Thank you very much. So it is a great pleasure to be here, but I kind of feel like I have to start by saying I feel like a complete interloper.
I am in no way ethicist or philosopher and so forth that I'm coming at this talk from essentially what is a politics perspective.
But I do hope that aspects of what I'll be talking about might get into the realm of applied ethics,
at least as insofar as I'm thinking about it from, as I said, a political and sociological perspective.
The other thing I wanted to say at the beginning was on Tuesday this week,
my colleague Jocelyn Alexander and I were invited to speak at a parliamentary hearing at the House of Commons,
where we were expert witnesses to talk about UK foreign policy and the role of deferred in Zimbabwe's present political and humanitarian crisis.
Now a 45 minute session getting grilled by a parliamentary committee and trying to explain
the formidably complex politics of Zimbabwe in a way that's short and sharp and snappy,
and that communicates to policymakers what they may or may not be able to do.
Needless to say, we failed catastrophically in this task.
But one of the key points that kept coming out was whether the British government should continue to impose sanctions on Zimbabwe.
Myself, Jocelyn and Stephen Chang, professor of international politics.
And so US were absolutely adamant that sanctions do more harm than good and that despite claims to condemning the Zimbabwean government,
sanctions were really being used as a political weapon to justify various forms of internal repression within the country.
After we spoke, the Minister of State for Africa, Harriett Baldwin, was gave her testimony.
When asked about the sanctions issue, she insisted that Britain was going to continue placing sanctions on Zimbabwe.
When pushed on this by the parliamentary committee who had said, well,
we have this countervailing evidence from academics who are saying this is a bad idea.
She was like, Yeah, no, no, we're still going to do that because it's kind of completely implausible for
us to be seen not to be punishing Zimbabwe for its human rights violations,
even if the measure and the instruments that we're using doesn't work.
The second thing that came up was whether or not Defence could work through ministries within Zimbabwe.
I argued quite adamantly that DFID should engage certain key ministries in the country and
that it is a mistake to either assume that a country's politics come down to one individual,
i.e. the president, or even when we use a term like government, that it's this kind of total, homogenous,
single minded entity that in fact belies a considerable degree of complexity about how these things work on the ground.
I talked about the ways in which civil servants and bureaucrats in the Ministry of
Health and the Ministries of Education actually do tremendous technocratic work
and would be willing to work with a number of donor agencies and have considerable
social legitimacy when trying to implement health and education programs.
When Harriet Baldwin was asked about this, she said, No, it's still going to channel the money through NGOs and through U.N. agencies,
and that we can't be seen to work with the government because it will be seen as bailing them out of a crisis that they've caused.
So I thought these two observations off in a way to set up this talk,
because what I'm going to be presenting this evening is taken from my forthcoming book,
which is called The Political Life of an Epidemic, Cholera Crisis and Citizenship in Zimbabwe.
And this book is about the 2008 and 2009 cholera outbreak.
But it's also more generally about the politics of the country, the politics of states,
and how international communities engage with African states in crisis.
So cholera is really functioning as a heuristic device to show all the multifarious ways in which crisis occurs.
And a number of the themes that emerged from the parliamentary hearing are actually based on this material.
And I think it was quite instructive. And in this, I, I perhaps say humbling, maybe, but I mean, if that's quite the right word.
But to see the disconnects that might exist between academic knowledge and the world of policy and politics,
so just bad those themes in mind as I as I present this work.
Okay. On the 11th of December 2008, the New York Times published an evocative article entitled Cholera Epidemic Sweeping Across Crumbling Zimbabwe.
The piece began by recounting how the disease had claimed the lives of the five youngest members of the good family with cruel and bewildering haste.
The children had been playing in the sewage flooded streets of a Harare township, gleefully unaware of the deadly bacteria lurking therein.
It was only a matter of hours before all five children began purging and vomiting.
Within less than a day, there were limp and hollow white as life seeped out of their desiccated bodies.
Then they started to die. Said their brother love God. Prisca was first, second Sammi, then Shantel, Cleophas and Aisha.
The littlest one lost The New York Times, along with numerous other media agencies, as well as regional and international organisations,
reported that this outbreak was indisputable evidence that Zimbabwe's most fundamental public services,
including water and sanitation, public schools and hospitals, had shut down, much like the organs of a severely dehydrated cholera victim.
The spread and lethality of the disease did not abate.
The country's public health systems floundered in response to a straightforward bacterial infection,
one that is easy to prevent, difficult to spread, and simple to treat.
Over the course of ten months,
Zimbabwe's cholera outbreak reached catastrophic proportions that are almost unrivalled in the modern history of the disease.
