We drive out of Harare about 200 kilometers and then rise steeply up an escarpment that is the southern end of the Rift Valley. The view is stunning as we crest and begin the journey down the other side. A vast plain lies out before us stretching into Mozambique and then Malawi. I’ve often viewed this huge plain from the Malawi side of the Shire Valley. It’s in this low lying plain that World Vision Zimbabwe has one of their 27 area development programs (ADPs).
World Vision commits to a 15 year program in each ADP. That’s a long-term commitment and the relationships that develop between the community and the World Vision staff result in great trust. The child sponsor program of World Vision comes from the children identified, followed, and cared for in these ADPs.
This ADP is called Muzarabani and there are 50,000 people living here. Its one of the areas hit hard by cholera last year and so World Vision worked with the Ministry of Health to provide PUR. In total, World Vision provided more than 20 million liters of PUR-treated water in response to this humanitarian crisis.
Melu tells me that about 70% of people in this area collect their water from rivers and other unprotected water sources. The remaining 30% have boreholes but there are many that are in disrepair. So, it’s an area where the PUR packets can make potentially make a big difference, and I’m eager to see first-hand if that’s the case.
Our first stop is the Dambakurima Health Clinic and we meet Admire Chiweshe, the chief nurse of this area. He tells us he’s grateful for the gift of PUR to help his neighbors. Melu tells me that it’s important for us to ask permission from the village leaders in order to visit the community. I’m impatient to get into the field and I’m worried, based on past experience, about getting trapped into a long discussion. My impatience shows and Melu is gracious in explaining this to the tribal chiefs. After 5 minutes of apology from Melu, they grant us permission to delay the speeches until later.
Our first stop is with William Kasimba and his wife Fatima. Their family of seven lives in a mud hut under a Baobab tree. They’ve been using PUR for 4 months and, in this hot area, they drink a lot of purified water. They typically don’t have anything else to drink other than water. That’s rare in my experience in the developing world and an indication of a very high level of poverty.
Faustina gathers water from the river that’s about a 30 minute walk from her hut. She hauls 2 buckets each day of 20 liters. She explains that prior to PUR they did not treat their drinking water. They started using PUR after Wiliam was struck by cholera.
A warning: I’m going to get a bit graphic now describing William’s cholera. It’s your choice of whether to continue reading – you’ve been warned.
It was just two days after Christmas when William started feeling ill. He started vomiting and then had severe cramps and diarrhea. Within only three hours, he had bloody stools (dysentery). William tells me that the projective vomiting and explosive diarrhea were the worst part. By now, he was too weak to walk to the clinic. Faustina helped him into an ox cart in order to get him to the clinic.
Chiweshe, the nurse, remembers treating William. He said that Wiliam had lost a lot of fluid and they quickly got him on an IV drip of Ringer’s lactate to replace the fluids. The explosive diarrhea and vomiting are the reaction to the Vibrio cholera bacteria. Chiweshe tells me that if you can keep the patient hydrated, then it will pass and the patient can recover. William was feeling much better within a couple of days. But, he tells me that he’s afraid of getting cholera again.
Perhaps because of this fear, William helps Faustina treat their drinking water with the PUR packets. It’s unusual to see a man involved in water treatment as this is almost always the job of women. The couple tells me that they’re very loyal users and hope that the PUR continues to be provided. They go to the clinic and get more PUR from Chiweshe when they need it.
We enjoy some laughs and break the tension from the serious discussion of cholera by having some PUR-treated water. William has a great smile, and he sums up his feelings about PUR with a big smile and a thumbs-up.
We visit the river where Faustina gathers her water. For many miles, there are villages along this river. World Vision has dug boreholes in the area, but in many places the water is brackish and not palatable, so people continue to gather their drinking water from the river. We meet a group of people who live outside the area served by World Vision. They tell us that they have not heard of PUR and so Chiweshe conducts a demonstration.
He’s a very good communicator. And, in his dress white nurse’s uniform, he looks very credible. People are scooping their water from shallow holes they’ve dug in the river bank. They think that this will help make the water safe because it’s filtered by the sand. But, that’s not going to be very effective in removing the bacteria and viruses. There is cattle poop all around the area and the water is filthy.
The people are amazed when they see the water clarify following the PUR demonstration. I provide a few suggestions to Chiweshe on communication points and to ensure that the water is stirred vigorously. He’s gracious in accepting the feedback and passes it along to the people. I’m glad to see that the World Vision people are also taking notes.
Our next stop is to meet Shupai Mashumba and her daughter Sylvia. It turns out that Sylvia is another cholera victim. She’s 13 years old and in grade 6. Her twin sister, Maidei, was struck by cholera and Sylvia took her to the clinic in a wheelbarrow.
Chiweshe tells me that Sylvia’s contact with her twin sister may be the reason that Sylvia was then struck by cholera. I see the creases of concern in Chiweshe’s face as he recounts Sylvia’s symptoms. Sylvia developed projective vomiting and massive, explosive diarrhea. Within about 4 hours, her situation was very severe. I can tell that it hurts Chiweshe to recall this case. He says he thought he was going to lose her. She became so dehydrated that her veins collapsed. But, he kept trying for an hour to get the needle into her to provide the life-saving fluids. Finally, he was successful in finding a vein and figures he only had minutes to spare.
I ask Shupai, Sylvia’s mom, what she’d do if she didn’t have PUR. There’s a long pause. It seems she doesn’t want to think about this possibility. Finally, she says she’d boil the water, but it’s tough to find firewood in this area. Typical of many women that I’ve met, Shupai is the one to make PUR for her family. She’ll not trust anyone else because she knows this is critical to her family’s health.
