1 00:00:06,120 --> 00:00:14,430 It's so hard to put into words just what it means to me to see so many people coming out, taking an interest in my work, 2 00:00:14,430 --> 00:00:24,420 willing to engage with words and ideas I've toiled over for the last five years and it feels, in that sense, an incredibly emotional moment. 3 00:00:24,420 --> 00:00:30,420 This project is just just outlined, began as my doctoral thesis, 4 00:00:30,420 --> 00:00:41,460 and the commitment I make to myself was that the very first line I ever wrote in the doctoral proposal would find its way into the book, 5 00:00:41,460 --> 00:00:45,330 and the book was written almost entirely in this department. And to me, 6 00:00:45,330 --> 00:00:56,900 it feels fitting that I get to launch the book here and slowly begin to mark the end of this particular part of my own intellectual journey. 7 00:00:56,900 --> 00:01:01,910 So I was in my fifth year of medical school at Newcastle University when I first stumbled 8 00:01:01,910 --> 00:01:08,120 upon the startling article entitled Cholera Epidemic Sweeping Across the Crumbling Zimbabwe. 9 00:01:08,120 --> 00:01:11,870 The piece, published in early December 2008, 10 00:01:11,870 --> 00:01:21,690 began by recounting how the disease had claimed the lives of the five youngest members of the Chibuku family with cruel and bewildering haste. 11 00:01:21,690 --> 00:01:30,630 These children had been playing in the sewage flooded streets of a Harare township, gleefully unaware of the deadly bacteria lurking there, 12 00:01:30,630 --> 00:01:36,780 and it was only a matter of hours before all five children began purging and vomiting. 13 00:01:36,780 --> 00:01:44,800 Within less than a day, they were limp and hollow wide as life seeped out of their desiccated bodies. 14 00:01:44,800 --> 00:01:51,640 Then they started today, said their brother, love God, pre-school was first, second time, 15 00:01:51,640 --> 00:02:00,070 then Shontell Colobus and Aisha, the littlest one, lost the New York Times, along with numerous other media agencies, 16 00:02:00,070 --> 00:02:02,980 as well as regional and international organisations, 17 00:02:02,980 --> 00:02:09,310 reported that this outbreak was indisputable evidence that Zimbabwe's most fundamental public services, 18 00:02:09,310 --> 00:02:14,230 including water and sanitation, public schools and hospitals, had shut down. 19 00:02:14,230 --> 00:02:21,950 Much like the organs of a severely dehydrated cholera patient. The spread of lethality of the disease did not abate, 20 00:02:21,950 --> 00:02:28,730 the country's public health systems floundered in response to what is otherwise a straightforward bacterial infection, 21 00:02:28,730 --> 00:02:34,130 one that's easy to prevent, difficult to spread and simple to treat. 22 00:02:34,130 --> 00:02:35,810 And over the course of 10 months, 23 00:02:35,810 --> 00:02:44,090 Zimbabwe's cholera outbreak reached catastrophic proportions that are almost unrivalled in the modern history of the disease. 24 00:02:44,090 --> 00:02:50,900 So the epidemic had begun in August 2008 in the high density suburbs of Canada's metropolitan area. 25 00:02:50,900 --> 00:02:56,120 It quickly spread into peri urban and rural areas before crossing the country's borders. 26 00:02:56,120 --> 00:03:03,230 As you can see, it's South Africa, Botswana, Zambia, Mozambique over the course of 10 months, as I've said. 27 00:03:03,230 --> 00:03:13,580 The disease infected over 98000 people, claimed over 4000 lives and with an exceptionally high case fatality rate at the peak of the epidemic. 28 00:03:13,580 --> 00:03:21,110 Zimbabwe, with 2008 and 2009 cholera outbreak, has been deemed the most extensive in recorded African history. 29 00:03:21,110 --> 00:03:30,050 Now, epidemiologically speaking, the outbreak can be explained by the cross-contamination of the country's water and sanitation systems. 30 00:03:30,050 --> 00:03:34,850 And yet such a reading belies the complex interaction of political, 31 00:03:34,850 --> 00:03:39,650 economic and historical factors that initially gave rise to the dysfunction of 32 00:03:39,650 --> 00:03:44,810 the water systems that delineate the social and spatial pattern of the outbreak. 33 00:03:44,810 --> 00:03:50,120 And that account for the fragmented and inadequate response of the national health system. 34 00:03:50,120 --> 00:03:54,680 So cholera then was much more than a public health crisis. 35 00:03:54,680 --> 00:04:00,410 It signals a new dimension to the country's deepening political and economic crisis of 2008, 36 00:04:00,410 --> 00:04:06,690 which brought into question the capacity and legitimacy of the state. 37 00:04:06,690 --> 00:04:15,990 So this book then does not address Colorado as a technical problem to be solved or to be prevented in future. 38 00:04:15,990 --> 00:04:21,360 And indeed, there already exists a rich epidemiological literature speaking to this very question. 39 00:04:21,360 --> 00:04:29,550 Instead, with this book, I tried to tell a story about the political life of the cholera epidemic. 40 00:04:29,550 --> 00:04:36,240 I examined the epidemics, origins, the pattern of its unfolding, its social impact. 41 00:04:36,240 --> 00:04:45,420 Institutional and communal responses to the outbreak and its aftermath in civic and public life across different institutional settings. 42 00:04:45,420 --> 00:04:49,710 Cholera engendered competing interpretations and experiences, 43 00:04:49,710 --> 00:04:56,250 and these created charged social and political debates about the breakdown of Zimbabwe's public health infrastructure, 44 00:04:56,250 --> 00:04:58,830 the country's failing bureaucratic order, 45 00:04:58,830 --> 00:05:07,230 the scope and limits of humanitarian relief and the country's profound levels of livelihood, poverty and social inequality. 46 00:05:07,230 --> 00:05:15,510 And so I'd like to suggest examining the political life of an epidemic offers compelling insights into how we think about politics, 47 00:05:15,510 --> 00:05:21,540 humanitarianism, social inequality, the state and citizenship in Africa. 48 00:05:21,540 --> 00:05:26,460 Now, cholera as an indicator and as a test of social and medical systems, 49 00:05:26,460 --> 00:05:31,710 has occupied a central place in much of the one non-medical literature on the subject. 50 00:05:31,710 --> 00:05:39,720 Indeed, the historian Richard Evans, in his groundbreaking work on the history of cholera in Hamburg in the latter part of the 19th century, 51 00:05:39,720 --> 00:05:42,810 advocates the study of the disease in this very manner. 52 00:05:42,810 --> 00:05:49,980 But Evans is quick to caution us that we need to be very careful and circumspect in handling this way of approaching cholera. 53 00:05:49,980 --> 00:05:56,820 For Evans cholera outbreak, the cholera outbreak that plagues social political life in Hamburg in the late 19th and early 20th 54 00:05:56,820 --> 00:06:03,150 century are best understood as events that might perhaps be ultimately insignificant to themselves. 55 00:06:03,150 --> 00:06:09,360 But nevertheless, in a flash of lightning, they illuminate an entire historical and social landscapes. 56 00:06:09,360 --> 00:06:14,850 As the elegantly articulated during a cholera outbreak, the workings of states and society, 57 00:06:14,850 --> 00:06:19,110 the structures of social inequality, the variety of values and beliefs, 58 00:06:19,110 --> 00:06:24,120 the physical contours of everyday life and the formal ideologies and informal 59 00:06:24,120 --> 00:06:30,950 ambitions of political organisations are all thrown into sharp and detailed relief. 60 00:06:30,950 --> 00:06:35,840 And in the spirit that I tried to approach the study of the 2008 and 2009 cholera 61 00:06:35,840 --> 00:06:41,180 outbreak in Zimbabwe as an event that might ultimately be insignificant in itself, 62 00:06:41,180 --> 00:06:49,790 but one which opens up a window onto many aspects of the country's historical, social and political landscapes that are otherwise left obscure. 63 00:06:49,790 --> 00:06:55,760 And the aim here that is to travel with cholera through time and space to illuminate the urban history of 64 00:06:55,760 --> 00:07:02,180 Harare to show the structural factors that led to high density residential areas that circumvent the city 65 00:07:02,180 --> 00:07:08,660 as being prone to diarrhoeal disease outbreaks to show the political disruptions wrought by the country's 66 00:07:08,660 --> 00:07:15,710 post-2000 crisis and how these disruptions had unforeseen and catastrophic consequences for human health. 67 00:07:15,710 --> 00:07:21,800 I try to reveal the inherently pluralistic nature of an epidemic and the divisive politics that accompany it, 68 00:07:21,800 --> 00:07:26,420 and to make apparent how a medical nightmare mask, the contours of life and death, 69 00:07:26,420 --> 00:07:33,420 belonging and exclusion, privilege and objection within the body politic. 70 00:07:33,420 --> 00:07:41,340 That being said, I'd like to think that this book is more important than its contribution to academe. 