Cholera in Zambia: When climate change makes you sick

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Cholera patients at the George Community Clinic in Lusaka

Photo: Loliwe Phiri / DER SPIEGEL

The heroes don't wear football boots, but rather white full-body suits. They are not fighting for a trophy, but for human lives. There is a lot of hectic activity in front of the Heroes Stadium. The nurses and doctors come out of the inside sweating, they quickly open their white overalls and gasp for air. They just placed IV fluids, washed away bodily fluids, cleaned the dead. Zambia's national stadium has been converted into a central treatment center for cholera sufferers.

In front of the gates of the makeshift hospital, colorfully dressed women and a few men sit in the shade of a tree. They wait for news of their loved ones fighting for their lives inside. The group suddenly jumps up and presses against the bars that have been set up in front of the arena. A helper sets up on the other side, a clipboard with pieces of paper in her hand. It's time for the list of names: Who has been discharged as recovered? Who didn't make it? Who has no news from, status unchanged? The relatives listen spellbound, breathe a sigh of relief, some cry.

Jennifer Chipulu has been here for three days, from 6 a.m. until it gets dark in the evening. Her 79-year-old mother suddenly became ill, had diarrhea and vomited. First she was admitted to a local hospital, then taken to the Heroes Stadium with flashing lights on, where she was already unconscious. Daughter Chipulu has been stuck in front of the bars ever since; she gave up her job to be near her mother. But her name is not on any list, no one can tell her what happened, whether she is still alive or has already been buried.

"I'm going crazy. I finally need certainty,” says the daughter. But no one can help her. In the past few weeks, many relatives have felt the same way as Chipulu, because cholera is spreading faster and faster in Zambia's capital Lusaka, and with it chaos.

In January, the stadium filled up quickly and the authorities were overwhelmed. At least some order has now been restored and processes are settling into place. But cholera continues to rage unabated. Old people and children in particular die.

All schools in Zambia have been closed for weeks, a maximum of five people are allowed to attend funerals, and the country has already suffered almost 600 deaths from cholera. It is the worst outbreak in decades, and the disease is also raging in neighboring Zimbabwe and Mozambique. Cholera is spreading across the continent.

Climate change is also to blame, experts say. They warn: In the future, such medical emergencies will become more common, and they will particularly affect the poorest in the countries of the Global South - even though they hardly contribute anything to climate change. "This is just the beginning, a kind of wake-up call," says Professor Roma Chilengi from the state-run Zambia National Public Health Institute. »We will see a sharp increase in disease outbreaks. Developing countries are facing massive problems due to climate change. Everyone should finally understand that.”

Jessica Bwali experiences these problems every day. She walks quickly through one of the poorer areas of the capital Lusaka. The small houses and huts are close together, no streets lead along the interior, only winding footpaths. Bwali often stops, talks to the residents and listens to them. The woman in her late twenties works for Tearfund, a church-based non-governmental organization.

In the past you could set the clock according to the rain

She was a former radio presenter, hosting a nationally known morning show. But then the power outages began in Zambia in 2019 due to ongoing drought. The dams were empty and hydropower was no longer available. Bwali started researching the reasons. Today she is one of the best-known climate activists in the country, going to schools and promoting local initiatives. »The rains used to always come on October 24th, you could set the clock accordingly. Today we sometimes wait until January for precipitation, and then suddenly a lot of it falls at once. People notice that, but they don't know that climate change is behind it," she says. She sees the current cholera outbreak as a harbinger of even darker times to come.

This Wednesday morning she forgot her rubber boots. She has to jump in sneakers over stones placed in puddles as an improvised path. The word puddle is a gross understatement, but rather there are small lakes that run through the district. They shimmer bright green, tadpoles swim around in them, and sometimes indefinable foam floats on the water.

Then a resident shows why cholera can spread so unchecked here: His toilet, an outhouse made of corrugated iron with an outhouse, was flooded by the heavy rain of the past few days. Feces float in the water and make their way past the neighbors' houses. Ideal breeding ground for vibrio cholerae, the tiny cholera bacterium that is primarily transmitted through contaminated water and food. “We breathe in death and disease,” the resident shouts angrily.

Next door, a construction worker stands on a waist-high concrete base. He uses a bucket to scoop out the poisonous green soup beneath him to mix concrete. Suzyo Daka has also been sick in the past few days and had stomach pain and diarrhea. Activist Bwali shouts a few questions at him, separated by a moat that she cannot cross in her sneakers. Daka knows nothing about climate change, but he does know about the floods in this area. With an outstretched hand he points to the building opposite; until recently it was under water up to the first floor.

An ideal breeding ground for the cholera bacterium

For him as a construction worker, these are good times, despite the illnesses that are circulating. Because more and more people want to raise their houses higher and have a platform built like the one Daka is currently working on. “This is the new standard,” says the 35-year-old. “Climate adaptation measures,” says Bwali, the activist, “people are helping themselves.”

