A girl walks among the mountains of waste in Garden Compound.

Zambians Shaken by Cholera Outbreak Face Another Rainy Season

LUSAKA—Natasha Bwalya, 35, lives in Garden House Compound, a sprawling maze of bumpy dirt tracks and makeshift shelters on the outskirts of Zambia’s capital, Lusaka, where some 50,000 people live in homes without toilets or clean water. 

It was a hotspot for cholera at the beginning of 2024, when the nation suffered its worst outbreak in a generation. At least 740 people died and over 20,000 cases were recorded as the waterborne disease thrived in the unsanitary conditions.

Bwalya’s 15-year-old son caught cholera in January and died just days later. “It’s still difficult for me to accept,” she says. “I never thought that he would die.”

On a ferociously hot November day, the ground around the stall where Bwalya sells fruit and vegetables was still scorched after six months of record-breaking drought. But Bwalya fears the forecast of heavy rains this season, which threaten to spread the disease again. 

With no other options, people defecate in the open or use pit latrines shared by many others. When the water levels rise, human feces pour into the neighborhood and contaminate the shallow wells where people draw their water. 

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Natasha Bwalya, wearing a pale blue t-shirt with black dots, stands near her fruit and vegetable stand.

Natasha Bwalya, who lost her son to cholera in January, stands near her fruit and vegetable stand. Lusaka, Zambia, November 6, 2024. Image: Freddie Clayton 

Bwalya says her two younger children already struggle with diarrhea, and she’s worried they will soon suffer as her son did. Almost a year on from the last outbreak, little has changed to calm her fears.

Since January’s cholera outbreak, the government built additional public toilets, improved waste management systems, and provided more clean water sources, says Kabukabu Akufuna, a senior environmental health officer at Zambia’s National Public Health Institute. “Significant progress has been made in strengthening Zambia’s capacity to prevent and respond to cholera,” says Akufuna. 

But 11 months on, it’s hard to see that progress on the ground. 

Massive water tanks stand empty as the government neglects to fill them, while flies move between food, feces and wells. Some government-run oral rehydration points in these settlements scarcely compensate for the lack of clean water that runs into the neighborhood. 

“The sanitation situation in our community remains in a poor state,” says Miriam Kabambanya, who volunteers with the Neighborhood Health Committee at the Garden House health post. “The toilets are in a bad condition. Most pit latrines are filled up with human waste, and in some cases, they are flowing into the open.”

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A makeshift toilet built from wood and rags, surrounded by debris.

 Some houses in the Garden House Compound area of Lusaka share makeshift toilets built from wood and rags. Lusaka, Zambia, November 6, 2024.  Image: Freddie Clayton

Kabambanya was on the frontlines of the crisis 10 months ago, helping to prepare dead bodies for pick-up by local authorities. She herself fell ill with cholera and doubts that enough has changed to prevent another outbreak.

“We are going to receive heavy rains, so the issue of contamination is going to happen again,” she says.

Her neighbor Kennedy Musonda, 37, who lost his wife in the last outbreak, is also pessimistic about the upcoming rainy season. Musonda’s relatives have taken his children away to live in the rural areas. 

“It’s not safe for them here,” he says.

UNICEF Zambia is among the organizations battling to prevent another cholera outbreak, but Emily Christensen Rand, its chief of Water, Sanitation and Hygiene (WASH), says she understands why some people feel nothing has changed. 

“WASH infrastructure is still in the same state it was pre and during the last outbreak,” she says. “Many areas, especially poor and densely populated neighborhoods, still lack proper water supply and sanitation facilities which are crucial for preventing cholera.”

But the government and UNICEF have also learned lessons from the last cholera outbreak ahead of the rainy season, she says. This time, WASH supplies were already in health care facilities to improve response time, and pre-emptive cholera vaccination was planned in cholera hotspots. 

While investment is lacking on the ground, other efforts to expand resources also offer hope for long-term change.  

In October, Zambia signed a Memorandum of Understanding with China to establish Africa’s first cholera vaccine manufacturing plant, which is expected to produce around three million doses annually. While it is unclear when the vaccine will be manufactured, China has said it will donate three million doses before production begins. 

The University of Zambia is also host to a new state-of-the art research laboratory, funded in part by the Scottish government, which promises to further biomedical research and clinical diagnoses in Southern Africa, including cholera testing and research.

However, such investments focus on treatment rather than prevention. The root cause remains.

“The truth lies in improvement of water and sanitation,” says Sody Munsaka, a professor and neuroimmune and infectious diseases scientist at the University of Zambia and head of operations at the new laboratory.  

“As much as we are pushing for testing and surveillance, as well as for vaccines, I feel that’s really not a solution, because the effectiveness of a vaccine cannot be compared to public health measures. If I was in charge of this, I would actually put a lot of money in improvement of water and sanitation.”

Rand says that attention to structural improvements has lacked financial support in the development of Zambia’s Multisectoral Cholera Elimination Plan in 2019, adding that “no significant funding has been allocated” to the plan, and that WASH budget allocations have since decreased.

For Natasha’s family, improvements can’t come fast enough.

“It still hurts,” says Bwalya, remembering her son. “I’m just worried about my other children.” 

 

Kennedy Phiri is a Zambian journalist reporting on environmental issues and the cofounder of Media Network Action on Climate Change. 

Freddie Clayton is a British journalist who covers climate, the environment, and public health. He is a reporter for NBC News, and has written for The Guardian, The Economist, and the Pulitzer Center on Crisis Reporting.

Ed. Note: This article is part of Global Health NOW’s Local Reporting Initiative, made possible through the generous support of loyal GHN readers.

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A girl walks among the mountains of waste in Garden Compound. Lusaka, Zambia, November 6, 2024. Image: Freddie Clayton