‘Adhere to Basic Hygiene Principles to Fight Cholera’
22 SEP, 2018 - 00:09
Zimbabwe Herald
Paidamoyo Chipunza: THE INTERVIEW
Zimbabwe declared a cholera outbreak in Harare after it was first reported on September 6 in Glen View and Budiriro, the epicentre of the disease which has since claimed 33 lives and affected nearly 8 000 people. Swift response by the Government and the private sector has helped to contain the outbreak, dousing fears of a repeat of the 2008 cholera outbreak which killed more than 4 000 people. Here, our Senior Health Reporter, Paidamoyo Chipunza (PC) speaks to newly-appointed Health and Child Care Minister Dr Obadiah Moyo (OM) on the outbreak.
PC: What is the source of the current cholera outbreak and how has this source been addressed?
OM: In this particular case, the problem arose as a result of blocked sewers, which were reported for at least two months, but took long to be repaired and now we have ended up with the whole Glen View and Budiriro area being affected. Garbage was also not being collected on a regular basis and there were erratic water supplies, leaving residents with no option but to resort to boreholes and shallow wells for drinking water. There has also been a lot of food vending in the area, which has contributed to spreading of cholera bacteria.
PC: To what extent has the outbreak spread to other parts of the country?
OM: It is quite clear that we have an epicentre, the area from which most of these cases are arising and this is the Glen View-Budiriro area. There are people who came from outside Harare and were visiting either Glen View or Budiriro. These are the people who got sick when they returned to their homes outside Harare. So in reality, the area of concern is Harare, particularly Glen View and Budiriro area.
PC : What strategies have you so far put in place to contain the outbreak and how effective have these strategies been?
OM: The President declared cholera an outbreak on September 12 and since then, my team throughout the country has been activated to be able to respond very fast to this emergency situation. An appeal of about $64 million has also been launched to assist with resources required in containing the outbreak. So our plan has been activated and everybody is 100 percent ready to go, in all the municipalities, in all the Government institutions. We have put a system in place which is highly responsive to the needs on the ground. We have put a high alert on cholera so that we can contain it appropriately and as a result, we have begun to see a decline in the number of cases. Numbers are coming down because of stop gap interventions that we’ve put in place. As of yesterday (Thursday) the death toll was at 33 with 7 919 cases since September 6. New cases recorded were 475 against more than a 1 000 cases which were being recorded in recent days. So, cases have come down to appreciable levels.
PC: What is the significance of declaring a situation such as a disease outbreak a state of disaster?
OM: Declaring cholera a state of disaster enables everyone in Government and those supporting us from partners and other stakeholders to focus on stopping the spread of this outbreak. We have seen that the possibility of this outbreak spreading to other parts of the country is high and that more people are likely to be affected. The declaration will also help us to put extraordinary measures to stop the spread of cholera in Harare and Zimbabwe such as banning food vending in the streets of Harare and use of other Government apparatus to control the outbreak.
PC: We have also heard that one of the challenges hindering effective control of the current outbreak is resistance to available antibiotics. How prevalent is this strain of drug-resistant cholera and typhoid?
OM: The sensitivity tests done to vibrio cholera have shown that it is resistant to a wide range of antibiotics, but let me emphasise that the mainstream or gold standard for cholera treatment is not antibiotics but fluids replacement that is lost through vomiting and diarrhoea.
PC: How far has Government gone in introducing both a cholera and typhoid vaccine?
OM: One of the measures to be employed to stop typhoid and cholera outbreaks in Harare is to institute a cholera vaccine which is available through WHO. This vaccine is easily administered through the mouth as drops and is effective is stopping cholera spread in hot spots. The process was started long before this outbreak and now that we have a crisis it’s the best time to deploy it. A typhoid vaccine is already approved for Harare typhoid hotspots and this could be deployed as soon as possible before year end, again with support from WHO and GAVI as well as other partners.
PC: But cholera and typhoid are medieval diseases, what are the long-term plans of preventing recurrence of these diseases?
