Cholera exhausts health care system
February 9, 2009
Treatment for a cholera-stricken baby in the Budiriro Health Center for Cholera in Harare.
HARARE (NPR) – In December, the World Health Organization’s worst case scenario for Zimbabwe’s cholera outbreak was that 60 000 people might become infected before end of March. But already nearly 70 000 cases of cholera have been reported.
Despite the fact that cholera is relatively easy to treat and to prevent with basic hygiene and appropriate sanitation, more than 3 300 people have died of the disease since the outbreak began in August 2008, according to the WHO.
A simple treatment of oral rehydration can save most lives, but health experts who have visited Zimbabwe recently say those measures simply aren’t available because the economy is in meltdown.
Under the present circumstances, it’s easy to forget that Zimbabwe once had one of the best health systems in Africa. That may have contributed to current problems, according to Dominique Legros, the WHO’s director of Disease Control in Emergencies.
Because the health system worked, Zimbabweans weren’t familiar with the disease when the current outbreak started.
“It’s a country so developed that they had very few cases of cholera,” Legros says. “Over the last year, they had small outbreaks they managed to control in a few weeks.”
“Contrary to some countries, the population [of Zimbabwe], as well as the health care workers were unfamiliar with the way to prevent it and the way to treat it,” he says.
WHO is beginning a campaign to educate the public and distribute oral rehydration kits and tablets to decontaminate water.
Legros says was impressed that the health facilities were still in good shape when he visited Zimbabwe in December, despite the fact that many had no electricity or running water.
“What I have seen are well-trained health-care workers and decent facilities,” he says. This is something quite different from countries that have experienced long-term war, he says.
Unlike other countries where the health infrastructure is devastated, Legros says, Zimbabwe won’t be starting from scratch — if and when measures are taken to improve the situation.
Simple things are most needed, he says. Things like paying the workers and getting them needed medical supplies, including masks and gloves.
A team of Americans and South Africans investigating the situation for Physicians for Human Rights found that Zimbabwe is not just facing a cholera epidemic, but a series of health crises.
Dr. Chris Beyrer of Johns Hopkins University, who was on the team, said he saw one nurse at a rural clinic who was trying to help two women in labor but didn’t have needles or sutures.
“The nurse said, ‘I have nothing for pain for these women. I have no antibiotics. I have nothing for post-partum hemorrhage.’”
Beyrer says that if one of the women had suffered a tear during delivery, the nurse would have had no way to repair it.
Zimbabwe, even before this crisis, had a high caseload of people infected with HIV. The rate of infection among adults is estimated at 15 percent, according to the WHO.
For every person dying of cholera, Beyrer says, another 10 people are dying of AIDS.
Beyrer was particularly concerned about people with HIV, because they were running out of anti-AIDS medications.
Worse than that, Beyrer says, HIV patients told the team of visiting doctors that the combinations of drugs they were taking were repeatedly changed.
“So, people are being switched on drug regimens, sometimes every two weeks,” he says. Patients were getting “all the negative effects of being on different drugs without the benefits.”
They ran the risk of generating another public health problem because swaping anti-retroval drugs causes resistance. The same thing is happening with the drugs for tuberculosis patients.
To remedy the situation, Physicians for Human Rights recommends that Zimbabwe’s sanitation system be put in receivership — and run by international health organizations — while the government is in transition. Humanitarian assistance to treat cholera has been pouring in, but has not significantly reduced the death rates.
Despite news reports of health workers abandoning health facilities, Beyrer says he found a tremendous number of doctors and nurses still trying to do their jobs, even though they hadn’t been paid in months.
A physician showed him one nurse’s pay stub.
“Her monthly salary came out to about 36 cents (U.S.),” he says. “Their monthly salary is now worth less than their bus fare to the bank to pick it up.”
Both the WHO and Physicians for Human Rights acknowledge that the political situation makes it difficult to get money to workers who need to be paid in dollars and other foreign currency, since the Zimbabwe dollar is virtually worthless.
Some non-governmental organizations such as the Global Fund to Fight AIDS, TB and Malaria, and the World Food Program are still operating in the country. But the assistance often does not reach some provinces of the country, all of which have been affected by the catastrophe.
As for the WHO’s worst case scenario now, it is that these conditions will become endemic, if the country’s water supply and health care systems are not repaired. Once past the rainy season in March, the threat of a malaria outbreak looms.
Read the article by the Physicians for Human Rights or the press release from the World Health Organization.
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Funny Mugabe is planning his worthless 85 years birthday to Zimbabwe by spending millions of peoples’ money whilst they are dying. Why cant he be sane enough and to be at least a realistic person who takes the environment into consideration. Its public knowledge that he does not care but he has gone too far and in shona “Kana kangoma koririsa koda kuparuka.” (When something is stretched to the limit, like a drum beating to its loudest, it is nearing its demise) Beware Mugabe!
