Cholera scourge Beitbridge, Zimbabwe

"I am feeling a little uncomfortable," says Henry quietly, a middle-aged gentleman politely looking up at Clara from where he is lying on the dirty floor. Henry is so dehydrated his cheeks are completely sucked in and his eyes stand out in his closely cropped skull. Clara CHAMIZO, a first-mission nurse for MSF's project in Beitbridge, is seeing the extreme absurdity of this statement. She is standing in the middle of tens of cholera patients, lying on the dirt in the backyard of Beitbridge's main hospital. Cholera overwhelmed this Zimbabwean border town of about 40,000 like contaminated wildfire.
"Normally cholera starts with a few cases and then we have the peak after a few weeks," explains Luis María TELLO, the MSF Emergency Coordinator who arrived a few days after the first cases were reported and is surprised to see such numbers. Though research is still needed to be done he thinks that perhaps it means that "a lot of people got the cholera from the same source at the same time."

On Friday, November 14, when 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.

Patients were first placed inside Beitbridge's main hospital, most lying on the cement floors in very poor hygiene conditions. With only one or two personnel for cleaning it was impossible, though, to manage and decontaminate. There was also a shortage of proper gear, chemicals, water and not to mention that all the hospital toilets have been blocked up for long.

Sunday morning, the hospital had to take the decision to put all the patients out behind the buildings, on the dirt so that the body excretions could be absorbed in the ground.

The sight was appalling. Patients lying in the dry dust under scorching 45 degree heat. All asking for the life-saving drip  in their vein. There wasn't even any water to give them since the hospital, like everywhere in town, had its water supply cut most days.

Clara and Veronica Nicola, the MSF doctor who is also Beitbridge's Project Coordinator, were the only MSF expatriates in the town when the emergency hit. Veronica, an Argentinean pediatrician who has been on several MSF missions, says she never has had to insert so many catheters in one day in her life.

"For me the hardest thing was to be able to concentrate on one person," explained Veronica later. "There was a man lying next to one of the trolleys under the sun. By the time I got to him he was in shock, we tried to get a vein like ten times, but then he started gasping and he died right there in front of our eyes." She pauses for a minute and then adds, "If I had seen him half an hour before we might have been able to do something about it, but there were so many people lying there, people calling you. But still," she adds thoughtfully, "we could have done something." In her calm manner she summarizes, "It was very bad." In one week 54 people died.

The Beitbridge hospital did not have any IV fluid or Oral Rehydration Salts (ORS) tablets in stock. MSF shipped over 800 liters of Ringer the first day of the intervention 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, 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 under which a bucket is placed in order that the diarrhea is released directly in the container) 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. If you don't, a person can die within hours of contagion.

The only real prevention is good hygiene. From the second day of the outbreak an MSF car with two officers from the Zimbabwean Environmental Health Office (HEOs) was dedicated to going around the town to give out information to the public on how to avoid getting cholera.

The town of Beitbridge is a shifting tide of migrants, truckers, sex workers, unaccompanied children and desperate people trying to find a better life – mostly by attempting to cross the border into South Africa. With the current crises in Zimbabwe, basic services are lacking and especially so in a town with such an uncontrolled growth. There is rubbish everywhere and open sewage runs through most of Beitbridges' streets. Almost everyday there are water-cuts, power-cuts.

As the MSF car was moving slowly through the neighborhoods and the Zimbabwean EHOs tried to give their speeches through a loudspeaker, everywhere 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?!!".

On the main highway which transverses Beitbridge, there is an area where all the truckers stop on their way to crossing over the border. Sometimes it can take days to clear the paperwork to cross so they camp here, together with passengers or relatives. When the MSF car stopped there, the truckers gathered around and were just as angry as local residents. They show some cesspools where they come to wash their hands and point out a dusty field next to them covered in human excrement. "Where are we supposed to go?" pleaded one man.

And 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 be able to pump from the water tower to the city. Electricity depends on a coal mine that hasn't been paid in over a year and can no longer supply coal. Then, there is no fuel to run the garbage trucks; there is no money to pay salaries for people to collect the garbage. There is no equipment or supplies to fix the sewage and no money to pay personnel to do it. But there are no quick solutions.