The Sound of Cholera

By Yasmin RABIYAN, Communications Advisor MSF

I couldn’t get the stench of chlorine off of my hands. My shirt still smelled like cholera when I picked it up days after I returned from Zimbabwe. It is a peculiar smell, incomparable to any other I know. You will be hit by it when you enter a cholera camp, where it comes at you together with a heavy note of chlorine – a fragrance combining hope and death.

With the cholera epidemic sweeping through Zimbabwe, killing more than three thousand and infecting tens of thousands, it has been weeks that I, working on communications about our projects in the country, have heard about cholera, spoken about cholera, and thought about cholera. To be face to face with the disease for the first time, however, I first got a real "sense" of it. I visited several cholera treatment centers or "camps" in and around Harare, where the outbreak was the worst. Depending on the situation, they are set up in wards of city health clinics, in more rural areas or, when the number of patients  gets really high, additional tents are set up to accommodate the overflow of  patients. I learned a lot about cholera and its effects, things that are not included in our regular, factual updates because they are not tangible, but help make cholera and those affected by it more real, more human and therefore harder to forget.

For a disease that is easily preventable but such a quick and decisive killer, I had wondered what it  would look like. I knew that the sick patients would be haggard, with cavernous eyes and sunken-cheeks. When you are infected with cholera, you lose up to 20 liters of fluid per day through vomit and extremely watery diarrhea. That’s also the reason you die of the disease within two days time if it is not treated. Cholera dries you out. I knew that beds in cholera units were especially adapted to that: they have a hole in the middle and a bucket placed beneath it to collect the seemingly endless flood of diarrhea. So is brown the color of this hideous disease? No. More than anything else, the color of cholera is white.

The rejected body fluids are of a whitish color, as is the omnipresent chlorine, the smell and color of which slowly settle over everything in a cholera camp. To prevent the spread of the bacteria, your shoes are sprayed every time you enter or exit a cholera treatment site. Inside, you wade through milky chlorine footbaths in between different patient rooms or tents and you wash your hands with an off-white chlorine solution every so often. Nevertheless, not to take any risks, there are particular kinds of greetings you get used to in times of cholera. As a regular handshake may well pass on the bacteria from one person to the next, in a cholera environment you make a fist and touch the other’s fist with your knuckles. Or you raise your elbow and greet another elbow in mid-air.

So much about the technical details I learned. What about the feel of cholera? What were the particular feelings I had when visiting the camps and treatment centers, I was asked at home. It is not easy to separate my emotions from those I saw suffering, needlessly.  My feelings were with the little girl lying on the floor with an IV-drip in her slender arm, sleeping of exhaustion. They were with the two young men carrying in their stepfather who fell ill after eating a sweet melon from their farm and who fell in to shock when they reached the camp. They were with the old man trying to pull the IV-drip out of his arm and to leave the camp as he had been there for days without eating because of food shortages. They were with the brave smile of a twenty-year old woman, nine months pregnant. They were with the sight of the restless doctors and nurses who forget to eat and sleep to keep the patients alive, the ambitious logisticians and helpers who build structures to allow the sick to lie on beds, have a roof above their heads and some dignity in fighting the disease. And my feelings were with the 45 community volunteers who came together in the morning to get information about the disease and instructions on how to prevent infection, which they then carried back with them to their neighbors and friends.

To me, the feeling is best understood accompanied by the sounds I heard at the camp after a busy Sunday, when the staff of a Christian medical charity started to sing songs to cheer themselves up. Later on, they visited every tent, one after another, to sing to the patients. Listening to them with the sun slowly setting, accompanied by the background camp noises of people discussing the days' happenings, the plans for tomorrow, tents being put up, and the grinding arrival of a truck announcing the awaited arrival of new supplies, I was filled with encouragement and admiration for everyone working so hard to ease the patients' suffering brought about by an ugly  disease which did not have to happen. To me, this is the sound of cholera – the sounds of life that continue despite it all.