ZIMBAWE’S WAY FORWARD AFTER THE GNU: A WAR VETs PESPECTIVE
I think there is cause for celebration for the GNU because it opens space and the image of the country might change ending hostile publicity. Even more so sanctions by the western powers might be lifted if MDC request for that. In this regard the GNU has to be supported. However progressive people should never be fooled and relax hoping that this is victory for the poor people.
There are four main problems that poor Zimbabweans have battled with and continue to battle with now. First is the fight against colonial dispossession, settler dominance and racial privileges. Land had remained intact after independence until this was challenged by the masses led by war veterans from 1998 onwards. There was also international capital represented by foreign industry, mines, estates (forestry, tea, orange, ranches) and finance capital (banks, insurances etc). Settler and international capital are both forms of imperialism and have common objectives of serving not domestic interests but the interests of the metropolitan countries (Europe and America). Reversing colonial legacy logically triggered reaction of international capital which was mobilized by settler capital. An attack on one is an attack on the other.
The other problem is about nationalist leadership and its abrogation of the liberation agenda. Robert Mugabe through an unconstitutional (because there were no conducive conditions for a representative congress of ZANU to be held during the war and in Mozambique) means in 1977. The new Central Committee was composed of people from outside the armed struggle recruited by letter to displace fighters, peasants and workers in the leadership of the war. Therefore this elite leadership, did not only negate the fighting forces but also had different ideology. The fighting masses and combatants wanted to change the colonial structure completely. They wanted smash the Rhodesian state and construct a new one which they controlled and which they would use to redistributed stolen wealth now in the hands of settlers and international capital. Nationalists wanted to take over political power and join the settlers to become a privileged black ruling class. They wanted to share the wealth in the hands of the white settlers. The two, because they had common economic interests, forged an alliance at Lancaster forming a ‘GNU’ through the Lancaster House Constitution followed by the policy of reconciliation. In 1987 this ‘GNU’ was enlarged by taking in the left-out PF ZAPU members. This became a one party state in de facto which imposed ESAP, a brutal economic policy that entrenched white settler capital.
GNUs are always followed by widespread suppression of the marginalized poor. In the 1980s war veterans were relegated. The state failed to socially or economically integrate ex-combatants and most drifted into abject poverty. The state also suppressed any voice of descent or criticism from the war veterans, peasants or the workers. In addition the white settlers, enjoying the coalition with nationalist ruling class, started treating blacks more inhumanly than the Rhodesian period. Racial abuse increased. For example, the media reported that women who had gone to fetch firewood were stripped naked by the farmer for the trespass. In another famous case, a white man made one black woman to have sex with a dog while he made a video of the act. Another white farmer pissed in the mouth of black worker. Dr. McGown, an anesthetist, experimented on blacks as guinea pigs, especially women and children. He injected into his victims overdoses of tranquilisers thereby killing many of them. Because of the GNU, these racial attacks were hardly or lightly punished. The white judges, in the McGown case, for example, gave him only 6 months jail sentence for the genocide.
When war veterans led the masses to challenge this elite/settler alliance (GNU), both settler and international capital dumped the ruling class and built a surrogate because the former had proved incapable of its role to suppress liberation demands from peasants, workers and marginalized war veterans. In reaction, the ruling class joined back the liberation movement fracturing the GNU. The MDC was therefore formed to take the role that ZANU PF elites had failed to perform, protecting settler and international capital and making itself the new enemy. This catalysed the enmity between ruling elites on one hand and settler/intenational capital, on the other. Meanwhile the liberation movement was now taking land from both settlers and international capital and to minimize conflict, accepted to forge an alliance with the ruling class against settler/international capital and MDC surrogates.
The current GNU between ZANU PF and the two MDCs is not a new feature for Zimbabwe. It is the same elite alliance of surrogates of international capital who have no interest in advancing the interests of the liberation war. This is important for people to realise. If anything people need to reorganize themselves in preparation of even more brutal attacks from the new elite alliance of MDCs and ZANU PF GNU. This is the position of Zimbabwe’s revolution now.
First marginalized and revolutionary war veterans need again to mobilize and educate workers and peasants on the new level of the struggle against the elite ruling class. They need to let the people know that at their enemy still remains the elites and international capital. The GNU is bringing these together. They have to let them come together in order for the economic situation to change but they need to organize for even a harder and final battle to take over power from the GNU elites. This calls for the active participation of revolutionary war vets. They have to continue with their vanguard role and complete their historic mission of total emancipation of people from racial, imperialist domination and neo-colonialism. A new party has to be formed around the land movement which will unite both peasants and workers as had happened during the land movement, a development that caused the elites to panic and brutally carry Operation Murambatsvina. If not, then the leadership of the current MDC and ZANU PF have to be taken over by war veterans, workers and peasants within them then forge a untied party of the grassroots. This should be followed by a programme to safeguard the gains of the revolution and carry further redistribution of national wealth for the benefit of the poor. Then the first African revolution will have been completed, opening a new post-colonial era on the continent.