LIVE: the cholera response aims to save lives

The cholera epidemic that hit Zimbabwe last November/December is the result of one decade of decline: decline in infrastructure, in the maintenance of wells, clinics, latrines and everything that keeps a population healthy. The epidemic peaked in January/February of this year with over 100,000 cases of cholera and at least 4000 deaths. Cholera tends to happen more in poor communities because the preconditions are there. If cholera hits your community, this is a good indicator that you have fallen a long way down. It is a wake up call that things are really not good.

Now it is the dry season in Zimbabwe however, a few more cases of cholera have been reported recently. Because of this there is concern that another epidemic could start at the onset of the rainy season. This is why CARE is, once again, addressing this issue. To prevent another outbreak, we are scaling up our prevention response.

We know how to stop cholera: with clean water, soap, and properly maintained toilets. CARE’s response to cholera in Zimbabwe is to address all of these issues. We have been rehabilitating bore holes, distributing soap, water purification tablets and promoting good hygiene habits. The distribution of water buckets is meant to help people keep their water clean. The buckets have lids. But we also know that distributing things is simply not enough. CARE also organizes community meetings to talk about good hygiene habits. Education about proper hygiene practices must also be promoted.

In a community that we visited, one of the disaster risk response (DRR) exercises focused on cholera. Community members worked on a ‘problem tree’ to structure the issue of cholera. The ‘roots’ of the tree symbolized the roots of problem. One woman told me clearly all the root causes of cholera. She was right on the mark. The ‘tree branches’ are the solution to the problem and the community’s role is to identify them. They know very well what causes cholera. The process of identifying both the problems and the solutions, as well as what you miss in between, is straightforward. The gaps can be addressed by CARE’s programs. Community members know what the gaps are.

Unlike other interventions spearheaded by CARE, community members were not singing and dancing at the cholera distribution site I visited. People are not proud when cholera strikes their community. They were patiently waiting for the essential items to be distributed. The distribution went off without a glitch, although it could have been faster and, in my opinion, more respectful of people’s time since I imagine many walked a long way to get to the distribution center.

Walking in Harare

The first time I came to Zimbabwe was in 1990, when I was working for World University Service of Canada, an organization that posted teachers all over the country and invested in teacher training. I spent most of the 90s in sub-Saharan Africa: in Zimbabwe, Zambia and Mali. This is the first real chance I have had since the 1990s to spend time in rural Zimbabwe. The last time I was in the Masvingo province, in the south eastern part of the country, was in 2002. Because I have lived in Zimbabwe before, this was a very emotional trip for me. So many places brought back memories.

The first thing I did when I arrived in Harare city was to take a long walk. I strolled for over two hours through the wide boulevards adorned with acacia and palm trees. On a superficial level and from a distance, the city looks the same as it did in the early nineties. But when you get close to it, look into the shop windows and talk to people, you realize how much has actually changed.

For much of the 1990s, Zimbabwe experienced rapid economic growth. It was perhaps not equitable growth but it was growth nevertheless. What is apparent to me now is that human capacity has not declined at all but that the infrastructure has literally collapsed. Zimbabweans are well educated, respectful and as aware as ever; perhaps even more so now then before. I was really astounded by the level of the conversation we had in the rural areas. Hyperinflation makes people destitute and this is what happened in Zimbabwe. When a currency has no longer any value and money becomes worthless, people have to sell their hard assets to simply cope. This is very palpable in Zimbabwe. You can see the hardships people have lived through for the past 15 years. Homes and shops have not been maintained because of the impact of hyperinflation.

As I strolled around Harare, I noticed very few cars and lots of shops selling items in bulk, with not much diversity. I went to the East Gate Shopping Center. The last time I was here was in 1999, when we visited from Zambia. This used to a fancy shopping mall because it was modern and new. This time around, I could not believe how much it had deteriorated. On the second floor, I saw all the franchise shops, including Debonaire Pizza and a Middle Eastern Deli, all selling the same traditional foods. This is a clear indication that what is available is extremely limited but it also highlights the Zimbabwean spirit, the fact that entrepreneurs still find a way to serve their customers. They did not abandon this place. They changed it. Of course, I do hope to come back someday and to see this shopping center as it once was: modern and lavish.

I have read somewhere that Zimbabwe has declined to the levels of 1953. Progress here means getting the country back to what it once was. The good news is that all the elements you need for recovery are in place. Most importantly, there is cohesion at the village level. You get straight to the point here. You can really talk to people about what they have and what they need and come to a rapid conclusion about first steps. Most of the CARE Zimbabwe programs are about taking first steps. They are not end points but steps towards recovery. They are a good demonstration of the ‘Live, Learn and Earn’ theme that CARE Canada seeks to promote.

Travelling in Zimbabwe

Have been in Zimbabwe for a few days now. Internet connections slow and unreliable. I'll post more about my experiences here when I can.

An Innovative Microfinance Project in Nairobi

The visit with Opportunity Kenya was a nice way to end our Kenya trip because it represented a positive progression. We went from the Dadaab refugee camps to the informal settlement of Kibera (often referred to as the largest ‘slum’ in sub-Saharan Africa) and finally to the Machako bus stop, a micro-enterprise hub on the outskirts of Nairobi.

To me this progression represents CARE’s ability to work with the ultra poor, the poor and those who are relatively better off. (Although compared to our standards in Canada they remain poor). Spending an entire day with men and women entrepreneurs who own small businesses really demonstrated to me what is possible. It made it clear that it is realistically for tens of thousands of Kenyans to engage in a productive economic life.

