Doctors Battle Zimbabwe's Cholera Crisis

'Failed state' is becoming a common phrase in foreign policy circles, with pirates operating with impunity in Somalia and civil war threatening to re-emerge in Congo. But it is sadly appropriate for Zimbabwe. The government of Robert Mugabe, after denying an outbreak of cholera for weeks, is now begging for international help to contain a "massive outbreak" that has spread to an estimated 60,000 people and claimed 600 lives. The disaster, which caps years of economic decline, has emerged from the deadlock over Mugabe's power-sharing deal with opposition leader Morgan Tsvangirai and the resulting chaos. Basic government services are almost nonexistent, food shortages are chronic and inflation has spiraled out of control—today a loaf of bread costs 30 million Zimbabwe dollars,but tomorrow that price could double.

The silver lining, say some experts, is that the crisis is putting pressure of Mugabe to step down. Last week, British officials announced a $14.7-million package and called for Mugabe's resignation. Leaders from the United Nations, United States, France and Kenya have followed suit. "It is time for Robert Mugabe to go," President George W. Bush said on Tuesday. "We urge others from the region to step up and join the growing chorus of voices calling for an end to Mugabe's tyranny." Even longtime ally China has proffered a rare critique, urging Mugabe to heed the power-sharing deal he struck. Mugabe, unrepentant, has accused the West of using the crisis as an excuse to rally support for an invasion. For now, leaders of the African Union and South Africa say the use of force is not an option. "We have a serious humanitarian crisis in Zimbabwe," an AU spokesman told reporters. "We have cholera. Do they think that we can eradicate cholera with guns?"

That's cold comfort to Zimbabweans stuck in a growing crisis. Doctors Without Borders, the international humanitarian group, has three medical teams stationed throughout the country providing antibiotics and other treatments. Marcus Bachmann, who coordinates the teams from Harare, spoke by phone with NEWSWEEK's Katie Paul about the situation on the ground. Excerpts:

How has the country changed since you arrived there in November?
When I arrived, I came into what was already an outbreak situation. The cholera epidemic clearly had started already, but since then, in these three weeks, the number of cases has really multiplied. At the same time, the epidemic has spread to nearly all parts of Zimbabwe. There is only one province not yet affected by cholera. So, both geographically and in terms of attack rate, it has spread enormously in the past three weeks.

What are the dangers for the region? What are you most concerned about?
Cholera is an avoidable disease and an easily treatable disease. So many people who lose their lives to cholera would be alive if two factors were different: if there were a functioning water supply for the population and if there were a functioning health care system. These systems imploded in this country, so often the treatment is ineffective. These both contribute to a very, very dangerous mix for infected patients.

We ' re seeing reports that the rivers themselves are infected. What are the implications of that?
Whenever a water source is infected with cholera bacteria, then we see a massive outbreak of patients. This is the worst case scenario that infects the most people within the shortest period of time. But we also see person-to-person transmission, because areas most affected are the high-density suburbs in the outskirts of Harare. Again, that's a very dangerous mix. Infected drinking water sources are the primary trigger, and then in a very densely packed population, one infection basically spreads to everyone living in that area. We see houses of maybe 20 square meters where maybe 50 or 60 people live. And this is an average.

Given the infection of rivers, what impact will the outbreak have on neighboring countries?
The rivers are actually not the major reason for the spread of the disease to other countries. The river is a dangerous matter only when people get their drinking water there. The bigger problem is shallow wells or ponds. But the major reason for the spread of the disease is person-to-person transmission—and a disease does not know national borders. Given the extremely precarious economic situation, one-third of the population of Zimbabwe is moving out of the country. With this massive stream of people, the cholera is moving. It's a river, but a river of people.

What ' s it been like trying to coordinate with Zimbabwe ' s ministries? What has been the biggest challenge?
All administrations in this world have a tendency to be very slow, and slowness kills in cholera. It's a constant pushing and pulling and lobbying and pleading to get them to move forward, because it's a very slow decision-making process. There are too many ministries involved at the same time and all the communication infrastructure is broken down. I see slight changes in the speed of decision-making, but it's not corresponding to the real need going on out there.

Mugabe has expressed a great deal of anger at foreign officials, saying they ' re exploiting the crisis for political gains. Are you on the receiving end of any of that anger?
Doctors Without Borders has a humanitarian, [non-political] mandate to help people in desperate medical need. But to speak honestly, we've had to plead very hard regarding our humanitarian obligation to do our work. On the other hand, we've treated 75 percent of the cholera cases in this country so far. That's a big number of patients.

In the beginning, government officials were denying and playing down the severity of the crisis. Did they place any pressure on you to portray the epidemic as less severe than it actually was?
Our mandate is to do effective hands-on work of infected patients, so we have to focus on that. But let me answer you this way: Cholera is a completely preventable disease. As in every epidemic, the starting phase is the most decisive part. If you act radically and effectively at the beginning, you can massively reduce the magnitude of the outbreak. In Zimbabwe right now, it is clearly a massive outbreak. Clearly, somewhere in this approach there was a breakdown.

Are you concerned that the political complications that come with foreign countries ' involvement could hinder your ability to deliver treatment and contain the outbreak?
We just have to focus on our medical relief action. Our focus is on the individual facing the consequences of insufficient and ineffective treatment. We can't involve ourselves in politics.

What is it like living with Zimbabwe ' s notorious inflation rate? How does that affect your ability to work there?
The decay of the economy in this country is an enormous challenge. Prices can nearly double within 24 hours. It's even quadrupled within 24 hours. That means personnel from our team who buy commuter passes to go to work in the morning might not have enough money to get home in the evening, because inflation is so aggressive. We also have to pay for local services—materials, water, food—and it's an incredible challenge. If you agree on a price, two hours later you'll need to renegotiate because inflation has already changed that price. We have mobile phones with prepaid accounts that are worth nothing within hours because of the inflation rate, and then we're out there without any functioning means of communication. A very banal thing, but it leads to situations where I cannot send the right number of people to priority locations. Living here is an experience in and of itself.

What has affected you most from your experience in Zimbabwe?
There is enormous stress. You are confronted with situations where hundreds of patients arrive at your treatment center within two hours' time. It's a war-like scenario. Hundreds of people are in life-threatening conditions pleading for you to provide aid, but you have limited resources. It's an enormously stressful situation when everyone has worked at their limit for very long hours, but then a patient who had to travel long distances just to get there dies before you can provide treatment. It's an overwhelming moment when you see kids losing their protection or their lives.

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