Cholera Is Raging, despite Denial by Zimbabwe

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Cholera Is Raging, Despite Denial by Mugabe By CELIA W. DUGGER

HARARE, Zimbabwe — Cholera swept through the five youngest children in

the Chigudu family with cruel and bewildering haste.

On a recent Saturday, the children had chased one another through

streets that flow with raw sewage, and chattered happily as they

bedded down for the night. The diarrhea and vomiting began around

midnight. Relatives frantically prepared solutions of water, sugar and

salt for the youngsters, aged 20 months to 12 years, to drink.

But by morning, they were limp and hollow-eyed. The disease was

draining their bodies of fluid.

" Then they started to die, " said their brother Lovegot, 18. " Prisca

was first, second Sammy, then Shantel, Clopas and Aisha, the littlest

one, last. "

A ferocious cholera epidemic, spread by water contaminated with human

excrement, has stricken more than 16,000 people across Zimbabwe since

August and killed more than 780. President G. Mugabe said

Thursday that the epidemic had ended, but health experts are warning

that the number of cases could surpass 60,000, and that half the

country's population of 12 million is at risk.

The outbreak is yet more evidence that Zimbabwe's most fundamental

public services — including water and sanitation, public schools and

hospitals — are shutting down, much like the organs of a severely

dehydrated cholera victim.

Zimbabwe's once promising economy, disastrously mismanaged by Mr.

Mugabe's government, has been spiraling downward for almost a decade,

but residents here say the free fall has gained frightening velocity

in recent weeks. Most of the nation's schools, which were once the

pride of Africa, producing a highly literate population, have

virtually ceased to function as teachers, whose salaries no longer

even cover the cost of the bus fare to work, quit showing up.

With millions enduring severe and worsening hunger, and cholera

spilling into neighboring countries, there are rising international

calls for Mr. Mugabe to step down after 28 years in power. But he

seems only to be digging in, and his announcement about the epidemic's

end came just a day after the World Health Organization warned that

the outbreak was grave enough to carry " serious regional implications. "

Water cutoffs are common and prolonged here, but last week the taps

went dry in virtually all of the capital's densely packed suburbs,

where people most need clean drinking water to wash their hands and

food, essential steps to containing cholera. On rutted streets crowded

with out-of-school children and jobless adults, piles of uncollected

garbage mounted and thick brown sludge burbled up from burst sewer lines.

The capital's two largest hospitals, sprawling facilities that once

would have provided sophisticated care in just such a crisis, had

largely shut down weeks earlier after doctors and nurses, their

salaries rendered virtually worthless by the nation's crippling

hyperinflation, simply stopped coming to work.

Inflation officially hit 231 million percent in July, but

on, an independent economist in Zimbabwe, estimates that it has

now surged to an astounding eight quintillion percent — that is an

eight followed by 18 zeros.

The situation has deteriorated to such a degree that soldiers — Mr.

Mugabe's enduring muscle — rioted last week on the streets of the

capital, breaking windows and looting stores, after waiting days in

bank lines without being able to withdraw their meager salaries from

cash-short tellers. A midlevel officer who participated in the mayhem,

but spoke on condition of anonymity for fear of prosecution, said

troops were enraged that they could no longer afford to buy food or

send their children to school.

" As we talk, children of chefs are in private schools learning while

ours are playing in dusty roads, " he said bitterly, using the local

term for the people in power.

Rumors about this extraordinary unrest in the army's ranks have

circulated feverishly, with some speculating that the rioting was

staged to justify imposing a state of emergency. Others hoped it

finally signaled the beginning of the end for Mr. Mugabe.

Still, the Mugabe government's ability to clamp down on dissent seems

intact. The police quelled the riot. Sixteen soldiers now face a

court-martial. Beyond that, about 20 opposition party activists and

human rights workers have recently disappeared. Last week, armed men

abducted a well-known human rights activist, Jestina Mukoko, at dawn

while she was barefoot, still in her nightgown and bereft of her

eyeglasses and as her teenage son looked on helplessly.

Political analysts have long predicted that Mr. Mugabe's hold on power

— which he has refused to loosen since September, when he signed a

power-sharing deal with his nemesis, opposition leader

Tsvangirai — would be broken only after the economy completely

imploded and daily life became intolerable.

But as the endgame of the octogenarian Mr. Mugabe's rule plays out,

the human tragedies mount.

In a country with the terrible distinction of having the second

highest proportion of orphans in the world — one in four children has

lost one or both parents — the closing of schools and hospitals is

hitting these most vulnerable children mercilessly.

Aisha Makombo, 15, has been raising her 11-year-old sister, Khadija,

since their mother died of AIDS last year. An expressive girl with a

soft, round face, Aisha, who is H.I.V. negative, has been struggling

to get drug treatment for Khadija, who is now sick with AIDS.

She took her little sister, so stunted she appears half her actual

age, to Parirenyatwa Hospital, the nation's largest referral hospital,

last year, but crucial test results needed to qualify Khadija for

life-saving medications were inexplicably misplaced.

