Cholera has overwhelmed this border town of about 40,000 like contaminated wildfire.
Normally, cholera starts with a few cases and then we have the peak
after a few weeks, says Luis MarÃÂa Tello, the MSF Emergency
Coordinator who arrived a few days after the first cases were reported
and is surprised to see such high numbers now. Though research still
needs to be done, Luis's theory right now is that a lot of people got
cholera from the same source at the same time.
On Friday, November 14, when the Zimbabwean Health Authorities in
Beitbridge first reported cholera to MSF, there were five cases. Two
days later, there were already more than 500; by the end of the week,
there were more than 1,500.
Cholera patients are treated on the ground at the main hospital in Beitbridge, which was overwhelmed with patients.
Patients were first placed inside Beitbridge's main hospital, most
lying on the cement floors, in very poor hygienic conditions. There is
a lack of cleaning personnel as well as proper gear, chemicals, and
water, not to mention all the hospital toilets have been blocked up for
a long time.
On Sunday morning, the hospital had to make the decision to put all the
patients out behind the buildings, on the dirt, so that body excretions
could be absorbed into the ground. The sight was appalling: patients
lying in the dust in the scorching heat; all asking for the life-saving
drip (Ringer lactate IV fluid). There wasn't even any water to give
them, since the hospital, as everywhere in town, has its water supply
cut on most days.
Clara and Veronica Nicola, the MSF doctor who is also the project
coordinator at the Beitbridge project, were the only MSF expatriates in
town when the emergency hit. Veronica, an Argentinean pediatrician who
has been on several MSF missions, says she never has had to insert so
many catheters in one day in her life.
For me, the hardest thing was to be able to concentrate on one person,
said Veronica. There was a man lying next to one of the trolleys under
the sun. By the time I got to him, he was in shock. We tried to get a
vein, like, ten times, but then he started gasping and he died right
there in front of our eyes. She pauses for a minute and then adds, If
I had seen him half an hour before, we might have been able to do
something about it, but there were so many people lying there, people
calling you. But still,
she adds thoughtfully, we could have done something. In her calm manner she summarizes, It was very bad.
In one week, 54 people died.
At the beginning of the crisis, the Beitbridge hospital did not have
any IV fluid or oral rehydration salts (ORS) tablets in stock. MSF
shipped over 800 liters of the Ringer's fluid the first day of the
intervention and since then there has been a continuous supply.
Shipments of medical and logistical supplies arrived over ten days. A
team of 16 expatriates, comprised of doctors, nurses, logisticians, and
administrators were sent to Beitbridge.
And more than 100 additional health workers, cleaners, and day workers have been hired locally.
In three days, a cholera treatment center (CTC) with 130 cholera
bedsâ€â€those with a hole in the middle under which a bucket is placed so
that the diarrhea is released directly in the containerâ€â€was set up.
Once the cholera bacteria enters the body, it releases a toxin which
causes part of the intestines to suck all the water from the body. The
intestines, unable to handle so much water, rejects it. The only thing
that can be done is to give the body enough fluids to survive until the
bacteria's own life cycle expires, usually in about five days. If a
person does not receive enough fluids, he or she can die within hours
of contagion.