THE suburb of Kuwadzana was topical in the last few days as cholera reared its ugly head. Many cases of diarrhoea were recorded among the residents of Kuwadzana as evidenced by the huge numbers of patients presenting themselves at the local council clinic.
The unfortunate part about cholera is that the disease remains largely underreported. People should know that it is only about 10% of the cases that develop very serious signs and symptoms. If properly managed, case fatality rate should remain below 1%.
The continuous spread of the disease is a serious test on primary healthcare which should orient its structures and functions towards the values of equity and social solidarity. Everyone should enjoy the highest attainable standard of health without distinction on the basis of race, religion, political beliefs, economic or social condition.
The principles required to sustain primary healthcare are its capacity to respond equitably and efficiently to the health needs of citizens, including the ability to monitor progress for continuous improvement and renewal, the responsibility and accountability of government, sustainability, participation and an orientation towards the highest standards of quality, safety and intersectoral approach.
Primary healthcare should thus dwell on health education and promotion, good nutrition, clean water supplies, good sanitisation, immunisations, affordable firstline drugs, easy patient transfers, to mention but just a few.
It is an embarrassment to die of cholera in this era and age. Death from cholera comes from severe dehydration which can be a result of vomiting or diarrhoea. The incessant loss of fluids can result in electrolyte imbalance, renal impairment or even muscle cramps.
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I visited one cholera treatment unit and came up with obvious reasons why people die from this treatable disease. Case management of symptomatic cholera should be robust and unnecessary delays in treating those with severe diarrhoea may be calamitous. The city council medical facilities seem to be overwhelmed and it is time government decentralises the management of cholera to other healthcare facilities as long as infection control principles are adhered to.
Private practitioners ought to be reminded to submit statistics if they are to manage the disease for strategic planning. When COVID-19 began in Zimbabwe, treatment was centralised to special units until a time when those units became overwhelmed. The ensuing liberalisation and decentralisation of COVID-19 treatment brought quicker relief to the country.
Mounds of garbage are becoming an ugly sight at many open spaces which include both high and low-density suburbs. It is now regarded normal to have garbage next to your home. Harare has become an eyesore with hordes of rubbish piling up in all open spaces. The consequences are catastrophic with water bodies exposed to contamination. Cholera has circulated in the city and it is not showing signs of remission. About 200 people have already lost their lives since February 12, 2023 when the first cholera cases were identified in Chegutu. We should remain very vigilant about cholera if we are not to have a repeat of 2008 when the country recorded about 98 585 cases and 4 287 deaths within a space of just 9 months. The 2019 cholera outbreak was milder with about 10 421 cases having been recorded and about 69 people succumbing to the disease.
With the rain season fast approaching, there is great potential for contamination of water bodies further and diseases like cholera, dysentery, typhoid will be very difficult to contain once they start to sprout. It is common knowledge that garbage has a high tendency to block water bodies and natural flows, thus becoming breeding sources for vectors such as mosquitoes that are very effective in malarial transmission. Why are we failing to contain cholera in our beautiful country? Is it not only mere incompetence? Strengthening water infrastructure remains critical in reducing many of the communicable diseases.
Inter-sectoral approach remains fundamental in the mitigation and containment of cholera with councils expected to take the leading role. People should also be reminded to practise good hygiene which includes hand-washing with soapy water, sanitisation. It is wise to shun suspicious water as it may be the source of vibrio cholerae, a toxin-producing bacterium.
Monopolising the treatment of cholera in this era is unfortunate since the disease can be easily managed. Issues of infection control and case reporting should be topical with private practitioners. If the city council has failed on water and sanitation, how can it succeed alone on case management of cholera? Decentralise cholera treatment to all medical practitioners!