71 00:07:41,340 --> 00:07:45,120 More important than its contribution to the advancement of my career and more 72 00:07:45,120 --> 00:07:50,280 important than its contribution to my own personal and intellectual edification. 73 00:07:50,280 --> 00:07:56,010 And so what comes to mind, and certainly not for the last time either in the book or in this presentation, 74 00:07:56,010 --> 00:08:01,080 is a passage from Albert Camus classic humanist novel The Plague. 75 00:08:01,080 --> 00:08:08,490 This book tells the story about an awful outbreak that gripped the coastal city of Iran in Algeria at the end of the novel. 76 00:08:08,490 --> 00:08:10,470 The narrator revealed to be the protagonist, 77 00:08:10,470 --> 00:08:18,780 Dr. Riyadh explains his compulsion to compile his chronicle so that he should not be one of those people to hold his peace, 78 00:08:18,780 --> 00:08:26,580 but should bear witness in favour of those plague stricken people so that some memorial of the outrage at injustice done them might endure. 79 00:08:26,580 --> 00:08:29,250 And so ultimately, it's my wish above all else, 80 00:08:29,250 --> 00:08:39,510 that this book will also serve as a memorial of the injustice and outreach done to those whose lives were devastated by Zimbabwe's cholera outbreak. 81 00:08:39,510 --> 00:08:46,830 OK. So today, as Josh mentioned, I'm going to give a whistle stop tour of the book. 82 00:08:46,830 --> 00:08:51,980 I'm going to focus on the subtitle of the book and three key dimensions. 83 00:08:51,980 --> 00:08:56,570 I'm going to talk briefly about cholera and how we might explain the epidemic. 84 00:08:56,570 --> 00:09:02,480 But rather than going through the detailed structural and historical analysis I give for why the epidemic occurs. 85 00:09:02,480 --> 00:09:10,040 I'm going to focus on one particular in-depth area of study, which is try to understand the collapse of Zimbabwe's water system. 86 00:09:10,040 --> 00:09:19,190 Then I'm going to look through the prism of crisis. I'm going to focus much more narrowly on the crisis around responding to the outbreak. 87 00:09:19,190 --> 00:09:25,880 Here, I'll highlight how cholera became a terrain of polarised political struggle and how bureaucrats, 88 00:09:25,880 --> 00:09:34,100 civil servants and humanitarians tried to negotiate such a complex field of both politics and public health. 89 00:09:34,100 --> 00:09:42,290 And then, within the rubric of freedom of citizenship, I'm going to reflect briefly on some of the key narratives that have come to embed 90 00:09:42,290 --> 00:09:47,520 themselves in social memory about what it was like to live with the cholera outbreak. 91 00:09:47,520 --> 00:09:52,530 From here, I'll conclude by tying some of these threads together and reflecting on some of this 92 00:09:52,530 --> 00:09:56,880 contribution and some of the contributions that this book makes to scholarship. 93 00:09:56,880 --> 00:10:06,300 Before sharing some final reflections. So in order to do this, we need to understand a little bit about cholera itself. 94 00:10:06,300 --> 00:10:10,230 Now, cholera is one of the most feared infectious diseases in public health. 95 00:10:10,230 --> 00:10:17,190 It is an acute bacterial infection of the intestine caused by certain strains of the organism Vibrio cholerae. 96 00:10:17,190 --> 00:10:20,790 Now, in theory, the disease should not be a major threat to human beings. 97 00:10:20,790 --> 00:10:28,530 Not only is the septic susceptibility highly variable between individuals, the bacteria can only be acquired in one way, 98 00:10:28,530 --> 00:10:33,630 and that's through the ingestion of food and water that has been contaminated by faecal matter from a person 99 00:10:33,630 --> 00:10:42,390 with active cholera or from standing bacteria present in plankton or seafood living in brackish water. 100 00:10:42,390 --> 00:10:47,400 Now, back in 1976, John Carpenter, writing in the Johns Hopkins Medical Journal, 101 00:10:47,400 --> 00:10:53,880 argued that cholera causes only a reversible and easily treatable biochemical effect, 102 00:10:53,880 --> 00:10:59,280 and he claimed that cholera replies are very gross level of contamination greater than 103 00:10:59,280 --> 00:11:04,470 any other known epidemic disease to produce illness in otherwise healthy individuals. 104 00:11:04,470 --> 00:11:09,630 So this accounted part of why cholera randi infects health care workers involved in its treatment. 105 00:11:09,630 --> 00:11:17,670 Now, many individuals will only acquire asymptomatic or mild cases of cholera when exposed to the bacteria. 106 00:11:17,670 --> 00:11:23,710 But the disease's progress for those who are susceptible is terrifying. 107 00:11:23,710 --> 00:11:25,420 The incubation period. 108 00:11:25,420 --> 00:11:34,780 Now this is the time between exposure to the pathogen and the manifestation of symptoms ranges from as short as 14 hours to as long as five days. 109 00:11:34,780 --> 00:11:43,330 Variation depends on a number of different factors, but primarily how long it takes the cholera bacteria to colonise the intestine. 110 00:11:43,330 --> 00:11:53,200 Now, once in the intestine, the bacteria secrete a powerful toxin that interferes with caloric absorption of water, salts and other electrolytes. 111 00:11:53,200 --> 00:11:58,240 As a result, the first stage of symptoms include sudden and explosive, watery diarrhoea. 112 00:11:58,240 --> 00:12:03,250 That's classically called rice, which is stool so that you can see depicted here now. 113 00:12:03,250 --> 00:12:12,550 The appearance of this particular stool is part of the vomit, all of which is to say that it is it only ever occurs in relation to cholera. 114 00:12:12,550 --> 00:12:18,790 This stool gushes out of the patient and empties the below about faecal matter extremely quickly. 115 00:12:18,790 --> 00:12:26,680 In a single day, an individual can pass up to 20 metres of stool, containing as much as 10 million Vibrio per millilitre. 116 00:12:26,680 --> 00:12:31,570 Now, the first frequent and painless diarrhoea is accompanied by hiccups, 117 00:12:31,570 --> 00:12:38,440 extensive retching and vomiting of the same whitish appearance which may come up, which may also contain the cholera bacteria. 118 00:12:38,440 --> 00:12:45,250 The tremendous loss of water and electrolytes can amounts to eight percent of normal body weight. 119 00:12:45,250 --> 00:12:52,300 The consequence? Dehydration then produces acute and agonising cramps in the muscles of the feet and the legs. 120 00:12:52,300 --> 00:12:56,040 Occasionally, the arms, the abdomen and the back. 121 00:12:56,040 --> 00:13:04,060 It gives patients a sense of frustration that can be extreme, lasting from two to 12 hours, depending on the severity of the symptoms. 122 00:13:04,060 --> 00:13:10,480 The second clinical stage of the disease, which is often reached within a day or two, is marked by continued purging and vomiting, 123 00:13:10,480 --> 00:13:17,500 followed by collapse, rapid dehydration and ruptured capillaries learnt in Asian experience to the patient. 124 00:13:17,500 --> 00:13:23,290 As you see here, the skin typically becomes blue and black. 125 00:13:23,290 --> 00:13:29,970 It becomes cold, wrinkled, clammy to touch. The voice becomes husky. 126 00:13:29,970 --> 00:13:35,090 The cheeks hollow, the eyes sunken and the expression listless. 127 00:13:35,090 --> 00:13:42,530 Signs of hype move Olympic shot, which is a severe state of circulating blood volume, appear with a plummeting blood pressure. 128 00:13:42,530 --> 00:13:51,290 A pulse is often not palpable at the wrist and urine output is suppressed, the legs and stomach convulsed, violently causing terrible pain. 129 00:13:51,290 --> 00:14:00,170 The loss of body fluid is often so great that blood can run as thickly as talk and to appear to puncture the vein of a cholera patient. 130 00:14:00,170 --> 00:14:08,690 You often get no results, and all the while the patients usually suffer the horror of cholera with full consciousness of his or her plight. 131 00:14:08,690 --> 00:14:15,950 Now, without adequate fluid replacement, death can occur from circulatory shock due to inadequate blood perfusion of vital organs. 132 00:14:15,950 --> 00:14:21,200 And in the most dramatic of cases, a healthy person can be dead within hours. 133 00:14:21,200 --> 00:14:26,060 Now, a third stage for those who survive this critical phase ultimately bring sensation 134 00:14:26,060 --> 00:14:30,770 of vomiting and diarrhoea is the second stage can be limited to only a few hours. 135 00:14:30,770 --> 00:14:37,130 Then it might be possible to restore circulating volume and blood pressure, and the flow of urine will resume. 136 00:14:37,130 --> 00:14:47,480 So it may seem that recovery is assured at this point, however, that can still occur within four or five days should impaired kidney function develop. 137 00:14:47,480 --> 00:14:58,090 So. The treatment of cholera is actually radically simple throughout the annals of modern medicine. 