Now, the outbreak had begun in August of that year, initially erupting in the high density townships of Harare's metropolitan area.
The epidemic quickly spread into peri urban and rural areas in Zimbabwe before crossing the country's borders into South Africa,
Botswana, Zambia and Mozambique, with over 98,000 suspected cases.
Over 4000 confirmed deaths and an exceptionally high case fatality rate at the peak of the epidemic.
Zimbabwe's 2008 cholera outbreak has been deemed the largest and most extensive in recorded African history.
Now, epidemiologically, the outbreak can be can be explained by the breakdown and cross-contamination of the city's water and sanitation systems.
Yet such a reading belies the complex interaction of political,
economic and historical factors that initially gave rise to the dysfunction of
the water systems that delineate the socio spatial pattern of the outbreak,
and that account for the fragmented and inadequate response of the national health system.
So in this way, cholera was not only a public health crisis,
it also signalled a new dimension to the country's deepening political and economic crisis in 2008,
which brought into question the capacity and legitimacy of the Zimbabwean state.
While it was unhappy that government was receiving widespread international opprobrium for the multifaceted crisis in the country,
and while ad hominem attacks were launched at President Robert Mugabe,
the regime ultimately refused to acknowledge the overwhelming extent and devastation of the cholera outbreak.
For the first three months. Inevitably, however, such political quiescence in the face of accumulating cadavers was impossible to maintain.
On the 4th of December 2008, under considerable political and bureaucratic pressure.
The Minister of Health at the time, Dr. David Pringle, proclaimed that the cholera epidemic was a national disaster,
and he pleaded for international relief and medical humanitarian assistance.
What appeared to be a positive development in the cholera saga was abandoned only a week later on the 11th of December.
In a televised address to the nation from from Hero's Acre, President Mugabe shocked many involved in the cholera response when he stated,
I am happy that we are being assisted by others and we have arrested cholera.
The controversy did not stop there, however.
The following day, the 12th of December, the former and now deceased minister of information, Dr. Sikhanyiso Blow,
who seized upon the cholera outbreak to launch a daring and vitriolic attack on the West and accused
it of being the source of cholera in charge is harking back to the liberation struggle of the 1970s,
during which the Rhodesian army had used biological warfare by spreading anthrax pathogens in weaponized form against guerrillas and rural civilians.
Global accuses the West of deploying similar tactics in 2008.
He claimed that British secret agents had clandestinely entered the country to spread
cholera and anthrax as a biological weapon to bring about regime change in the country.
Now, amidst all the recriminations of the for the cholera outbreak and the deaths left in its wake,
a humanitarian response to the disease was slowly forged by an extraordinary assemblage of institutions and actors.
The patchwork of agencies involved in this response galvanised around wide
ranging moral and political discourses and imperatives to deliver public health.
So in writing about humanitarianism, it's far too tempting,
but also far too limiting to adopt either a posture of hagiography or of relentless critique in characterising
how relief workers of various descriptions tend to those struck by a disaster such as the cholera outbreak.
Perhaps I'd like to suggest a more interesting question is what political dynamics emerge from such circumstances?
Responses to the outbreak came in a variety of forms, from disparate actors motivated by different forms of responsibility and civic commitment and
predicated on multiple yet often competing understandings of the very nature of the cholera crisis.
However, as I argue in this paper, these heterogeneous positions converged on the ineluctable and morally unimpeachable logic of saving lives.
I call this logic the Salvation Agenda. I borrowed the term from writer Alex Duvall, who defined the Salvation Agenda as, and I quote,
a belief that a combination of money, technology and goodwill can solve any problem.
To this definition. I add that the very notion of salvation as the preservation of deliverance from ruined,
horrible loss became the tea lost the ultimate endpoint of the humanitarian response to cholera.
Now, crucially, the salvation agenda results,
not salvation agendas command over the underlying structural and political factors that led to the cholera outbreak was ever precarious and unsure.
So in this paper I'll illustrate the salvation agenda in the following ways.
First, I want to discuss how such an agenda came to be seen as imperative.
I'll do so by detailing eyewitness accounts of the bloody experience of cholera and
the pathetic medical care available in Zimbabwe's failing health system at that time.
Disturbing bodily experiences of faecal incontinence and unrestrained vomiting and horrific images of dead bodies
piled on top of each other in makeshift mortuaries were foundational to the moral imagination of relief workers,
development professionals and bureaucrats who insisted that something must be done to end the suffering.
Second, I argue that the life or death immediacy of such experiences attenuated a more political and structural response to the outbreak.
