MSF staff try to clear the backlog of patients that extends into the street in Beitbridge, Zimbabwe. November 2008.
Photo by MSF
On Friday, November 14, the Zimbabwean Health Authorities in Beitbridge first reported cholera to MSF. There were 5 cases. Two days later, there were already more than 500. By the end of the week, over 1,500.
The Beitbridge hospital did not have any IV fluid or Oral Rehydration Salts (ORS) tablets in stock. MSF shipped over 800 liters of rehydration solution on the first day of responding and since then there has been a continuous supply. Twelve shipments of medical and logistical supplies arrived in ten days. A team of 16 expatriates comprising of doctors, nurses, logisticians, administrators were sent to Beitbridge. And over 100 extra health workers, cleaners and daily workers have been hired locally.
In 3 days, a CTC (Cholera Treatment Center) with 130 specialized beds (which means the bed has a hole in the middle and a bucket underneath) was set up.
Once the cholera bacteria enter the body, they release a toxin, which causes the intestine’s pumps to suck all the water from the body. The intestine, unable to handle so much water, rejects it. The only thing you can do is give the body enough fluids to survive until the bacteria’s own life cycle expires, in usually about 5 days. Without fluids, a person can die within hours of contagion.
The town of Beitbridge is a shifting tide of migrants, truckers, sex workers, unaccompanied children and people desperately trying to find a better life, mostly by crossing the border to South Africa. With the current crises in Zimbabwe, basic services are lacking and especially so in a town with such uncontrolled growth. There is rubbish everywhere and open sewage runs through most of Beitbridges’ streets. The only real prevention for cholera is good hygiene.
As the MSF car moved slowly through the neighborhoods and Zimbabwean staff tried to broadcast their message through the loudspeaker, angry crowds gathered to shout: “How do you expect us to control cholera when there is no water!!” “Look at this sewage running here right next to us!” “Why don’t you clean up the garbage in the streets?”.
The problems are long-term. The water station doesn’t have the parts to properly repair its pumps. Even if it did, it depends on electricity to pump water to the city. Electricity depends on a coal mine that can no longer supply coal. There is no fuel to run the garbage trucks and no money to pay people to collect it. While MSF struggles against the tide of this highly contagious disease, the long term future looks bleak.