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Zimbabwe: Life surrounded with cholera

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Dadirai’s Strength

© Joanna Stavropoulou/MSF
Dadirai with patients at the HIV clinic in Epworth

16 March, 2009

I get a call from Médecins Sans Frontières Headquarters that they need a brief story of a Médecins Sans Frontières beneficiary for the Annual Report. I have met so many, heard so many stories, written about so many of them, that I decide it is easier just to drive over to our closest project and just meet someone new. I, anyway, always like going to Epworth.

Epworth is about a 30-minute drive east of Harare. We drive along with sunny wind coming through the window. As we get to the township I see the big tan boulders for which this place is so well-known for. The boulders balance incredibly one on top of another, often seeming to defy the laws of gravity. I’ve seen them many times before; they are even on Zim’s now defunct currency notes. Yet, the sight never ceases to amaze me – they are almost like Zimbabwe itself, so precarious yet still, somehow, standing – and beautiful.

We get to the Médecins Sans Frontières HIV clinic and I meet Stef, the Project Coordinator who I had called in advance. She has an enthusiastic twinkle in her eye, “I’ve got just the lady for you,” she says, “she’s amazing.” We go towards the clinic entrance where endless lines of patients are waiting; either sitting or lying in the wheelbarrows their relatives have used to push them here. “Ah, it’s a quiet day today,” comments Stef which might come off as ironic if you looked around, yet wasn’t if you have been here on other days. The Epworth Médecins Sans Frontières Project takes care of over 10,000 HIV positive people that live in the area.

At the register table a tall proud lady with a lilac apron is collecting data from waiting patients. Stef asks her if she would be willing to be promoted as one of Médecins Sans Frontières’s beneficiaries and she enthusiastically agrees. Stef leaves us and I go off to talk with Dadirai.

Even from the first minute I meet Dadirai, I am impressed by her. There is a strength that emanates from her. A drive within, powerful, unquenchable.

It keeps her going on. She tells me first about how her husband got sick but refused out of fear to get treatment. Even when he was dying at the hospital he did not take any medicine -- and he died. Then her baby girl got sick and it was discovered the child was HIV positive. Soon after, she herself got sick and when she got tested she found out what she had already guessed -- that she also was HIV+. “It was a hard time,” she says matter-of-factly but without self-pity. She could not walk, or eat or take care of herself, let alone her two HIV+ girls. Her older daughter, now 11 years-old, though she was not sick, when she got tested was positive as well. But Dadirai held on and with the help of ARVs both she and her little daughter got better.

“I want to help many people,” she says nodding her head firmly and repeating herself, “that’s right, MANY people. I want to stop HIV in Zimbabwe. I WANT that there will be no one more with HIV.” She speaks passionately and with conviction. “I want to help people learn how to prevent HIV, how to take care of themselves – that’s what I want to do.”

Dadirai, now 32, started taking ARVs through Médecins Sans Frontières’s program in Epworth in 2007. When she joined the program she worked for a year as a volunteer Peer Educator, talking to other HIV+ people and helping them to accept their status and keep on their treatment.

After a year of working hard as a volunteer and through encouragement from Médecins Sans Frontières staff, she decided to go back to school. She had to walk each day 2 hours -- “footing it up and down every day” -- to get to the college. She sold vegetables in the evening and Sunday to feed herself and her two girls. “It was difficult times,” she says but she kept on. She eventually graduated from college and now she is proudly working with Médecins Sans Frontières as a Nurse Aide. She hopes in the future to become a counselor.

In the meantime, she raises her children not to be embarrassed about being HIV+ but rather that they talk to their fellow classmates and teachers at school about the disease, openly, without fear. She herself talks to anyone, anywhere, about her status and the importance of getting tested. Sometimes, she tells me laughing, she will preach to people waiting at the bus stop with her. When they don’t believe she is HIV positive she takes out her container of ARVs and shakes at them. “I tell them – know your status, come get tested, come GET TREATED,” she says with enthusiasm. How could anybody resist this force?

 

Finding a little Miracle

10 March, 2009

We finally get to the number we had looked for, but find out that Maria doesn’t live there; it is her brother’s house. He says where she lives there are no numbers and that is why Maria uses his address. He offers to show us the way.

We drive along the dirt roads between the houses until the road can go no longer. Then we walk along a small footpath through tall bright green grass and maize crops rising up around us. It is hard to believe we are still in Harare. We come to a small settlement of houses, with various children around, some ladies, some chickens, a well.

And then, there is Maria walking towards us, shyly smiling, quite obviously not pregnant anymore. I am so happy to see her, I feared the worst, yet had fervently hoped for the best.

Liliosa explains to Maria that we have come to check up on her and she is clearly astonished. She leads us back to her small home, a one-bedroom wooden structure with a corrugated-iron roof. There on the bed lies a small miracle. Her week-old daughter who Maria proudly says she has named Takudzwa, which means “We have been honoured” in the local language. The child is perfect, she is even trying to open her eyes and I swear she smiled when I cooed at her.