It focussed attention on addressing the clinical needs of patients with cholera and removing the most proximal causes of the outbreak.
In other words, the necessary short term delivery of intravenous fluids and clinics and the distribution of water purification tablets in
the community eclipsed the needs to attend to the long term and multi-scale political economic determinants of the crisis.
And I'll demonstrate the motive of action by looking at the formation and politics of the health cluster approach in Zimbabwe.
The medical outreach work of the Evangelical Church, celebration health and the disaster relief provided by international humanitarian organisations.
I argue that what we see in the Salvation Agenda is something akin to the not
identical to what anthropologist James Ferguson calls the anti-politics machine.
For Ferguson, development interventions and discourses entail, among other things, a representation of social and economic life which denies politics.
This development apparatus is an anti-politics machine.
Its de-politicize politicises, in Ferguson's words, everything it touches everywhere, whisking political realities out of sight,
all the while performing almost unnoticed its own pre-eminently political operation of expanding bureaucratic state power.
Now, the salvation agenda in this case did not deny the political per say,
but rather it knowingly and often explicitly bypassed the political in favour of the technical and the ethical.
And unlike Ferguson's anti-politics machine, the salvation agenda did not surreptitiously expand bureaucratic state power in Zimbabwe.
Instead, I argue, the Salvation Agenda undermined Zimbabwe's bureaucracies by yielding much command of the medical humanitarian response to cholera,
to non-state entities, with the justification that something had to be done to stop the emergency and
that Zimbabwe state bureaucracies were incapacitated and ill equipped to deliver.
As I hope will become clear through the paper,
the Salvation Agenda clashed with local pre-existing views and normative expectations of the Zimbabwean state as the primary vehicle for the delivery,
for the delivery of development.
And it also clashed with the hopes of more enduring solutions to the country's multifaceted crisis, of which cholera was only a part.
Ultimately, then,
the Salvation Agenda represented a bottom line agreement to offer the necessary and vital palliation in the face of a deadly disease.
And it's here.
I suggest that we see a striking similarity between the salvation agenda and the anti-politics machine insofar as the exigency of saving lives,
depoliticised cholera and its socio economic conditions through the operation of a technical,
ostensibly ethical and apolitical humanitarian apparatus.
And so the remainder of the presentation will unfold in full punch, as I as I demonstrate this argument.
I begin by talking about the kind of moral witnessing, the idea of being present and attentive to human suffering,
and how that shapes a kind of moral and political imagination.
I'll then look at the organisational politics around the formation of the sea, for which is the cholera command and control centre.
Before turning my attention to church actors who are quite literally seeking salvation for cholera victims,
and then I'll discuss the possibilities, pitfalls and paradoxes of the salvation agenda.
The existential stakes of Zimbabwe's political economic meltdown were thrown
into intense relief of the colour at the sites where cholera was being treated.
Now, this is a picture of a ward and the Beatrice Road Infectious Disease Hospital.
This is a major referral hospital that sits on the outskirts of Harare and almost marks a boundary between
the central business district and the high density townships that were epicentres of the cholera outbreak.
What you can see is a number of bodies wrapped in blankets.
These were people who are being treated for cholera. But adjacent to them are a number of bodies that are wrapped in black bin Laden.
And these are the bodies of people who had already died from cholera but couldn't
be moved outside of the hospital because there wasn't the capacity to do so.
Perhaps the tone to show and charismatic, if not conceited,
preacher in central Harare and the head of the evangelical church celebration held describes to me
the harrowing scenes at Beatrice Road when he went there as part of a missionary outreach project.
He described it as follows. I visited Beatrice Road Infectious Disease Hospital and could not believe what I saw.
There were about 300 people outside with drips that were hanging from trees or from the fence.
I became angry and indignant. I wanted to know why they were not in the hospital being treated on the wards.
We went into the hospital itself. The whole place was covered in vomit and diarrhoea.
We had to wear gumboots to walk through the mess, which was several inches deep.
The smell was the blood, vomit, diarrhoea and urine that were bodies piled on top of bodies piled on top of bodies.
There weren't enough beds, not enough buckets and not enough medicines in the paediatric ward.
We saw four young children. One of them had his eyes rolled into the back of his head.
I asked why the kids were not on drips, and I was told that they only had adult drips and that these kids would be dead in the morning.
We saw the mortuary, which was just a room with stacks of dead bodies in it.
They ran out of body bags and they wrapped children in disposable plastic bags from supermarkets.
And the bodies were sliding and falling off of each other. I had never seen anything like that.
This is no way to run a country. And I was pissed off.
Similar things were unfolding throughout the country as Brits also happened to travel around around Zimbabwe, setting up cholera treatment facilities.
