Choléra, Choléra!

My assignment today is to find a cholera kid – that is find a child above five that has cholera and whose guardian would allow me to talk to them in order to get a child’s perspective on this disease that has hit Zimbabwe.

My task may seem straightforward, since even today there are a hundreds of cholera cases around the country – over 93,000 total since the epidemic started. And, indeed, only shortly after my inquiry, Juliette, our MSF Head Nurse in Harare’s main Cholera Treatment Center, calls me to tell me that yes, there is a 10-year old kid that was admitted two days ago and I could see him since his guardian agreed.

When I arrive, Dennis refuses to open his eyes when Juliette addresses him. His grandmother, a handsome elderly lady with a crucifix hanging from her front gently shakes his shoulder. “He is pretending,” she says to us with a smile. “He thinks you will make him drink the ORS (Oral Rehydration Salts necessary for recovery).” Gogo (grandmother in Zimbabwean dialect) is about to try and rouse Dennis again, but I confer with Juliette and decide just to come back tomorrow.

Photo: J Stavropoulou, MSF. | 10-year old cholera patient, Denis.

Before I leave, I sit and talk with Gogo a bit, with the help of Juliette translating. Gogo lives in Mbare. This is one of the poorest high-density areas of the capital. It is dusty and dirty; it is where the bus terminal arrives from southern Zimbabwe and where also the whole-sale fruit and vegetable market is located. There are a number of three-storey overcrowded and derelict flats there which our watsan experts have already identified as highly unsanitary. I have already heard stories of sewage pipes burst and flowing into people’s apartments, while toilets are backed-up and completely infested.

Gogo, 69, lives in a small two-bedroom apartment with her two remaining children and nine grandchildren. I stumble on the word remaining and turn to Juliette. “How many children did she have?” I ask. Gogo answers the question matter-of-factly. “She had nine children in total; now only two are alive,” translates Juliette. I ask about their conditions of life. Gogo says there is no one with an income in the house so they rely on Catholic Relief for a monthly supply of basic food commodities.

Gogo’s daughter – Dennis’ mother – just two weeks ago gave birth to another child. That is why Gogo is at the hospital caring for Dennis; the mother is still at home with the newborn. I thank Gogo for chatting and she smiles and graciously inclines her head telling me “mazvita” – thank you.

“So why do they call them elephant pumps?” I asked Precious, as I stand in front of an aqua blue round concrete that comes up as high as my head. To each side are handles and in front of me is a protruding pipe.

Precious Matarutse, 24, has worked for MSF for a year in implementing water sanitation programs and her positive and enthusiastic attitude are still indomitable. As long as she is out with communities helping people nothing is hard for her, “just don’t put me behind a desk,” she tells me laughing.

Now she smiles and asks me to step a little back from the pump. “You see on the ground the round formations where people stand to turn the handles are like elephant ears and then under the faucet there is a small trench which is like the snout. She’s right, it does look like an elephant!

Photo: J Stavropoulou | Elephant pump

MSF has constructed close to 30 of these elephant pumps in two areas around Zimbabwe’s capital. Precious and I are now in Mabvuku Tafara, a township of about 150,000 people. “Some parts have not had water for over a year,” says Precious as we drive through the township checking on each pump that MSF has constructed here.

Photo: J Stavropoulou | Queueing for the well.

We get to one site where there is a long line of people waiting with buckets and jerry cans of all colors, blue, green, yellow. It is next to a now defunct pottery factory and that is why they call it the Pottery Pump. We get out of our minivan and a 4-year old little girl wearing a short white dress comes up to me to touch my white skin and everyone laughs. She runs away.

Photo: J Stavropoulou | Filling up at an"elephant pump."

Mr. Cleopas Kajekere, a man who lives near the pump has assumed the responsibility for its care. “This pump works 24-hours a day,” he tells me as he looks on at the waiting line. “Maybe at least 5 a day.” I wonder what he means by 5, and then he clarifies “yes about 5,000 people come to fetch water a day.” The queue is endless since, once some people go with their clean water, more replace them in the line.