In any case, the government hardly intervenes here. There isn't even a garbage disposal in the area; the waste usually ends up in the sewer, which only makes the flooding worse. Almost a year ago, the national disaster authority was in the area, the residents say. They took photos of the water and asked residents what to do. They didn't come back. “Countries like Zambia have no resources to address climate change; our health systems are already at their limits,” says Bwali.

It's not just the floods that are a problem: because of the increasingly late rains, water becomes scarce from October onwards and the pipes often remain dry. During this time, many people turn to unsafe water sources, such as shallow wells. The most recent cholera outbreak originated there last fall and the first cases of the disease were reported. When the heavy rains followed at the end of the year, the cholera-contaminated feces mixed with the drinking water, the perfect storm.

The disease leads to acute dehydration

The mood is tense at the George Community Clinic in the city's largest slum. A doctor is reading out the names of those who are to be taken to the Heroes Stadium. Most of those mentioned protest loudly. They are afraid of the large treatment center. Rumors and conspiracy theories circulate among the patients that experiments are being carried out on people there and that they will never be able to get out again. But they are not allowed to stay in the small, local hospital; the beds are urgently needed.

The dark green couches stand on the concrete floor just a few centimeters apart, and a thin light green curtain separates the half of the room for male patients from the half for female patients. It smells of chlorine and the bare ground is kept moist around the clock. Holes are cut into the loungers at waist height and there are buckets underneath. A cholera patient can produce one liter of diarrhea per hour; the disease leads to acute dehydration and is therefore quickly fatal if left untreated.

Here in the clinic almost all of the patients are on a drip, including some children, some have completely stopped. An elderly woman has just vomited and a nurse quickly turns her onto her side so that she doesn't suffocate. Many of the helpers are volunteers, like Violet Chizema. The 65-year-old has been helping at the George Clinic for more than 20 years and has been through several cholera outbreaks. She found fetuses in the buckets under the loungers that pregnant women had lost due to diarrhea. "The other day a little boy came in, I sang songs with him, and shortly afterwards he was dead." She didn't have time to cry. She washes the cholera dead with a solution containing two percent chlorine.

The government had actually promised nurses like her 100 Zambian Kwacha per day, the equivalent of around three euros. But to date nothing has arrived. Chizema continues anyway, a shift every day, eight hours at a time, for weeks now. “I want to help my community, we have to get through this together,” she says. She hardly relies on any help from the government anymore.

Chizema not only works in the hospital, she also does her rounds in the neighborhood after work and checks compliance with hygiene regulations. The 65-year-old gets out of her white overalls and disinfects her shoes. Then she walks through the market, raw meat is displayed on self-made wooden stands, sometimes whole cow heads, lots of innards, everything full of flies. Every now and then the market women try to drive them away with small wands, but immediately afterwards the goods are covered in black dots again.

Chizema explains in a calm voice why she is here, she says sentences like: "I don't want to take your business away from you." She then asks the saleswomen to at least put nets over the goods, because flies could transmit diseases - but her requests usually remain unsuccessful. A car with a loudspeaker mounted on it is driving past on the street behind her, and a loud voice is booming out of it, calling for relatives with symptoms to be taken to the hospital immediately. Violet Chizema waves briefly to her colleagues, they know each other.

Another team of volunteers is out and about in the district; they should promote the cholera vaccine. There aren't even enough vaccine doses in the country. Millions are missing worldwide. The outbreaks are becoming more and more frequent, but production is stalling. »Cholera is a poor man's disease, there is not as much investment in it as with Corona. The pharmaceutical industry is not interested in the Global South, there is no business to be done here,” complains

Professor Roma Chilengi from the Zambia National Public Health Institute.

The countries of the Global North wanted to make 100 billion euros available to the countries of the Global South every year so that they can deal with the consequences of climate change. Actually. The sum was never reached, and the direct damage caused by tropical storms, floods and droughts is already immense, so there is hardly any money left for acute health crises. Zambia is heavily indebted and was already on the verge of bankruptcy during the corona pandemic in 2020 when it was no longer able to service a Eurobond loan.

The Zambian government is currently trying to limit the damage to its image. On a Thursday morning, the health minister and a cabinet colleague walked through the slums of Lusaka, accompanied by a press entourage; the action was intended to show determination. They inspect toilets, go into stores and have licenses shown. The mayor in attendance is regularly asked: Why does this unhygienic business even have a license, why is the sewer full of garbage?

Finally, the entourage comes across a city cleaning worker who is using a long, thin wire to clear a clogged wastewater tank, the smelly gray-brown liquid running down the slope. "That does not work like this! Who is your boss?” shout the politicians. Then the Minister for Municipal Affairs makes two phone calls at the same time in front of the cameras, one on the left ear and one on the right. In the end he seems satisfied that the fecal vacuum cleaner is coming!

The surrounding residents are more skeptical: "We're constantly being promised something, but in the end nothing happens," shouts one.

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