“We are refugees in our own country,” says Blessing, a young Zimbabwean man as he stares around the field in front of Bindura’s Chiwaridzo Clinic . Lying in the dirt under a scorching sun are 71 cholera patients who local authorities have left outside in the courtyard rather than enter into the empty polyclinic building right in front of them. Some patients have found a couple of broken down benches to lie across, while others hide under the side-flaps of some small tents set up. The one open-aired tent that is set up is overcrowded and filthy. But most have no shelter either from the blistering sun or the periodical torrential rains that frequent this time of year. The cholera crisis in Zimbabwe is far from over. Though the case load in the capital Harare has decreased, outbreaks in mid-sized cities and rural areas continue. The prediction that Zimbabwe would reach the 50,000 mark of cholera cases was surpassed months ago and the epidemic still rages throughout the country, infecting more than 89,000 people, according to WHO estimates from March 8. Médecins Sans Frontières (MSF) has been treating roughly 56,000 of those patients through its mobile units and by setting up and running dozens of cholera treatment centres (CTCs) around the country. One of the latest outbreaks is in the city of Bindura, in the northeastern part of Zimbabwe. A week earlier, the local health authorities had considered closing down the small CTC that MSF had helped them set up in front of the clinic. MSF was able to dissuade them of closing it since there was still an average of 10 patients getting care at the site. On Feb. 22, the MSF mobile unit came by to check up on the small CTC and discovered there was a spike in cases, with 56 patients admitted in the camp. In two days there were 71. The local authorities had refused to allow the patients to be moved inside the available and empty clinic building in front of the camp, claiming difficulties of cleaning and disinfecting the premises after the crisis is over. For MSF, such a number of patients cannot be adequately and humanely treated out in the courtyard. At that moment, neither the patients nor the government nurses have any food in this makeshift CTC. Some patients’ relatives are able to bring food but this adds to the dangers of infection since the food is being cooked back at the sites where cholera has broken out. Those patients, though, are the lucky ones since others don’t have someone to bring them food or their families simply don’t have food themselves. Additionally, the food situation is affecting the health staff. “The morale of the nursing staff is quite low,” comments one of the district health officers in a health partners meeting. And it is no wonder. Not only has the government nursing staff not been paid for months but now they do not even receive food at their work. Despite this, the Zimbabwean government nurses work tirelessly day and night to try and ensure patients are kept alive. Yet, case management of the patients is difficult under the bad conditions of the site. A 50-year-old woman died a couple of days after MSF arrived in Chiwardizo, but in the crowded corner none of the staff noticed she was dead until hours later. The deceased was lying among other inert and exhausted cholera victims. The MSF environmental health officers had to disinfect and wrap the body in front of the other patients as there was nowhere else to do it. “How can you treat someone like this,” says one of the MSF staff. There is no mortuary either in the clinic or in the camp’s field. The body was set to lie in the corner of the camp next to the patients under the boiling sun. There was nowhere else to store it. Eleven hours pass before it is taken away. “This is a human being,” says the staff, shaking her head sadly, “it should not be this way.”  

Note: Since this article was written, local authorities have cooperated in making a football field in the area available for MSF to set up a new CTC there. Ministry of Health authorities have also promised to respond faster to emergency situations and ease bureaucratic constraints.

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