December 18, 2008

A second cholera outbreak has hit Chegutu, a town 100 km south of Harare, where more than 100 people have died since the first cases appeared on November 24.

MSF arrived in Chegutu, which has a population of 55,000, on December 12 after being told that day of the cholera emergency there.

The scene MSF found at the town’s small government cholera treatment center (CTC) was grim. The reported number of registered cases was more than 650 and 74 people were said to have died.

Patients were lying on the floor, some next to dead bodies, sanitation services were non-existent, and there was no water and no food to be found.

“The situation was absolute chaos,” said Luis Maria Tello, the MSF emergency team medical coordinator. “There were no beds and patients everywhere. People were dying of thirst because there was no water.”

The disposal of the dead was one of the first priorities set by the emergency team. “Dead people were lying everywhere,” said Tello.

MSF was able within a day to carry out disinfection and disposal of the corpses.

The MSF team has brought in more than 150 cholera beds, close to 3,500 liters of ringer lactate, used to treat cholera, and six tents. Due to the high levels of contamination in the area around the CTC, MSF is constructing a new isolated CTC with tents and latrines in a separate controlled area. MSF staff are facilitating better registration of patients while a more effective process screening of patients is being used to clearly identify cholera cases.

The team is concerned, however, that a number of people reportedly died of cholera at home because they were initially afraid to go to the clinic.

“People were staying at home because so many people died in the clinic and they were afraid to come,” said Grant Anthony, the water/sanitation technician, part of the MSF Emergency Team. “They would rather be treated at home,” says Grant Anthony,

Another challenge is getting food to the patients in the clinic. Many have been in the CTC for days and have not eaten anything. One elderly man was trying to remove his IV and leave the CTC.

“I am hungry, I haven’t eaten for nine days,” he said. He added that if people saw him with the infusion drip they would know he was carrying cholera and he would be stigmatized. Many health centers throughout the country do not have food for their patients. MSF and other agencies are looking into ways of assuring basic nutrition for the patients.

The sources of the outbreak are believed to have been discovered. Government authorities found many of the sick had used water from broken pipes that had been vandalized by others to access water. Chegutu has been experiencing water shortages for the past seven months, according to residents. Since there are also many burst sewage pipes in the town, it is believed that sewage fairly easily contaminated these drinking sources.

Cases are also being found outside the town, in the surrounding farms. The heavy rains have already started which means the cholera bacteria potentially can spread more easily beyond the town and into rural areas. MSF will soon be conducting exploratory missions in the surrounding areas to look for any other major outbreaks.

The number of cases MSF is seeing in Harare is decreasing. MSF treated 742 patients the week of December 8, whereas the week before, MSF saw 1,143 cases. The number of cases in Gweru is also decreasing. In Epworth and Chitungwiza, however, the number of patients are increasing, but in small numbers. Cases in Mudzi District, near the border with Mozambique, had been decreasing, but since mid-December, two clusters of cases have arisen with about 40 cases each. Most of the cases in one of the clusters was traced to a single contaminated water source.

MSF is finding new cases in rural areas in the eastern provinces of Masvingo and Manicaland. MSF has also seen a surge of cases in the southern part of Buhera, many of them severe. MSF has seen more than 100 new patients in the last week in these areas. Because these areas are more remote and the cases scattered, it is more difficult to find and treat new cases in these areas.

MSF will treat cholera as the outbreak continues. The strike of some government health workers in parts of the country continues to make the work more difficult, but MSF has been able to hire hundreds of nurses and other staff to help with the caseload. Additional humanitarian assistance is needed throughout the country, including more supplies, and more clean water and sanitation services must be provided.

MSF has been in Zimbabwe since 2000 running HIV programs.

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