138 00:14:58,090 --> 00:15:05,720 One of the greatest innovations has been a simple concoction of salts, sugars and fluid to treat cholera. 139 00:15:05,720 --> 00:15:11,170 This is often known as oral rehydration therapy when administered quickly and efficiently. 140 00:15:11,170 --> 00:15:19,480 Oral rehydration therapy can reduce the mortality rate of cholera from 50 percent down to one percent. 141 00:15:19,480 --> 00:15:26,650 Moreover, oral rehydration therapy is cheaply and available cheaply, available almost worldwide, 142 00:15:26,650 --> 00:15:33,640 and so the historian of cholera, Margaret Ellenberg, argues that no one should die of cholera today. 143 00:15:33,640 --> 00:15:41,860 So considering all of this, that the emergence of cholera, she always trouble us now throughout the intellectual history of epidemiology. 144 00:15:41,860 --> 00:15:47,860 Charles Rosenberg has identified two fundamental styles of explaining the occurrence of epidemics, 145 00:15:47,860 --> 00:15:52,870 and he calls these respectively contamination and configuration for Rosenburg, 146 00:15:52,870 --> 00:16:00,070 contamination is a reductive mode of analysis that typically reduces itself to the idea of person-to-person 147 00:16:00,070 --> 00:16:06,250 contagion through the transmission of some morbid material from one individual to another. 148 00:16:06,250 --> 00:16:12,940 The configuration theme, however, assumes a much more holistic system of infection, 149 00:16:12,940 --> 00:16:19,900 one that emphasises interconnection the social environment that gives rise to the spread of morbid material. 150 00:16:19,900 --> 00:16:22,270 And so throughout this book, as you'll see shortly. 151 00:16:22,270 --> 00:16:28,330 I argue that cholera outbreaks are best understood through this configuration or style of explanation. 152 00:16:28,330 --> 00:16:35,590 Since the disease is primarily spread through food and water, and since it's typically difficult to spread, it easily prevented. 153 00:16:35,590 --> 00:16:43,450 It only tends to appear in contexts where epidemic form, that is where people are living in overcrowded and dilapidated housing, 154 00:16:43,450 --> 00:16:50,560 or temporary settlements, where sanitary conditions are poor and where malnutrition is widespread and severe. 155 00:16:50,560 --> 00:17:00,040 In this sense, cholera outbreaks are very rare in the absence of major structural change, such as war or environmental catastrophe. 156 00:17:00,040 --> 00:17:08,560 So the image you have here was taken in 1994, and this prior to the 2008 cholera outbreak, 157 00:17:08,560 --> 00:17:17,650 was the deadliest and most extensive cholera outbreak that occurred in refugee camps in Goma in eastern DRC following the Rwandan genocide. 158 00:17:17,650 --> 00:17:25,060 This resulted in about 70000 cases of cholera, but many more deaths estimated at about 12000. 159 00:17:25,060 --> 00:17:34,120 And so if we take this seriously, we realise, of course, that cholera outbreaks that are often into or impregnated within social, 160 00:17:34,120 --> 00:17:43,850 economic and political disasters both as cause and as consequence. So how do we begin then to explain cholera in Zimbabwe? 161 00:17:43,850 --> 00:17:53,240 I mean, give here a very truncated political history of Zimbabwe just to set up some of the context for the study. 162 00:17:53,240 --> 00:18:01,730 So during Zimbabwe's transition to independence and black majority rule in 1980, the incoming government inherited a highly technocratic, 163 00:18:01,730 --> 00:18:06,950 centralised and powerful bureaucratic state apparatus from its Rhodesian predecessor. 164 00:18:06,950 --> 00:18:14,330 The new ruling party, the Zimbabwe African National Union Patriotic Front was RPF was quick to put this 165 00:18:14,330 --> 00:18:20,270 powerful machine to use in the service of modernising development throughout the 1980s. 166 00:18:20,270 --> 00:18:25,460 The majority of Zimbabweans gained unprecedented access to education and health care, 167 00:18:25,460 --> 00:18:31,430 while a large land resettlement programme for the for the benefit of rural people was underway. 168 00:18:31,430 --> 00:18:37,940 Of note, the government made remarkable progress in the provision of water and sanitation to rural households. 169 00:18:37,940 --> 00:18:42,410 Winning praise from the World Health Organisation and from UNICEF for the government's 170 00:18:42,410 --> 00:18:50,810 ability to provide safe drinking water to 84 percent of the national population by the 1990s, 171 00:18:50,810 --> 00:18:59,900 Zimbabwe could probably claim a substantial middle class and an educated population, a diversified economy and a sophisticated infrastructure. 172 00:18:59,900 --> 00:19:10,290 Crucially, as Joyce and others have argued, the Zanu-PF government derived legitimacy as a result of its capacity to deliver development. 173 00:19:10,290 --> 00:19:17,070 But in 2008, the situation could scarcely look any more different after a decade long economic slide. 174 00:19:17,070 --> 00:19:23,790 Annual inflation rates estimated somewhere in the region of 231 million percent, 175 00:19:23,790 --> 00:19:33,720 according to official statistics and estimates by independent economists, at a rate of eighty nine point seventy six trillion percent. 176 00:19:33,720 --> 00:19:39,090 If you can make sense of those numbers that have reached world record setting levels, 177 00:19:39,090 --> 00:19:43,590 public services, including health and education, had largely disintegrated. 178 00:19:43,590 --> 00:19:48,900 Major shortages of basic commodities had piled on top of political turmoil and violence, 179 00:19:48,900 --> 00:19:54,330 and cholera was competing for lives with one of the highest HIV rates in the world. 180 00:19:54,330 --> 00:20:01,770 Now, the 1990s are often cited as the epochal in making this transition from modernising development to crisis in Zimbabwe. 181 00:20:01,770 --> 00:20:09,060 This period saw a shift in the social and political forces in the country, during which the popular legitimacy of the ruling party declined, 182 00:20:09,060 --> 00:20:16,320 while concurrently a range of social movements cohered into the most successful opposition party in post-colonial Zimbabwe. 183 00:20:16,320 --> 00:20:22,350 That is the Movement for Democratic Change or the MDC. The MDC, formed in 1999, 184 00:20:22,350 --> 00:20:31,860 presented Zanu-PF with its first real possibility of electoral defeat in the general and presidential elections of 2000 and 2002, respectively. 185 00:20:31,860 --> 00:20:39,900 From 2000 onwards and upheaval why he referred to as the crisis consisting of a combination of economic decline, 186 00:20:39,900 --> 00:20:49,290 authoritarian nationalism and violence came to define Zimbabwe's changing political landscape. 187 00:20:49,290 --> 00:20:55,380 Now, there are any number of explanations for the origins, character and quotes of Zimbabwe's crisis. 188 00:20:55,380 --> 00:20:58,680 These are far too intricate to summarise here. Instead, 189 00:20:58,680 --> 00:21:05,430 what I'd like to do is emphasise a strand of literature amongst Zimbabweans that's paid close attention to the 190 00:21:05,430 --> 00:21:13,140 changing character of Zimbabwe older than sorry and its relationship to its own bureaucratic institutions. 191 00:21:13,140 --> 00:21:19,440 Justin and Alexander's other scholars have emphasised one of Xenopus response to the crisis 192 00:21:19,440 --> 00:21:24,990 as its assault on what had previously made Zimbabwean state bureaucracies authoritative, 193 00:21:24,990 --> 00:21:34,020 authoritative, which was that they are expert and rule bound character. This assault by the ruling party manifested itself as the manipulation of law, 194 00:21:34,020 --> 00:21:39,390 the deployment of political violence and making partisan use of state institutions and resources, 195 00:21:39,390 --> 00:21:43,830 and it was crucial to Zanu-PF strategy of retaining political power. 196 00:21:43,830 --> 00:21:50,130 A logic a new logic of political power weakened and politicised the state such that professionalism, 197 00:21:50,130 --> 00:21:54,960 education and skills were no longer the predominant criteria for holding posts 198 00:21:54,960 --> 00:21:59,670 within government and instead loyalty to that APF and to military and political, 199 00:21:59,670 --> 00:22:10,080 military and political connexions became more important. And as these changes undermined one of the most compelling claims to legitimacy, 200 00:22:10,080 --> 00:22:14,160 which was the delivery of public services by professional civil servant, 201 00:22:14,160 --> 00:22:20,090 several authors have gone on to analyse these changes across a range of social institutions. 202 00:22:20,090 --> 00:22:25,380 These days include the work and the law courts, as my colleagues Jonathan Hoyle has shown. 203 00:22:25,380 --> 00:22:30,450 The military is mouth into hiding somewhere in the back of the documented extensively. 