The bad news coming from Zimbabwe constantly getting worse. Now the problem is cholera.
Cholera is one of the few diseases that can literally kill a healthy person in 24 hours. You start vomiting, get terrible diarrhea to the point that your bowels empty and you end up passing clearish fluid. You literally dehydrate to death: You lose so much fluid you go into shock (low blood pressure from loss of the fluid in blood) and die.
The discovery of Oral Rehydration fluid is one of the miracles of modern medicine, but the idea is so simple that it gets little press. Someone discovered if you replace the fluid with water with just a certain amount of sugar and a small amount of salt, the fluid is absorbed much more efficiently by the sick person’s intestines.
A 1-liter preparation of ORT solution contains:
Usually hospitals buy pre measured packets of the stuff (one packet for one liter of boiled water), but when I worked in Africa, our hospital pharmacist used to mix up our own, and made up packets to give out to our “village health workers” to keep in the villages. The dirty little secret is that diarrhea is common, and families might not have the time, money or transportation resources to go to the big clinic and sit all day waiting for treatment for common diarrhea; as a result, some kids die. But having trained workers in villages nearby who are trained to use this simple fluid saves many of these lives.
The rehydration fluid is especially important to save the lives of small children with diarrhea of all sorts. But for adults, it has made the difference in saving the lives of adults with cholera or more severe types of diarrhea.
Most of the time, these diarrhea type illnesses are “sporadic”: they break out, make a lot of people sick, a few end up in the hospital, but usually the disease is mild.
But cholera, even the less severe strain that is common in Africa, is different.
In epidemics, hospitals may be overwhelmed with cases. The danger of spreading the disease to other patients is high, so usually you place the patient in an isolation ward. The treatment is simple: You place a relative on a stool next to the patient, and instruct the relative to give the patient lot and lots of rehydration fluid. In areas where cholera was common, my friends told me that they used special beds with holes, so the diarrhea just drips through the cot into a bucket to make cleanup easier.
The nurses and doctors keep an eye on the patients, and if they can’t get enough fluid by mouth, might start fluid in a vein (IV therapy). But in third world hospitals, this is expensive, and in an epidemic you might run out of supplies. For rural epidemics, there may not be a nearby hospital, just a small clinic. Transporting a lot of very sick patients is impossible, so usually one sets up a cholera clinic at a local school or similar building, and the patients use (disposable straw) mats instead of beds.
This is, of course, a recipe for massive outbreak of the disease, but emphasizing strict hygiene and hand-washing prevents it from spreading.
Cholera can be treated with antibiotics (but they are not usually necessary), and there is a vaccine that gives some protection, but the real answer is hygiene and prevention.
In Zimbabwe, the problems with the Harare water supply has been known and complained about by residents for over a year. In January 2007, there were reports of sewage contaminating the water supply, then a few months ago, reports that those administering the water supply were not able to afford chemicals to keep the water clean. So it is not as if the epidemic could not have been foreseen.
Since the Zimbabwe National Water Authority (Zinwa) had failed to find chemicals to treat the water supply, the state-run utility on Sunday stopped pumping water in the capital, the government mouthpiece Herald newspaper said….
Residents in Harare’s populous sister city of Chitungwiza said that their taps had also run dry. People throughout the city were carrying containers searching for water, while others have resorted to digging shallow wells in their yards in the hope of finding water.
Shallow wells, however, are often contaminated by sewage, or from latrines, and only make the problem worse.
In rural Zimbabwe, people traditionally go “in the woods”, away from the village; one shudders to think of what has entered into the water of “shallow wells” in city slums that lack sewers and septic tanks. Only those who have deep wells will be safe.
In the absence of a working government, the UN is trying to do these things to keep people from dying:
The United Nations Children’s Fund… has secured sufficient chemicals to treat Harare’s mains water for two or three weeks, with another four months’ worth of supplies on their way. Unicef is also distributing millions of water purification tablets and taking 360,000 litres of clean water to Harare’s poorest suburbs every day.
But Roeland Monasch, its acting representative in the country, said that many households could not manage the simplest preventative measure - boiling their drinking water - because they cannot afford the fuel.
The poor state of nutrition in a Zimbabwe where many are out of work or lack enough food means means that more of them will die. My friend has written that those in her area are starving; December and January are traditionally the “hunger season” before the crops are harvested, but this year there is little rain.
My friend, a teacher, was laid off last year because the government couldn’t pay more experienced teachers the higher salary; this year, however, many teachers are not paid at all, and most of the schools are closed….and despite the epidemic, many hospitals are closed because they can’t pay the salaries of the doctors and nurses (many of whom are leaving to work in other countries) and the hospitals that are still open lack medicines…
Obviously, one can see where this is going. With the economy collapsing, even more people will join the Zimbabwe diaspora, and some will take cholera with them.
As a result, already there are reports of Cholera outbreaks in nearby Botswana, Zambia and South Africa.
But the possibility of tens of thousands of deaths in Zimbabwe still hasn’t made Mugabe change his heart.
The European Union, President Bush, the presidents of Botswana, Zambia, and Kenya, Archbishop Tutu and others have said that Mugabe needs to leave, and proposed international peacekeepers to stabilize the collapsing country. What is preventing this is that, with only a few exceptions, the African Union continues to oppose his removal by force. I understand why pride makes some oppose outside intervention, but what good is pride when thousands will die?
The dirty little secret is that South African forces could remove Mr. Mugabe with little or no problem, yet that country has so far refused to do so.