Jeanette Zhuwau is a mother of three children. The children are sitting on the stoop in front of their hut and are quite photogenic. Jeanette says it’s fine to take their pictures and we give them some PUR-treated water that she’s already prepared. Patrick is 5, Nyasha is 2 ½ , and little Rollington is 18 months old.
Nyasha means “Grace”, and Chiweshe tells me Nyasha’s story that indeed seems appropriate to her name. This is the first small child that I’ve seen today who suffered from cholera. Chiweshe tells me that her story is not as dramatic as Sylvia’s hair-raising brush with death from cholera. Unfortunately, the very little ones either make it or quickly pass away. You see they’re too little to give much fight and the dehydration will quickly lead to shutting down their heart. This quick black hand of death is what steals so many babies from cholera. Luckily, Nyasha’s symptoms were quickly diagnosed and she made it to the clinic in time.
I learn that World Vision also has a program to help hundreds of people with HIV/AIDS in just this single ADP. Zimbabwe has a high rate of HIV/AIDS, about 16% at the last census. It’s likely to have increased even higher during the collapse of the country from political unrest. I ask Melu if it would be possible to meet one of the people with HIV/AIDS that received PUR because of the cholera response. I promise that I’ll be sensitive to her status and respect the need for her to maintain her dignity.
Most of the day, we’ve been a pretty large group traveling from house to house. But, for this visit, only a few of us approach the home of Anna Nyakudya. She gestures for me to take a seat beside her on the straw mat in front of her house. It’s turned quite warm now, and I’m grateful to sit down after hours of walking from house to house in the hot sun.
Everything seems to calm down during my conversation with Anna. Keith later tells me that it was one of the most beautiful moments that he’s ever observed during his many visits to the developing world. I felt exactly the same and was initially surprised that it was so obvious to someone looking at the conversation as he was doing.
Keith said that he could see me change somehow during the conversation. The calm was apparent in both me and Anna. Usually I write about how PUR transforms dirty water into clear water, but in this conversation, the transformation was the mutual understanding that Anna and I shared about the role that PUR plays in saving lives in people with HIV/AIDS. The content of our discussion was about the important role that PUR provides to people with HIV/AIDS. I’ve now spoken with hundreds of people with HIV/AIDS and witnessed the critical role that PUR provides for them. Anna was no exception. She frequently had persistent diarrhea prior to using PUR. Now she almost never has diarrhea and when she does it’s not the severe type that she used to experience.
Anna’s husband is not doing as well as her, and she knows he may die. One of her children is also HIV positive. Anna’s taking antiretroviral medication for the virus and is very grateful to have the PUR-treated water every time that she swallows her two pills a day. Anna looks me in the eye and quietly tells me that “PUR is helpful, it’s so very helpful to us”. We thank her for her time, and ask for a photo to remember our time together.
After a long day, I agree to the time for the speeches with the village leaders. I’m ready to sit and, as typical of these speeches, I hear everyone say a lot of words without saying much. But it’s critical to have the acceptance of the village elders and the health officials. Melu takes the opportunity to admit that he’s been watching me today. He asks the others if they’ve been doing the same, and they all shake their head that they’ve been watching me. I guess during all my travels that I’ve sort of forgotten that as a “varunga” or foreigner/white person, I’m under a microscope as much as the people that I “interrogate” with my never ending questions about their experiences with PUR. I’m very grateful when the people then tell me that what they all noticed was how much that I care about the people and the passion that I show for this work. It’s such a great honor to lead the P&G Children’s Safe Drinking Water Program and I’m thankful to able to demonstrate this passion.
But the best part of the speeches is to honor Chiweshe. Keith, Melu, and I are leaving in a few minutes, but Chiweshe is staying. He’ll be here again when the cholera hits. He’ll have to sleep in the clinic during the height of the outbreak because people will come during the day or night. It’s heartening that his load will be less because of PUR. In other programs, there’s been dramatic reduction in cholera when PUR was provided in advance of the rainy season.
Because it’s winter now, there’s not much cholera and Chiweshe sleeps at home. In a few months, the rainy season will start and it’s predicted that cholera will once again claim many more lives. I’m thankful that the people in this area will be protected with PUR. Melu tells me that he hopes P&G and World Vision can do much more in this area and the other ADPs run by World Vision. World Vision has more than 1,200 staff in Zimbabwe and has a sustained and deep community presence that can make provision of the PUR packets extremely effective. We’ve seen that today and I tell Keith, Melu, and Chiweshe that I’m eager to do more together to save lives in Zimbabwe.
Postscript
After returning from Zimbabwe, I received the following message from Bwalya Melu, of World Vision Zimbabwe.
Greetings from Harare Dr Allgood,
I just wanted to say that it was a real honor for WV Zimbabwe to have you visit one of our ADP's - Muzarabani. There remains no doubt in our minds of the value PUR has had on countless lives in Zimbabwe. In some cases, as we heard recounted in the project visit, in critical life/death situations - lives were saved.
We are excited about the prospects of expanding the relationship and to that end Keith has been in touch with the team here. I am confident that you will soon be receiving the proposed path forward.
Looking forward to working with you to that end.
Thank you once again.
Bwalya
I just want to tell you that when I read the articles about PUR and the wonderful and amazing difference it is making to so many lives, it humbles me.
All of the people involved in this initiative to me are incredible and fantastic and I cannot say enough good things about you all.
Congratulations and do keep going with the obvious strength and passion you have for this project.
Posted by: Lorraine Shaw | Aug 18, 2009 12:39:04 AM
What a wonderful program! Thanks for your compassion for people without clean drinking water! It is awesome to see what other people are doing to help out! Thanks!
Posted by: Holly Allen | Oct 21, 2009 5:09:07 PM