Choléra, Choléra!

Back in the car I stare out the window thinking about the situation. I ask Precious if she like so many of her country-people is thinking of leaving the country. “No,” she says shaking her head. “Sometimes it is not about you, it is about the next person, about the next vulnerable person. You have to think about that other person,” she explains.

We reach another section of Mabvuku where 160 households have not had water and electricity for over a year. But worse than this is that not only do their toilets not work, but the sewage blocks up and spills into their houses. “The woman that lives there,” says Precious pointing to a house to our right, “was weeping to me last week in despair because the sewage had covered all the rooms in her house. She didn’t have anything to properly clean and disinfect her home after she cleared the filth.”

“It is by the grace of God that you have found us and we are not dead from cholera,” says Moses, 45, one of the residents of the area. He has used sandbags to block the sewage pipes from backing up into his house.

Precious and I hit the road again and travel to a neighboring settlement called Caledonia Farm. This is so close to Harare, but it is a completely rural settlement, with sand-dirt roads, fields of corn, sunflowers smiling out through deep lush green. Here people were dumped when the government destroyed over 700,000 houses during 2005 in an alleged effort to clean up high-density settlements.

Hardwork Malifande, a resident shows us around. He is a teacher but now he doesn’t go to teach since the government is not giving them adequate salaries to live. He tries to get by through private lessons.

Hardwork walks over to one of the house where MSF has built one of the 200 latrines constructed for this community. Regina is very proud of her freshly-varnished wood latrine and is broadly smiling. “How many families use this latrine?” I ask her. She calculates slowly and answers, “about five families.” Five families! I think how just between my boyfriend and I we get into an argument about the use of our toilet, I can’t imagine five families!

Photo: J Stavropoulou | New latrine.

But Regina is very content, even if it means that the work of keeping the latrine clean falls to her since she is the one living closest. “I am very happy,” she says. “Before I was always travelling a long distance to go to the toilet, but now there is no problem because everything is now in my good hands.”

Hardwork takes us to another homestead where an elderly man and his wife take care of the newly constructed latrine. The man has white grizzled hair cropped short and gnarled hands. He can not speak English, though he seems to want eagerly to share something with me. But he is shy and embarrassed. Finally, as we are about to leave he looks me in the eyes and haltingly says “Thank you.”

“So why do they call them elephant pumps?” I asked Precious, as I stand in front of an aqua blue round concrete that comes up as high as my head. To each side are handles and in front of me is a protruding pipe.

Precious Matarutse, 24, has worked for MSF for a year in implementing water sanitation programs and her positive and enthusiastic attitude are still indomitable. As long as she is out with communities helping people nothing is hard for her, “just don’t put me behind a desk,” she tells me laughing.

Now she smiles and asks me to step a little back from the pump. “You see on the ground the round formations where people stand to turn the handles are like elephant ears and then under the faucet there is a small trench which is like the snout. She’s right, it does look like an elephant!

Photo: J Stavropoulou | Elephant pump

MSF has constructed close to 30 of these elephant pumps in two areas around Zimbabwe’s capital. Precious and I are now in Mabvuku Tafara, a township of about 150,000 people. “Some parts have not had water for over a year,” says Precious as we drive through the township checking on each pump that MSF has constructed here.

Photo: J Stavropoulou | Queueing for the well.

We get to one site where there is a long line of people waiting with buckets and jerry cans of all colors, blue, green, yellow. It is next to a now defunct pottery factory and that is why they call it the Pottery Pump. We get out of our minivan and a 4-year old little girl wearing a short white dress comes up to me to touch my white skin and everyone laughs. She runs away.

Photo: J Stavropoulou | Filling up at an"elephant pump."

Mr. Cleopas Kajekere, a man who lives near the pump has assumed the responsibility for its care. “This pump works 24-hours a day,” he tells me as he looks on at the waiting line. “Maybe at least 5 a day.” I wonder what he means by 5, and then he clarifies “yes about 5,000 people come to fetch water a day.” The queue is endless since, once some people go with their clean water, more replace them in the line.

