Zimbabwe: MSF teams help tackle cholera in Buhera district

It’s swelteringly hot under the midday sun in Chapanduka village in Buhera, a district of Manicaland province in south-eastern Zimbabwe, where a cholera outbreak has been raging since October 2023. A vehicle belonging to Médecins Sans Frontières/Doctors Without Borders (MSF) is navigating the bumpy road, heading to a local clinic to help treat patients and support local health staff in the management of the deadly waterborne disease.

Suddenly the MSF vehicle draws to a halt. A man is lying on the roadside, drawing a crowd of onlookers, many of whom assume he is dead. MSF medics establish that the man, who has cholera symptoms, is still alive, but lost consciousness after collapsing from dehydration on his way to a clinic five km away. Still on the roadside, the MSF team resuscitate and rehydrate him through a drip  before ferrying their patient to a clinic for further treatment and monitoring.

Rosewita and other MSF staff have been responding to the cholera outbreak in Buhera since early October, treating patients and mentoring health staff at all 37 health facilities in the district. They also helped set up 21 cholera treatment centres in local health facilities and six oral rehydration points in villages across the district, as well as putting in place infection prevention and control measures, and engaging with local communities to encourage people to come for treatment and help stop the disease from spreading further.

The importance of community health promotion to stop infection

Because of a lack of clean drinking water and sanitation facilities in Buhera district, many people regularly drink river water and use bush toilets – practices which have encouraged the spread of the disease. An additional challenge is that three-quarters of the population – around 200,000 people – belong to a religious community which rejects mainstream healthcare. Most of its members refrain from seeking treatment in health facilities or taking part in public health initiatives, resulting in many avoidable deaths within the community and in cholera victims being buried covertly, without guidance from health authorities. 

Additionally, MSF in collaboration with MOHCC and other partners trained 362 village health workers on case surveillance, active case finding, risk communication and community engagement and reporting.

To counter this, MSF teams have worked with village health workers from the apostolic community, who have slowly but steadily succeeded in sharing health messages with members of their community, increasing their understanding of good hygiene practices and encouraging them to come for medical treatment when needed. 

Tecla Mandizvo is a village health worker from the apostolic community, who explains "seeing people die every day pushed me to change my behaviour and save my family. I got the motivation to encourage others in our community to break the misconceptions about cholera. I managed to move door-to-door to engage with the community, including members of the church, and encouraged them to reach out to me for oral rehydration if they notice any cholera symptoms. Today I have many who are coming to me if they suspect any cholera cases in their home.
 

Promoting safe water hygiene

Jethro Bondai, head of Berenyazvi village, is appreciative of the work done by village health promotion workers in tackling the disease. “The efforts of the community volunteers are appreciated by the entire community and this is important for us to learn how to prevent and protect ourselves from cholera,” he says.  

Bondai is one of 270 traditional leaders across Buhera district who are helping to tackle the outbreak. He says that most people in his village drink river water because of the shortage of clean drinking water, but he is advising them to find alternatives or to boil the water to kill bacteria. 
 

The efforts made by community members, MSF and Zimbabwean health authorities to curb the spread of the disease appear to be working, as the number of cholera-related deaths are going down. MSF is now scaling down its activities in Buhera district to refocus in other districts with acute crisis, including the capital Harare, where MSF has started focusing on water sanitation and hygiene (WASH) and treating of cholera patients. 

Caring for patients and enhancing cholera prevention measures are both critical elements to bringing the outbreak under control. But MSF warns that, without meaningful action to ensure people’s access to safe drinking water, cholera is likely to resurface regularly in Buhera district.

MSF has been working in close partnership with the Zimbabwean Ministry of Health and Child Care (MoHCC) since 2000 in response to cholera outbreaks and other health emergencies in Zimbabwe.