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,
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.
This project is just just outlined, began as my doctoral thesis,
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,
and the book was written almost entirely in this department. And to me,
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.
So I was in my fifth year of medical school at Newcastle University when I first stumbled
upon the startling article entitled Cholera Epidemic Sweeping Across the Crumbling Zimbabwe.
The piece, published in early December 2008,
began by recounting how the disease had claimed the lives of the five youngest members of the Chibuku family with cruel and bewildering haste.
These children had been playing in the sewage flooded streets of a Harare township, gleefully unaware of the deadly bacteria lurking there,
and it was only a matter of hours before all five children began purging and vomiting.
Within less than a day, they were limp and hollow wide as life seeped out of their desiccated bodies.
Then they started today, said their brother, love God, pre-school was first, second time,
then Shontell Colobus 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 patient. The spread of lethality of the disease did not abate,
the country's public health systems floundered in response to what is otherwise a straightforward bacterial infection,
one that's easy to prevent, difficult to spread and simple to treat.
And over the course of 10 months,
Zimbabwe's cholera outbreak reached catastrophic proportions that are almost unrivalled in the modern history of the disease.
So the epidemic had begun in August 2008 in the high density suburbs of Canada's metropolitan area.
It quickly spread into peri urban and rural areas before crossing the country's borders.
As you can see, it's South Africa, Botswana, Zambia, Mozambique over the course of 10 months, as I've said.
The disease infected over 98000 people, claimed over 4000 lives and with an exceptionally high case fatality rate at the peak of the epidemic.
Zimbabwe, with 2008 and 2009 cholera outbreak, has been deemed the most extensive in recorded African history.
Now, epidemiologically speaking, the outbreak can be explained by the cross-contamination of the country's water and sanitation systems.
And 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 social and spatial pattern of the outbreak.
And that account for the fragmented and inadequate response of the national health system.
So cholera then was much more than a public health crisis.
It signals a new dimension to the country's deepening political and economic crisis of 2008,
which brought into question the capacity and legitimacy of the state.
So this book then does not address Colorado as a technical problem to be solved or to be prevented in future.
And indeed, there already exists a rich epidemiological literature speaking to this very question.
Instead, with this book, I tried to tell a story about the political life of the cholera epidemic.
I examined the epidemics, origins, the pattern of its unfolding, its social impact.
Institutional and communal responses to the outbreak and its aftermath in civic and public life across different institutional settings.
Cholera engendered competing interpretations and experiences,
and these created charged social and political debates about the breakdown of Zimbabwe's public health infrastructure,
the country's failing bureaucratic order,
the scope and limits of humanitarian relief and the country's profound levels of livelihood, poverty and social inequality.
And so I'd like to suggest examining the political life of an epidemic offers compelling insights into how we think about politics,
humanitarianism, social inequality, the state and citizenship in Africa.
Now, cholera as an indicator and as a test of social and medical systems,
has occupied a central place in much of the one non-medical literature on the subject.
Indeed, the historian Richard Evans, in his groundbreaking work on the history of cholera in Hamburg in the latter part of the 19th century,
advocates the study of the disease in this very manner.
But Evans is quick to caution us that we need to be very careful and circumspect in handling this way of approaching cholera.
For Evans cholera outbreak, the cholera outbreak that plagues social political life in Hamburg in the late 19th and early 20th
century are best understood as events that might perhaps be ultimately insignificant to themselves.
But nevertheless, in a flash of lightning, they illuminate an entire historical and social landscapes.
As the elegantly articulated during a cholera outbreak, the workings of states and society,
the structures of social inequality, the variety of values and beliefs,
the physical contours of everyday life and the formal ideologies and informal
ambitions of political organisations are all thrown into sharp and detailed relief.
And in the spirit that I tried to approach the study of the 2008 and 2009 cholera
outbreak in Zimbabwe as an event that might ultimately be insignificant in itself,
but one which opens up a window onto many aspects of the country's historical, social and political landscapes that are otherwise left obscure.
And the aim here that is to travel with cholera through time and space to illuminate the urban history of
Harare to show the structural factors that led to high density residential areas that circumvent the city
as being prone to diarrhoeal disease outbreaks to show the political disruptions wrought by the country's
post-2000 crisis and how these disruptions had unforeseen and catastrophic consequences for human health.
I try to reveal the inherently pluralistic nature of an epidemic and the divisive politics that accompany it,
and to make apparent how a medical nightmare mask, the contours of life and death,
belonging and exclusion, privilege and objection within the body politic.
That being said, I'd like to think that this book is more important than its contribution to academe.
More important than its contribution to the advancement of my career and more
important than its contribution to my own personal and intellectual edification.