After Precious talks to the chlorinator teams, we jump into the minivan and head for the next MSF station. “What does Mavuku Tafara mean?” I ask as we jostle over dirt roads of the township. “We are rejoicing,” replies our driver absently; his attention is diverted as he tries to go through a river flowing down one of the township’s main dirt roads. I turn my head and look out the window and I gasp at the stench that hits me. The river that is flowing is sewage. I quickly cover my face; it is unbearable. But all around people are walking, kids playing, small shops with men loitering outside right at the edge of the river. I get out to take a photo, but it is hard to breathe, I cover my mouth and nose with a scarf. A man comes over to me and we both stare at the river of raw sewage. “How long has it been like this?” I ask my voice muffled through the scarf. “Since August.” “Since August?!” I cry aghast. “Aa,” says the man calmly, “this won’t be fixed anytime soon.”

By now it is quite sunny. We’ve got a while to go until we reach our next destination. We exchange stories with Georgina about our lives; she shows me mobile phone-photos of her 4-year daughter who I in all honesty exclaim over since she does look absolutely adorable. Both she and her husband are nurses and they both have work now, but even so if things don’t improve in the country she is considering moving to Botswana.

We eventually both nod off to sleep in the softly bumping ride with the warm sun making it cozy inside our cholera van.

Photo: J Stavropoulou | The Oral Rehydration Points situated in Harare's townships are often located in remote areas which are reached only through difficult inaccessible roads. MSF monitors these areas through the ORPs and transfers patients with cholera-care adapted minivans.

Arriving at Dziva, we both wake up quickly since at our ORP there are two dehydrated patients waiting for transfer to the MSF Cholera Treatment Center (or CTC in short). One lady has her 1-year old baby with her. “Is your baby sick as well?” I ask her. “No,” she shakes her head weakly, “but I am breast-feeding and I don’t have anywhere to leave the baby.” A few days later I would see this same lady at the CTC and by then her baby was also infected with cholera.

The other lady is 9-months pregnant. The attending nurse at the ORP tells Georgina that according to the patient there hadn’t been any fetus movement for the past three days. The two nurses shake their head. It is very usual for pregnant women getting cholera to loose their babies.

While they take care of the paperwork, I go over to talk to the pregnant lady. She already has four children and had given birth to all of them in her home, even though after the second birth she had post-partum hemorrhage. Her husband does not support her; he does not have work. She and other five families all drink from a shallow well; she does not have the means to boil the water and she thinks that is where she got the cholera.

Today the sky is turquoise blue with smiling white clouds floating around but all during last night it had been raining. I’m accompanying Georgina one of our MSF nurses. She is 32, pretty with an open smile and neat hairdo of raised cornrows and very determined. She wants to visit one of MSF’s most remote Harare ORPs (Oral Rehydration Points). We have set up 17 all over Harare; basically they are small cholera centers that help patients get access to treatment.

We have gotten to a point where the road just looks like one muddy river. Tinashe, our driver, just shakes his head good naturedly and he sets his cholera-ambulance converted minivan to splash through the mud – we are through! We all laugh relieved. We bob along the dirt road, through fields of maize and soya plantings. This is the summer season in Zimbabwe – everything is lush green, the air is crisp and warm and every other day it rains.

“There’s our ORP,” points out Georgina and in the middle of a field I distinguish a small tarpaulin-covered stand and two ladies sitting inside. When we approach they come out smiling to greet us.

Photo: Joanna Stavropoulou | Residents in high density townships set up small stands selling anything from cookies to soap. Their houses are makeshift shacks covered with tarpaulin.

Mary and Zodwa are in their late fifties and have lived in Hathcliff Extension for decades. They are very happy to see us. They are wearing the plastic aprons we have given them over their neat attire. They show Georgina their notebook where they have carefully recorded who visited their little center, what symptoms they had, how much Oral Rehydration Salts they administered. No visitor today had needed to be transfer to the cholera treatment center for more intense treatment.

