The Intersection of Unpaid Care Work and Cholera In Zimbabwe: The Untold Tales of Women in Rural Settings

By Michael Gwarisa in Buhera

Data from previous epidemics show that women and girls take on the bulk of unpaid or poorly paid care work in families and communities when formal health systems are unable to cope with the rising tide of infections. When COVID-19 hit in 2020, healthcare workers were overwhelmed with managing a novel but highly infectious respiratory infection.

The growing demand for care in the context of the COVID-19 crisis deepened already existing inequalities in the gender division of labour, placing a disproportionate burden on women and girls. As COVID-19 subsided, in Zimbabwe and several other countries in the Sub-Saharan region, a new threat re-emerged in the form of Cholera.

In February 2023, Zimbabwe recorded its first Cholera case in Chegutu, Mashonalnd West province.  Ten months later, the disease had spread to every corner of the country. In Buhera District in Manicaland province, the disease wreaked havoc in several villages including Mubvirwi, Chikuwa, Wenhira, Maisiri, Chikaka, Tikiza, Tabarira, Sunduza and Zingwini villages.

Several lives were lost and many villagers were hospitalised. However, at the onset of the outbreak in Buhera, Apostolic sect members opted to treat their loved ones at home using home remedies. Unfortunately, it was the women who had to contend with the risk of infection as they cared for their loved ones.

Such was the case in Mubvirwi Village, under Chief Nyashanu in Buhera, where one family lost five family members within a space of a week. Despite the unfortunate turn of events in the family, the daughter-in-law, Mrs Tsvetai Mukurunge took it upon herself to nurse the sick relatives.

Mrs Mukurunge is also the wife of the new headman Mubvirwi who survived Cholera by a whisker. In an interview with HealthTimes, she said, she feared she would contract Cholera when she cared for her in-laws and husband.

My mother-in-law fell sick in the morning and sent a child to let me know she was not feeling well. I went to her homestead soon after the church.  I attended to her and gave her some beverages I had bought. At this point, we didn’t know what it was. She was sick for three days before she died on Tuesday,” said Mrs Mukurunge.

On Thursday of the same week, her husband fell sick and vomited profusely at the same time excreting rice water like diarrhoea.

“I cleaned after my husband but this time I was aware now that it was Cholera so I did not want to spend more time without getting help. We got a vehicle and took him to the hospital. When we were at the hospital, we got a call that my father-in-law and his brother were sick as well.”

Even though they later lost their lives, healthcare workers came through to manage the funerals. Mrs Mukurunge however bemoaned limited access to safe water and insufficient sanitation facilities which she says remain key determinants driving cholera transmission in her village.

Women and girls have always come through to offer unpaid services to families during health emergencies and outbreaks. Apart from caring for their sick, the unpaid care work also includes household duties such as cooking, cleaning, water and fuel collection, child care, or elder care.

In Chinhuo village, also in Buhera Mrs Estery Masiraha unfortunately contracted Cholera while caring for her child.

“My child was the first to contract Cholera. However, at our church, we are not allowed to seek health services from the clinic so I gave my child a salt and sugar solution from home and she recovered. I however contracted Cholera and for me, it was a different story. I had to be taken to Chiwenga Clinic where I got assistance,” said Mrs Masiraha.

According to Ministry of Health and Child Care (MoHCC) data, as of June 1, 2024, a cumulative total of 34 550 suspected cholera cases, 88 laboratory-confirmed deaths, 631 suspected cholera deaths & four-thousand two hundred and sixteen (4 217) laboratory-confirmed cases were reported. As of 31 May 2024, among the cumulative cholera cases reported, 50 per cent were women, 31 per cent were children below 15 years and 13 per cent were children under five years.

Sister Nyengeterai Mutero, the Nurse in Charge and Mudanda Clinic in Buhera said at the initial stages of the outbreak in Buhera, women from religious objecting groups would bear the brunt of caring for the sick.

“We recorded 207 cases here but no institution death. Even though we never recorded a death at this clinic, you find that about four deaths were community deaths mainly from religious objectors as most cases were attended to in communities. At first, people would take long to seek treatment because they were being managed in communities, especially the objecting communities,” said Sr Mutero.

Meanwhile, data shows that unpaid Care work disproportionately affects women and girls, particularly those who also experience disadvantages based on income, age, race, geographic location, migration status, disability, sexual orientation and health status.

Women’s movements the world over, have been advocating for the recognition of unpaid care work as a form of employment. They argue that unemployed women who bear the brunt of unpaid care work should be remunerated just like their working counterparts. In a study titled  ‘Value the Invaluable’, researchers estimated the contribution of healthcare related unpaid care work to the Global Gross Domestic (GDP) to be around  2.35 per cent of global GDP or the equivalent of US$1.488 trillion. When women’s contribution to all types of care (not just health care) is considered, this figure rises to a staggering US$11 trillion or 9 per cent of global GDP

Mrs Edinah Masiyiwa, a member of the Women Coalition of Zimbabwe (WCoZ) Health Cluster and Executive Director for the Women’s Action Group (WAG) said women are the first responders  in every disease outbreak and epidemic and should be remunerated for their work.

“What we are finding is that when disease outbreaks occur, women are called to duty. We are now at a time when unpaid care work has to be recognised and we are saying we are all working and unpaid care work at home is a form of employment. Sometimes you find that it’s the same women who are going out for productive or paid work but still they have to do the unpaid care work. The issue of unpaid care work is a concern even if there is no outbreak,” said Mrs Masiyiwa.

She added that there is need to strengthen the health delivery system in order to lessen the burden of health related unpaid care work in women.

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