And so what comes to mind, and certainly not for the last time either in the book or in this presentation,
is a passage from Albert Camus classic humanist novel The Plague.
This book tells the story about an awful outbreak that gripped the coastal city of Iran in Algeria at the end of the novel.
The narrator revealed to be the protagonist,
Dr. Riyadh explains his compulsion to compile his chronicle so that he should not be one of those people to hold his peace,
but should bear witness in favour of those plague stricken people so that some memorial of the outrage at injustice done them might endure.
And so ultimately, it's my wish above all else,
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.
OK. So today, as Josh mentioned, I'm going to give a whistle stop tour of the book.
I'm going to focus on the subtitle of the book and three key dimensions.
I'm going to talk briefly about cholera and how we might explain the epidemic.
But rather than going through the detailed structural and historical analysis I give for why the epidemic occurs.
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.
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.
Here, I'll highlight how cholera became a terrain of polarised political struggle and how bureaucrats,
civil servants and humanitarians tried to negotiate such a complex field of both politics and public health.
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
themselves in social memory about what it was like to live with the cholera outbreak.
From here, I'll conclude by tying some of these threads together and reflecting on some of this
contribution and some of the contributions that this book makes to scholarship.
Before sharing some final reflections. So in order to do this, we need to understand a little bit about cholera itself.
Now, cholera is one of the most feared infectious diseases in public health.
It is an acute bacterial infection of the intestine caused by certain strains of the organism Vibrio cholerae.
Now, in theory, the disease should not be a major threat to human beings.
Not only is the septic susceptibility highly variable between individuals, the bacteria can only be acquired in one way,
and that's through the ingestion of food and water that has been contaminated by faecal matter from a person
with active cholera or from standing bacteria present in plankton or seafood living in brackish water.
Now, back in 1976, John Carpenter, writing in the Johns Hopkins Medical Journal,
argued that cholera causes only a reversible and easily treatable biochemical effect,
and he claimed that cholera replies are very gross level of contamination greater than
any other known epidemic disease to produce illness in otherwise healthy individuals.
So this accounted part of why cholera randi infects health care workers involved in its treatment.
Now, many individuals will only acquire asymptomatic or mild cases of cholera when exposed to the bacteria.
But the disease's progress for those who are susceptible is terrifying.
The incubation period.
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.
Variation depends on a number of different factors, but primarily how long it takes the cholera bacteria to colonise the intestine.
Now, once in the intestine, the bacteria secrete a powerful toxin that interferes with caloric absorption of water, salts and other electrolytes.
As a result, the first stage of symptoms include sudden and explosive, watery diarrhoea.
That's classically called rice, which is stool so that you can see depicted here now.
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.
This stool gushes out of the patient and empties the below about faecal matter extremely quickly.
In a single day, an individual can pass up to 20 metres of stool, containing as much as 10 million Vibrio per millilitre.
Now, the first frequent and painless diarrhoea is accompanied by hiccups,
extensive retching and vomiting of the same whitish appearance which may come up, which may also contain the cholera bacteria.
The tremendous loss of water and electrolytes can amounts to eight percent of normal body weight.
The consequence? Dehydration then produces acute and agonising cramps in the muscles of the feet and the legs.
Occasionally, the arms, the abdomen and the back.
It gives patients a sense of frustration that can be extreme, lasting from two to 12 hours, depending on the severity of the symptoms.
The second clinical stage of the disease, which is often reached within a day or two, is marked by continued purging and vomiting,
followed by collapse, rapid dehydration and ruptured capillaries learnt in Asian experience to the patient.
As you see here, the skin typically becomes blue and black.
It becomes cold, wrinkled, clammy to touch. The voice becomes husky.
The cheeks hollow, the eyes sunken and the expression listless.
Signs of hype move Olympic shot, which is a severe state of circulating blood volume, appear with a plummeting blood pressure.
A pulse is often not palpable at the wrist and urine output is suppressed, the legs and stomach convulsed, violently causing terrible pain.
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.
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.
Now, without adequate fluid replacement, death can occur from circulatory shock due to inadequate blood perfusion of vital organs.
And in the most dramatic of cases, a healthy person can be dead within hours.
Now, a third stage for those who survive this critical phase ultimately bring sensation
of vomiting and diarrhoea is the second stage can be limited to only a few hours.
Then it might be possible to restore circulating volume and blood pressure, and the flow of urine will resume.
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.
So. The treatment of cholera is actually radically simple throughout the annals of modern medicine.
One of the greatest innovations has been a simple concoction of salts, sugars and fluid to treat cholera.
This is often known as oral rehydration therapy when administered quickly and efficiently.
Oral rehydration therapy can reduce the mortality rate of cholera from 50 percent down to one percent.
