"I am feeling a little uncomfortable," Henry said, quietly. He is a middle-aged gentleman, lying on a dirty floor, politely looking up at Clara Chamizo. Henry is so dehydrated his cheeks are completely sucked in and his eyes stand out in his skull.
Chamizo, a nurse with the Médecins Sans Frontières (MSF) project in Beitbridge, southern Zimbabwe, sees the absurdity of this statement. She is standing in the middle of tens of cholera patients, on the dirt in the backyard of the main hospital. Cholera has overwhelmed this border town of about 40,000 like wildfire.
"Normally cholera starts with a few cases and then we have the peak after a few weeks," explained 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. Research will confirm later whether people got the cholera from the same source at the same time, as he suspects.
On Friday, November 14, when the Zimbabwean health authorities in Beitbridge first reported cholera to MSF, there were five 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 poor hygienic conditions.
With only one or two cleaners available, it was impossible to manage the sanitary needs and decontaminate the ward. There was also a shortage of proper equipment, chemicals and water – not to mention that all the hospital toilets have been clogged for a long time. By Sunday morning, the hospital decided to put all the patients out behind the buildings, on the dirt, so that body excretions could be absorbed into the ground. The sight was appalling. Patients lying in the dry dust in scorching 45ºC heat, all seeking the life-saving drip (Ringer Lactate IV fluid) for their veins. There wasn't even any water to give them since the hospital, like everywhere else in town, had its water supply cut most days.
Veronica Nicola, an Argentinean paediatrician and MSF Project Coordinator who has been on several MSF field assignments, says she has never 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," said Dr. Nicola. "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 in his arm ten times, but then he started gasping and he died right there in front of our eyes." Nicola paused, and then added, "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. It was very bad."
In one week, 54 people died. The Beitbridge hospital did not have any IV fluid or oral rehydration salt tablets in stock. MSF shipped over 800 litres of Ringer the first day of the intervention, and since then there has been a continuous supply. Twelve shipments of medical and logistical stocks arrived in ten days.
A team of 16 international doctors, nurses, logisticians and administrators are in Beitbridge for the outbreak. More than 100 extra health workers, cleaners, and daily workers have been hired locally. In three days, a cholera treatment centre was set up with 130 specialised beds that have a hole in the middle, under which a bucket is placed to catch the flowing diarrhoea.
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 and drives the body into a level of severe dehydration that can kill. Infected patients can lose up to 10 litres of fluids in one day and the medical response is to give the body enough fluids to survive until the bacteria's own life cycle expires, usually in about five days. Without this, a patient can die within hours of contagion. The drip is not a cure but a means of survival.
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 political and economic crisis in Zimbabwe, basic services are lacking, especially in a town with such uncontrolled growth. There is rubbish everywhere. Open sewage runs through most of Beitbridge's streets. Almost everyday, there are cuts to water and electricity. 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 (EHO) went around the town to give out information about how to avoid getting cholera. But public education on hygiene and prevention can be met with hostility.
As the MSF car moved slowly through the neighborhoods and the Zimbabwean EHO staff tried to give their speeches through a 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?"
On the main highway that crosses Beitbridge, there is an area where all the truckers stop on their way to the border. Sometimes it can take days to clear the paperwork to cross, so they camp out with passengers and relatives. When the MSF car stops there, the truckers gather around. They are just as angry as the local residents. They point out cesspools where they must wash their hands, and a dusty field next to them covered in human excrement. "Where are we supposed to go?" pleaded one man.
The problems are long-term. The water station does not have the parts to properly repair its pumps. Even if it did, it depends on electricity to pump water from the tower to the city. Electricity depends on a coal mine that has not been paid in over a year and can no longer supply coal. 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 system, nor money to pay personnel to do it. There are no quick solutions.