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http://www.nytimes.com/2008/12/12/world/africa/12cholera.html

December 12, 2008

Cholera Is Raging, Despite Denial by Mugabe

By CELIA W. DUGGER

HARARE, Zimbabwe - Cholera swept through the five youngest children 
in the Chigudu family with cruel and bewildering haste.

On a recent Saturday, the children had chased one another through 
streets that flow with raw sewage, and chattered happily as they 
bedded down for the night. The diarrhea and vomiting began around 
midnight. Relatives frantically prepared solutions of water, sugar 
and salt for the youngsters, aged 20 months to 12 years, to drink.

But by morning, they were limp and hollow-eyed. The disease was 
draining their bodies of fluid.

"Then they started to die," said their brother Lovegot, 18. "Prisca 
was first, second Sammy, then Shantel, Clopas and Aisha, the littlest 
one, last."

A ferocious cholera epidemic, spread by water contaminated with human 
excrement, has stricken more than 16,000 people across Zimbabwe since 
August and killed more than 780. President Robert G. Mugabe said 
Thursday that the epidemic had ended, but health experts are warning 
that the number of cases could surpass 60,000, and that half the 
country's population of 12 million is at risk.

The outbreak is yet more evidence that Zimbabwe's most fundamental 
public services - including water and sanitation, public schools and 
hospitals - are shutting down, much like the organs of a severely 
dehydrated cholera victim.

Zimbabwe's once promising economy, disastrously mismanaged by Mr. 
Mugabe's government, has been spiraling downward for almost a decade, 
but residents here say the free fall has gained frightening velocity 
in recent weeks. Most of the nation's schools, which were once the 
pride of Africa, producing a highly literate population, have 
virtually ceased to function as teachers, whose salaries no longer 
even cover the cost of the bus fare to work, quit showing up.

With millions enduring severe and worsening hunger, and cholera 
spilling into neighboring countries, there are rising international 
calls for Mr. Mugabe to step down after 28 years in power. But he 
seems only to be digging in, and his announcement about the 
epidemic's end came just a day after the World Health Organization 
warned that the outbreak was grave enough to carry "serious regional 
implications."

Water cutoffs are common and prolonged here, but last week the taps 
went dry in virtually all of the capital's densely packed suburbs, 
where people most need clean drinking water to wash their hands and 
food, essential steps to containing cholera. On rutted streets 
crowded with out-of-school children and jobless adults, piles of 
uncollected garbage mounted and thick brown sludge burbled up from 
burst sewer lines.

The capital's two largest hospitals, sprawling facilities that once 
would have provided sophisticated care in just such a crisis, had 
largely shut down weeks earlier after doctors and nurses, their 
salaries rendered virtually worthless by the nation's crippling 
hyperinflation, simply stopped coming to work.

Inflation officially hit 231 million percent in July, but John 
Robertson, an independent economist in Zimbabwe, estimates that it 
has now surged to an astounding eight quintillion percent - that is 
an eight followed by 18 zeros.

The situation has deteriorated to such a degree that soldiers - Mr. 
Mugabe's enduring muscle - rioted last week on the streets of the 
capital, breaking windows and looting stores, after waiting days in 
bank lines without being able to withdraw their meager salaries from 
cash-short tellers. A midlevel officer who participated in the 
mayhem, but spoke on condition of anonymity for fear of prosecution, 
said troops were enraged that they could no longer afford to buy food 
or send their children to school.

"As we talk, children of chefs are in private schools learning while 
ours are playing in dusty roads," he said bitterly, using the local 
term for the people in power.

Rumors about this extraordinary unrest in the army's ranks have 
circulated feverishly, with some speculating that the rioting was 
staged to justify imposing a state of emergency. Others hoped it 
finally signaled the beginning of the end for Mr. Mugabe.

Still, the Mugabe government's ability to clamp down on dissent seems 
intact. The police quelled the riot. Sixteen soldiers now face a 
court-martial. Beyond that, about 20 opposition party activists and 
human rights workers have recently disappeared. Last week, armed men 
abducted a well-known human rights activist, Jestina Mukoko, at dawn 
while she was barefoot, still in her nightgown and bereft of her 
eyeglasses and as her teenage son looked on helplessly.

Political analysts have long predicted that Mr. Mugabe's hold on 
power - which he has refused to loosen since September, when he 
signed a power-sharing deal with his nemesis, opposition leader 
Morgan Tsvangirai - would be broken only after the economy completely 
imploded and daily life became intolerable.

But as the endgame of the octogenarian Mr. Mugabe's rule plays out, 
the human tragedies mount.

In a country with the terrible distinction of having the second 
highest proportion of orphans in the world - one in four children has 
lost one or both parents - the closing of schools and hospitals is 
hitting these most vulnerable children mercilessly.

Aisha Makombo, 15, has been raising her 11-year-old sister, Khadija, 
since their mother died of AIDS last year. An expressive girl with a 
soft, round face, Aisha, who is H.I.V. negative, has been struggling 
to get drug treatment for Khadija, who is now sick with AIDS.