Moreover, oral rehydration therapy is cheaply and available cheaply, available almost worldwide,
and so the historian of cholera, Margaret Ellenberg, argues that no one should die of cholera today.
So considering all of this, that the emergence of cholera, she always trouble us now throughout the intellectual history of epidemiology.
Charles Rosenberg has identified two fundamental styles of explaining the occurrence of epidemics,
and he calls these respectively contamination and configuration for Rosenburg,
contamination is a reductive mode of analysis that typically reduces itself to the idea of person-to-person
contagion through the transmission of some morbid material from one individual to another.
The configuration theme, however, assumes a much more holistic system of infection,
one that emphasises interconnection the social environment that gives rise to the spread of morbid material.
And so throughout this book, as you'll see shortly.
I argue that cholera outbreaks are best understood through this configuration or style of explanation.
Since the disease is primarily spread through food and water, and since it's typically difficult to spread, it easily prevented.
It only tends to appear in contexts where epidemic form, that is where people are living in overcrowded and dilapidated housing,
or temporary settlements, where sanitary conditions are poor and where malnutrition is widespread and severe.
In this sense, cholera outbreaks are very rare in the absence of major structural change, such as war or environmental catastrophe.
So the image you have here was taken in 1994, and this prior to the 2008 cholera outbreak,
was the deadliest and most extensive cholera outbreak that occurred in refugee camps in Goma in eastern DRC following the Rwandan genocide.
This resulted in about 70000 cases of cholera, but many more deaths estimated at about 12000.
And so if we take this seriously, we realise, of course, that cholera outbreaks that are often into or impregnated within social,
economic and political disasters both as cause and as consequence. So how do we begin then to explain cholera in Zimbabwe?
I mean, give here a very truncated political history of Zimbabwe just to set up some of the context for the study.
So during Zimbabwe's transition to independence and black majority rule in 1980, the incoming government inherited a highly technocratic,
centralised and powerful bureaucratic state apparatus from its Rhodesian predecessor.
The new ruling party, the Zimbabwe African National Union Patriotic Front was RPF was quick to put this
powerful machine to use in the service of modernising development throughout the 1980s.
The majority of Zimbabweans gained unprecedented access to education and health care,
while a large land resettlement programme for the for the benefit of rural people was underway.
Of note, the government made remarkable progress in the provision of water and sanitation to rural households.
Winning praise from the World Health Organisation and from UNICEF for the government's
ability to provide safe drinking water to 84 percent of the national population by the 1990s,
Zimbabwe could probably claim a substantial middle class and an educated population, a diversified economy and a sophisticated infrastructure.
Crucially, as Joyce and others have argued, the Zanu-PF government derived legitimacy as a result of its capacity to deliver development.
But in 2008, the situation could scarcely look any more different after a decade long economic slide.
Annual inflation rates estimated somewhere in the region of 231 million percent,
according to official statistics and estimates by independent economists, at a rate of eighty nine point seventy six trillion percent.
If you can make sense of those numbers that have reached world record setting levels,
public services, including health and education, had largely disintegrated.
Major shortages of basic commodities had piled on top of political turmoil and violence,
and cholera was competing for lives with one of the highest HIV rates in the world.
Now, the 1990s are often cited as the epochal in making this transition from modernising development to crisis in Zimbabwe.
This period saw a shift in the social and political forces in the country, during which the popular legitimacy of the ruling party declined,
while concurrently a range of social movements cohered into the most successful opposition party in post-colonial Zimbabwe.
That is the Movement for Democratic Change or the MDC. The MDC, formed in 1999,
presented Zanu-PF with its first real possibility of electoral defeat in the general and presidential elections of 2000 and 2002, respectively.
From 2000 onwards and upheaval why he referred to as the crisis consisting of a combination of economic decline,
authoritarian nationalism and violence came to define Zimbabwe's changing political landscape.
Now, there are any number of explanations for the origins, character and quotes of Zimbabwe's crisis.
These are far too intricate to summarise here. Instead,
what I'd like to do is emphasise a strand of literature amongst Zimbabweans that's paid close attention to the
changing character of Zimbabwe older than sorry and its relationship to its own bureaucratic institutions.
Justin and Alexander's other scholars have emphasised one of Xenopus response to the crisis
as its assault on what had previously made Zimbabwean state bureaucracies authoritative,
authoritative, which was that they are expert and rule bound character. This assault by the ruling party manifested itself as the manipulation of law,
the deployment of political violence and making partisan use of state institutions and resources,
and it was crucial to Zanu-PF strategy of retaining political power.
A logic a new logic of political power weakened and politicised the state such that professionalism,
education and skills were no longer the predominant criteria for holding posts
within government and instead loyalty to that APF and to military and political,
military and political connexions became more important. And as these changes undermined one of the most compelling claims to legitimacy,
which was the delivery of public services by professional civil servant,
several authors have gone on to analyse these changes across a range of social institutions.