The organisation documented the experiences of people living with the scourge of cholera.
For example, outside a clinic in the small town of Bindura lay 71 cholera patients.
These patients were prevented from entering the building, which had become a cesspool of diarrhoea and vomiting.
The open air tents where MSF delivered treatment were quickly overcrowded and filthy.
Accounts from health care workers in my interviews and in public documents are in doubt.
The act of caregiving within a special moral agency largely founded on the sense that imminent human
harm could be avoided and existing pain could be mitigated with a concerted humanitarian effort.
I gathered similar testimonies from journalists, from doctors, from nurses, students, from civil servants,
and from politicians who had all stepped into the treatment centres at that time through stories of agony and of healing,
accounts of terrible needs and altruistic volunteerism and reflections on the pain wrought by an ugly and avoidable disease.
The treatment centres concentrated collective attention on the critical need to set aside partisan differences that had so badly torn apart
the country's ruling party and its opposition to embrace the common sense of purpose and act on bodies affected by or at risk of cholera.
In other words, these testimonies speak of the sheer necessity and urgent possibility of salvation.
Now the declaration of the cholera outbreak as a national disaster marked a watershed in the trajectory of the epidemic.
So this week, these data were provided to me by the Ministry of Health and derived from a joint report
that the Ministry of Health and the W.H.O. had produced in the aftermath of the outbreak.
Week 36 on the on the horizontal axis represents August of 2008.
And as you can see, there is a conspicuous lack of data for what is effectively the first three months of the outbreak.
In part, this is because the Zimbabwean government, the ruling party,
had lost an election earlier in 2008 and a runoff was called to determine more definitively who the president would be.
That interregnum was marked by the worst political violence that the country had
witnessed since the massacres of the 1980s that were tantamount to a genocide.
The violence was so bad that Opposition Leader Morgan Tsvangirai pulled out of the runoff election in July of that year.
And so from August, there was a serious crisis of political legitimacy.
Nobody knew who was governing the country. And the the ruling party, with its opposition,
entered into protracted negotiations to form a government of national unity to bolster its bargaining position.
The ruling party at that time zone, APF, insisted that no data could be published indicating how badly you are managing the crisis.
As one of my informants put it, cholera was just one crisis, too many.
And so public health agencies could actually publish data on what was going on at that time until it became a national disaster.
Health the gap that we see happening here, because in a manner of speaking,
or at least official documents, cholera didn't really exist until December of that year.
Now, according to a joint report by the Ministry of Health and the World Health Organisation,
the declaration led to the establishment of a multi-sectoral task force under the leadership of the Zimbabwean government.
The report states that the Ministry of Health took time to ship and coordination across all sectors,
including a wide range of government ministries, international partners, private donors, NGOs and so forth.
Meanwhile, the United Nations activated its humanitarian cluster system, a new entity, the C4, i.e. the Cholera Command and Control Centre,
was established and this was co-chaired between the Ministry of Health and the W.H.O.,
and it was led by Dr. Stephen Malpass, who was specifically tasked with coordinating these different agencies.
In reality, of course, sitting behind the proclamations of these documents of an organised multisectoral response,
the response was actually intense competition over leadership in the management of the response to the cholera and contested ideas
of authority and legitimacy in coordinating the different government and humanitarian bodies that had been assembled at the outset.
For instance, there was intense disagreement over where physically to locate the sea.
For now, the obvious site, which is the Ministry of Health offices in a government building called Kagwe House in downtown Harare,
was kind of ruled out in part because the Ministry of Health's own building didn't have any
clean water facilities to keep water flowing through it or any adequate sanitation facilities.
Now in Zimbabwe, a building in that state should be shut down and condemned by order of the Public Health Act.
And the Minister of Health could not bring himself to shut down his own building in the name of public health.
This only serves to undermine this credibility and the standing of the Zimbabwean government,
who are still insisting on taking ownership and leadership over the management of the cholera crisis as a compromise.
The seafood was eventually situated in a W.H.O. annexe at Patagonia to a hospital.
Now, an NGO worker from ActionAid was part of the National Task Force Against Cholera, representing civil society organisations.
And he describes to me meeting at the sea for the following way.
Government could only provide the buildings and the space, but they couldn't even serve us tea, let alone logistical support.
And then, of course, in operations it was UNICEF that coordinated everything in Times Square.
A prominent health activist and executive director of the Community Working Group on Health,
as well as Bambara, another Zimbabwean but works for the International Organisation of Migration.
While also interviewed were regular participants in these multi-stakeholder meetings for humanitarian relief.
