By Michael Gwarisa
In Zimbabwe every year, December 22, marks Unity Day, an occasion to commemorate the signing of the Unity Accord in 1987, when Zimbabwe’s two rival political parties signed an agreement to end a protracted period of conflict. 36 years later, on December 22, 2023, everyone woke with anticipation to celebrate this important day on the national Calendar.
For most Zimbabweans, it was a normal but cloudy Unity Day Holiday, with a high likelihood of precipitation later in the day. However, for Tanaka Nyamukoko (23) from Hopley, a Harare peri-urban community, the universe had other plans. As a single mother of one who survives solely on vending, the plan was to cash-in on the Holiday and capitalise on the impulse buying and care-free spending mood that is associated with the festive season the world over.
She opened her vending stall early and by mid-morning, she had served several customers. All was going well. Business was booming. Tanaka could already see herself giving her one-year-old child a Christmas to remember. Her joy would however not last long as she started experiencing irritable bowel symptoms, some bit of nausea and a headache.
At first, I thought it was nothing serious. I had this irritating feeling in my tummy and I thought it was going to end in no time,” said Tanaka.
She said she knew there and then that what she was experiencing was probably Cholera since she had lost three of her neighbours some weeks before. Hopely is one of the Cholera epicenters in Harare and has been recording increased cases of Cholera and deaths since the onset of the outbreak in February 2023.
Fortunately for Tanaka, she resides a few yards from an Oral Rehydration Point (ORP) that was set-up a few weeks before Christmas in 2023. The ORPs serve as the primary points of care and the first lines of defence for community-level cholera case management through administration of oral rehydration therapy.
“When I got to the ORP, I was administered Salt and Sugar Solution and was given some sachets and Watergurd. I went home and applied the water guard to the drinking water. In the evening I had episodes of Diahorea tummy and vomiting. I was alone, I feared I was going to die. People died here and if I am not mistaken, we lost about three neighbours last year.”
Tanaka did not stop taking the Salt and Sugar Solution despite its unpleasant taste. She said she had to beat the Cholera. She had to do it for her child.
“I continued taking the salt and sugar solution. By dawn, I was already feeling better, the running tummy and vomiting had stopped and I was not dehydrated. I think this OPR is helping people a lot,” said Tanaka.
The Oral Rehydration Point at Nhando in Hopley is among the three such points that have been deployed by the Zimbabwe Reed Cross Society through financial support from the European Union and the Finnish Red Cross. The Oral Rehydration Points are the brainchild of a cholera preparedness project titled the “Integrated Strategy for Cholera Risk Elimination and Mitigation” in 10 hotspot wards in Harare Southern and Western districts.
The project has a focus on three key components namely Prevention, Containment, and Upscaling and aims to prevent the spread of cholera among at-risk communities in urban Zimbabwe by breaking transmission through Risk Communication and Community.
The ORP deployments are being supported by teams of volunteers who are continuously providing Risk Communication and Community engagement (RCCE) through door-to-door visits to break transmission in communities.
Arnold Chitsotso, the Team Leader for Volunteers in Holey said the Oral Rehydration Point has decongested health facilities and reduced transport burden on patients as well as save lives by providing quick treatment.
“If it’s a severe case, especially if it’s children below the age of five, the elderly and pregnant women, we refer those to the clinic for further management. We also refer those with serious symptoms to the clinic,” said Chitsotso.
The Volunteers also conduct home treatment sessions where they follow up on clients with mild symptoms they would have referred back home to provide rehydration services in the comfort of the patient’s home. The patients who visit the Oral Rehydration Points are also given hand-washing soaps, ORS Sachets, and water guard tabs to help manage and prevent further transmission of the disease at home.
Finnish Red Cross Representative in Zimbabwe, Micaela Sodergard said they are considering scaling the projects to reach out to other districts that are battling Cholera.
“Zimbabwe Red Cross together with the Finnish Red Cross and our donor the European Union have trained 200 volunteers in 10 Cholera Hotspots in Harare West and Harare South and Hopley is one of them. This specific project is targeting urban areas and Harare specifically, however, ZRCS is also responding in other parts of the country,” said Sodergard
Under the Preparedness pillar, the Project purchased 10 Oral Rehydration Point (ORP) kits and household hygiene kits to create buffer stocks in readiness for cholera response. Ten additional ORPs are being procured to support scaling up response.
Mr Ealias Hwenga, the Secretary-General for the Zimbabwe Red Cross Society (ZRCS) said they have installed three Oral Rehydration Points in Harare.
“Since the the 20th of December 2023, the project has deployed 3 ORPs in Nhando (Hopley), Churu farm and Budiriro 5 extension. In addition, 3 ORPs were deployed outside in Manicaland, Masvingo and Mazowe,” said Mr Hwenga.
He added that 1 426 patients have been served at the 3 ORPs to date in Harare while 309 have been referred to nearest health facilities for further attention.
“This aims to prevent the spread of cholera among at risk communities in urban Zimbabwe by breaking transmission through Risk Communication and Community Engagement (RCCE), improve community-level and institutional response capacities to contain outbreaks and limit impact on affected communities, and increase scale up capacities to rapidly and flexibly respond to larger outbreaks in the country.”
ZRCS is looking forward to deploy more ORPs in Harare and beyond as we plan to scale up our response in the country.
Even though a number of interventions have been deployed in Hopley to avert the Cholera crises, a number factors are making it difficult to completely eradicate the disease in the informal settlement.
Mr John Manyara, the Chief of Environmental Health Officer in the City of Harare said the set-up of Oral Rehydration Points in Harare have greatly reduced community and institutional deaths from the high burdened areas.
“We have had so many cases of Cholera from this area because it is an informal area. There is no reticulated water and sewer and it also compromises hygiene. We have reported several cases from this neighbourhood and the fact that people are now having aces is helping a lot. We are seeing an improvement and we are no longer reporting community deaths and also institutional deaths,” said Mr Manyara.
Hopley is part of huge network of informalised communities of Stonridge and Southlands with a combined estimated population of about 300,000. Since the beginning of the outbreak in February 2023, approximately 850 cases of Cholera and 14 deaths have been recorded in the district. The Cholera trend is however on the decline following the OPRs intervention among a cocktail of other measures that are being implemented by government and its partners.
Research has shown that 80 percent of suspected cholera cases (mild to moderate) can be easily managed at community ORP and may not need to visit a local health facility. A number of people from poor communities succumb to cholera death due to delayed treatment as travel long distances to health centres. Apart from providing oral rehydration therapy, the ORPs serve as information and reporting centres where patients get critical information about breaking cholera transmission and treatment and provide critical reports to health facilities about levels of infection and community readiness for response.