Mary and Zodwa work at this little MSF cholera point from 8am to 5pm everyday. They proudly show me around their stand, point where the buckets of disinfecting water is to wash out cups, the ORS solution, where they store the satchels. The MSF stand is standing in the middle of a red-muddy field and yet the tarpaulin placed on the stand’s floor is spotless, everything orderly, clean. The ladies complain that they would like to have a mop, they use their own rags to clean every inch on their knees. They then explain the procedures they follow when a patient comes to their stand, what symptoms they check for, how many hours they keep them under observation, how they decide whether to transfer them or not.

Mary and Zodwa are volunteers; they do not even receive an allowance. I am amazed by their dedication and diligence and can only wonder at what difficulties they must have in their lives and how they are able to put that aside to come and help their fellow residents.

We stay a little bit just to talk to them, of their life, their difficulties. They tell me that now the biggest problem people face is that they can’t pay the fees that clinics and hospitals are demanding; Zimbabwe’s public health care system started charging this past month in US dollars.

“People here, they don’t even know the [US$] dollar,” says Mary with emphasis, “they don’t ever see it, don’t even know its color.”

“But, so what to the people do?” I ask.

“Aah,” she shakes her head, “they just die.”

They told me of one of their neighbors this past week who gave birth at home because she did not have the 50 US$ the clinics are charging for maternity fees. But her placenta didn’t come out and after three days she died.

“At least if they could educate some midwives,” says Mary. But the ones that are around, she explains, don’t know what they are doing. Zimbabwe had such a good health system that everybody had access to health care and local midwifery went largely disused.

We respectfully thank our ladies and Georgina and I jump back in the minivan.

Photo: J. Stavropoulou | MSF community teams inject the right amount of concentrated chlorine into water containers

“Why can’t you fix the whole urban water system,” asks a man as Dominique, MSF’s Water & Sanitation (watsan) expert and I stop at a busy market place in Dzivarasekwa; a Harare township. Our MSF mobile team of bucket chlorinators is here and Dominique wants to see how they are doing. The team goes around and injects disinfecting concentrated solution of chlorine into containers of water that people bring to make sure the water is safe to drink.

The market is busy. Small stands under umbrellas are selling anything you can imagine. From vegetables, especially mangoes and avocados, to shoes — but with only one of the pair displayed (to utilize better the space, to assure that they are not stolen?). I am standing next to a vegetable stand behind which is running a river of open sewage. The stench is so overwhelming that I am turned off from buying any fruit. I am talking to the lady who owns the vegetable stand. The man who had asked the question is standing idly nearby, like so many unemployed people in Zimbabwe.

The lady agrees. “Is it for life, is it forever this treatment you are doing?” she asks. I explain that no, that we are an emergency organization that is here to help with the cholera epidemic. She says she doesn’t want to chlorinate her water. I am a little stunned but try not to show my reaction because I want to understand. “But aren’t you afraid that you will get sick?”

“But then when you stop giving this we will be affected even more than before,” she explains. The man agrees, adding laughing, “We are resistant like wild dogs; we’ve been drinking unsafe water for a long time.”

Dominique overhears our conversation. He is passionate about clean water, about his job, about keeping people safe — he tirelessly and zealously checks water systems, problems areas, possible sources of infection, he never stops, never quits. I wonder if he will react impatiently because truth to tell I was feeling a little impatient myself with this attitude expressed by the people. But Dominique takes 20-minutes to reason with Jane. On and on he talks to her, about the importance of sanitation, about keeping her four kids safe, about clean water. I look on smiling — how long will she resist? She finally has to agree simply from the force of the argument. One more family saved?

Photo: Joanna Stavropoulou | Dzivaresekwa is a typical high-density township of Harare with open sewage running throughout its streets.

Dominique and I go off in the MSF minivan towards Dziva extension. The area is in its summer rainy season lush green has small shacks built along muddy roads and some half-built brick buildings. We stop at one of the shacks and this one, like all the others in the area has its own shallow well. Amai Trust seems to be the head of the household. Tall and proud she shows us her well. The compact dirt of her small compound is well swept, a line of clothes is hanging out to dry, a well tended vegetable garden by the side of the well. The children around are barefoot and with sparse clothing, but they are well-behaved.

Photo: Joanne Stavropoulou. | Most households in Dzivaresekwa Extension have their own wells. Because these are usually very shallow they run a high-risk of contamination.

