By Karin Brulliard
Washington Post Foreign Service
Friday, December 5, 2008
MUSINA, South Africa -- Zimbabwe's crumbling economy and services have transformed this South African border town into a teeming district of shoppers, asylum-seekers and job hunters. Now something new has traveled south across the river that divides the two countries: cholera.
This week, the front lawn of Musina's lone, 80-bed hospital was a scene of despair. Beneath trees exploding with yellow and red blossoms, more than 100 adults and children lay inside steamy tents and under bushes, intravenous tubes stretching from the backs of their hands to bags of liquid hanging from tree trunks. Some, suffering through the gravest stages of an illness that causes severe diarrhea and dehydration, wore nothing but adult-size diapers.
Nearly all were from Zimbabwe, where the government declared a national emergency Thursday because of the cholera epidemic ravaging its population and reaching farther each day into neighboring countries such as this one.
"At the moment I knew something was wrong, I had to come here to Musina," said Godfrey Mawunganidze, 40, a Zimbabwean cross-border trader who lay under a tree, a damp towel covering his head. "Because if you go to a hospital in Zimbabwe, that's a dead zone."
Zimbabwe's humanitarian and economic crisis is so dire that millions have fled the nation, where sewage and health-care systems are nearly defunct and food is scarce. Cholera, which is spread through contaminated water and food, has become a symbol of the regional spillover of Zimbabwe's devastation.
But as it crosses borders, the outbreak may also serve as a catalyst for neighboring countries to become more involved in ending months of political impasse that has defied regional mediation and international pressure.
In recent months, cholera has killed more than 570 people and infected more than 12,700 others in Zimbabwe. The disease has since surfaced in Botswana and Mozambique. Zambia, to the north, is screening for symptoms at border posts.
Health workers in the province surrounding Musina, where cholera was last reported in 2001, have treated more than 435 patients in recent weeks, nearly 90 percent Zimbabwean. The crocodile-infested river along the border here has tested positive for the cholera bacteria, South African health officials said, probably because Zimbabwean communities with no sewage systems are flushing waste into the waterway.
"Zimbabwe is a sore on the rest of southern Africa," James D. McKee, the U.S. ambassador to Zimbabwe, said in a recent interview in Harare, Zimbabwe's capital.
Even Zimbabwe's supporters, among them regional power South Africa, are growing anxious. Noting the cholera epidemic, South Africa's cabinet said last month that it would withhold $28 million in agricultural aid to the government of Robert Mugabe, who was sworn in as Zimbabwe's president after an internationally condemned election in June. Interim South African President Kgalema Motlanthe has called for the swearing in of Zimbabwean opposition leader Morgan Tsvangirai as prime minister and Mugabe as president -- a comment interpreted here as a sign that Motlanthe views Mugabe as an illegitimate leader.
One hopeful columnist for the Standard, an independent newspaper in Zimbabwe, wrote that bacteria might be the breakthrough that summits, protests and political violence have not reached. He dubbed it the "Cholera Effect."
In bustling Musina, where six cholera patients have died, health workers are officially steering clear of politics. The focus is on saving lives, and patients are treated regardless of their nationality, said Phuti Seloba, a provincial health department spokesman.
Seloba would not say how much South Africa has spent to treat Zimbabweans. But he scarcely concealed his frustration. He said crossing the border illegally is easy because South Africa, a "human rights country," no longer has an electric fence. South African farmers want cheap labor, he said, so they hire Zimbabweans and "become beneficiaries of the madness of leaders in Zimbabwe."
"We can say the problem is in Zimbabwe," he said, referring to cholera. "It's spilling on us here."
Behind him were three white tents filled with beds for cholera patients, whose illness can be treated fairly easily with rehydration solutions if caught in time. There were 110 patients on this day.
One was Clever Kachitigu, a despondent-looking, rail-thin young man hooked up to an intravenous tube and wearing nothing but a faded NASCAR T-shirt around his waist. He said he left his home outside Harare a week earlier in search of work. There was no running water there. He fell ill four days later.
"We're just praying that the Lord will help us, because our president is killing us now," Kachitigu, 23, said softly.
He knew his predicament would be far worse in Zimbabwe. There, international aid organizations have been carrying the burden of an escalating outbreak by digging boreholes, distributing water-purification kits and setting up treatment centers. On Monday, the U.N. health agency appealed to donors for $2 million to fund a "three-month assault" on the epidemic.
The outbreak is worst in Harare, much of which has no running water because the bankrupt government cannot buy purifying chemicals and pipes are broken. In the packed townships, sewage runs freely.
The start of the rainy season is threatening to spread bacteria, while the summer heat is increasing the need to drink -- though many people are too poor to buy wood to build fires for boiling what little water they can find.
Making matters worse, a health-care system that was once one of Africa's finest has fully collapsed after years of deterioration, Western diplomats and local health-care workers say. Government hospitals have shut down, in part because hyperinflation has left employees unable to pay for transportation to work on their salaries.
"Our central hospitals are literally not functioning," Health Minister David Parirenyatwa said at a meeting of government and international aid officials Wednesday, according to the state-run Herald newspaper.
Western diplomats and health-care workers say emergency services are nonexistent because of shortages of supplies and staff. Power outages mean surgeries are performed by the light of cellphones. A scarcity of coal means medical waste is incinerated only sporadically.
Those who get sick stay at home or travel to rural mission hospitals, which one Western diplomat described as "overflowing." Private clinics require cash deposits of hundreds or thousands of dollars.
"It's insurmountable. So people die," said one doctor working in Harare, who spoke on the condition of anonymity to avoid the attention of authorities.
So some have come to Musina, a town now used to handling crushes of Zimbabweans. It can take hours to get through the border post into South Africa, well worth it to Zimbabweans seeking massive bags of cornmeal and boxes of soap available in far more abundance and for far less than in Zimbabwe.
Those without visas crawl through the many holes in the desolate border fence. Many sleep outside the town's fairgrounds, where immigration authorities take applications for asylum. The site has become a cholera hot spot, health officials say: On a recent day, there were six portable toilets for thousands of asylum-seekers.
Mawunganidze, the trader, said his Harare suburb had not had water for eight months. Everything, he said, had ground to a halt.
But he said he felt encouraged by what he interpreted as South Africa's tougher stance on Mugabe. Perhaps, he said, the United Nations could come into Zimbabwe "in a big way."
Then again, he wasn't sure.
"Is the world listening?" he asked, adjusting the brick that served as a pillow under his head. "Otherwise, we might be talking and talking and talking and talking and talking and talking."
He paused, then asked again.
"Is the world listening?"