By Michael Gwarisa
It’s about 11:00 in the morning, and Tichaona Shumba (45) from Chikuni Village, Farm 157 in Mutare Rural sits quietly on his bed at Zvipiripiri Clinic. He is probably wondering how he survived Cholera despite the disease having killed many people in his district between October and December 2023.
There is not much activity at the facility, left for a few men carrying out some renovations in one of the wards. A handful of Village Health Workers (VHWs) are also seated under a shed ahead of their meeting with Clinic officials. Tichaona is the only Cholera patient at the facility and the nurses are already preparing papers for his discharge since he has already recovered.
I started feeling sick on my way from collecting some goods from the bus that had arrived from Harare. I started feeling weak,” said Tichaona.
“I took a nap under a tree on my way home and arrived late in the evening. When I got home, I was served food and that’s when I started vomiting profusely. I was given water and milk and the vomiting got worse.”
Because Mutare rural and other neighbouring districts have experienced Cholera in its worst form, it didn’t take his family time to realise he could be experiencing Cholera symptoms.
“A vehicle came to ferry me. I was given salt and sugar solution on my way here. I started having Diarrhoea on arrival. I came here three days ago and was admitted and received treatment. I am now okay and ready to go back home,” added Tichaona.
Such is the picture at most Cholera Treatment Centres around Manicaland province as new cases and facility admissions have greatly declined over the past 30 days. Several centres are now going for days without admitting any Cholera patients. Mudanda Clinic in Buhera for example last had facility admission on November 29, 2023.
Nyengeterai Mutero, the Sister in Charge for Mudanda Health Centre Buhera said following government and partners’ interventions, they last recorded Cholera cases on November 29, 2023.
“We first got our case on 15 September from one of the Villages, that’s is Mubvirwi Village. Cases started increasing from September 22, 2023, up to November 29, when we last admitted a case here at the facility. We recorded 207 cases from the beginning up to the time we stopped having cases here. We didn’t record a death at the facility but four community deaths of people who were objectors from Mubvirwi village,” said Sister Mutero.
On the other hand, Zvipiripiri Clinic started admitting Cholera patients at the onset of the outbreak in March 2023. During the first wave that was recorded in March, Zvipiripiri Clinic had 13 patients and among the 13, three were laboratory-confirmed Cholera positive. The second wave which started from October 16, 2023 to date has seen the facility attending to and admitting 401 patients in the Cholera Treatment Centre.
Ester Gombakomba, the Nurse-in-Charge at Zvipiripiri Clinic said the admissions have greatly gone down owing several interventions by the government and partners.
“We used to admit 48 patients per day at the peak of Cholera in December but now we only have this one patient we are about to discharge,” says Sister Gombakomba.
“When we started, we were assisted by the community. The community through the health centre committee, Village Heads, councillors, Churches and the community at large assisted a lot. We were supplied with food for the patients. From there, we had supplies of food from the district.”
At the onset of the outbreak, only the Ministry of Health and community players were actively present, offering services to patients. However, as the outbreak progressed, other partners came into picture. These include the World Health Organisation, the United Nations Children Fund (UNICEF), the Zimbabwe Red Cross Society (ZRCS), Mercy Corps, Africa Ahead, and the Civil Protection Unit among others. This phase saw tents being pitched at the facility for administration since the facility was now having a lot of people who were visiting the Clinic.
“At first, we did not have anywhere to admit the patients as we were getting very large numbers. That is when UNCEF and WHO came in with those tents where we admitted our patients. We also received Cholera Beds. We also received medicines and also received bucket and soap,” added Sister Gombakomba.
In December 2023, the World Health Organisation (WHO) Zimbabwe upgraded and expanded the cholera treatment centre at Zvipiripiri Rural Health Centres to strengthen the facility’s response to the cholera outbreak. The upgrading of the CTC led to increased bed capacity through expanding the facilities to accommodate a larger number of cholera patients and provide them with essential treatment. For Zvipiripiri, an eight (8) bed unit was transformed into a 12-bed to strengthen cholera case management. WHO did the same for Chiadzwa clinic where a 6-bed unit was turned into a 16-bed treatment centre.
World Health Organisation Zimbabwe Representative, Professor Jean Marie Dangou said Strengthening Healthcare Systems is essential in ending the recurring Cholera disease.
“Robust healthcare systems are the backbone of effective cholera response. By investing in healthcare infrastructure, training healthcare workers, and ensuring the availability of essential medical supplies, we can improve the diagnosis, treatment, and management of cholera cases,” said Prof Dangou.
The Zimbabwe Red Cross Society facilitated the establishment of Oral Rehydration Points (ORPs) in Villages surrounding Zvipiripiri. These include Nyangani Village, Mafararikwa and Chipiro Village. Other ORPs have been set up in the Chakaza business centre in Marange and Farikai Village in Chiadzwa. The OPRs have greatly decongested cholera treatment centres as mild cases are being attended to at the ORPs and at times being discharged without even needing facility admission.
Zimbabwe Red Cross Society Secretary General, Mr Elias Hwenga said the establishment of Oral Rehydration Points to bring medical assistance closer to the communities was their main thrust as it would go a long way in saving lives.
“The setting up of ORPs helps increase chances of quick recovery and reduces cholera death. Oral Rehydration Points are run by community volunteers and health workers. While Cholera treatment units and cholera treatment centres may be too far for people to reach them quickly, ORPs are located within communities and offer easy access to basic screening and rehydration,” said Mr Hwenga.
Zvpiripiri Clinic serves a total population of 22,818 including 688 children below the age of one and 2,509 aged one to four years. The under-five population is 3,197. Those above the age of 15 are 13,330. Three-quarters of the population is apostolic sect. A total 45 community deaths were recorded mainly amongst members of apostolic sects from the 21 different villages under the Zvipiripiri catchment area. The most affected villages were Nyamadzawo, Machira, Taguta, Nyangani, Torera and Wajembwa. One institutional death was recorded from Chibero Village.
The issue of human resources is crucial in every outbreak, epidemic or pandemic. The Cholera response in Manicalnd also saw the Ministry of health also provide the human resources to attend to the Cholera crisis. These include nurses, Village Health Workers, and Environmental Health Technicians among others.
Lovejoy Mudzingwa, an Environmental Health Technician under the Ministry of Health and Child Care working closely with the Mafarikwa Community where several religious objectors emanate from said
“When the Cholera problem grew bigger, we intervened in communities considering several community deaths were occurring mainly among religious objecting apostolic sects community. We assisted with burials since the communities didn’t have the resources to do so. We also ensured people stopped serving food at Cholera Funerals and we ensured the gatherings were small. This helps us a lot to reduce the Cholera problem,” said Mudzingwa.
Meanwhile, the Ministry of Health and Child Care also engaged community leaders in order to inform their response to the Cholera outbreak.
Manicaland Province Medical Director, Dr Munyaradzi Mukzunga said community and traditional leaders helped them implement some of their interventions including the supervision of funerals and addressing Water Sanitation and Hygiene concerns.
“We are quite happy now that at this stage, much of the community is now aware of the dangers of Choelra. They know the signs and symptoms of Cholera. We now have people that are presenting early for treatment. As Ministry of Health, we don’t segregate, we get to a community and we engage the communities using existing community structures be they traditional political religious or otherwise. We discuss and agree,” said Dr Mukuzunga.
Manicaland has been the second hardest-hit by the cholera outbreak after Harare Metropolitan, with an average of 60 cases per day at the peak of the outbreak. Dr Mukuzunga said over 97 percent of the targeted population in the province had received the vaccine as of February 15.