OM: Let me reiterate that all the measures that have so far been employed are only stop gap measures. The definitive measures here are to correct, repair the dilapidated water and reticulation infrastructure, and provide safe and adequate water for the residents in all the towns and in all the rural settlements in our country. We need water, we need proper infrastructure, we need health settings for our people. We have therefore requested as Ministry of Health and Child Care, that we find the absolute solution, identify the absolute cause of the problem and fix it otherwise we will continue having cases of cholera and typhoid arising. The response which has so far come from the Ministry of Local Government, Public Works and National Housing, the Mayor for Harare and other mayors throughout the country has been encouraging. They all want to ensure that the water and sanitation systems are upgraded to the correct level so that we forget about these mediaeval diseases occurring again. Prevention, prevention, prevention is essential in a situation of this nature; stop gap measures are what we are doing which has seen a reduction in a number of cases arising at our treatment centres and we appreciate that. However, we need long lasting solutions. Boreholes are stop gap measures, availability of containers of water are stop gap measures, what we need is the absolute solutions, long term solutions, availability of clean water on a daily basis. We also want to make sure that Lake Chivero, which is a source of water for Harare and Darwendale, are cleaned. We do not want them to end up as sewer ponds. There has to be proper solid waste management. We are urging local authorities to put in place systems where all the waste would be used to produce energy, rather than just leave it so that we can have a cleaner city at the end of the day.
Vendors should not sell food which is contaminated. It is simple, if you eat food that is contaminated you get sick and we have a typical example that happened at Tichagarika. The lady who was selling her food had three of her clients dying because of cholera. So we cannot run away from the fact that if you eat from the vendors who are selling contaminated food, you will get sick and we also want to say cholera does not only affect those who eat contaminated food, but those who sell it as well.
So, illegal vending has to be put under control. It’s painful but necessary in order for our population to continue living.
I have also implored the Ministry of Local Government to take a re-look at their public toilets, most of which are now an eyesore. You can’t even use them. It’s a health time bomb, and we cannot allow that to continue. We want these corrections to be made now, not tomorrow. We feel as the Ministry of Health that these toilets are also becoming a source of diseases.
I want to challenge officials from our local authorities to use those toilets. If they can’t use them then it means they cannot be used. That is the measurement of quality. If you can’t use it yourself how then do you expect other people to use them?
PC: Your parting words to the people of Zimbabwe against that backdrop?
OM: In order for us to ensure that we are doing the right things in terms of hygiene, it has to start with every individual. Every Zimbabwean must make sure that they adhere to basic hygiene practices. Let’s ensure that we look after where we live, remove and reduce the amount of garbage around our homes and at the end of the day we want to make sure that Zimbabwe is clean again and this is only possible through concerted efforts by all of us. Like they say, cleanliness is next to godliness, Zimbabwe shall be clean again. We do not want anyone to get sick from cholera or typhoid.
Zimbabwe Herald
Paidamoyo Chipunza: THE INTERVIEW
Zimbabwe declared a cholera outbreak in Harare after it was first reported on September 6 in Glen View and Budiriro, the epicentre of the disease which has since claimed 33 lives and affected nearly 8 000 people. Swift response by the Government and the private sector has helped to contain the outbreak, dousing fears of a repeat of the 2008 cholera outbreak which killed more than 4 000 people. Here, our Senior Health Reporter, Paidamoyo Chipunza (PC) speaks to newly-appointed Health and Child Care Minister Dr Obadiah Moyo (OM) on the outbreak.
PC: What is the source of the current cholera outbreak and how has this source been addressed?
OM: In this particular case, the problem arose as a result of blocked sewers, which were reported for at least two months, but took long to be repaired and now we have ended up with the whole Glen View and Budiriro area being affected. Garbage was also not being collected on a regular basis and there were erratic water supplies, leaving residents with no option but to resort to boreholes and shallow wells for drinking water. There has also been a lot of food vending in the area, which has contributed to spreading of cholera bacteria.
PC: To what extent has the outbreak spread to other parts of the country?
OM: It is quite clear that we have an epicentre, the area from which most of these cases are arising and this is the Glen View-Budiriro area. There are people who came from outside Harare and were visiting either Glen View or Budiriro. These are the people who got sick when they returned to their homes outside Harare. So in reality, the area of concern is Harare, particularly Glen View and Budiriro area.
PC : What strategies have you so far put in place to contain the outbreak and how effective have these strategies been?
OM: The President declared cholera an outbreak on September 12 and since then, my team throughout the country has been activated to be able to respond very fast to this emergency situation. An appeal of about $64 million has also been launched to assist with resources required in containing the outbreak. So our plan has been activated and everybody is 100 percent ready to go, in all the municipalities, in all the Government institutions. We have put a system in place which is highly responsive to the needs on the ground. We have put a high alert on cholera so that we can contain it appropriately and as a result, we have begun to see a decline in the number of cases. Numbers are coming down because of stop gap interventions that we’ve put in place. As of yesterday (Thursday) the death toll was at 33 with 7 919 cases since September 6. New cases recorded were 475 against more than a 1 000 cases which were being recorded in recent days. So, cases have come down to appreciable levels.