Both told me that the Ministry of Health was so severely under-resourced in terms of materials and workforce that it
couldn't exercise any meaningful leadership over the multitude of international agencies operating in the country.
GOLDMAN Word from the Ministry of Health at the time, the director of Environmental Health insisted that the problem wasn't with the government,
but it was with the donors who come in and think that they can run the show and that they can run the government of Zimbabwe,
setting their own organisation, their own structures and their own reporting systems.
It's crucial to state that all the while that this is going on, people are quite literally arguing over who can serve,
which toilets they can use and who is in charge of taking minutes in these in these meetings,
all the while that this cholera outbreak is unfolding now, push them along to zero.
The director of Disease Control in Epidemiology provided a more evenhanded assessment, noting that a number of stakeholders were doing excellent work.
But by and large, all sides were found wanting, in her words.
From her perspective,
the ministry could only provide loose coordination because of its incapacitation in terms of material resources and its limited available workforce.
But at the same time, the partners some partners came and did a good job.
While many added to the chaos, the most important rift, according to many of my informants, occurred between the government and MSF.
The strength working relationship between the government and MSF kind of illustrates two very competing conceptions of the state.
The image of a developmental and bureaucratic state, albeit one in acute crisis,
was aspired to and held by Zimbabwean civil servants, local NGOs and many ordinary people.
And this jarred with MSF model of humanitarian rescue.
For the former,
the cholera crisis signified a profound rupture in the historical trajectory of state led delivery of public health and authority in Zimbabwe,
and that should be exercised over non-state actors. And it was this rupture that needed to be repaired.
By contrast, as Peter Redfield argues,
MSF operates oriented toward emergency in a highly targeted way and justifies its actions through more legitimacy.
And so the tension between Zimbabwe's bureaucratic state model and MSF humanitarian rescue sharply reveals how different actors,
based on their different histories, ideologies and institutional ambitions, responded to the outbreak and clashed while doing so.
I made numerous and repeated attempts to secure an interview with someone from MSF and failed.
After multiple inquiries with the organisation,
I eventually received an email saying Unfortunately we have to abstain from participating in the study.
The issue is still felt as politically charged and participation might therefore affect our current
good standing with medical authorities and the prolongation of our current medical activities.
I later learned after considerable degree of investigation, that once the cholera outbreak was done,
MSF had so badly offended members of the government that they were threatened
with immediate expulsion were they not to cooperate in any future efforts?
So institutional responses to the outbreak were permeated by these multifaceted disputes and intersecting critiques.
So how would such differences and oppositions overcome to mount what ultimately was a successful operation in terms of stopping the outbreak?
The Ministry of Health and W.H.O. report formally states that in spite of the challenges,
the coordination and the many different perspectives on what needed to be done,
all stakeholders were united in a commonality of purpose and determination to
stop the avoidable loss of life from cholera that was afflicting the nation.
And so here we see the salvation agenda as a rhetorical driver of action and a
justification for bypassing the political in favour of the technical and the ethical.
I delved into these issues with Persimmon and Jazeera as I sought to understand her views on if and
how the Ministry of Health forged alliances with international and local non-governmental agencies.
Given the divisive politics that I've just outlined, and she reinforced the salvation agenda in the following way.
I remember talking to some of our partners and saying, Look here, your government is fighting with my government,
but that doesn't mean that you and I should stop working together.
You think about the person out there in the rural area who has lost a child and is about to lose another child.
They just want good health for their children. They don't care which government which government is fighting.
Which government. The views of multiple development organisations working through the Si4 are captured by AJ Poole of German Agro Action,
who said to me there wasn't the breathing space to go through the political dimensions of this cholera outbreak or indeed the the account,
but accountability mechanisms.
Agencies have got different roles to play and our role certainly wasn't to do anything other than immediate response, lifesaving response.
We were too busy with that. Now, having given some insights, some of the intricate politics of this and of the formation of the C for.
I'm going to shift focus in this next section and and talk a bit about what was happening
on the ground and the work taken by volunteers who are trained to campaign against cholera.
So after after talking to Shell and his team that visited Beatrice Road Infectious
Disease Hospital as part of their outreach trip to Celebration Ministries,
he initiated a massive philanthropic drive into Shell's account.
He met prominent Zimbabwean businessmen and several American churches to help channelling philanthropic donations.
Celebration Ministries proceeded to pay the salaries of Harare based doctors and nurses for the month of December,
January and February, the peak of the epidemic, doctors received a per diem of 19 USD, while nurses been awarded $45.
The Capstone Project of Celebration Ministries was Operation Outstretched Hand.