204 00:22:30,450 --> 00:22:38,530 The prisons, as just as written about the education sector as done documents and local government colleagues like Joanne MacGregor and Suspend 205 00:22:38,530 --> 00:22:45,510 Sussex have documented and yet reading across the different literatures in the early parts of the formation of this book, 206 00:22:45,510 --> 00:22:49,650 I was struck by the lack of attention given to the health sector, 207 00:22:49,650 --> 00:22:55,560 particularly given the powerful role that public health played in Zimbabwe social and political crisis. 208 00:22:55,560 --> 00:23:04,290 So if you were to consider the fact that, according to UNICEF, Zimbabwe's health sector was until the 2000s what is the best in sub-Saharan Africa? 209 00:23:04,290 --> 00:23:12,700 Health care delivery has historically played a critical role in buttressing the legitimacy of the ruling party and a public health emergency. 210 00:23:12,700 --> 00:23:18,540 What part of the disintegration of the health system was a central feature of Zimbabwe's crisis? 211 00:23:18,540 --> 00:23:24,240 And so it seems to me that studying the politics of public health has an awful lot to tell us 212 00:23:24,240 --> 00:23:29,160 about the nature of political change in Zimbabwe and elsewhere in the world more generally. 213 00:23:29,160 --> 00:23:34,440 At the same time, the literature that was coming from the health sciences in the early stages of the 214 00:23:34,440 --> 00:23:38,970 cholera outbreak did little more than interrogate the politics of this period than, 215 00:23:38,970 --> 00:23:45,690 say, bad governance. A lack of political will and poor economic policies were responsible for the crisis. 216 00:23:45,690 --> 00:23:49,260 And so this book attempts to fill this gap in the literature, 217 00:23:49,260 --> 00:23:58,470 accounting for how political change and institutional assault the unravelling of bureaucracy affect the public health. 218 00:23:58,470 --> 00:24:08,370 Now, the first major argument I make in the book about why the outbreak occurred is I suggest that the origins, 219 00:24:08,370 --> 00:24:17,200 scale and impact of the cholera outbreak were over, determined by a multilevel failure of Zimbabwe's public health infrastructure. 220 00:24:17,200 --> 00:24:22,600 I highlight three key factors the women mentioned to brief him and discuss one thing a little bit more depth. 221 00:24:22,600 --> 00:24:30,280 So the most immediate causal factor for the severity of the epidemic appeared to be to be the dysfunction of the health care delivery system. 222 00:24:30,280 --> 00:24:36,100 So you have an image of Zimbabwe's main infectious disease hospital called Beatrice Rhodes. 223 00:24:36,100 --> 00:24:42,730 And as you can see, this is not this is the waiting area where patients wait to be seen with their families. 224 00:24:42,730 --> 00:24:51,080 This is not. It was. And here you have intravenous fluids being administered to patients and being 225 00:24:51,080 --> 00:24:57,400 comfortable and effectively clothing lines because of limited capacity on the wards. 226 00:24:57,400 --> 00:25:02,860 Moreover, Conroy was able to disseminate throughout the country without an effective system to detect it, 227 00:25:02,860 --> 00:25:07,510 to disrupt its spread or to prevent timely treatment to its victims. 228 00:25:07,510 --> 00:25:11,170 In the book, I go into more detail about how the health care system collapsed. 229 00:25:11,170 --> 00:25:16,090 But what I want to point out here is something that Dr Portia Menangle zero, 230 00:25:16,090 --> 00:25:22,000 who was the who's the current director of disease control of epidemiology in the Ministry of Health in Zimbabwe, 231 00:25:22,000 --> 00:25:29,830 said to me, she said very pointedly as we discussed the outbreak that when you look at cholera, it's not a health issue. 232 00:25:29,830 --> 00:25:35,440 It only happens when people eat [INAUDIBLE]. Now put differently. 233 00:25:35,440 --> 00:25:41,050 What she was saying was despite the moribund state of Zimbabwe's health care delivery system in 2008, 234 00:25:41,050 --> 00:25:47,680 the primary determinants of the outbreak was situated in the wider set of forces and systems shaping the material 235 00:25:47,680 --> 00:25:53,650 conditions of everyday life and the collapse of the infrastructure needed to deliver essential services. 236 00:25:53,650 --> 00:26:01,510 So we see this here in the second major factor that I identify that I'm calling here the political economy of everyday life. 237 00:26:01,510 --> 00:26:11,380 So as many of you will know, given our 96 percent inflation rate, Zimbabwe had become a country, a nation of starving billionaires. 238 00:26:11,380 --> 00:26:15,640 So as the joke goes, Zimbabwean men are having a drink in a bar. 239 00:26:15,640 --> 00:26:21,280 One says, My wife made me a billionaire. I used to be a millionaire. 240 00:26:21,280 --> 00:26:26,380 And now it's really hard to overemphasise how bad these changes were. 241 00:26:26,380 --> 00:26:32,610 Just to give one other example, on the first of August 2008, an egg in individual egg in Harare. 242 00:26:32,610 --> 00:26:42,430 It cost five Zimbabwe dollars five February 2009, when the ding dong at this stage was replaced by the use of foreign currency. 243 00:26:42,430 --> 00:26:48,850 The same egg would cost two trillions in dollars, which for those of you were not passed on your maths. 244 00:26:48,850 --> 00:26:55,060 That's a $40 per percent increase in the space of six months. And as a result, 245 00:26:55,060 --> 00:27:04,000 the context of hyperinflation and economic collapse had a series of cascading consequences across all aspects of trade and employment, 246 00:27:04,000 --> 00:27:11,710 and often coincided with homelessness, squalor, food, fuel and currency shortages. 247 00:27:11,710 --> 00:27:18,640 Crucially, widespread food insecurity in the country resulted in the catastrophic malnutrition crisis, 248 00:27:18,640 --> 00:27:23,590 which rendered vast swathes of the Zimbabwean population vulnerable to a cholera infection. 249 00:27:23,590 --> 00:27:30,580 As you recall, early on one what I mentioned was that cholera outbreaks tend to occur where malnutrition 250 00:27:30,580 --> 00:27:38,830 is widespread and severe owing to malnutrition incapacitation of the immune system. 251 00:27:38,830 --> 00:27:45,610 So here I want to give just a little bit more attention to the role that urban water supply played in the making of this outbreak. 252 00:27:45,610 --> 00:27:47,350 Now, throughout the 2000s, 253 00:27:47,350 --> 00:27:59,310 control of urban water became a crucial state of struggle between Zanu aligned state institutions and municipalities run by opposition MDC. 254 00:27:59,310 --> 00:28:06,810 There are a host of different reasons for this. One of the factors was that APF tried to nationalise the water through the creation 255 00:28:06,810 --> 00:28:10,770 of a national water water body called the Zimbabwe National Water Authority, 256 00:28:10,770 --> 00:28:16,380 or Xinhua, which is popularly referred to as Zimbabwe. No water available. 257 00:28:16,380 --> 00:28:19,530 Now didn't want play multiple different political functions. 258 00:28:19,530 --> 00:28:29,910 It was a way of rent seeking by siphoning off water rates and redirecting them to the military and the military in Pakistan and within the country. 259 00:28:29,910 --> 00:28:36,030 Xinhua often would sack entire municipalities that had previously be responsible 260 00:28:36,030 --> 00:28:40,260 for water delivery in different parts of urban Zimbabwe and as a consequence, 261 00:28:40,260 --> 00:28:47,430 not only with technical expertise lost, but years of capital investment was discarded as well. 262 00:28:47,430 --> 00:28:51,840 Moreover, there were underlying structural factors at play here. 263 00:28:51,840 --> 00:28:58,830 So in the much longer term, much longer duration view of water supply in the city, 264 00:28:58,830 --> 00:29:05,940 we see that the water supply was initially laid down when Harare was founded as the colonial city of Salisbury. 265 00:29:05,940 --> 00:29:13,620 Now, when these pipes were laid down, they were often cited in the same water catchment zone as the sewage system. 266 00:29:13,620 --> 00:29:17,760 They have not been maintained a great deal since they were established in 1953, 267 00:29:17,760 --> 00:29:22,620 and there's been a misalignment between water provision and population needs. 268 00:29:22,620 --> 00:29:31,860 In addition to this, the economic crisis and the nationalisation of Xinhua, we have a kind of multi-modal collapse of the water system. 269 00:29:31,860 --> 00:29:33,510 Now I want to say this took me a very, 270 00:29:33,510 --> 00:29:41,070 very long time to make sense of because everyone I would speak to would keep saying that infrastructure is damaged or they would tell me that, 271 00:29:41,070 --> 00:29:43,350 you know, sewage pipes burst and so forth. 272 00:29:43,350 --> 00:29:49,110 But I this an inadequate explanation to say, Well, how do we go from both sewage pipes to the appearance of cholera? 