After Precious talks to the chlorinator teams, we jump into the minivan and head for the next MSF station. “What does Mavuku Tafara mean?” I ask as we jostle over dirt roads of the township. “We are rejoicing,” replies our driver absently; his attention is diverted as he tries to go through a river flowing down one of the township’s main dirt roads. I turn my head and look out the window and I gasp at the stench that hits me. The river that is flowing is sewage. I quickly cover my face; it is unbearable. But all around people are walking, kids playing, small shops with men loitering outside right at the edge of the river. I get out to take a photo, but it is hard to breathe, I cover my mouth and nose with a scarf. A man comes over to me and we both stare at the river of raw sewage. “How long has it been like this?” I ask my voice muffled through the scarf. “Since August.” “Since August?!” I cry aghast. “Aa,” says the man calmly, “this won’t be fixed anytime soon.”

Photo: J. Stavropoulou | MSF community teams inject the right amount of concentrated chlorine into water containers

“Why can’t you fix the whole urban water system,” asks a man as Dominique, MSF’s Water & Sanitation (watsan) expert and I stop at a busy market place in Dzivarasekwa; a Harare township. Our MSF mobile team of bucket chlorinators is here and Dominique wants to see how they are doing. The team goes around and injects disinfecting concentrated solution of chlorine into containers of water that people bring to make sure the water is safe to drink.

The market is busy. Small stands under umbrellas are selling anything you can imagine. From vegetables, especially mangoes and avocados, to shoes — but with only one of the pair displayed (to utilize better the space, to assure that they are not stolen?). I am standing next to a vegetable stand behind which is running a river of open sewage. The stench is so overwhelming that I am turned off from buying any fruit. I am talking to the lady who owns the vegetable stand. The man who had asked the question is standing idly nearby, like so many unemployed people in Zimbabwe.

The lady agrees. “Is it for life, is it forever this treatment you are doing?” she asks. I explain that no, that we are an emergency organization that is here to help with the cholera epidemic. She says she doesn’t want to chlorinate her water. I am a little stunned but try not to show my reaction because I want to understand. “But aren’t you afraid that you will get sick?”

“But then when you stop giving this we will be affected even more than before,” she explains. The man agrees, adding laughing, “We are resistant like wild dogs; we’ve been drinking unsafe water for a long time.”

Dominique overhears our conversation. He is passionate about clean water, about his job, about keeping people safe — he tirelessly and zealously checks water systems, problems areas, possible sources of infection, he never stops, never quits. I wonder if he will react impatiently because truth to tell I was feeling a little impatient myself with this attitude expressed by the people. But Dominique takes 20-minutes to reason with Jane. On and on he talks to her, about the importance of sanitation, about keeping her four kids safe, about clean water. I look on smiling — how long will she resist? She finally has to agree simply from the force of the argument. One more family saved?

Photo: Joanna Stavropoulou | Dzivaresekwa is a typical high-density township of Harare with open sewage running throughout its streets.

Dominique and I go off in the MSF minivan towards Dziva extension. The area is in its summer rainy season lush green has small shacks built along muddy roads and some half-built brick buildings. We stop at one of the shacks and this one, like all the others in the area has its own shallow well. Amai Trust seems to be the head of the household. Tall and proud she shows us her well. The compact dirt of her small compound is well swept, a line of clothes is hanging out to dry, a well tended vegetable garden by the side of the well. The children around are barefoot and with sparse clothing, but they are well-behaved.

Photo: Joanne Stavropoulou. | Most households in Dzivaresekwa Extension have their own wells. Because these are usually very shallow they run a high-risk of contamination.

