by Tawanda Musariri

Spirited efforts by the major players in the health sector have managed to contain the cholera outbreak that held the city of Harare's southern suburbs by ransom in the face of an antiquated fresh water and sewer reticulation system.

Glenview is the epicentre of the disease which has so far killed 55 people in the past 42 weeks, averaging more than one person every week.

The Ministry of Health, the World Health Organisation, the Global Alliance for Vaccination and Immunisation (GAVI) and the Harare City Health Department have, together with the corporate community and well wishers pulled in one direction to contain a potentially devastating outbreak which recorded 9500 suspected cases.

Although the number of patients has declined tremendously, according to Director for Epidemiology and Disease Control in the Ministry of Health, Dr Portia Manangazira, a disease outbreak is declared finished when the disease is not reported anywhere in the country for fourteen straight days.

A visit by the Harare Post on Friday afternoon to Glenview Poly Clinic satellite cholera treatment camp housed at the institution's gardens, saw an almost entire staff complement of nurses manning tents with open beds save for a solitary 82 year old lady, Mrs Annah Mutomari of 1182 Glen Norah A, Harare.

Mrs Mutomari who had arrived earlier in the morning with symptoms similar to those of cholera said she had consumed tap water supplied by the city of Harare.

Harare has a debilitating fresh water reticulation system which requires to be uprooted and replaced with a brand new and expanded system with a bigger carrying capacity.

Speaking to the media on the cholera situation on Thursday in Mazowe, Dr Manangazira said all efforts carried to fight off cholera so far were interim measures meant to save lives but were not a permanent solution to the cholera threat. She said without an organised and modern Water, Sanitation and Hygiene (WASH) program, the city remained a candidate for cholera and other water borne diseases.

Harare has three major sources of water, i.e. piped water supplied by the City of Harare, public community boreholes drilled by NGOs and private boreholes together with privately owned shallow wells in newly developed suburbs.

None of these are reliable sources of clean water. Piped chlorinated water often does cross lines with sewer water because of disintegrating pipes due to old age and pressure from overload. The Harare water and sewer system was designed before independence when the city had less than hundred thousand residents. Today Harare has more than two million residents.

Because of the frequently disintegrating sewer pipes, there is seepage of contaminated water into borehole and shallow wells catchment areas. The epicentre of the Glenview cholera shock was a borehole sunk by a sympathetic pharmacy which gave water to neighbouring residents that went long periods on end without running water. The unsuspecting community consumed the water oblivious that the borehole had been desecrated by uncontrolled underground sewer water, courtesy of the Harare City Department of water.

WHO, GAVI, MoHCC and the City Health Department have embarked on a cholera immunisation blitz which is targeting high risk areas.

These include Glenview and surrounding suburbs, new suburbs without WASH facilities and densely populated areas. As the Harare Post arrived at Tamuka College in Hopely, a team of nurses manning a satellite vaccination centre had already administered the oral vaccine to 700 walk in patients. Since the start of the program on October 3, Hopely suburb had administered the drug to at least 16 000 people.

The World Health Organisation's Dr Marc Poncin said they had decided to take the vaccination to the people through erecting satellite vaccination centres because they did not want to overwhelm clinics and health centres with patients as they had everyday patients and possible cholera patients to contend with. Dr Poncin also said that taking the drug to the people was reaping more results as people prefer to spend their time at their usual places instead of going to queue in a hospital line when they do not feel sick. 

The oral  cholera vaccine has been administered in at least 20 countries globally and has produced impressive results.

The vaccination exercise is racing to be completed before the onset of the rainy season. The drug which is administered in two doses inside a period of six months gives immunity for up to five years.

Dr Poncin encouraged people to  continue observing personal and community hygiene even if one is immunised.

Cholera and all waterborne diseases thrive under conditions of poor hygiene. The cholera virus, vibrio cholerae is found in human faecal matter and will attack its victim once it is ingested, said Dr Manangazira.

The cholera bacterium is destroyed by heat, so cooking food thoroughly and eating it whilst still hot is encouraged.

If anyone suspects that he has contacted cholera, he should start taking the oral rehydration solution as he rushes to the nearest hospital. The public also has a duty to report any suspected cholera case to the nearest hospital as soon as possible.

The oral rehydration solution is made of a litre of clean water mixed with a level teaspoon of salt and six level teaspoons of sugar. If one is unsure of the quality of water, boiling it is advisable. A patient is encouraged to take as much of the ORS as he can tolerate, so prepared quantities must correspond to the estimated time the patient may take to reach the nearest medical centre.