South African hospitals overflow as Zimbabweans seek treatment for cholera

BMJ 2008; 337 doi: (Published 22 December 2008) Cite this as: BMJ 2008;337:a3057
  1. Pat Sidley
  1. 1Johannesburg

    Eight people have so far died from cholera and 805 are being treated for the disease in the South African town of Musina, on the country’s border with Zimbabwe.

    Musina is a poor town that has itself faced several outbreaks of cholera in the passt independently of the crisis in Zimbabwe. Hospitals in the town are overflowing, and tents have been erected to treat the influx of refugees seeking treatment.

    A major town in Limpopo province, Musina relies on trade brought to the area by Zimbabweans, either on their way to Johannesburg to find work or returning to Zimbabwe with goods they cannot buy in their own country. Now, however, the town has drawn an army of doctors, public health officials, epidemiologists, water and sanitation experts, and nurses to ensure that patients who cannot be accommodated in overfilled hospital wards are treated.

    Cholera has been a problem in South Africa since the 1970s. Outbreaks have occurred in Limpopo and its neighbouring provinces along the Limpopo River, and into Mozambique, and also down the eastern side of South Africa, in KwaZulu-Natal. Inadequate sanitation and drinking water and a lack of health campaigns to teach people how to reduce the risk of infection have been blamed. The pattern of outbreaks continued after democratic elections in 1994 and at times has worsened. In 2000 and 2001 more than 100 000 people contracted cholera across several provinces.

    Barbara Hogan, South Africa’s new health minister, who was appointed in part to reduce the burden of infectious disease, has been to the area and given a frank assessment of the task at hand. But her rapid deployment to the area and its tent cities of refugees have highlighted the lack there of permanent health services and adequate clean water and sanitation.

    The Department of Health said that cholera bacteria had been found in the Limpopo River, a dangerous pointer to the possibility of a much larger epidemic. The river runs across the northern border of South Africa into Mozambique and then into the Indian Ocean. On its way it irrigates large agricultural areas. Adjoining provinces such as Mpumalanga and its neighbour, KwaZulu-Natal, face regular outbreaks of cholera, because of the lack of sanitation and hygiene. This week, however, the health authorities have said that they have found no signs of the presence of the cholera organism in the river.

    Ms Hogan said cases of cholera had been reported in Gauteng province (in which Johannesburg and Pretoria are situated), KwaZulu-Natal, and other provinces and that the government had acted swiftly to put in place systems and people to assess and deal with the problem.

    However, she warned: “Given the scale of the outbreak, the weakened health system in Zimbabwe, and the extent of the cross border movement of people it was agreed that all aspects of our interventions needed to be scaled up and that a renewed sense of urgency to deal with this outbreak was needed at all levels. Clearly, a major focus should be to assist the people of Zimbabwe to access clean water and to repair sanitation plants.”


    Cite this as: BMJ 2008;337:a3057