On a later visit, Aisha was told the machine that performed the tests

was broken. Now the hospital is virtually closed. Aisha said she was

referred to private doctors who demanded payment in South African rand

or American dollars, but the girls had no money.

Aisha's eyes filled with tears as she explained that she had been able

to obtain only cotrimoxazole, an antibiotic used to treat

opportunistic infections, for her little sister.

Aisha used to escape the sadness of her life by going to school, but

two months ago the teachers at her high school stopped showing up.

" She didn't bid us farewell, she just left, " Aisha said of her math

teacher, the one she misses most of all. " At first, we thought she

would come back, but then we gave up hope. "

Aisha now scrambles to barter her labor for food, while her little

sister, too weak to work, attends a small school run by a nonprofit

group. Last week, Aisha started a four-day job, bent over in a field,

readying it for planting. In exchange, she was to get two pounds of

flour and a bottle of cooking oil, as well as a shirt and blouse for

Khadija.

The girls pray together each night before going to sleep in the tiny,

grubby, windowless room they share. The small house belongs to their

grandfather, but he admitted it was Aisha who provided the food for

him and her 45-year-old uncle who sometimes steals the cornmeal she

earns, as well as the girls' clothes to sell secondhand.

Yet the girls say they cling to their dreams. Aisha's is to be a

doctor, Khadija's a bank teller, each hungering for what the sisters

do not have — health and money for medicine and food.

Zimbabwe has one of the world's highest rates of H.I.V. infection, and

now a raging cholera crisis. But with the economic collapse decimating

revenues needed to run the country's public health systems, mortality

rates among cholera victims here are five times higher than in other

countries, public health experts said.

Mr. Mugabe's government — in its pursuit of power and money — has also

contributed to both catastrophes, analysts say.

Earlier this year, the government jeopardized $188 million in aid from

the Global Fund to Fight AIDS, Tuberculosis and Malaria by taking $7.3

million the organization had donated and spending it on other,

unrelated expenses. Only at the 11th hour, under threat that the money

would be withheld, did the government reimburse the Global Fund for

the missing funds.

And two years ago, the government took control of Harare's water and

sewer systems from the opposition-controlled city council, depriving

the local government of a crucial source of revenue to keep services

functioning.

" The real motive was to dilute the influence of the opposition

Movement for Democratic Change and cripple them financially, " said

Justice Mavezenge, an officer with the Combined Harare Residents

Association, a civic group.

Last week, even Mr. Mugabe's mouthpiece, the newspaper The Herald,

castigated the state-run water authority for running out of chemicals

to purify Harare's water supply — chemicals it said could have been

trucked in from South Africa in less than 24 hours.

The United Nation's Children's Fund and international donors have

stepped into the void. They have begun trucking 50 tankers of fresh

water into the most densely settled suburbs and will be providing

water treatment chemicals for the city over the next four months, said

Unicef's acting country director, Roeland Monasch.

But some aid officials fear that the epidemic will be impossible to

contain because of the failing water and sanitation systems in places

like Budiriro, the Harare suburb where the Chigudu children died and

where half the country's cases have occurred.

" We're not going to be able to control it, " said one aid agency

adviser, speaking anonymously for fear of retribution. " The likely

scenario is that people who get sick in places like Budiriro will go

home for the festive season and you'll get flash points all over the

rural areas. "

Cholera stole the five Chigudu children in just two days, on Nov. 17

and 18, and the grandmother and aunt who helped care for them died

just days later. Their father, who returned home just hours after the

last of his children died, got his first inkling of unspeakable

calamity when his youngest ones weren't there to clamber all over him

as he walked in the door.

" I will never get my children back, " he said.

The death toll mounts each day. Chipo and Tecla Murape rushed their

orphaned 5-year-old niece, Moisha, to the clinic in Chitungwiza, a

city just south of Harare, last week. Nurses told the family the veins

in the girl's arms had collapsed because she had lost so much fluid.

No doctor ever saw her, her relatives said, and the nurses never hit a

vein. Moisha, a shy, but friendly girl, instead drank rehydration fluids.

Throughout the day, she complained of a terrible thirst and a

stomachache. On the advice of clinic workers, her aunts did not even

hold her hand as she lay dying, fearing infection. After night fell,

the nurses said there was nothing more they could do and suggested

that Moisha's relatives take her to the city's hospital, some two and

a half miles away.

But there was no ambulance. Tecla Murape, 42, swaddled Moisha to her

back and set off hurriedly for the hourlong walk, her heart pounding

with worry. Under a dark, moonless sky, she took a shortcut through a

maize field, leaping across yet another putrid sewage spill. By the

time they arrived, Mrs. Murape's clothes were soaked with Moisha's

watery diarrhea. Hours later, Moisha died.

http://www.nytimes.com/2008/12/12/world/africa/12cholera.html