Their well is no more than a meter or two deep, with a tire to make the opening and a make-shift tap to cover the opening. Dominique asks where the toilet is and everyone turns around to laugh between themselves; “they always laugh when I ask,” says Dominique smiling at me. The latrine is no more than ten meters away from the well. “It rains, the water flows from latrine to well, people walk around, or they leave the bucket on the ground then dip it into the well,” explains Dominique. I ask Amai Trust if she boils the water. She doesn’t understand but Revayi our driver helps to translate. “No,” he explains for her after conversing, “there is no electricity in this area and firewood is very expensive and precious. There is no way for her to boil water.”

A crowd has gathered around our MSF minivan and they are laughing. I ask Revayi why they are laughing. “They are afraid to touch our car,” he says smiling, “because they say if they do it will infect them with cholera.” I shake my head at the irony of this.

“Coléra, coléra!!” shout little Zimbabwean kids running after our MSF minivan as it splashes through sewage soaked muddy roads in the high density Harare township of Dzivaresekwa (or Dziva or just Dizzy as some expats have started calling it). Revayi our driver laughs and puts the music up higher. He usually works his minivan as a combi (privately owned transport for locals). “What’s your name mean Revayi?” I ask him as I try to hold on in the back seat — all Zimbabwean names mean something. He says it means bad gossip, because his mother-in-law talked bad about his mother while she was pregnant so in revenge she named her son like that. Dominique turns around and we look at each other, both rather stunned with the explanation and not really knowing how to respond.

Photo: J Stavropoulou | The collapsing water and sanitation system in Zimbabwe has been one of the prime causes of the cholera epidemic in the country. People in Dzivaresekwa Extension don't have running water or electricity.

I change the subject and ask Dominique to tell me about his field of water sanitation and the project of trying to get safe and clean water to Harare’s most vulnerable residents. Dominique, French-Canadian, young and crazy obsessed with water. Any kind of water, dirty, clean, sewage — with dark thick hair and intense brows he gets easily carried away about his favorite subject.

He tells me how in this township of Dziva that we are going through they do actually have tap water, but because the system is so damaged, with pipes burst and pumps not functioning properly, that there is no pressure. This has allowed the sewage, which is running freely everywhere from its own bust and backed up pipes, to infiltrate the water system. People are literally drinking their own excrement. “We could smell the sewage in the tap water,” he says and as we splash through another open sewer in the street and the stench fills our minivan it is not very hard to imagine.

We stop at an MSF water point where our teams use a concentrated solution of chlorine to inject into people’s water buckets and thus disinfect the water. There are a lot of people walking around, kids (school has started again in Zim but there are no teachers), men and women (80% unemployment). Many try and sell anything, small cardboard boxes under rainbow colored umbrellas; mangoes, tomatoes, avocados.

Dominique is talking to the chlorinators. He is intense but he also laughs with them and they all want to know when he will be back to check on their work. I wander into a nearby house. People are always so friendly here in Zimbabwe. The people of this house come up to greet me and I ask them if they have problems with water. One of the men of this 9-people home (children, aunts, brothers) shows me their tap. It is dripping into a bucket and he says that is how the pressure has been since last year. He says they cannot wash things like blankets anymore, it would be impossible. “What about your toilet?” I ask. “Toilett?!” he cries in frustration, “it has been backed up for more than a year” he says. “Sometimes it overflows and we have to empty it with buckets.” He shows me the latrine. I look down into a dark greenish mass and I think my eyes are playing tricks on me, or the light is funny because it is almost as if it is moving, but it can’t be. I hold my breath and squint a little closer. Then, I jerk back in shocked disgust; it is a mass of thousands of maggots seething everywhere. I quickly exit.

I ask him if they have any money to get by. He sends one of the women into the house and she comes out with a pay slip. He wants to show me. He earns 13,742,381,818.1 Zim dollars a month. It looks like a lot on paper but unfortunately 13 trillion Zim dollars is less than 1 US$ today. Tomorrow, even less.

Photo: Joanna Stavropoulou

I thank the whole family, take some photos of the kids and to their absolute delight show them the result and rejoin Dominique.