273 00:29:49,110 --> 00:29:54,180 Or if you're telling me that there's no water flowing through the system? What are people drinking? 274 00:29:54,180 --> 00:30:00,300 And is that where the cholera resides and how does? So what are the actual dynamics of the political economy of collapse? 275 00:30:00,300 --> 00:30:09,900 Two. Cholera getting under the skin So I use inspired by my medical training, I invoke, of course, triad. 276 00:30:09,900 --> 00:30:15,450 Now, the medicks in the world will know that when you're trying to understand fluid dynamics in a system, 277 00:30:15,450 --> 00:30:21,930 they're kind of three key factors to look at. One is phenomena associated with hydrodynamic changes. 278 00:30:21,930 --> 00:30:25,650 So this is about the speed of flow of water within the system. 279 00:30:25,650 --> 00:30:32,310 So here, for instance, I show that because of the economic, the economic collapse that was happening in the country, 280 00:30:32,310 --> 00:30:40,830 the poor maintenance of the engineering works in the city. There was an intermittent and turbulent flow through piping infrastructure. 281 00:30:40,830 --> 00:30:43,920 This matters because in a normal piping system, 282 00:30:43,920 --> 00:30:50,800 you have the accretion of bacteria and organic materials forming a biofilm, which is the natural lining of the pipe. 283 00:30:50,800 --> 00:30:59,580 Now, if you don't maintain continuous pressure within the system, the biofilm loses its stability and starts to drop off through the luminal floor. 284 00:30:59,580 --> 00:31:07,530 So if those bacteria now contain diarrhoeal causing organisms, they effectively get delivered into people's household. 285 00:31:07,530 --> 00:31:12,690 When there is a burst of water flowing. So that's one dynamic, another dynamic. 286 00:31:12,690 --> 00:31:18,660 I look at phenomena associated with the integrity of the vessels themselves and their vicinity. 287 00:31:18,660 --> 00:31:23,490 And so here I tried to show how not only do you have this problem that intermittent water supply, 288 00:31:23,490 --> 00:31:32,280 but the leaking of vessels between the water delivery systems and the sewage systems meant there was tremendous scope for cross-contamination. 289 00:31:32,280 --> 00:31:38,790 Not to mention the fact that the bursting of sewage pipes onto the streets of Harare, particularly the townships. 290 00:31:38,790 --> 00:31:47,240 As you see here, the dormitory town of Chitungwiza would then go into pits and gradually seep its way back into the water pipes. 291 00:31:47,240 --> 00:31:56,120 The third dynamic I show is that there are phenomena associated with that with the actual properties of the water that's flowing into the system. 292 00:31:56,120 --> 00:32:06,770 So Harada in particular, has a very complex engineering system for the adequate treatment of water, and this includes, 293 00:32:06,770 --> 00:32:17,180 amongst other things, use of various kinds of acids, activated charcoal, a sodium silicate flatulent eight and so forth. 294 00:32:17,180 --> 00:32:22,010 Usually, when water has been treated in this manner, it's then pumped into reservoirs. 295 00:32:22,010 --> 00:32:30,170 Now, if not, his main reservoir is lake chimaera and stored here before being delivered into this network that distributes water to people's homes. 296 00:32:30,170 --> 00:32:34,310 So during the crisis, these processes failed at every step. 297 00:32:34,310 --> 00:32:42,110 So owing to hyperinflation, embezzlement and underinvestment, Xinhua couldn't purchase the required chemicals needed to treat the water as the 298 00:32:42,110 --> 00:32:46,400 mother's water treatment centres before they were then delivered to the reservoirs. 299 00:32:46,400 --> 00:32:57,710 On top of this, we have these pumping failure mechanisms that I had highlighted and then, as reported by the Iren network at one stage, 300 00:32:57,710 --> 00:33:06,710 then was so desperate to deliver some water to people's homes that it resorted to pump raw sewage into the into the water supply dam directly. 301 00:33:06,710 --> 00:33:11,270 So this is partly what I mean by the systemic collapse being over determined that 302 00:33:11,270 --> 00:33:15,200 there were these multi-point failures that even if you had one or a few of them, 303 00:33:15,200 --> 00:33:21,200 there was still something else that was going to cause the collapse of the water system. 304 00:33:21,200 --> 00:33:32,810 Now all of these factors then result is not only the outbreak because of these highly sort of propitious conditions for the spread of the disease, 305 00:33:32,810 --> 00:33:41,930 but a crisis in the response. As should be apparent, there is a very glaring omission of data in the scrap. 306 00:33:41,930 --> 00:33:47,630 So this I got from the Ministry of Health and the W.H.O. joint report on the 307 00:33:47,630 --> 00:33:51,560 cholera outbreak and if it goes to trace the epidemic curve of the outbreak. 308 00:33:51,560 --> 00:34:02,960 Yet this year, we think it represents August of 2008, and this year the first couple of blue bars represents December of 2008. 309 00:34:02,960 --> 00:34:11,990 In the middle here was this lack of data reflects the incapacity inability to actually trace what was happening 310 00:34:11,990 --> 00:34:17,960 in the country at the time to have reporting mechanisms of how cases were spreading throughout the country. 311 00:34:17,960 --> 00:34:25,160 So I spoke to one aid worker who tried to describe to me what was happening in this period, and it was a profound sense of confusion. 312 00:34:25,160 --> 00:34:29,660 I quote here the outbreak spread from China without really, really fast. 313 00:34:29,660 --> 00:34:35,480 It was then included then in Chinhoyi, then in Cordoba, and then just all across the rational lines in particular. 314 00:34:35,480 --> 00:34:41,480 The scale caught everybody off guard. All agencies were behind the curve, literally and figuratively. 315 00:34:41,480 --> 00:34:48,260 We were all behind the curve. We were always chasing it. We needed to be much quicker with chlorination of urban water supplies. 316 00:34:48,260 --> 00:34:54,050 We needed to get points of use disinfection out there. But they went to their partners in the fields to do that. 317 00:34:54,050 --> 00:34:58,280 W.H.O. systems are just totally unprepared and unable to cope. 318 00:34:58,280 --> 00:35:04,730 You had a volatile mix. You had an epidemic that was spreading fast in rural areas and in high density populated areas. 319 00:35:04,730 --> 00:35:10,190 You had public health services that were on the verge of breakdown because doctors and nurses were on strike. 320 00:35:10,190 --> 00:35:14,450 You had the lack of capacity and partners in resources to do simple interventions 321 00:35:14,450 --> 00:35:19,100 like oral rehydration therapy and other key lifesaving interventions. 322 00:35:19,100 --> 00:35:25,130 There were not enough partners. We knew how to do that. We had clinics that were completely overwhelmed. 323 00:35:25,130 --> 00:35:32,990 Now, in addition to the structural incapacitation and entering into the realm of imagination that just that just introduced, 324 00:35:32,990 --> 00:35:39,440 we have this question of a profound hesitancy on the part of the government to declare 325 00:35:39,440 --> 00:35:45,620 that there was a national cholera crisis or to identify cholera as an emergency. 326 00:35:45,620 --> 00:35:54,470 As a humanitarian aid worker divulged to me who was involved in some of the politics of putting pressure on the government to declare emergency. 327 00:35:54,470 --> 00:35:59,570 He said, You know, cholera is one of those words which causes things to happen when you say it. 328 00:35:59,570 --> 00:36:04,220 The two other words that have that effect are famine and genocide. 329 00:36:04,220 --> 00:36:07,430 Cholera is the little brother of those big words that changed things. 330 00:36:07,430 --> 00:36:13,520 When you say them, there are all kinds of reasons why the government might want, might not want to announce that there is cholera, 331 00:36:13,520 --> 00:36:17,960 and it's very common for countries around the world not to announce that they have cholera. 332 00:36:17,960 --> 00:36:22,640 And as he says, cholera makes you look like a badly run Dirty Tin Pot country. 333 00:36:22,640 --> 00:36:28,910 And that's why people are so afraid of it. It damages your reputation. It damages your economy and damages tourism. 334 00:36:28,910 --> 00:36:33,260 It's really bad news to have cholera in your country. 335 00:36:33,260 --> 00:36:38,900 So at the heart of many of these political dynamics that followed disasters in general is cholera. 336 00:36:38,900 --> 00:36:47,150 Outbreak in particular was a kind of frantic competition to gain the legitimacy and public standing, 337 00:36:47,150 --> 00:36:53,030 or else to shy away from being labelled as illegitimate or incompetent or incompetent. 