Maria delivered her right there on the bed. Two days after she got back from our cholera camp. She not only didn’t have the money for the hospital fees, she didn’t even have the money (2 USD) for transport to get to a clinic.

But somehow she only had one hour of labour pains and then Takudzwa arrived. It was a clean birth, no complications.

The future, though, still lies uncertain. Maria has three other children. The only income she and her sister have is buying fish wholesale and selling it to individuals. But she has no money to go to the clinic for a check-up after the birth, nor has she been able to take the child for its immunisation shots.

But still, a small miracle is before us and we all smile down on the baby. Maria says despite it all she is very happy with her daughter.

© Joanna Stavropoulou/MSF
Maria delivered her baby daughter at home because she could not afford the 50 USD fee state clinics are charging nowadays for pre-natal care and delivery.

Looking for Maria

10 March, 2009

Remember the pregnant lady I met at the Oral Rehydration Point? A week and a half later, I went to look for her and find out what had become of her and the baby.  

“Hey Heidi!” It is always great meeting up with Heidi, our Médecins Sans Frontières nurse who works at the Médecins Sans Frontières cholera camps in Harare. Blonde hair, big blue eyes she looks like an angel and has a personality to match. She is never too tired, too stressed, or too busy to dedicate time to patients and their care.

I haven’t seen Heidi for a couple of days and am anxious to find out what happened to Maria, a nine-month pregnant cholera patient I had met about a week and a half ago.

I had first come across Maria when I accompanied the cholera patient transfer bus on its rounds. She was quite ill when we came to her, lying in a cholera bed in one of the Médecins Sans Frontières Oral Rehydration Points we have established around in the far-flung townships of Harare. We quickly transferred her to Budiriro Clinic where Médecins Sans Frontières has set up a cholera treatment centre. Heidi had made sure she got two IV lines right away.

I had asked Maria then if she had the money to pay to register for antenatal care at any clinic near her home. She had simply stared at me as if I was delusional – where would she get $50 for the maternity fees charged nowadays by Zimbabwean clinics and hospitals?
 
When I now asked Heidi what happened with Maria, she just shook her head sadly. “I was praying for her to go into labour while in Budiriro, but it was not happening. And then I begged the Zimbabwean doctor for two days more after she got over cholera to let her stay. But after then he discharged her. There was nothing I could do against that,” she says and sighs and we both look at each taking a deep breath.

Once patients in cholera camps are cured from cholera they are discharged, even if they have something else. Unfortunately, in almost all instances these patients then have nowhere else to go and no money to afford any other option.

“I’m going to go find Maria,” I decide right there and then and Heidi’s eyes light up. We both agree it would be wonderful to find out what has happened to her. But Heidi cautions me not to be too optimistic.

I arrange for transport and take Liliosa with me, one of our Médecins Sans Frontières Zimbabwean nurses. She is herself quite pregnant, but extremely active nevertheless and when I explain to her our mission she becomes as enthusiastic as I am to find Maria.

We drive through the neighborhood of Kwadzana. Here, like almost all other townships of Harare, what never ceases to amaze me is its contrast between nice small houses with their carefully tended gardens and fences and the open sewer running freely through the streets. It’s sunny and there are many people walking around, unsurprising with such high unemployment in the country. There are a lot of home-based barber shops, a chair and a mirror with signs like “New Beginnings Hair Saloon” or “Golden Hair Barber.”

We’re looking for just a number. That’s how this works, no street names, just all the houses numbered, sometimes logically, sometimes not. We get directions from a lady who says we have to turn where the telephone booths used to be – Liliosa laughs; another of the many features of a deteriorating Zimbabwe.

© Joanna Stavropoulou/MSF
Maria lives on the outskirts of Harare in a settlement with no power or running water.

Lifelines

20 February, 2009

By now it is quite sunny. We’ve got a while to go until we reach our next destination. We exchange stories with Georgina about our lives; she shows me mobile phone-photos of her 4-year daughter. Both she and her husband are nurses and they both have work now, but even so if things don’t improve in the country she is considering moving to Botswana.

We eventually both nod off to sleep in the softly bumping ride with the warm sun making it cozy inside our cholera van.

Arriving at Dziva, we both wake up quickly since at our ORP there are two dehydrated patients waiting for transfer to the Médecins Sans Frontières Cholera Treatment Center (or CTC in short). One lady has her 1-year old baby with her. “Is your baby sick as well?” I ask her. “No,” she shakes her head weakly, “but I am breast-feeding and I don’t have anywhere to leave the baby.” A few days later I would see this same lady at the CTC and by then her baby was also infected with cholera.

The other lady is 9-months pregnant. The attending nurse at the ORP tells Georgina that according to the patient there hadn’t been any fetus movement for the past three days. The two nurses shake their head. It is very usual for pregnant women getting cholera to loose their babies.

