Keeping track of cholera

During the whole of my first week in Harare, I was busy attending meetings all day everyday with stakeholders in the humanitarian response - humanitarian agencies such as the committee of the International Red Cross (ICRC) and the World Food Programme (WFP), donor government agencies - European Commission Humanitarian Organisation (ECHO) and non-governmental organisations (or "charities" in the British press) such as Medecins sans Frontieres / Doctors without Borders (MSF).

The best of the meetings was the fortnightly combined health and water/sanitation cholera crisis meeting on Wednesday morning: it was the presentation by Alice Croisier, the World Health Organisation (WHO) epidemiologist that really provided some much needed oxygen for my humanitarian flame, which had struggled to stay alight in the dark days of December.

Map showing the trend in cholera cases in Zimbabwe from 22 – 28 February - click for bigger picture (© WHO)

Here for the first time since I had followed the cholera epidemic, was a clear and detailed body of technical information (cases and deaths, institutional compared to community, surveillance findings, laboratory test results) about the cholera outbreaks, and an interpretation of this evidence. Now we could clearly see in maps and graphs in which towns and districts the new cholera outbreaks were increasing, and where they were declining. We could see where resources should be sent, and where cholera treatment units were being closed down as the outbreaks were diminishing.

This new Cholera Control and Command Centre (C4) was finally doing a great job! Now we could see what the path of the overall progression of cholera was in the country, and see its progression clearly dissected in week by week steps over the past months. Our ability to see in the hazy humanitarian landscape was improving, and some of that thick white cloud I had first flown into had lifted.

It was reassuring to hear at the end of the presentation that there was a true decline in the number of cholera cases and that the trend countrywide was reducing. There is still a need to remain on guard, insisted Alice, as in two provinces (Mashonaland East and Midlands), there had been an increase in reported cases compared to the previous week.

With the recent heavy rains there was also a risk of further spikes in cholera outbreaks in some districts.  And nowhere was the breakdown in the nations' ability to provide health care more clear than in the "appalling" proportion of cholera deaths occurring in the homes of country folk in three provinces (Midlands, Mashonaland East and Manicaland), who had been unable to reach any type of medical care or treatment in a health centre.

The full weekly report from the WHO for the cholera crisis from 22-28 February 2009 can be found here.

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