338 00:36:53,030 --> 00:36:59,420 And the political stakes around declaring the outbreak were especially high as the ruling party was involved in a protracted 339 00:36:59,420 --> 00:37:06,980 negotiation for a political settlement with its opposition MDC following highly disputed elections that had happened earlier that year. 340 00:37:06,980 --> 00:37:12,710 In this way, we see cholera as the terrain of polarised political struggle with numerous headlines are. 341 00:37:12,710 --> 00:37:19,160 All of these are just taken from the Herald, in which the national newspaper Zimbabwe open a mouthpiece of the state. 342 00:37:19,160 --> 00:37:24,380 And even here, there wasn't coherence as to what was actually happening. 343 00:37:24,380 --> 00:37:28,580 So we have some versions claiming that Mugabe was responsible for the cholera, 344 00:37:28,580 --> 00:37:34,100 others saying that cholera was the lady that was the West's latest weapon on Zimbabwe. 345 00:37:34,100 --> 00:37:42,620 The Minister of Health at the time, you can see him here, and Dr. Parimutuel kept trying to reassure people that the government was managing cholera. 346 00:37:42,620 --> 00:37:48,200 Only for few admits in the following article that cholera was killing hundreds of people. 347 00:37:48,200 --> 00:37:48,590 And again, 348 00:37:48,590 --> 00:37:54,930 these are the headlines cholera could have been avoided and the government coming out saying that the pandemic is under control and so forth. 349 00:37:54,930 --> 00:38:03,750 So the rumours and reporting around cholera and the battle to shape public narratives around the disease raised a host of different questions. 350 00:38:03,750 --> 00:38:11,760 Where did cholera come from? Who and what was at risk? What could be done to stop it as this was happening? 351 00:38:11,760 --> 00:38:17,490 The international NGO Physicians for Human Rights sent to the team of investigators 352 00:38:17,490 --> 00:38:22,620 to document what was happening in Zimbabwe over just a week in early December. 353 00:38:22,620 --> 00:38:32,220 They conducted a series of interviews trying to document the cholera outbreak and its links to human rights violations producing this report. 354 00:38:32,220 --> 00:38:37,200 In it, they wrote that the health and health care crisis in Zimbabwe was a direct outcome of the 355 00:38:37,200 --> 00:38:42,570 malfeasance of the Mugabe regime and the systematic violation of a wide range of human rights. 356 00:38:42,570 --> 00:38:48,570 These, they argued, constituted at minimum violations of the rights to life, health, food and water. 357 00:38:48,570 --> 00:38:55,590 And when examined in the context of 28 years of massive and egregious human rights violations against the people of Zimbabwe, 358 00:38:55,590 --> 00:39:00,780 Robert Mugabe and Zanu Piaf were guilty of the Commission of Crimes against Humanity. 359 00:39:00,780 --> 00:39:07,320 Responsibility to protect No was invoked with an international commentariat calling for 360 00:39:07,320 --> 00:39:13,980 military intervention in Zimbabwe to stop cholera fighting bacteria with guns and [INAUDIBLE], 361 00:39:13,980 --> 00:39:21,570 as one commentator put it. And on the flip side, you had an entirely belligerent counter-narrative. 362 00:39:21,570 --> 00:39:27,420 The late, the now late and former Minister of Information Dr Stiglitz on Global, 363 00:39:27,420 --> 00:39:33,150 wrote or said at a press conference in Harare in December that cholera is a calculated 364 00:39:33,150 --> 00:39:39,180 racist terrorist attack on Zimbabwe by the unrepentant and former colonial power, 365 00:39:39,180 --> 00:39:44,760 which has enlisted support from its American and Western allies so that it can invade the country, 366 00:39:44,760 --> 00:39:50,730 install their stooge Morgan Tsvangirai, the leader of the opposition, who will allow them to repossess our resources. 367 00:39:50,730 --> 00:39:56,380 British operatives are in the country now under disguise and have increased cholera and anthrax seeding. 368 00:39:56,380 --> 00:39:58,680 There's been a replanting of cholera and anthrax. 369 00:39:58,680 --> 00:40:05,520 This is serious biological and genocidal warfare on our people by the British still fighting to recall the name symbolic. 370 00:40:05,520 --> 00:40:11,850 So you basically have all the words genocide, racism, sovereignty, invasion and so forth. 371 00:40:11,850 --> 00:40:18,720 And this is just a narrow slice of the different ways in which cholera became quite common in a range of humanitarian discourses. 372 00:40:18,720 --> 00:40:23,760 Discourses about human rights, about state media, about security. 373 00:40:23,760 --> 00:40:27,120 All the while revealing a certain fundamental level. 374 00:40:27,120 --> 00:40:36,720 A kind of instability to what the category of cholera actually was, what the epidemic represented as it was communicated in a myriad of crises. 375 00:40:36,720 --> 00:40:46,800 I go a step further in the book that many of the literatures I engage with and argue that this was not only a question of rhetoric or framing, 376 00:40:46,800 --> 00:40:52,470 but that cholera itself, the cholera epidemic itself had multiple ontologies. 377 00:40:52,470 --> 00:40:56,460 It meant not only does it mean different things to different people, 378 00:40:56,460 --> 00:41:03,270 but different sorts of institutions were responding to and acting on different versions of cholera that are all interrelated, 379 00:41:03,270 --> 00:41:12,420 but not exactly the same thing. Now, overcoming this divisive politics kind of cohere around a sort of bottom line 380 00:41:12,420 --> 00:41:16,800 agreement that there was nothing else more important than the saving of lives. 381 00:41:16,800 --> 00:41:19,440 I call this in the book The Salvation Agenda. 382 00:41:19,440 --> 00:41:27,060 It was one of the ways of understanding the cholera epidemic, not within the frame of its larger structural consequences, 383 00:41:27,060 --> 00:41:34,170 or even its myriad political meanings, but rather through the narrow prism of cholera as a public health emergency. 384 00:41:34,170 --> 00:41:40,610 Now, there are compelling reasons to think about the epidemic in this way. I'm just going to quote. 385 00:41:40,610 --> 00:41:50,950 One actual church leader, a very pompous and charismatic white American Republican, 386 00:41:50,950 --> 00:41:57,110 was making a fortune through a charismatic church in Harare, but that's a separate story. 387 00:41:57,110 --> 00:42:04,220 And he had been visiting some of the cholera treatment centres in the country, including the one that appeared to wrote Infectious Disease Hospital. 388 00:42:04,220 --> 00:42:10,880 And as he put it to me, I've visited Beatrice wrote infectious disease hospital and could not believe what I saw. 389 00:42:10,880 --> 00:42:15,860 There are about 300 people outside with drips that were hanging from trees or from the fence. 390 00:42:15,860 --> 00:42:20,330 I wanted to know why they were not in hospital. We went inside the hospital itself. 391 00:42:20,330 --> 00:42:28,300 The place was covered in vomit and diarrhoea. We have to wear gumboots to walk through the mess, which was several inches deep. 392 00:42:28,300 --> 00:42:35,950 The smell, blood, vomit, diarrhoea in Europe, there were bodies piled on top of bodies piled on top of bodies. 393 00:42:35,950 --> 00:42:42,310 There were enough beds, not enough buckets and not enough medicines in the paediatric ward. 394 00:42:42,310 --> 00:42:47,080 We saw four young children. One of them had his eyes rolled into the back of his head. 395 00:42:47,080 --> 00:42:55,780 I asked why they were not on drips and I was told they only had outlawed drips and these children would be dead in the morning. 396 00:42:55,780 --> 00:43:04,240 And so the salvation agenda, I argue, Drew together the a host of different humanitarian, governmental, 397 00:43:04,240 --> 00:43:12,430 legal medical organisations together and focussed minds on addressing cholera as a public health emergency 398 00:43:12,430 --> 00:43:18,220 all across the country after the formation of the government of national unity in February 2009. 399 00:43:18,220 --> 00:43:23,500 With cholera now recognised as a public health emergency, treatment centres were set up. 400 00:43:23,500 --> 00:43:31,390 Large groups of volunteers did tremendous outreach work, both treating cholera, promoting safe hygiene practises, 401 00:43:31,390 --> 00:43:38,410 distributing water treatment tablets, drilling boreholes and erecting water tanks where there wasn't a communal supply of water. 402 00:43:38,410 --> 00:43:45,190 Undoubtedly, tens of thousands of people were saved from the disease, and it's likely that many more, 403 00:43:45,190 --> 00:43:50,420 many hundreds and thousands of lives were spared from being infected at all. 404 00:43:50,420 --> 00:43:58,220 And nevertheless, the resources and energy poured into the salvation agenda could never be anything more than short term after the outbreak. 405 00:43:58,220 --> 00:44:02,540 No serious efforts were undertaken to change that health. 