his mother gets sick he can take care of her. It was his mother who brought him to the hospital. Even though she had recently given birth, she carried Dennis on her back all the way; they don’t have the money for transport.

I ask him what he would wish for if he had the chance. He looks down at his thin hands resting on the red hospital blanket and says almost in a whisper, “I want to go to school.” When Juliette questions him further he says he can’t go to school because he doesn’t have books, notebooks or pens.

I say goodbye and hope that Dennis recovers fully soon. Maybe next week, once they are back at home, I will try and visit them at their flat in Mbare. For now, I turn and cup my hands in the Zimbabwe indication of gratitude and say, “Mashvita, Gogo, mashvita Dennis.” They both laugh and repeat the same for me.

My assignment today is to find a cholera kid – that is find a child above five that has cholera and whose guardian would allow me to talk to them in order to get a child’s perspective on this disease that has hit Zimbabwe.

My task may seem straightforward, since even today there are a hundreds of cholera cases around the country – over 93,000 total since the epidemic started. And, indeed, only shortly after my inquiry, Juliette, our MSF Head Nurse in Harare’s main Cholera Treatment Center, calls me to tell me that yes, there is a 10-year old kid that was admitted two days ago and I could see him since his guardian agreed.

When I arrive, Dennis refuses to open his eyes when Juliette addresses him. His grandmother, a handsome elderly lady with a crucifix hanging from her front gently shakes his shoulder. “He is pretending,” she says to us with a smile. “He thinks you will make him drink the ORS (Oral Rehydration Salts necessary for recovery).” Gogo (grandmother in Zimbabwean dialect) is about to try and rouse Dennis again, but I confer with Juliette and decide just to come back tomorrow.

Photo: J Stavropoulou, MSF. | 10-year old cholera patient, Denis.

Before I leave, I sit and talk with Gogo a bit, with the help of Juliette translating. Gogo lives in Mbare. This is one of the poorest high-density areas of the capital. It is dusty and dirty; it is where the bus terminal arrives from southern Zimbabwe and where also the whole-sale fruit and vegetable market is located. There are a number of three-storey overcrowded and derelict flats there which our watsan experts have already identified as highly unsanitary. I have already heard stories of sewage pipes burst and flowing into people’s apartments, while toilets are backed-up and completely infested.

Gogo, 69, lives in a small two-bedroom apartment with her two remaining children and nine grandchildren. I stumble on the word remaining and turn to Juliette. “How many children did she have?” I ask. Gogo answers the question matter-of-factly. “She had nine children in total; now only two are alive,” translates Juliette. I ask about their conditions of life. Gogo says there is no one with an income in the house so they rely on Catholic Relief for a monthly supply of basic food commodities.

Gogo’s daughter – Dennis’ mother – just two weeks ago gave birth to another child. That is why Gogo is at the hospital caring for Dennis; the mother is still at home with the newborn. I thank Gogo for chatting and she smiles and graciously inclines her head telling me “mazvita” – thank you.

I get a call from MSF Headquarters that they need a brief story of an MSF beneficiary for the Annual Report. I have met so many, heard so many stories, written about so many of them, that I decide it is easier just to drive over to our closest project and just meet someone new. I, anyway, always like going to Epworth.

Photo: Yasmin Rabiyan : Balancing rocks of Epworth

Epworth is about a 30-minute drive east of Harare. We drive along with sunny wind coming through the window. As we get to the township I see the big tan boulders for which this place is so well-known for. The boulders balance incredibly one on top of another, often seeming to defy the laws of gravity. I’ve seen them many times before; they are even on Zim’s now defunct currency notes. Yet, the sight never ceases to amaze me – they are almost like Zimbabwe itself, so precarious yet still, somehow, standing – and beautiful.

We get to the MSF HIV clinic and I meet Stef, the Project Coordinator who I had called in advance. She has an enthusiastic twinkle in her eye, “I’ve got just the lady for you,” she says, “she’s amazing.” We go towards the clinic entrance where endless lines of patients are waiting; either sitting or lying in the wheelbarrows their relatives have used to push them here. “Ah, it’s a quiet day today,” comments Stef which might come off as ironic if you looked around, yet wasn’t if you have been here on other days. The Epworth MSF Project takes care of over 10,000 HIV positive people that live in the area.

