In Zimbabwe, chaos gives cholera a foothold

HARARE, Budiriro, Zimbabwe — A bony limb flops from the wheelbarrow in limp resignation. A head lolls amid the pile of blankets. A woman is trundling her elderly mother home from a clinic to die.\r\n

In Zimbabwe’s cholera- ravaged townships, the dying make their final journey home in wheelbarrows and pushcarts, sent away from clinics by nurses too overworked and underpaid to care much about who survives.
 
One 71-year-old man, Tarcisius Nerutanga, had to carry his dying 27-year-old son, Allan, home over the weekend on his back. When Nerutanga was summoned to the clinic in Budiriro township, he found Allan dumped on a wooden bench outside, racked by severe vomiting and diarrhea.

"They didn’t say anything. They just said, ‘Take him home,’ " Nerutanga said, as his wife, Loveness, sat on the concrete floor in their tiny room weeping silently. "I knew he was in a terrible state. I didn’t think he’d survive."

Allan Nerutanga died Monday.

Zimbabwe’s cholera epidemic has killed at least 775 people and sickened more than 16,000, the United Nations reported Wednesday.

Under normal circumstances, the waterborne disease is relatively easy to treat. In Zimbabwe, it is spreading uncontrolled amid the country’s economic collapse and political turmoil as the 28-year-old regime of President Robert Mugabe clings to power after disputed elections.

A tangle of problems makes the disease intractable: decaying water system infrastructure; burst sewage pipes left unrepaired; government failure to buy water treatment chemicals or collect garbage; a lack of nurses because of low wages; a shortage of medicines; poverty and declining literacy because of the education system’s collapse.

The accumulation of woes leads many observers to fear that a defeatable disease that normally ebbs and flows with the seasons may remain a serious problem for a long time to come.

"It’s down to the political situation. If they don’t collect the refuse, if they don’t repair the sewage, if they don’t provide water, it’s going to get worse. It’s a mammoth task, repairing those things," said Douglas Muzanenhamo of the Combined Harare Residents Assn., a rights advocacy group.

"Without doing that, people will go back to the same situation, back to where this thing has come from," he said. "And they’ll get sick again."

In one area of Budiriro, a township hard-hit by cholera, swallows swooped in exhilarating arcs over the stinking green pools of sewage alongside the streets. Children with soccer balls made from plastic bags played in the streets, leaping across channels of raw waste.

There was a makeshift latrine nearby for the whole neighborhood, behind a sagging plastic wall. In the same field people had dug shallow brackish wells, where they fetch water on the frequent occasions when the taps don’t work. The water was cloudy; iridescent green flies buzzed around the edges.

In some areas of the township, said Muzanenhamo, there was no tap water from August on. In others there has been no running water for two years.

Even in Harare, the nation’s capital, the battle against cholera is plagued by shortages, including a lack of medical personnel. In the only major public hospital still functioning in the city, a senior physician said there were six doctors of the required complement of 22 and 12 nurses of a required 100. Four of the eight wards are open. Most medical staff have gone to Australia, Britain and neighboring African countries in search of better salaries.

The physician, who spoke on condition of anonymity for fear of reprisals by government officials, is preparing to leave soon.

"The government won’t be able to control it [cholera]. They’ve tried," he said. "No one is keen to deliver services."

He said many patients died of cholera because there were too few nurses and too few of the needed saline drips. A severely ill patient needs to receive drips every 30 minutes to survive. "They just die from dehydration," he said.

Patients are well aware of the need to "thank" medical personnel with bribes, he said, to get services and medications, such as the antiretroviral drugs used to treat AIDS.

"This is now a very corrupt country," the physician said. "Myself, I don’t ask for money. They actually know they have to give me money, not just a verbal thank you."
 

In the Budiriro clinic, Rudolf Mheyamwa desperately sought help. His family has no tap in their single-room home, so they were forced to use well water. His wife and three of his four children had contracted cholera.

Beauty Mheyamwa lay helpless in a clinic bed, tears pouring down her cheeks, as her husband tried to save their oldest girl, 13-year-old Romana. The girl’s condition was growing worse after she had lain all night in a nearby bed without a drip. When Rudolf Mheyamwa begged nurses to replenish it, they bustled past.

"The nurses just said, ‘We’ll do it in the morning.’ They were busy," said Mheyamwa, 38, a fisherman. "There was no way you could convince them to do anything because they’d respond rudely. They were just saying, ‘We’re not working for one person, there are so many cases,’ as they just rushed by.

"I blame the government," he said. "I feel angry, but there’s nothing I can do."

A clinic nurse said the pay was so low that most of the nursing staff were working only out of dedication. She spoke on condition of anonymity, also fearing reprisal.

The clinic’s nurses staged a sit-in for 10 days ending last week to protest their monthly salaries of 5 million Zimbabwean dollars each — the equivalent of 14 U.S. cents.

Although the sit-in was over, the nurse who was interviewed remained at home, as did some of her colleagues. She said her feet were too sore to work.

"We are overworked," she said. "At times you are very stressed. A patient can come and vomit in your face and you can get infected."

When she arrives at work, she said, 15 to 20 worried relatives crowd around, demanding treatment for their loved ones.

"They get angry. We tell them to cool off," she said.

The burden of caring for the dying thus often falls to the families.

In the last hours of his son’s life, Tarcisius Nerutanga lifted Allan’s frail body onto his knee, hugged him and begged him to cling to life. Loveness Nerutanga kept feeding and cleaning Allan, silently praying. Nothing helped.

Allan Nerutanga died grieving that his life was over before he could rescue his parents from their grinding poverty, his mother recalled.

"He just said, ‘Mom, we’re a laughingstock. We die a laughingstock.’ "