406 00:44:02,540 --> 00:44:10,970 The public health and hydraulic infrastructures that were underlying the outbreak, especially since such fundamental and long term development, 407 00:44:10,970 --> 00:44:16,940 were what seemed to fall out of the purview of responding to an epidemic as an as emergency. 408 00:44:16,940 --> 00:44:21,440 And so I tried to raise the question in the book of what happens when we pluralistic conception of 409 00:44:21,440 --> 00:44:27,920 what epidemics are and situate them within the depth of their historical and structural complexity. 410 00:44:27,920 --> 00:44:32,060 So finally, I just want to reflect on a few of the narratives that people told me the meanings 411 00:44:32,060 --> 00:44:38,990 and memories with which cholera has come to be built years after its occurrence. 412 00:44:38,990 --> 00:44:43,070 And I point out that for the majority of my performance, 413 00:44:43,070 --> 00:44:51,380 the outbreak aroused public anger and outrage for the government and its causal role in the epidemic and in the inadequacy of its relief efforts. 414 00:44:51,380 --> 00:44:57,930 Yet this anger has not translated into any effective political mobilisation for permanent change. 415 00:44:57,930 --> 00:45:06,350 And so what I show in the work is the sense of both indignation and impotence that cholera has left in its aftermath. 416 00:45:06,350 --> 00:45:12,110 Moreover, I argue that the multiple ontologies of cholera also appeared in the popular stories, 417 00:45:12,110 --> 00:45:18,290 talked about it as cholera came to be discussed or committed to social memory as a health crisis, 418 00:45:18,290 --> 00:45:26,510 a political economic crisis, a social crisis, as well as the crisis of expectations, history and social identity. 419 00:45:26,510 --> 00:45:35,690 So to illustrate this with just a couple of examples, it's cholera ravaged the Harare's high-density areas. 420 00:45:35,690 --> 00:45:42,440 Many Zimbabweans watched with concern and disbelief and eventually horror as scores of people succumb to infection. 421 00:45:42,440 --> 00:45:46,070 And the first three months of the outbreak, before it was declared a national emergency, 422 00:45:46,070 --> 00:45:55,920 the Ministry of Health promoted individual health behaviours extolling the virtues of personal hygiene as a way of dealing with the outbreak. 423 00:45:55,920 --> 00:46:01,610 And yet. As one informant put to me, look at it this way, 424 00:46:01,610 --> 00:46:07,130 if you have the power to give me water and you give me dirty water, I would say that you were killing me. 425 00:46:07,130 --> 00:46:13,580 In other words, it was all good for the government to talk about health promotion and personal hygiene. 426 00:46:13,580 --> 00:46:18,920 Yet all of that meant very little in the face of overwhelming structural conditions. 427 00:46:18,920 --> 00:46:33,500 Many of my interviewees were were quick to point the blame at Xinhua as one quite vocal and angry interlocutor of mine put it to me. 428 00:46:33,500 --> 00:46:40,700 If you look at most of the parastatal, there is no productive business going on that apparently there is a lot of looting in the parastatal. 429 00:46:40,700 --> 00:46:43,670 Look at the national railways and look at in itself. 430 00:46:43,670 --> 00:46:48,950 It is a very important arm of the government that is supposed to deliver in terms of water and sanitation. 431 00:46:48,950 --> 00:46:50,180 But there is nothing. 432 00:46:50,180 --> 00:46:56,900 There were supposed to be revamping the infrastructure, but if they're even getting that money from the Ministry of Finance, then they're misusing it. 433 00:46:56,900 --> 00:47:05,180 You look at the absurd salaries that are given to top executives. Somebody is earning 30000 US dollars per month or even more, and he lost. 434 00:47:05,180 --> 00:47:11,510 Yet there is no money for simple purification treatments. There is a lack of accountability, he says. 435 00:47:11,510 --> 00:47:19,490 When you look at the situation with Xinhua, there was an accountability when when municipality was taking responsibilities of such issues. 436 00:47:19,490 --> 00:47:24,620 But now that's gone. Xinhua is a corruption. It's a non-performing entity. 437 00:47:24,620 --> 00:47:32,320 It's a white elephant, as it were. Now, this interlocutor of mine called favour unleashed this diatribe, 438 00:47:32,320 --> 00:47:40,390 and I think it's less important for the veracity of his claims and more for what this reveals about the social welfare occupies. 439 00:47:40,390 --> 00:47:50,620 The forms of frustration that he discusses show that the actions of Zen were no straightforward dereliction of duty for him. 440 00:47:50,620 --> 00:47:57,340 Zimbabwe's once ruled by an expert, bureaucracies have self cannibalised through institutionalised greed that emanates from the 441 00:47:57,340 --> 00:48:02,140 highest ministerial level and trickles down to even the most local forms of government. 442 00:48:02,140 --> 00:48:06,880 This greed enriches those with access to power and leaves the poor to wallow in their own [INAUDIBLE]. 443 00:48:06,880 --> 00:48:18,640 Quite literally. And so the implacable ruthlessness of cholera left behind a spectacle of death as the bodies of its victims, the friends, lovers, 444 00:48:18,640 --> 00:48:24,820 family and neighbours of my informants laid bare the political and class fault lines that marked the difference between 445 00:48:24,820 --> 00:48:32,390 those who have full citizenship rights and those who felt they'd been excommunicated from the sphere of political concern. 446 00:48:32,390 --> 00:48:36,550 So here we see an all too common sight, which was the number of people who are being delivered, 447 00:48:36,550 --> 00:48:44,090 the number of cholera patients being delivered to hospitals in wheelbarrows because of the lack of ambulances. 448 00:48:44,090 --> 00:48:54,950 And yet the refrain that people had when I asked them about such occurrences was that the Zimbabwean government no longer cares about the people, 449 00:48:54,950 --> 00:48:59,670 right? Key emphasis on the notion of no longer carrying. 450 00:48:59,670 --> 00:49:04,740 These township residents vigorously questioned the nationalist narrative of liberation and sovereignty, 451 00:49:04,740 --> 00:49:14,580 which had been so central to the group's construction of patriotic history that lionised its role in Zimbabwe's liberation in the context of struggle. 452 00:49:14,580 --> 00:49:18,480 This narrative came to be questioned in quite a profound way. 453 00:49:18,480 --> 00:49:26,970 A teenage girl in Glen Norah complains that politicians in Zambia will talk about colonial times, but those times past long back, she says. 454 00:49:26,970 --> 00:49:30,600 Even if you worked for the white people, they gave you everything you needed. 455 00:49:30,600 --> 00:49:35,130 They understood some of the problems. Politicians don't understand our problems. 456 00:49:35,130 --> 00:49:40,440 Similarly, a focus group participant I spoke to in the last quarter expressed her frustration 457 00:49:40,440 --> 00:49:44,190 with Zimbabwe's post-colonial trajectory when she said I would rather be 458 00:49:44,190 --> 00:49:48,510 banned from working on forced streets under the segregationist laws of the 459 00:49:48,510 --> 00:49:54,360 Rhodesian regime and keep my dignity than live in a free Zimbabwe without water. 460 00:49:54,360 --> 00:49:58,260 Now I think that these and other references to the more effective public service 461 00:49:58,260 --> 00:50:02,910 delivery under colonial rule are hardly nostalgia for the Rhodesian era, 462 00:50:02,910 --> 00:50:12,120 but are instead a potent way of indicting the post-colonial government and a rejection of its King of kings to legitimacy as the bringer of unity, 463 00:50:12,120 --> 00:50:22,100 development and nationalism. And the census is captured in the satirical cartoon that appeared in The Guardian in 2008. 464 00:50:22,100 --> 00:50:31,820 It depicts a once you write police officer asking permission from then President Robert Mugabe for permission to arrest or cholera sufferers. 465 00:50:31,820 --> 00:50:34,610 And in a sense, 466 00:50:34,610 --> 00:50:44,390 the notion of arresting cholera sufferers was getting out the ways in which vast swathes of Zimbabwe's population had been left disposable. 467 00:50:44,390 --> 00:50:50,240 How being hidden from public view was designed to make a socially and politically embarrassing disaster less 468 00:50:50,240 --> 00:50:58,840 visible and a way of hiding the shortcomings of the multiple infrastructural failures that produced this moment. 469 00:50:58,840 --> 00:51:05,140 I do want to say, though, that it would be a mistake to conclude that when my informants make forceful critiques 470 00:51:05,140 --> 00:51:10,840 of the Zimbabwean government that they all uniformly agree about where the blame lies. 471 00:51:10,840 --> 00:51:19,420 For many people, I spoke to the state, the ruling party, the opposition, national government, local government are not monolithic homogenous entities. 