Photo: J Stavropoulou. Dadirai collecting patient data.

At the register table a tall proud lady with a lilac apron is collecting data from waiting patients. Stef asks her if she would be willing to be promoted as one of MSF’s beneficiaries and she enthusiastically agrees. Stef leaves us and I go off to talk with Dadirai.

Even from the first minute I meet Dadirai, I am impressed by her. There is a strength that emanates from her. A drive within, powerful, unquenchable.

It keeps her going on. She tells me first about how her husband got sick but refused out of fear to get treatment. Even when he was dying at the hospital he did not take any medicine — and he died. Then her baby girl got sick and it was discovered the child was HIV positive. Soon after, she herself got sick and when she got tested she found out what she had already guessed — that she also was HIV+. “It was a hard time,” she says matter-of-factly but without self-pity. She could not walk, or eat or take care of herself, let alone her two HIV+ girls. Her older daughter, now 11 years-old, though she was not sick, when she got tested was positive as well. But Dadirai held on and with the help of antiretroviral medicines (ARVs) both she and her little daughter got better.

“I want to help many people,” she says nodding her head firmly and repeating herself, “that’s right, MANY people. I want to stop HIV in Zimbabwe. I WANT that there will be no one more with HIV.” She speaks passionately and with conviction. “I want to help people learn how to prevent HIV, how to take care of themselves – that’s what I want to do.”

Dadirai, now 32, started taking ARVs through MSF’s program in Epworth in 2007. When she joined the program she worked for a year as a volunteer Peer Educator, talking to other HIV+ people and helping them to accept their status and keep on their treatment.

After a year of working hard as a volunteer and through encouragement from MSF staff, she decided to go back to school. She had to walk each day 2 hours — “footing it up and down every day” — to get to the college. She sold vegetables in the evening and Sunday to feed herself and her two girls. “It was difficult times,” she says but she kept on. She eventually graduated from college and now she is proudly working with MSF as a Nurse Aide. She hopes in the future to become a counselor.

Photo: J Stavropoulou. Dadirai collecting patient data.

In the meantime, she raises her children not to be embarrassed about being HIV+ but rather that they talk to their fellow classmates and teachers at school about the disease, openly, without fear. She herself talks to anyone, anywhere, about her status and the importance of getting tested. Sometimes, she tells me laughing, she will preach to people waiting at the bus stop with her. When they don’t believe she is HIV positive she takes out her container of ARVs and shakes at them. “I tell them – know your status, come get tested, come GET TREATED,” she says with enthusiasm. How could anybody resist this force?

We finally get to the number we had looked for, but find out that Maria doesn’t live there; it is her brother’s house. He says where she lives there are no numbers that is why Maria uses his address. He offers to show us the way.

Photo: J Stavropoulou.

We drive along the dirt roads between the houses until the road can go no longer. Then we walk along a small footpath through tall bright green grass and maize crops rising up around us. It is hard to believe we are still in Harare. We come to a small settlement of houses, with various children around, some ladies, some chickens, a well.

And then, there is Maria walking towards us, shyly smiling, quite obviously not pregnant anymore. I am so happy to see her, I feared the worst, yet had fervently hoped for the best.

Photo: J Stavropoulou. | Maria's home.

Liliosa explains to Maria that we have come to check up on her and she is clearly astonished. She leads us back to her small home, a one-bedroom wooden structure with a corrugated-iron roof. There on the bed lies a small miracle. Her week-old daughter who Maria proudly says she has named Takudzwa, which means “We have been honored” in the local language. The child is perfect, she is even trying to open her eyes and I swear she smiled when I cooed at her.

Photo: J Stavropoulou. | Maria and baby Takudzwa.

Maria delivered her right there on the bed. Two days after she got back from our cholera camp. She not only didn’t have the money for the hospital fees, she didn’t even have the money (2 USD$) for transport to get to a clinic.

But somehow she only had one hour of labor pains and then Takudzwa arrived. It was a clean birth, no complications.

Photo: J Stavropoulou. | Maria and baby Takudzwa.

The future, though, still lies uncertain. Maria has three other children. The only income she and her sister have is buying fish wholesale and selling it to individuals. But she has no money to go to the clinic for a check-up after the birth, nor has she been able to take the child for its immunization shots.