The operation entailed the mass mobilisation of junior doctors, medical students, nurses,
pharmacists, logisticians, drivers through the church's network to respond to the outbreak.
The team established large cholera treatment centres in Djibouti, Koroma and Chinhoyi,
where they offered clinical care and run health promotion campaigns in surrounding areas.
So I'm going to describe the experiences of working in these settings by drawing heavily on one particular interview with Dr. Mohammed.
When I grew up known as Tonga, at the time, Tonga was a 22 year old medical student, and he's now a junior doctor specialising in internal medicine.
Throughout to his narrative, I will interweave the perspectives of several of my informants and go to this account as an individual one.
It is situated in the collective experience of coming of age for many despondent young
people who had been left feeling idle and redundant during Zimbabwe's economic crisis,
but who rose to the epic challenge of giving life saving treatment in the most unfavourable of circumstances.
And in truth, his narrative, we see a political awakening. As I will discuss to his own self-professed faith in Zimbabwe's nationalist project,
with its claims to liberation and development was shaken to the poor in 2008 and 2009.
He was confronted by the vulnerability and suffering brought about by the country's political economic meltdown in ways previously unimagined.
And so to the story, this illustrates the larger claims of the paper,
where politics offered little possibility of transforming a dire social situation.
The self salvation agenda allowed individuals to exercise some modicum of agency,
justified through the morally compelling work of saving lives, and took his own words.
The first thing I heard was would it hero and good to cholera is that big time to.
The studies had been interrupted at the University of Zimbabwe once the medical school had been suspended,
since there was no money to pay, the teaching staff and the wards in the public hospital were closed.
The medical profession was seized with discontent over low pay for doctors and poor working conditions in the hospitals.
Nevertheless, to me, as parents have forbade him from participating in the doctors strike at the time,
arguing that he needed to focus on his studies even though he wasn't able to go to medical school.
All the while the situation was deteriorating and rumours of the cholera outbreak were were propagating.
As to he says it was basically weeks of sitting around and hearing all of this coming in and not knowing what was what.
Because there was this suppression of information to the then was recording at this point the uncertainty about
the outbreak before it was officially acknowledged as a national disaster and after several weeks of mutterings,
it eventually became evident that Zimbabwe was in the throes of a big outbreak, and that's when we knew we were in trouble, he says.
People knew by that time the country was in no position to respond.
Fortunately, at that time there were a lot of NGOs with interest in health that were that.
One of the NGOs that to the West was referring to was Celebration Health, the outreach arm of Celebration Ministries.
There'd been an epic escalation of cholera cases in late December, and that was when to join the humanitarian relief effort.
His first deployment was in the town of Djibouti, and he was astonished by the scenes he saw at the clinics.
Patients were dying at a phenomenal rate as the numbers of cholera cases continue to rise,
compounded by delays in replenishing stocks of necessary medications such as antibiotics and intravenous fluid after the camp got set up, he says.
It was just an explosion from late December.
I remember I spent New Year's away from home for the first time in my life because we normally spend years together as a family.
But this time I was out there in the boondocks. So in December and January, I was barely home, he describes.
You'd come home for two weeks and then you go back to find that it's just getting worse and worse and worse.
It was just an explosion in December and January. When you go online and see the stats.
You're like, What is going on? It was a really scary time for us.
At the same time, Sugar says, we were excited because we were doing clinical work away from our consultants and no one was shouting at us.
We were actually doing work and getting things done. That was exciting, but at the same time, we were scared.
We were like, This is real. This cholera. This is real. It was mixed emotion.
Tunga and other volunteers worked indefatigably.
Further assistance came from MSF and together the organisations brought the situation in Djibouti under control.
From that celebration, Health moved to Cordoba to work in concert with MSF and UNICEF.
The team arrived to find cholera cases rising at a seemingly exponential rate again.
One night in early February, Tula recalls that the number of cases exploded, as he says, from 100 people to 600 or 700.
Overnight, it exploded. The volume of cases exceeded the capacity of the local and treatment setup at the hospital,
and instead the three organisations migrated to treat cholera cases in an ad hoc treatment site in a football pitch in the middle of the city.
Different organisations gelled together and their combined effort started making a difference as deaths began to drop.
Two men.
I talked extensively about his emotional reactions to being part of this effort and to being and and and to witnessing both the crisis unfolding,
but the convergence of different organisations in response to the outbreak.
He, like several others who I interviewed in Celebration Health,
commented on the speed with which the medical charity was able to respond to desperate need.
He also stressed the flexibility that Celebration Health exercised its protocols on practices,
especially compared to the sclerotic and cash strapped government bureaucracies.
