Life in the Time of Cholera


A Zimbabwean family bury their relative Betty Bvute who died of cholera on December 8, 2008. Image: DESMOND KWANDE/AFP/Getty Images

The cholera epidemic in Zimbabwe has no end in sight.  The numbers are stunning.  Some 60,000 people infected and more than 3,100 deaths caused by one of the most preventable environmental diseases on the face of the planet.  Cholera has spread to other African nations, including South Africa, Zambia and Malawi.  Not only is the outbreak far more severe in Zimbabwe, but the fatality rate of 5% far exceeds the 1% rate seen in South Africa.

This isn’t some scene in a Gabriel Garcia Marquez novel. It’s not even London in 1854, when a cholera epidemic took the lives of over 10,000 people and led to the creation of the field of public health.  This is Africa in the 21st century and pioneering epidemiologist Dr. John Snow isn’t coming to the rescue.

I get monthly World Health Organization updates on water quality issues around the world, and included in the latest message are all the common sense steps that the WHO and public health professionals have taken to stem the outbreak.  All of the short-term solutions are low cost.  Those who get infected need to get hydrated and treated with oral rehydration salts.  Immediate prevention measures involve effective disinfection and/or high-level filtration.

Longer-term fixes are more expensive and they involve sewage and water supply infrastructure improvements to keep human sewage out of water supply sources. Common sense, but not cheap to implement. These problems remain the primary cause of gastroenteritis (fever, stomach flu, diarrhea and nausea) on the planet.

People have the right to clean water that is safe to drink.  The consequences of failing to protect those rights are massive epidemics with severe health outcomes and tremendous loss of life.  People may feel better blaming the outbreak solely on the Mugabe dictatorship, but the reality is that the epidemic was preventable and controllable.  Not enough is being done globally to stop the epidemic.  Perhaps people should realize that in a time of increasing climate change, infective Vibrio cholerae populations are more likely to thrive in temperate regions and cholera outbreaks will become more frequent.

Former National Science Foundation director Rita Colwell has spoken frequently on the potential for wider spread cholera outbreaks. In other words, Zimbabwe may be the world’s worst-case scenario on cholera outbreaks, but with climate change leading to warmer waters globally, it may be a portent for outbreaks to come.

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