Take Pauline Muthoni for example.

She is a scrap metal trader who buys discarded metal sheets from the port city of Mombasa, transports them to Nairobi where she has a workshop. Here she makes wheels barrels, school boxes and chicken feeders. Six years ago she borrowed 10,000 KSH (about US$ 130). Now, when she needs to borrow, she takes out a sum in the range of 300,000 KSH (about US$ 4,500). Her business, which she inherited from her mother, is now thriving. She employs over six people and even sells raw material to other traders.

In Kibera and Dadaab we saw what CARE can do for poor people but through Opportunity Kenya, we saw what Kenyans can do for themselves. CARE still helps but the scale [percentage of help in relation to impact] has tipped. Our role now is largely an advisory one to the board. The entrepreneurs are the ones truly responsible for their success. They are creating it.

The first half of the day we visited microfinance clients met the management team of Opportunity Kenya. We saw how they run their business and how they are building micro finance opportunities. Then we met with the board of WEDCO, they are the ones providing the advice to Opportunity Kenya. [WEDCO is the original name of the microfinance entity that CARE supported]. The Board consists of a lawyer, an employee of one of the largest bilateral aid agencies, a senior banker with 25 years of experience in East and Southern Africa, and two CARE employees with strong experience in the financial sectors.

For a microfinance initiative to be successful it has to work in two directions: it has to serve its customers but also make a profit. The regulatory framework in Kenya is constantly changing. WEDCO and Opportunity Kenya must influence microfinance legislation in Kenya so that it benefits poor people. That is why we are involved. CARE has its feet in the market and a seat in the boardroom. We can talk effectively to people like Pauline but can also pick up the phone and talk to a representative in the central bank who can influence policy that ultimately affects poor people. That is our strength.

Visit to the Kibera informal settlement in Nairobi

Often, when people talk about Kibera, they use superlatives: this is the ‘largest slum in Africa’, there are ‘more than 1 million people’ living here, 20 percent of HIV positive people live in Kibera, etc. Big statements are always made about Kibera. Because CARE actually works here, I got the opportunity to go beyond the superlatives and to meet the individuals and people who live in this part of Nairobi. I was able to go beyond the broad statements. When you do that, you see how hard people work in Kibera. Their days are incredibly long. We walked down one street where the metal workers and furniture makers are. They are mostly men. In the next street over it was full of hair salons and food stalls, mostly managed by women. There are lots of negative statements made about Kibera but people here are striving, trying to improve their lives and working incredibly hard.

In Kibera we went to meet women who are members of a Savings and Loans Group initiated by CARE. You see, many people hear about microfinance projects but not a lot is said about savings and loans groups. At the level where we work, these are mostly an insurance scheme. Group members have access to financial resources that belong to all. Because of this, when they have a critical need, they do not have to sell their livelihood assets like a sewing machine or take their children out of school to access money. I am quite happy to see those programs working. We have access to credit cards for borrowing small amounts of money but for poor people the savings and loans groups are their insurance scheme.

When you introduce these programs to people who do not normally borrow and exchange money, you actually prepare them for next step up on the financial ladder. The language around this practice may be clumsy but the concept is very powerful. If you prevent people from experiencing financial shocks they are much better off because they do not fall deeper into the poverty trap.

In urban settings like Kibera, where people come from different parts of the country, the savings and loans groups also have a role in promoting social cohesion and peace. Because people come together around a common need, financial security in this case, they are able to overcome other divisions—like ethnicity. There are definitely civil society elements at the core of the savings and loans group philosophy promoted by CARE. Although it may be challenging to measure the impact of these interventions, you can see when they work and hear it directly from the people who participate in them.

Visiting the refugee camps of Dadaab

The last time I visited the Dadaab refugee camps was back in 1993 when CARE was establishing them. These were the early days of the Somalia crisis. The camps at the time were thought of as temporary structures. Part of that temporary mentality was truly visible. The message was that people would not stay there very long. The official line was that but Somali refugees knew their situation was going to last a long time. I have come back fifteen years later to find the same people in the camps.

Kadija is one of the women I met today. She is part of our plastic recycling project. She arrived in the camps in 1993, the same year I last visited. I was able to leave the camps because I was a visitor but Kadija is still there. It makes me realize how fortunate I have been in my life. I have been able to do so much over the past fifteen years while Kadija has been in the same camps. She is sorting plastic for 115 KSH per day (less than US$ 2). I want to make her life better. But what is indeed remarkable about her is that she is not giving up. She has responsibilities and continues to aspire for a better life. You have to admire that spirit.

Another thing that struck me today is the great partnership that the CARE staff on the ground has with the residents of the camps. I was impressed with the communication between our staff and the refugees. In a lot of refugee camps around the world this is not the case. Refugees get frustrated and communication can break down but here in Dadaab we have exceptional staff that understand the context and continue to do their job with commitment and patience. Take the issue of female circumcision for instance. One of the reasons why we have succeeded in reducing the incidence of circumcision of girls in the camps is because we have a relationship based on trust with the residents. You cannot achieve that kind of social change quickly and CARE staff has really made important strides. The women I spoke to today told me that progress on this topic remains fragile, that female circumcision has not been entirely eliminated and that there is still a way to go. I was nevertheless impressed by the women’s commitment and the frank discussions around this very issue. We have to give credit to CARE staff on the ground that has managed to nurture trust and keep a strong relationship with the refugees over the years.