On a more personal level, the responsibility and industriousness demanded of tugger,
combined with the remuneration earned, became a means of attaining a certain form of social adulthood.
Responding to the outbreak marked transition from being a medical student who felt
acutely cast aside and dismissed when the country's medical institutions had collapsed.
To being a medical humanitarian.
A professional caregiver during the audience work of saving lives in the midst of a public health nightmare, as he put it.
Being paid was a very new concept to us. We were kids.
Yes, times were tough, but we were used to asking our parents for help to get like medical.
Like many medical students came from an average middle class home in Zimbabwe.
So, he says, we barely suffered from the long queues because of the economic crisis, because we were still very much dependent.
And then Celebration Health offered to pay us per day.
They would pay us when we came back from the field. Then you'd spend a week at home and go back into the field.
We didn't even really have time to use that money.
We used to buy groceries for home, get airtime for our cell phones, buy a pair of jeans, and then go back into the field.
It was actually quite exciting. We were helping people as students who were almost finishing their training.
We felt relevant. That was another big thing we actually felt relevant for.
To get the experience was life changing and it transformed them into what he described as a different political animal.
And he put it this way. I think from high school, I have always been a conformist.
I always went with the system. I followed the rules.
By that time, though, in 2008, I began to question those in power for the first time in my life.
I had never done that before.
The cholera outbreak then raised deeper and more profound social and political questions for him about justice and equality.
Moreover, it diminished his faith in the country's political system and stirred a new political and historical consciousness.
One much more critical of the group's patriotic history and its claims to modernising development, as he puts it.
I had supported the fast track land reform and the taking back of our land from the white farmers.
In fact, I thought that should have happened much earlier.
But when I got to the University of Zimbabwe, I got more exposure to what's happening in our country.
That's when I began to see the corruption and failure of our leadership.
We saw the real life of what this cholera outbreak was like. It was scary and it was an eye opener.
I used to have a lot of trust in the system, and I don't have trust in the system anymore at all because it failed.
I now started questioning a lot of things. From that time onwards, it changed what I was.
I would no longer blindly follow or blindly believe. I learned to ask a lot more questions.
I also learned that I deserve better. That was a real shift for me at the time.
Leadership failed us and 2008 proved that beyond all doubt.
Now to that went on to lament and our discussion the kind of internecine blame game that unfolded between the ruling party and its opposition.
For him, the country's elites were distracted from urgent matters on the ground and ordinary people were left to deal with the crisis on their own.
Indeed, Tonga insisted that to be effective in the cholera response, it was vital to, and I quote,
turn a deaf ear to politics and to suppress whatever anger, indignation, fear or regret that he and others had felt about the country's crisis.
As he put it to me. We were born into a functional and good country.
And then there was just this decay that happened, a gradual decay of governance and the economy that led to this final scenario we were in.
People were angry, but they were also afraid. Remember, we had just come from that oh eight election.
People were angry, but no one articulated it in that way.
There was this fear. There was this fear. People were angry, but they stayed quiet and reserved.
They didn't voice it out loud, but there was definite anger.
There was a feeling of being let down, especially for us as medical students who are unsure of our futures.
We were very angry. We were very disappointed. But at the same time, we had we had a lot to do.
In the end, we just ignored that and focussed on the work at hand.
And we had what we had to face and hope that maybe one day the medical school would open up again.
And that's what we ran with. Finally, I asked Hugo what impact the experience had had on his political allegiances,
having been raised, having himself been raised in a staunch supporting household,
capturing a white sense of paralysis and political pessimism, he simply responded, I am a spoilt ballot until a decent opposition emerges.
Now Tuesday's narrative echoes essential aspects of the salvation agenda.
But it also reveals much more than this, and it allows us to see the political subjectivities that emerged during the cholera crisis.
We see a venting of outrage at the failures of the state under ZANU-PF.
We see a shift in historical consciousness in the country's trajectory in which expectations of the state as the bringer of development are suspended.
But there remains a hope that in due course, Zimbabwe will return to being a functional and good country as well.
But we also see the creative, moral agency of responding to a crisis for the sake of individual and collective survival.
Now back to top to show. Tom commended to me the focussed and high minded work of his own organisation,
and he denounced NGOs and U.N. agencies from inviting themselves in Zimbabwe's divided politics and thereby undercutting his own effectiveness.
For him, at least rhetorically, the Church claimed the primary duty toward salvation in all senses of the word,
and that duty, he said, comes before, above and beyond and after politics.
Now, undoubtedly, celebrations, celebration, health contribution to the humanitarian relief effort was profound.