472 00:51:19,420 --> 00:51:25,150 So while some discussions were dismissive of all and sundry, we're talking about Zimbabwe's myriad political failures. 473 00:51:25,150 --> 00:51:30,760 Many others drew astute distinctions between different political, individual and institutional bodies. 474 00:51:30,760 --> 00:51:36,240 Whereas Venmo was squad, people pitted the beleaguered Ministry of Health. 475 00:51:36,240 --> 00:51:45,960 One of my informants, a middle aged woman called City, who's made her life growing up in the high density areas, 476 00:51:45,960 --> 00:51:53,580 works as misuse and vendor and an all round street hustler, she describes herself. 477 00:51:53,580 --> 00:51:58,710 And I asked her over an informal conversation. I was sorry. 478 00:51:58,710 --> 00:52:06,210 I let slip in an informal, informal conversation with her. My disgust and how badly our government had mismanaged the cholera crisis. 479 00:52:06,210 --> 00:52:13,740 She looked at me and burst into laughter, unleashing a full and former. And she and she insisted that despite the ordeals she has endured, 480 00:52:13,740 --> 00:52:19,830 she will continue to support Mugabe until, as she puts it, death to us support for her. 481 00:52:19,830 --> 00:52:25,140 The freedom that came as Zimbabwe's independence was an act of possession. 482 00:52:25,140 --> 00:52:29,580 It was hard and patient and imbued with historical agency for her. 483 00:52:29,580 --> 00:52:31,920 Mugabe remained the vanguard of liberation, 484 00:52:31,920 --> 00:52:40,770 even as she looked at the born free generation and understood their sense of abandonment in contemporary Zimbabwe. 485 00:52:40,770 --> 00:52:47,310 Come and talk to friends, Chibok were less sympathetic to this other government. 486 00:52:47,310 --> 00:52:55,110 Speaking of their old lives and the truncated horizons of youth that they faced, they said We were born in poverty. 487 00:52:55,110 --> 00:52:58,200 We will live in poverty and we will die in poverty. 488 00:52:58,200 --> 00:53:08,170 And Favre said to me morosely at the end of our interview, I think if cholera comes back, it's going to wipe us all but. 489 00:53:08,170 --> 00:53:16,170 And so. And this presentation I've tried to highlight, I think. 490 00:53:16,170 --> 00:53:24,000 Four key themes that come out through the book. One is try to understand the long term makings of an epidemic, right? 491 00:53:24,000 --> 00:53:27,900 Epidemics have history that they do not appear from nowhere. 492 00:53:27,900 --> 00:53:37,530 The other is I try to show how the cholera outbreak actually reveals the interconnections through many different facets of Zimbabwe's crisis, 493 00:53:37,530 --> 00:53:48,880 with quite devastating effect. More theoretically, I'd like to suggest that the study of cholera invites us to think about epidemics in new ways. 494 00:53:48,880 --> 00:53:52,660 And here I argue that epidemics are many things at the same time. 495 00:53:52,660 --> 00:53:59,770 They are biological phenomena that is an infectious disease occurring through a given population, an excess of normal expectancy. 496 00:53:59,770 --> 00:54:04,480 They are a social phenomena as they spread through populations in socially patterned ways. 497 00:54:04,480 --> 00:54:06,430 They are historical phenomena. 498 00:54:06,430 --> 00:54:14,020 Often, the combination of multiscale political and economic processes that obtain over time, and they are political phenomena. 499 00:54:14,020 --> 00:54:19,780 The declaration of an epidemic is almost always followed by political contests over the attention, 500 00:54:19,780 --> 00:54:24,490 resources and priority that that epidemic should receive. 501 00:54:24,490 --> 00:54:30,850 So epidemics have never only just public health emergencies or security threats. 502 00:54:30,850 --> 00:54:37,040 Such a limited take on epidemics, I argue, should be challenged to the wider purview that this book suggests. 503 00:54:37,040 --> 00:54:42,890 And I've also said here that outbreaks like cholera always produce and reflect social difference, 504 00:54:42,890 --> 00:54:48,200 marking the contours of abandonment, rejection and exclusion. 505 00:54:48,200 --> 00:54:57,310 So if you'll indulge me, I'm just going to try to conclude she has some very final reflections from the book. 506 00:54:57,310 --> 00:55:05,420 And this is how I've chosen to close this. To close this study. 507 00:55:05,420 --> 00:55:12,650 Disastrous epidemics such as Zimbabwe's cholera outbreak in 2008 and 2009 deserve our attention for what they 508 00:55:12,650 --> 00:55:19,250 contribute to a general history of society as much as for what they contribute to the history of illness and medicine. 509 00:55:19,250 --> 00:55:26,330 By listening to, reflecting upon and compiling the stories documented in this book with affect and connexion, 510 00:55:26,330 --> 00:55:32,150 I hope that I provided a new perspective on a very dark time in Zimbabwe's recent history. 511 00:55:32,150 --> 00:55:39,950 Through this work, I've immersed myself in the stories of how people suffer from treat, manage and argue about a hideous disease. 512 00:55:39,950 --> 00:55:44,720 I've also shown how a disease touches virtually every aspect of social and political life, 513 00:55:44,720 --> 00:55:49,640 thereby making the dense and intricate linkages between history and political economy, 514 00:55:49,640 --> 00:55:53,930 infrastructures and public services, social relations and individual bodies. 515 00:55:53,930 --> 00:56:06,040 Much more apparent. As I talk with each of my interviewees, I also became intensely aware of my own personal detachment from the events of 2008 2009. 516 00:56:06,040 --> 00:56:13,900 In the introduction, I describe cholera as a visceral experience, one that induces tremendous physical pain. 517 00:56:13,900 --> 00:56:22,640 One whose ugly symptoms evoked shame and humiliation. And one that may explain how vulnerable and resilient bodies can be. 518 00:56:22,640 --> 00:56:27,290 Writing about such experiences in a reflective and considered way over a long period 519 00:56:27,290 --> 00:56:33,050 of time is a far cry from confronting the immediacy of cholera in the laboratory, 520 00:56:33,050 --> 00:56:38,330 in the clinic, in the home or in official buildings where policy decisions are made. 521 00:56:38,330 --> 00:56:42,230 Each of my informants spoke to me with depth and candour, 522 00:56:42,230 --> 00:56:49,940 with sharpness of memory and with expressions of disgust and remorse that cannot be conveyed adequately by words on a page. 523 00:56:49,940 --> 00:56:56,000 Indeed, I am not sure how well I grasped just what it was like to live through such an experience. 524 00:56:56,000 --> 00:57:05,270 Perhaps it was simply ineffable. Nevertheless, the analytical distance afforded to me by such a project comes with its own unique perspective. 525 00:57:05,270 --> 00:57:13,370 What I lack in the depth of anyone experience I came back through a more panoramic view of how cholera infiltrated different social, 526 00:57:13,370 --> 00:57:16,070 institutional and political settings. 527 00:57:16,070 --> 00:57:25,100 This Wide-Ranging view has impressed upon me that cholera outbreaks are most salient, not for the dramatic character of its particular events, 528 00:57:25,100 --> 00:57:32,060 but for its exposition of how terrifying and fatal Zimbabwe's post-2000 political economic crisis was, 529 00:57:32,060 --> 00:57:38,570 and of how deep into history the origins of seemingly short term emergency can extend to naivety, 530 00:57:38,570 --> 00:57:46,010 the former Minister of Finance in Zimbabwe said to me at the end of our conversation, I have absolutely no doubt that it's going to happen again. 531 00:57:46,010 --> 00:57:54,710 That's what kills me about Africa. We don't learn from yesteryear. Historians will tell you where that when history repeats itself, it is a farce. 532 00:57:54,710 --> 00:57:59,870 So it's my sincere hope that this book presents vital lessons from yesteryear such that we, 533 00:57:59,870 --> 00:58:05,900 as Zimbabweans, prevent the tragic loss of another cholera outbreak as a final thought. 534 00:58:05,900 --> 00:58:11,220 This book has been about suffering and about political failures, but it has also been about hope. 535 00:58:11,220 --> 00:58:19,320 When disaster occurs, when political life appears bleak, bleak when deadly illnesses strike with callous disregard. 536 00:58:19,320 --> 00:58:22,980 There is always hope to be found in the qualities of compassion, 537 00:58:22,980 --> 00:58:33,180 care and creativity shown by people who far too often are the unsung heroes of history and in whom the possibility of a more equitable future resides. 538 00:58:33,180 --> 00:58:37,050 So for these reasons, and to paraphrase, I'll be coming for the last time. 539 00:58:37,050 --> 00:58:42,870 What I have learnt in a time of pestilence is that there is much more to admire in humanity than to despise. 540 00:58:42,870 --> 00:58:45,717 Thank you very much.