While they take care of the paperwork, I go over to talk to the pregnant lady. She already has four children and had given birth to all of them in her home, even though after the second birth she had post-partum haemorrhage. Her husband does not support her; he does not have work. She and other five families all drink from a shallow well; she does not have the means to boil the water and she thinks that is where she got the cholera.

Georgina has come over and with the help of the other nurses both patients are put into our cholera minivan and we transfer them to the Médecins Sans Frontières Cholera Treatment Center. After we leave the CTC, Georgina who had overheard part of the conversation wonders at how this lady has so many children, “One child is so expensive,” she says thinking of the expenses for her own daughter, “How can they take care of so many?”

© MSF
Patients receiving oral and intravenous rehydration inside the overwhelmed Kadoma Cholera treatment centre.

The Mighty Dollar

© Joanna Stavropoulou/MSF
MSF staff setting up another cholera treatment centre in Zimbabwe

20 February, 2009

Today the sky is turquoise blue with smiling white clouds floating around but all during last night it had been raining. I’m accompanying Georgina one of our Médecins Sans Frontières nurses. She is 32, pretty with an open smile and neat hairdo of raised cornrows and very determined. She wants to visit one of Médecins Sans Frontières’s most remote Harare ORPs (Oral Rehydration Points). We have set up 17 all over Harare; basically they are small cholera centers that help patients get access to treatment.

We have gotten to a point where the road just looks like one muddy river. Tinashe, our driver, just shakes his head good naturedly and he sets his cholera-ambulance converted minivan to splash through the mud – we are through! We all laugh relieved. We bob along the dirt road, through fields of maize and soya plantings. This is the summer season in Zimbabwe – everything is lush green, the air is crisp and warm and every other day it rains.

“There’s our ORP,” points out Georgina and in the middle of a field I distinguish a small tarpaulin-covered stand and two ladies sitting inside. When we approach they come out smiling to greet us.

Mary and Zodwa are in their late fifties and have lived in Hathcliff Extension for decades. They are very happy to see us. They are wearing the plastic aprons we have given them over their neat attire. They show Georgina their notebook where they have carefully recorded who visited their little center, what symptoms they had, how much Oral Rehydration Salts they administered. No visitor today had needed to be transfer to the cholera treatment center for more intense treatment.

Mary and Zodwa work at this little Médecins Sans Frontières cholera point from 8am to 5pm everyday. They proudly show me around their stand, point where the buckets of disinfecting water is to wash out cups, the ORS solution, where they store the satchels. The Médecins Sans Frontières stand is standing in the middle of a red-muddy field and yet the tarpaulin placed on the stand’s floor is spotless, everything orderly, clean. The ladies complain that they would like to have a mop, they use their own rags to clean every inch on their knees. They then explain the procedures they follow when a patient comes to their stand, what symptoms they check for, how many hours they keep them under observation, how they decide whether to transfer them or not.

Mary and Zodwa are volunteers; they do not even receive an allowance. I am amazed by their dedication and diligence and can only wonder at what difficulties they must have in their lives and how they are able to put that aside to come and help their fellow residents.

We stay a little bit just to talk to them, of their life, their difficulties. They tell me that now the biggest problem people face is that they can’t pay the fees that clinics and hospitals are demanding; Zimbabwe’s public health care system started charging this past month in US dollars.

“People here, they don’t even know the [US$] dollar,” says Mary with emphasis, “they don’t ever see it, don’t even know its color.”

“But, so what to the people do?” I ask.

“Aah,” she shakes her head, “they just die.”

They told me of one of their neighbors this past week who gave birth at home because she did not have the 50 US$ the clinics are charging for maternity fees. But her placenta didn’t come out and after three days she died.

“At least if they could educate some midwives,” says Mary. But the ones that are around, she explains, don’t know what they are doing. Zimbabwe had such a good health system that everybody had access to health care and local midwifery went largely disused.
 
We respectfully thank our ladies and Georgina and I jump back in the minivan.

 

The Force of Argument

© Joanna Stavropoulou/MSF
MSF water and sanitation expert Dominique is training over 80 teams of bucket-chlorinators to work in the communities of Harare's high-density townships.

10 February, 2009

“Why can’t you fix the whole urban water system,” asks a man as Dominique (Médecins Sans Frontières’s Watsan expert) and I stop at a busy market place in Dzivarasekwa, a Harare township. Our Médecins Sans Frontières 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 pairs on display (I wonder if it is to utilize the space better or 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 organisation 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?

Dominique and I go off in the Médecins Sans Frontières 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.

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 Médecins Sans Frontières 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.

 

Any Kind of Water

© MSF
Joanna Stavropoulou

10 February, 2009

“Cholera, cholera!!” shout little Zimbabwe kids running after our Médecins Sans Frontières 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).

I 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 a Médecins Sans Frontières 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 Zimbabwe but there are no teachers), men and women (there is 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. “Toilet?!” 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.

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