Kept quiet, not solved  

Jolanda Naafs

Zimbabwe is facing a huge health crises: a cholera outbreak of biblical proportions. Cholera, caused by the bacteria Vibrio cholerae, is easily treatable and preventable. The magnitude of this epidemic is one of the symptoms of a collapsed health system, caused by the political breakdown in Zimbabwe. 
In this article, Jolanda Naafs, reflects on the extent of the cholera outbreak, the role of politics in this outbreak and how the Zimbabwean government is handling this epidemic.

The worst outbreak in years

Cholera outbreaks in Zimbabwe have occurred annually since 1998, but previous epidemicshave never reached today’s proportions, says the World Health Organization (WHO). The current cholera epidemic is the worst in years, according to Médecins Sans Frontières (MSF, Doctors Without Borders). Last year, the first cholera cases were reported in August 2008. From November, the incidence rate increased significantly and cholera spread rapidly to Zimbabwe’s provinces. According to WHO reports, the death toll of the outbreak reached 1 500 in December and surpassed 4 000 by the end of March 2009. Over 90 000 people are infected.

Zimbabwe has dealt with cholera outbreaks annually, so what is the reason that this outbreak could take on such enormous proportions? Numerous explanations, all interrelated, can be identified.

 

First of all, Zimbabwe has lingering politicalproblems. Since 1987 Robert Mugabe has been President of Zimbabwe. He was initially complimented for his progressive actions, but his governing style soon changed and repression became the essence of his dictatorship. In the year 2000 a period of economical and political turbulence began when Mugabe chased the white farmers off their lands. This action resulted in a collapse of Zimbabwe’s agricultural sector, which up till then had been the main source of income in the country. The situation worsened ever since, but 2008 was the year in which economical,political and humanitarian conditions deteriorated.

In April 2008 the leader of the opposition, Tsvangirai, claimed a victory in national elections. Mugabe openly questioned the results, and because of the little difference between him and Tsvangirai, a second round was organized that Mugabe won. Many people supportive of Tsvangirai have been abducted, tortured or murdered. In September 2008, Tsvangirai and Mugabe finally reached an agreement to share power. Despite this deal, Mugabe still did not consult the opposition and political instability persisted.

Economic problems developed parallel to the political crisis. From the year 2000 onwards the inflation rate increased and as a reaction, the government decided to print more banknotes. But as the total economy did not improve, the currency devalued. This resulted in hyperinflation that caused the country to become bankrupt and ungovernable. The financial situation led to an inability to pay decent salaries. A mass departure ofhealth care workers, lack of management and shortage of resources caused a collapse of the health care system. Hospitals soon became ghost hospitals. The access to available health care facilities is poor because hospitals are overfull and most people are unable to pay for transport and treatment.

Besides the abovementioned circumstances, ignorance further contributes to the spread of the disease. Cholera spreads via contaminated food or water and can be prevented by good sanitation and easily treated with rehydration. The people of Zimbabwe, especially those in rural areas, are ignorant and have little means for prevention and treatment.

Hushing up the disease

Despite warnings from the WHO and organizations like MSF, President Robert Mugabe denied the presence of cholera. They want military intervention, because of cholera. But I’m happy to say that our doctors […] have now arrested cholera, Mugabe saidin a speech. The Herald, a state-controlled newspaper in Zimbabwe, announced on 18December, 2008: Cholera cases on the decline and assigned this claim to the WHO.

I asked Zimbabwe correspondent Bram Vermeulen why the Zimbabwean government has chosen to hush up the disease. Cholera is a symptom of the economical crisis in Zimbabwe. There is no money for chemicals to provide the country with clean water. This makes the cholera epidemic embarrassing for the regime, he answered. International political leaders criticized President Mugabe and suggested his withdrawal. We need a fair and sustainable political solution in Zimbabwe. And we need it fast, announced Ban Ki-moon, secretary-general of the UN, at his 2008 end of the year news conference. However, getting Mugabe to step down iseasier said than done. After initial threats to leave the power-sharingdeal, Tsvangirai announced in January 2009 that his party was ready to join the unity government. Tsvangirai is now Prime Minister and Mugabe will remain President. Although Mugabe's government has accepted this decision, many have a vivid recollection of his 2008 claim: Only God can dethrone me.