She took her little sister, so stunted she appears half her actual 
age, to Parirenyatwa Hospital, the nation's largest referral 
hospital, last year, but crucial test results needed to qualify 
Khadija for life-saving medications were inexplicably misplaced.

On a later visit, Aisha was told the machine that performed the tests 
was broken. Now the hospital is virtually closed. Aisha said she was 
referred to private doctors who demanded payment in South African 
rand or American dollars, but the girls had no money.

Aisha's eyes filled with tears as she explained that she had been 
able to obtain only cotrimoxazole, an antibiotic used to treat 
opportunistic infections, for her little sister.

Aisha used to escape the sadness of her life by going to school, but 
two months ago the teachers at her high school stopped showing up.

"She didn't bid us farewell, she just left," Aisha said of her math 
teacher, the one she misses most of all. "At first, we thought she 
would come back, but then we gave up hope."

Aisha now scrambles to barter her labor for food, while her little 
sister, too weak to work, attends a small school run by a nonprofit 
group. Last week, Aisha started a four-day job, bent over in a field, 
readying it for planting. In exchange, she was to get two pounds of 
flour and a bottle of cooking oil, as well as a shirt and blouse for 
Khadija.

The girls pray together each night before going to sleep in the tiny, 
grubby, windowless room they share. The small house belongs to their 
grandfather, but he admitted it was Aisha who provided the food for 
him and her 45-year-old uncle who sometimes steals the cornmeal she 
earns, as well as the girls' clothes to sell secondhand.

Yet the girls say they cling to their dreams. Aisha's is to be a 
doctor, Khadija's a bank teller, each hungering for what the sisters 
do not have - health and money for medicine and food.

Zimbabwe has one of the world's highest rates of H.I.V. infection, 
and now a raging cholera crisis. But with the economic collapse 
decimating revenues needed to run the country's public health 
systems, mortality rates among cholera victims here are five times 
higher than in other countries, public health experts said.

Mr. Mugabe's government - in its pursuit of power and money - has 
also contributed to both catastrophes, analysts say.

Earlier this year, the government jeopardized $188 million in aid 
from the Global Fund to Fight AIDS, Tuberculosis and Malaria by 
taking $7.3 million the organization had donated and spending it on 
other, unrelated expenses. Only at the 11th hour, under threat that 
the money would be withheld, did the government reimburse the Global 
Fund for the missing funds.

And two years ago, the government took control of Harare's water and 
sewer systems from the opposition-controlled city council, depriving 
the local government of a crucial source of revenue to keep services 
functioning.

"The real motive was to dilute the influence of the opposition 
Movement for Democratic Change and cripple them financially," said 
Justice Mavezenge, an officer with the Combined Harare Residents 
Association, a civic group.

Last week, even Mr. Mugabe's mouthpiece, the newspaper The Herald, 
castigated the state-run water authority for running out of chemicals 
to purify Harare's water supply - chemicals it said could have been 
trucked in from South Africa in less than 24 hours.

The United Nation's Children's Fund and international donors have 
stepped into the void. They have begun trucking 50 tankers of fresh 
water into the most densely settled suburbs and will be providing 
water treatment chemicals for the city over the next four months, 
said Unicef's acting country director, Roeland Monasch.

But some aid officials fear that the epidemic will be impossible to 
contain because of the failing water and sanitation systems in places 
like Budiriro, the Harare suburb where the Chigudu children died and 
where half the country's cases have occurred.

"We're not going to be able to control it," said one aid agency 
adviser, speaking anonymously for fear of retribution. "The likely 
scenario is that people who get sick in places like Budiriro will go 
home for the festive season and you'll get flash points all over the 
rural areas."

Cholera stole the five Chigudu children in just two days, on Nov. 17 
and 18, and the grandmother and aunt who helped care for them died 
just days later. Their father, who returned home just hours after the 
last of his children died, got his first inkling of unspeakable 
calamity when his youngest ones weren't there to clamber all over him 
as he walked in the door.

"I will never get my children back," he said.

The death toll mounts each day. Chipo and Tecla Murape rushed their 
orphaned 5-year-old niece, Moisha, to the clinic in Chitungwiza, a 
city just south of Harare, last week. Nurses told the family the 
veins in the girl's arms had collapsed because she had lost so much 
fluid. No doctor ever saw her, her relatives said, and the nurses 
never hit a vein. Moisha, a shy, but friendly girl, instead drank 
rehydration fluids.

Throughout the day, she complained of a terrible thirst and a 
stomachache. On the advice of clinic workers, her aunts did not even 
hold her hand as she lay dying, fearing infection. After night fell, 
the nurses said there was nothing more they could do and suggested 
that Moisha's relatives take her to the city's hospital, some two and 
a half miles away.

But there was no ambulance. Tecla Murape, 42, swaddled Moisha to her 
back and set off hurriedly for the hourlong walk, her heart pounding 
with worry. Under a dark, moonless sky, she took a shortcut through a 
maize field, leaping across yet another putrid sewage spill. By the 
time they arrived, Mrs. Murape's clothes were soaked with Moisha's 
watery diarrhea. Hours later, Moisha died.