Occupational incompetence fuelling cholera

Primary healthcare should thus dwell on health education and promotion, good nutrition, clean water supplies, good sanitation, immunisations, affordable first line drugs and easy patient transfer to mention but just a few.

TWO days ago, news was all over that Harare’s Kuwadzana high-density suburb was being hounded by cholera and eight people had already succumbed to the diarrhoeal disease.

The disease should not kill many people as the case fatality rate is usually less than 2%. The continuous spread of the disease is a serious test on the strength of our 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 of race, religion, political beliefs, economic or social standing. 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 and safety and intersectoral approach.

Primary healthcare should thus dwell on health education and promotion, good nutrition, clean water supplies, good sanitation, immunisations, affordable first line drugs and easy patient transfer to mention but just a few.

It is an embarrassment to record cholera deaths in this era. The disease is attributed to poor sanitation and contaminated water. There are many office bearers in councils who seem incompetent to deal with the perennial health matters for our cities and towns. Is it that meritocracy is not considered in selection and recruitment?

Harare city fathers seem to concentrate their energy on clamping vehicles and charging amounts ranging from US$57 to US$120 depending on whether towing of the vehicle was done or not. Patronage, nepotism and favouritism are killing our country because undeserving people are occupying important offices.

It is quite surprising that many office bearers do not have the requisite qualifications which should surely include even a certificate, diploma or degree in management. How can one run a whole health institution when they are ignorant of management expectations? Taking a doctor from school and thrusting them into a medical boss’ chair at a hospital is tantamount to setting them up for failure.

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 one’s home. Harare has become an eyesore with mounds of rubbish piling up in open spaces. The consequences are catastrophic, namely serious contamination of water bodies.

Cholera has circulated in the city and it is not showing signs of remission. About 200 people have lost their lives across the country since February 12, 2023 when the first cholera cases were identified in Chegutu, Mashonaland West province. We should remain vigilant about cholera if we wish to avoid a repeat of 2008 when the country recorded more than 98 000 cases and over 4 000 deaths within a space of just nine months. The 2019 cholera outbreak was milder with about 10 421 cases having been recorded and about 70 people succumbing to the disease.

It is not long ago that President Emmerson Mnangagwa declared a state of disaster in Harare’s four metropolitan local authorities of Harare, Ruwa, Epworth and Chitungwiza, due to their failure to collect and dispose of waste. Epworth has experienced waste disposal misery with residents now dumping waste in rivers and open spaces, much to the detriment of people’s health.

With the rain season fast approaching, there is great potential for the contamination of water bodies and diseases like cholera, dysentery and typhoid will be very difficult to contain once they start to sprout. It is common knowledge that garbage has a tendency to block water bodies and natural flows, thus becoming unwanted breeding sources for vectors such as malaria-spreading mosquitoes.

Why are we failing to contain cholera in our beautiful country? Is it not only mere incompetence? Strengthening water infrastructure remains critical in reducing the impact of many of the communicable diseases.

Statutory Instrument 140 of 2023 has potential to mitigate poor waste management as the Environmental Management Agency (Ema) is now mandated to manage refuse collection and waste management within Harare metropolitan province. Funds from Treasury will be used by Ema to co-ordinate the clearance of illegal dumpsites across the province.

If Treasury avails funds, then garbage should be a thing of the past. Unethical practices like corruption and embezzlement of funds can hinder progress in any project and failure to address corruption will take us backwards as a country. The Judiciary should not smile at all those implicated in corruption.

Inter-sectoral approach remains fundamental in the mitigation and containment of cholera with councils expected to take a  leading role. People should also be reminded to practise good hygiene which include hand-washing with soapy water as well as sanitising their hands. It is very wise to shun suspicious water as it may be the source of Vibrio Cholerae, a toxin-producing bacterium currently wreaking havoc across Zimbabwe.

Johannes Marisa is president of the Medical and Dental Private Practitioners Association of Zimbabwe. He writes here in his personal capacity.

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