Reflection

In conclusion, the political instability created an environment for hyperinflation and thus for the collapse of the health caresystem. These and other factors allowed fo rthe rapid spread of cholera: there has been a huge shortage of nearly everything that could have stopped the epidemic. Of one thing I am certain: the current, appalling situation must not continue. The number of deaths keeps topping itself and the amount of affected cases already surpassed the worst case scenario of the WHO estimates in 2008. Even though the situation is complex, I am surprised that political interventions are virtually nonexistent.

Of course, I am aware that a lot of Zimbabwean and foreign doctors are working extremely hard, but what is being done by world leaders to eliminate the underlying causes of this epidemic? I genuinely hope Tsvangirai will be able to truly enter the government and, with help of the international community, to get Zimbabwe out of this enormous negative spiral. I disapprove of the hushing up of the disease and the passive manner in which the current government is dealing with the epidemic. Changing the situation in Zimbabwe will be a tough process and the hardest part will be the beginning: substantially reducing the power of Mugabe.

About the author

Jolanda Naafs is a first year medical student from Utrecht.

References

1. World Health Organization (WHO), Zimbabwe Cholera and Health Situation -  1 December 2008, WHO Response And Needs. Geneva.
2. BBC News, Mugabe: there is no cholera. 2008 11 December. 
3. World Health Organization (WHO), Cholera in Zimbabwe: Epidemiological Bulletin number 1 - 15 December 2008.
4. United Nations News Centre, Death toll from Zimbabwe’s cholera outbreak tops 1,000. 2008 18 December. 
5. Médecins Sans Frontières (MSF), Zimbabwe: MSF Responds to Worst Cholera Outbreak in Years. 2008 12 December.  
6. NRC Handelsblad, Korte geschiedenis Zimbabwe. 2008 27 March. Updated: 2009 11 February. 
7. Bram Vermeulen, Cholera is maar een van de vele plagen. NRC Handelsblad. 2008 9 December. 
8. The Times, Zimbabwe cholera epidemic toll rises above 1,000. 2008 18 December. 
9. The Zimbabwe Times, Collapse of health delivery violates rights. 2008 19 November. 
10. Xan Rice. Tsvangirai agrees to join unity government. The Guardian. 2009 31 January. 
11. World Health Organization (WHO), Global, national efforts must be urgently intensified to control Zimbabwe cholera outbreak. Geneva. 2009 30 January. 
12. Bram Vermeulen, Zimbabwe correspondent, via email.

 

Photo © by Amfion Fotoshoots (Antonette de Groot-Klootwijk), photos for Global Medicine only, all rights reserved.
Photo by Julien Harneis, shared under Creative Common License.
 

Readers' respones

Two comments on this article are cited below. Please share your opinion in the response box under the article or send an email to Dit e-mailadres is beschermd tegen spambots. U heeft Javascript nodig om het te kunnen zien. . 

 

A Dutch nutritionist with 10 years working experience in Zimbabwe:

I think Jolanda Naafs' article lacks subtlety. Reality is more complicated than drafted here. Have you ever treated cholera patients? In my experience it is really tough to make (often vomiting) people drink huge amounts of fluids in conditions where safe water for drinking and cleaning is extremely scarce. Also, not everyone disapproves of Mugabe: most African goverments  recognize him as a democratically elected president. 

With you I encourage medical doctors to look beyond the biological causes of disease. I agree, the case of cholera in Zimbabwe is a clear example to show the impact of underlying causes in this disease, and its increase in incidence in the past decade. Many cities in the country cannot afford to import the necessary chemicals to treat the water supply. A medical solution only will not tackle the spread of cholera in Zimbabwe. The cholera outbreak in Zimbabwe is a symptom of a sick economy and sick politics. 

 

A Zimbabwean medical student:

Our media are not really reliable on the issue of cholera. Most articles discuss ZANU-PF, Zimbabwe African National Union – Patriotic Front (Mugabe’s political party) but not its failures. What hurts most now is that the biggest hospitals are in fact malfunctioning, drugs and other basic medical things are scarce and Mugabe’s party celebrates a birthday worth thousands of USD. 

I managed to visit one cholera camp and saw a few patients. Among the patients there was a woman who had been admitted a few days after her husband had died of Cholera. People are getting infected after attending mass gatherings (usually funerals for Cholera victims) and ZINWA, the water board that has just been fired, has not been purifying water adequately. It is like in every institute there is corruption: everyone trying to make a living and ZINWA is just another institute. Basic facilities are either malfunctioning or non functional at all. The government is not doing enough for the Cholera victims,  they are leaving everything to the donor community to deal with this crisis.