Their well is no more than a meter or two deep, with a tire to make the opening and a make-shift tap to cover the opening. Dominique asks where the toilet is and everyone turns around to laugh between themselves; “they always laugh when I ask,” says Dominique smiling at me. The latrine is no more than ten meters away from the well. “It rains, the water flows from latrine to well, people walk around, or they leave the bucket on the ground then dip it into the well,” explains Dominique. I ask Amai Trust if she boils the water. She doesn’t understand but Revayi our driver helps to translate. “No,” he explains for her after conversing, “there is no electricity in this area and firewood is very expensive and precious. There is no way for her to boil water.”

A crowd has gathered around our MSF minivan and they are laughing. I ask Revayi why they are laughing. “They are afraid to touch our car,” he says smiling, “because they say if they do it will infect them with cholera.” I shake my head at the irony of this.

“Coléra, coléra!!” shout little Zimbabwean kids running after our MSF minivan as it splashes through sewage soaked muddy roads in the high density Harare township of Dzivaresekwa (or Dziva or just Dizzy as some expats have started calling it). Revayi our driver laughs and puts the music up higher. He usually works his minivan as a combi (privately owned transport for locals). “What’s your name mean Revayi?” I ask him as I try to hold on in the back seat — all Zimbabwean names mean something. He says it means bad gossip, because his mother-in-law talked bad about his mother while she was pregnant so in revenge she named her son like that. Dominique turns around and we look at each other, both rather stunned with the explanation and not really knowing how to respond.

Photo: J Stavropoulou | The collapsing water and sanitation system in Zimbabwe has been one of the prime causes of the cholera epidemic in the country. People in Dzivaresekwa Extension don't have running water or electricity.

I change the subject and ask Dominique to tell me about his field of water sanitation and the project of trying to get safe and clean water to Harare’s most vulnerable residents. Dominique, French-Canadian, young and crazy obsessed with water. Any kind of water, dirty, clean, sewage — with dark thick hair and intense brows he gets easily carried away about his favorite subject.

He tells me how in this township of Dziva that we are going through they do actually have tap water, but because the system is so damaged, with pipes burst and pumps not functioning properly, that there is no pressure. This has allowed the sewage, which is running freely everywhere from its own bust and backed up pipes, to infiltrate the water system. People are literally drinking their own excrement. “We could smell the sewage in the tap water,” he says and as we splash through another open sewer in the street and the stench fills our minivan it is not very hard to imagine.

We stop at an MSF water point where our teams use a concentrated solution of chlorine to inject into people’s water buckets and thus disinfect the water. There are a lot of people walking around, kids (school has started again in Zim but there are no teachers), men and women (80% unemployment). Many try and sell anything, small cardboard boxes under rainbow colored umbrellas; mangoes, tomatoes, avocados.

Dominique is talking to the chlorinators. He is intense but he also laughs with them and they all want to know when he will be back to check on their work. I wander into a nearby house. People are always so friendly here in Zimbabwe. The people of this house come up to greet me and I ask them if they have problems with water. One of the men of this 9-people home (children, aunts, brothers) shows me their tap. It is dripping into a bucket and he says that is how the pressure has been since last year. He says they cannot wash things like blankets anymore, it would be impossible. “What about your toilet?” I ask. “Toilett?!” he cries in frustration, “it has been backed up for more than a year” he says. “Sometimes it overflows and we have to empty it with buckets.” He shows me the latrine. I look down into a dark greenish mass and I think my eyes are playing tricks on me, or the light is funny because it is almost as if it is moving, but it can’t be. I hold my breath and squint a little closer. Then, I jerk back in shocked disgust; it is a mass of thousands of maggots seething everywhere. I quickly exit.

I ask him if they have any money to get by. He sends one of the women into the house and she comes out with a pay slip. He wants to show me. He earns 13,742,381,818.1 Zim dollars a month. It looks like a lot on paper but unfortunately 13 trillion Zim dollars is less than 1 US$ today. Tomorrow, even less.

Photo: Joanna Stavropoulou

I thank the whole family, take some photos of the kids and to their absolute delight show them the result and rejoin Dominique.