It was clear from my interviews with local and national government figures that Celebration Health,
along with numerous other humanitarian agencies, played an indispensable role in the medical response to the epidemic.
Nevertheless, medical acts leave a political trace.
For all that, communities welcomed the largesse of the international relief effort.
Questions emerged about the more fundamental aspect of socio economic inequality that undergirded the outbreak.
Humanitarians themselves were sharply aware of their limitations in this regard.
A communications officer with MSF described visiting the high density suburb of one of the areas where it conducted
a lot of work and she and her team were running a water and sanitation and hygiene program in that community,
primarily injecting concentrated solution of chlorine into containers of water to ensure that it was safe to drink.
The trio also treated local water sources with cholera, with chloride.
Why can't you fix the whole water system? A man off the May. Another resident joining the conversation asked.
Is it for life? Is it forever? This treatment you are doing?
This MSF worker then went on to explain.
Explain to the two, to her interlocutors that MSF is an emergency organisation that was there to help with the cholera epidemic alone.
After this exchange, the resident who impose the initial questions refused to have her water chlorinated when the MSF worker authorised it.
If she was afraid that she would fall sick without chemically treated water,
the woman quipped and retort, But when you stop giving dust, we will be affected even more than before.
Another eavesdropper chimed into this conversation, adding, We are resistant like wild dogs.
We've been drinking unsafe water for a long time.
For James Materazzi, a resident of Chitungwiza, another heavily affected area which is badly hit by cholera and is often a local NGO worker,
and he'd been involved in many facets of the cholera response. He argued that the humanitarian effort came to something of an abrupt end,
forgoing more long term rehabilitation and development work, especially in the high density areas of Harare.
And I quote, Once it was under control, the clinics cleared and everybody went home.
A few guys stayed behind and did and did a few more boreholes, but it was like, Thank goodness it's over.
We can all go home and rest. And so the Salvation Agenda ultimately achieved its aim.
It galvanised a disparate array of actors and institutions to save tens of thousands of people from ruin or loss because of cholera.
As I've argued in the section and throughout this paper,
it did so by effectively ignoring the complexities of the cholera outbreak in terms of its historical and political,
economic determinants and dimensions, focusing collective action instead, and pooled resources on the urgent needs that warranted immediate action.
Given the diversity of institutions involved in the response,
each expressing wide ranging views on the true origins of and allocation of culpability for the cholera crisis,
each asserting different claims to legitimacy and response to the disaster,
and each restricted by its operational mandate and its access to donor funds and each accountable to different constituencies.
It is very little surprise that it was in the salvation agenda where a common purpose was found.
But of course, the Salvation Agenda was not without its without its pitfalls.
Most obviously, humanitarian relief came at the expense of longer term action, as anthropologist Miriam Tipton has argued.
Critics of humanitarian action argue that in the absence of other types of long term structural responses,
coordinated or enacted by political movements or even by institutions like the state,
humanitarian and disaster NGOs end up filling gaps resulting in what is ultimately the conservative management
of social and political problems one that works to retain what is already there rather than to change,
rather than to change it, or to plan for a different future.
This, of course, is evidenced by Zimbabwe's contemporary humanitarian and public health crisis.
I began this paper by sharing testimonies of harrowing scenes at the cholera treatment centres.
I argued that witnessing the spine chilling clinical and social effects of cholera ignited the moral imagination of medical professionals,
relief workers, development specialists, religious volunteers and bureaucrats to forge an alliance dedicated to saving the lives
of those afflicted by cholera and to remove the most proximal causes of the disease.
The motive, the motivating impulse behind this alliance was to address the force majeure of the dysfunctional Zimbabwean
states through what I have called the Salvation Agenda itself a powerful moral and rhetorical force.
The Salvation Agenda allowed agencies and actors to set aside their multiple interlocking
disputes over the causes of the epidemic and responsibility for its resolution,
and to focus instead on averting imminent death. Like Ferguson's anti-politics machine,
the Salvation Agenda presented a complex political and social and socio economic reality as a defined problem amenable to technical fixes.
Thus, it is unsurprising. When cholera passed, it was it was like, Thank goodness it's over now.
We can all go home and rest. Crucially, unlike the anti-politics machine, the Salvation Agenda did not expand Zimbabwe's bureaucratic state power.
To the contrary, the assemblage of institutions involved in the medical humanitarian response treated the cholera outbreak primarily as an emergency,
and they left behind them and under-resourced and politically divided state that is still struggling to manage the deeply
embedded patterns of socioeconomic inequality and partisan conflicts that initially led to the epidemic in the first place.
And so as a concluding word, this. Many crises.
And I look forward to your questions. Thank you.