But still, a small miracle is before us and we all smile down on the baby. Maria says despite it all she is very happy with her daughter.

Remember the pregnant lady I met at the Oral Rehydration Point? A week and a half later, I went to look for her and find out what had become of her and the baby.

“Hey Heidi!” It is always great meeting up with Heidi, our MSF nurse who works at the MSF cholera camps in Harare. Blond hair, big blue eyes, she looks like an angel and has a personality to match. She is never too tired, too stressed, or too busy to dedicate time to patients and their care.

I haven’t seen Heidi for a couple of days and am anxious to find out what happened to Maria, a nine-month old pregnant cholera patient I had met about a week and a half ago.

I had first come across Maria when I accompanied the cholera patient transfer bus on its rounds. She was quite ill when we came to her, lying in a cholera bed in one of the MSF Oral Rehydration Points we have established around in the far-flung townships of Harare. We quickly transferred her to Budiriro Clinic where MSF has set up a Cholera Treatment Center (CTC). Heidi had made sure she got two IV lines right away.

I had asked Maria then if she had the money to pay to register for Anti-Natal Care at any Clinic near her home. She had simply stared at me as if I was delusional – where would she get $50 for the maternity fees charged nowadays by Zimbabwean clinics and hospitals?

When I now asked Heidi what happened with Maria, she just shook her head sadly. “I was praying for her to get into labor while in Budiriro, but it was not happening. And then I begged the [Zim] doctor for two days more after she got over cholera to let her stay. But after then he discharged her. There was nothing I could do against that,” she says and sighs and we both look at each taking a deep breath.

Once patients in cholera camps are cured from cholera they are discharged, even if they have something else. Unfortunately, in almost all instances these patients then have nowhere else to go and no money to afford any other option.

“I’m going to go find Maria,” I decide right there and then and Heidi’s eyes light up. We both agree it would be wonderful to find out what has happened to her. But Heidi cautions me not to be too optimistic.

I arrange for transport and take with me Liliosa, one of our MSF Zimbabwean nurses. She is herself quite pregnant, but extremely active nevertheless and when I explain to her our mission she becomes as enthusiastic as I am to find Maria.

We drive through the neighborhood of Kwadzana. Here, like almost all other townships of Harare, what never ceases to amaze me is its contrast between nice small houses with their carefully tended gardens and fences and the open sewer running freely through the streets. It’s sunny and there are many people walking around, unsurprising with such high unemployment in the country. There are a lot of home-based barber shops, a chair and a mirror with signs like “New Beginnings Hair Saloon” or “Golden Hair Barber”.

We’re looking for just a number. That’s how this works, no street names, just all the houses numbered, sometimes logically, sometimes not. We get directions from a lady that says we have to turn where the telephone booths used to be – Liliosa’s laughs; another of the many features of a deteriorating Zimbabwe.

We leave the burial and disinfecting team to get on with their business and four of us set off to Kingston Farm. I find out that actually it is now no longer a privately owned farm but rather a community which has taken over and each care for his or her crops.

Photo: J Stavropoulou | Huts at Kingston Farm.

We find the settlement of huts and our driver stops in an opening and starts honking his horn. Soon women, children and men all start gathering around the car. The health promoters explain the use of aquatabs, chlorine purification tablets to disinfect contaminated water, and the importance of washing hands and cleaning eating utensils.

Photo: J Stavropoulou | Kingston Farm kids

There is one tall young man who is the acting chairman (the older chairman is being treated for cholera at the cholera treatment center (CTC). He is tall, well-muscled and handsome with fine chiseled characteristics. Since nobody has a car in the community, it has fallen to him to transport the sick cholera patients with his scotch-cart to the CTC. It took us 40 minutes to reach this place by car; I can’t imagine pushing someone all that distance.

The young handsome chairman is angry. He is shouting something to the whole community. I ask our driver what he is saying. “He is shouting to the women that they can’t wash the dirty clothes at the same place that the village gets their drinking water,” our driver explains, “he is telling them he is tired of taking people to the clinic.” I ask and find out that there are 85 households in this community; in the past two weeks 77 people got cholera from here and had to go to the clinic.