PC: What is the significance of declaring a situation such as a disease outbreak a state of disaster?
OM: Declaring cholera a state of disaster enables everyone in Government and those supporting us from partners and other stakeholders to focus on stopping the spread of this outbreak. We have seen that the possibility of this outbreak spreading to other parts of the country is high and that more people are likely to be affected. The declaration will also help us to put extraordinary measures to stop the spread of cholera in Harare and Zimbabwe such as banning food vending in the streets of Harare and use of other Government apparatus to control the outbreak.
PC: We have also heard that one of the challenges hindering effective control of the current outbreak is resistance to available antibiotics. How prevalent is this strain of drug-resistant cholera and typhoid?
OM: The sensitivity tests done to vibrio cholera have shown that it is resistant to a wide range of antibiotics, but let me emphasise that the mainstream or gold standard for cholera treatment is not antibiotics but fluids replacement that is lost through vomiting and diarrhoea.
PC: How far has Government gone in introducing both a cholera and typhoid vaccine?
OM: One of the measures to be employed to stop typhoid and cholera outbreaks in Harare is to institute a cholera vaccine which is available through WHO. This vaccine is easily administered through the mouth as drops and is effective is stopping cholera spread in hot spots. The process was started long before this outbreak and now that we have a crisis it’s the best time to deploy it. A typhoid vaccine is already approved for Harare typhoid hotspots and this could be deployed as soon as possible before year end, again with support from WHO and GAVI as well as other partners.
PC: But cholera and typhoid are medieval diseases, what are the long-term plans of preventing recurrence of these diseases?
OM: Let me reiterate that all the measures that have so far been employed are only stop gap measures. The definitive measures here are to correct, repair the dilapidated water and reticulation infrastructure, and provide safe and adequate water for the residents in all the towns and in all the rural settlements in our country. We need water, we need proper infrastructure, we need health settings for our people. We have therefore requested as Ministry of Health and Child Care, that we find the absolute solution, identify the absolute cause of the problem and fix it otherwise we will continue having cases of cholera and typhoid arising. The response which has so far come from the Ministry of Local Government, Public Works and National Housing, the Mayor for Harare and other mayors throughout the country has been encouraging. They all want to ensure that the water and sanitation systems are upgraded to the correct level so that we forget about these mediaeval diseases occurring again. Prevention, prevention, prevention is essential in a situation of this nature; stop gap measures are what we are doing which has seen a reduction in a number of cases arising at our treatment centres and we appreciate that. However, we need long lasting solutions. Boreholes are stop gap measures, availability of containers of water are stop gap measures, what we need is the absolute solutions, long term solutions, availability of clean water on a daily basis. We also want to make sure that Lake Chivero, which is a source of water for Harare and Darwendale, are cleaned. We do not want them to end up as sewer ponds. There has to be proper solid waste management. We are urging local authorities to put in place systems where all the waste would be used to produce energy, rather than just leave it so that we can have a cleaner city at the end of the day.
Vendors should not sell food which is contaminated. It is simple, if you eat food that is contaminated you get sick and we have a typical example that happened at Tichagarika. The lady who was selling her food had three of her clients dying because of cholera. So we cannot run away from the fact that if you eat from the vendors who are selling contaminated food, you will get sick and we also want to say cholera does not only affect those who eat contaminated food, but those who sell it as well.
So, illegal vending has to be put under control. It’s painful but necessary in order for our population to continue living.
I have also implored the Ministry of Local Government to take a re-look at their public toilets, most of which are now an eyesore. You can’t even use them. It’s a health time bomb, and we cannot allow that to continue. We want these corrections to be made now, not tomorrow. We feel as the Ministry of Health that these toilets are also becoming a source of diseases.
I want to challenge officials from our local authorities to use those toilets. If they can’t use them then it means they cannot be used. That is the measurement of quality. If you can’t use it yourself how then do you expect other people to use them?
PC: Your parting words to the people of Zimbabwe against that backdrop?
OM: In order for us to ensure that we are doing the right things in terms of hygiene, it has to start with every individual. Every Zimbabwean must make sure that they adhere to basic hygiene practices. Let’s ensure that we look after where we live, remove and reduce the amount of garbage around our homes and at the end of the day we want to make sure that Zimbabwe is clean again and this is only possible through concerted efforts by all of us. Like they say, cleanliness is next to godliness, Zimbabwe shall be clean again. We do not want anyone to get sick from cholera or typhoid.
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