Tackling cholera in Zimbabwe

It’s swelteringly hot under the midday sun in Chapanduka village in Buhera, a district of Manicaland province in south-eastern Zimbabwe, where a cholera outbreak has been raging since October 2023. A vehicle belonging to Doctors Without Borders (MSF) is navigating the bumpy road, heading to a local clinic to help treat patients and support local health staff in the management of the deadly waterborne disease.

Suddenly, the MSF vehicle draws to a halt. A man is lying on the roadside, drawing a crowd of onlookers, many of whom assume he is dead. MSF medics establish that the man, who has cholera symptoms, is still alive but lost consciousness after collapsing from dehydration on his way to a clinic five km away. Still, on the roadside, the MSF team resuscitated and rehydrated him through a drip before ferrying their patient to a clinic for further treatment and monitoring.

"It doesn’t matter where we are,” says MSF nurse Rosewita Marunza. “If the patient needs immediate attention, we attend to the patient immediately. The goal is to save lives.”

So far, 2,223 people have been infected with cholera in the Buhera district, and 44 people have died. Across Zimbabwe’s ten provinces and 62 districts, 24,885 people have been infected, and there have been 501 deaths since the first cases were identified in February 2023.

"We have had encounters with critically ill patients, some lying on the roadsides, some being ferried to the hospital in scotch carts [two-wheeled horse-drawn carts] and wheelbarrows, and some when we visited homes,” says Rosewita. “When lives are saved, I am fulfilled.”

Rosewita and other MSF staff have been responding to the cholera outbreak in Buhera since early October, treating patients and mentoring health staff at all 37 health facilities in the district. They also helped set up 21 cholera treatment centres in local health facilities and six oral rehydration points in villages across the district, as well as putting in place infection prevention and control measures and engaging with local communities to encourage people to come for treatment and help stop the disease from spreading further.

Because of a lack of clean drinking water and sanitation facilities in the Buhera district, many people regularly drink river water and use bush toilets – practices that have encouraged the spread of the disease. An additional challenge is that three-quarters of the population – around 200,000 people – belong to a religious community which rejects mainstream healthcare. Most of its members refrain from seeking treatment in health facilities or taking part in public health initiatives, resulting in many avoidable deaths within the community and cholera victims being buried covertly without guidance from health authorities.

In collaboration with MOHCC and other partners, MSF also trained 362 village health workers on case surveillance, active case finding, risk communication and community engagement and reporting.

To counter this, MSF teams have worked with village health workers from the apostolic community, who have slowly but steadily succeeded in sharing health messages with members of their community, increasing their understanding of good hygiene practices and encouraging them to come for medical treatment when needed.

Accompanied by MSF health promoters, the village health workers attend public gatherings and hold education sessions in busy places such as marketplaces and churches. They also attend funerals of cholera victims to make sure that infection prevention control measures are in place.

"Seeing people die every day pushed me to change my behaviour and save my family,” says Tecla Mandizvo, a village health worker from the apostolic community. “I also got the motivation to encourage others in our community to break the misconceptions about cholera. I managed to move door-to-door in order to engage with the communities, including members of the church, and encouraged them to reach out to me for oral rehydration en route to the nearby clinic if they notice any cholera symptoms. Today I have many who are coming to me if they suspect any cholera cases in their homes.”

Jethro Bondai, head of Berenyazvi village, is appreciative of the work done by village health workers in tackling the disease. “The efforts of the community volunteers are appreciated by the entire community and this is important for us to learn how to prevent and protect ourselves from cholera,” he says.

Bondai is one of 270 traditional leaders across the Buhera district who are helping to tackle the outbreak. He says that most people in his village drink river water because of the shortage of clean drinking water, but he advises them to find alternatives or boil the water to kill bacteria.

"Most people have been drinking water from the river because of the scarcity of boreholes,” says Bondai. “I am encouraging households in my community to go and fetch water from the few boreholes that are well protected or boil their water so as to prevent the transmission of cholera. The spread of cholera has got out of hand."

The efforts made by community members, MSF and Zimbabwean health authorities to curb the spread of the disease appear to be working, as the number of cholera-related deaths are going down. MSF is now scaling down its activities in Buhera district to refocus on other districts with acute crises, including the capital, Harare, where MSF has started focusing on water sanitation and hygiene (WASH) and treating cholera patients.

Caring for patients and enhancing cholera prevention measures are critical elements to control the outbreak. But MSF warns that, without meaningful action to ensure people’s access to safe drinking water, cholera is likely to resurface regularly in Buhera district.

MSF has been working in close partnership with the Zimbabwean Ministry of Health and Child Care (MoHCC) since 2000 in response to cholera outbreaks and other health emergencies in Zimbabwe.

ENDS