The health promoters hand out aquatabs, 30 per household, as well as oral rehydration salts (ORS). They explain how to use the tabs, and how the ORS (dissolved in water) is a simple but effective means to rehydrate patients suffering from diarrhoea.

Photo : J Stavropoulou | MSF health promotion workers instruct Kingston Farm community members.

Then the village men take us to see their water source. We walk about ten minutes through fields of pumpkins, ground nuts, soya and maize. The community members are chattering excitedly to the health officials in front of me, while I get escorted by an extremely polite and solicitous young man who wishes to now about my country and how long I have been here.

We arrive at the water sources after ten minutes walk. It is a small river. Its flow is slow and lazy and at many places the water is still. They show us a half-meter hole they have dug next to the stream which has filled with stagnant water. From this they had been drawing water to drink. The health promoters are appalled. They tell them they have to cover this up and forget about it.

Photo: J Stavropoulou. | Looking into a borehole. Kingston Farm.

We leave the community behind and the team in the car is excited and pleased with the good work they have done. They tell me I will see that no more patients will come from this site. That there is no need to take over the clinic’s building and build a proper CTC. They tell me they don’t understand why people exaggerate this cholera crisis, that they have everything under control.

Next day though, seven more cases of cholera come from Kingston Farm.

By checking on their cholera treatment center in Chiwardizo clinic in Bindura (about 88 kilometers northeast of Harare), MSF teams found a new spike in cases on February 22, with 65 people admitted and the numbers rising rapidly. I went to visit Chiwardizo for a couple of days soon afterwards.

Photo: J Stavropoulou | Chiwardizo Clinic, Bindura

The patio of Chiwaridzo clinic, in the north-eastern city of Bindura, is filled up with cholera cases from a community called Kingston Farm. The local health authorities plan to go there and I ask if I can go along with them. “Aa, no problem we will come just now to pick you up.”

Photo: J Stavropoulou | Treating a man at Chiwardizo Clinic

They then all get in a white pick-up truck and drive off leaving me standing in the clinic’s patio; I wonder if they will come back or just blow me off. It is midday and excruciating hot. I realize that they must have gone off for lunch. I join Nick, our water and sanitation expert, in the back of our car where we are at least shaded from the blinding sun. We munch on some snack food, chat and drink warm chlorine-treated water from our tank. Tana, an MSF Environmental Officer and part of our Emergency Team, comes over to get something to drink. I ask how things are in the camp; ‘it’s TOO hot!’ she complains and also says that proper cleaning and disinfecting needs to be done to the camp. She mentions that especially in the left corner there is a terrible smell emanating from something.
Just as I was thinking that the health officials weren’t coming back to pick me up they show up and back up their pick-up truck towards the camp entrance. ‘What you think their doing?’ I ask as Nick and I both peer around the side of our open back door. ‘I don’t know, loading up supplies I suppose,’ says Nick. I get off our car and walk over while shading my eyes. Then I see them carrying out an elongated object wrapped in black plastic sheeting. It takes me a moment to realize that it is a corpse. Somebody standing beside me says what a shame they had left the body there all day behind the tent in this heat.

The local men stash the body in the back of the pick-up and wave to me to join them. I feel rather queasy getting in the car with the corpse in the back, but we all pile in and set off. There are three of us squished in the back and the man in dark olive work suit next to me is reeking powerful chlorine fumes. Introductions are made all around and I realize that my immediate neighbour is actually the undertaker. I roll down the window even further.

We ride out into the countryside. Since it is the hot rainy season everything is green and overflowing. I have never seen grass so tall, at places it is double the height of the car and it feels like we are swimming through it.

We stop at the deceased’s village. Yellow-ochre round mud huts topped with conical thatching surrounded by soya crops. I find out the deceased is an old lady who does not have relatives to take care of her burial. As we dive through more tall grass I wonder at this life that has passed away, who she was, what her worries were, what her joys. How many lives have been taken by this bacterium scourging this beautiful land?

Suddenly one of the young men who jumped onto the back of our car earlier to help with the burial, slaps the side of the truck. I wonder if something fell off, but then realize that there is a small little track off the right of the road through trees and grass. I walk over with them and see a clearing surrounded by trees while a carpet of orange flowers spreads out beneath. It is very peaceful. A nice place to be laid to rest.