These days include the work and the law courts, as my colleagues Jonathan Hoyle has shown.
The military is mouth into hiding somewhere in the back of the documented extensively.
The prisons, as just as written about the education sector as done documents and local government colleagues like Joanne MacGregor and Suspend
Sussex have documented and yet reading across the different literatures in the early parts of the formation of this book,
I was struck by the lack of attention given to the health sector,
particularly given the powerful role that public health played in Zimbabwe social and political crisis.
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?
Health care delivery has historically played a critical role in buttressing the legitimacy of the ruling party and a public health emergency.
What part of the disintegration of the health system was a central feature of Zimbabwe's crisis?
And so it seems to me that studying the politics of public health has an awful lot to tell us
about the nature of political change in Zimbabwe and elsewhere in the world more generally.
At the same time, the literature that was coming from the health sciences in the early stages of the
cholera outbreak did little more than interrogate the politics of this period than,
say, bad governance. A lack of political will and poor economic policies were responsible for the crisis.
And so this book attempts to fill this gap in the literature,
accounting for how political change and institutional assault the unravelling of bureaucracy affect the public health.
Now, the first major argument I make in the book about why the outbreak occurred is I suggest that the origins,
scale and impact of the cholera outbreak were over, determined by a multilevel failure of Zimbabwe's public health infrastructure.
I highlight three key factors the women mentioned to brief him and discuss one thing a little bit more depth.
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.
So you have an image of Zimbabwe's main infectious disease hospital called Beatrice Rhodes.
And as you can see, this is not this is the waiting area where patients wait to be seen with their families.
This is not. It was. And here you have intravenous fluids being administered to patients and being
comfortable and effectively clothing lines because of limited capacity on the wards.
Moreover, Conroy was able to disseminate throughout the country without an effective system to detect it,
to disrupt its spread or to prevent timely treatment to its victims.
In the book, I go into more detail about how the health care system collapsed.
But what I want to point out here is something that Dr Portia Menangle zero,
who was the who's the current director of disease control of epidemiology in the Ministry of Health in Zimbabwe,
said to me, she said very pointedly as we discussed the outbreak that when you look at cholera, it's not a health issue.
It only happens when people eat [INAUDIBLE]. Now put differently.
What she was saying was despite the moribund state of Zimbabwe's health care delivery system in 2008,
the primary determinants of the outbreak was situated in the wider set of forces and systems shaping the material
conditions of everyday life and the collapse of the infrastructure needed to deliver essential services.
So we see this here in the second major factor that I identify that I'm calling here the political economy of everyday life.
So as many of you will know, given our 96 percent inflation rate, Zimbabwe had become a country, a nation of starving billionaires.
So as the joke goes, Zimbabwean men are having a drink in a bar.
One says, My wife made me a billionaire. I used to be a millionaire.
And now it's really hard to overemphasise how bad these changes were.
Just to give one other example, on the first of August 2008, an egg in individual egg in Harare.
It cost five Zimbabwe dollars five February 2009, when the ding dong at this stage was replaced by the use of foreign currency.
The same egg would cost two trillions in dollars, which for those of you were not passed on your maths.
That's a $40 per percent increase in the space of six months. And as a result,
the context of hyperinflation and economic collapse had a series of cascading consequences across all aspects of trade and employment,
and often coincided with homelessness, squalor, food, fuel and currency shortages.
Crucially, widespread food insecurity in the country resulted in the catastrophic malnutrition crisis,
which rendered vast swathes of the Zimbabwean population vulnerable to a cholera infection.
As you recall, early on one what I mentioned was that cholera outbreaks tend to occur where malnutrition
is widespread and severe owing to malnutrition incapacitation of the immune system.
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.
Now, throughout the 2000s,
control of urban water became a crucial state of struggle between Zanu aligned state institutions and municipalities run by opposition MDC.
There are a host of different reasons for this. One of the factors was that APF tried to nationalise the water through the creation
of a national water water body called the Zimbabwe National Water Authority,
or Xinhua, which is popularly referred to as Zimbabwe. No water available.
Now didn't want play multiple different political functions.
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.
Xinhua often would sack entire municipalities that had previously be responsible
for water delivery in different parts of urban Zimbabwe and as a consequence,
not only with technical expertise lost, but years of capital investment was discarded as well.
Moreover, there were underlying structural factors at play here.
So in the much longer term, much longer duration view of water supply in the city,
we see that the water supply was initially laid down when Harare was founded as the colonial city of Salisbury.
Now, when these pipes were laid down, they were often cited in the same water catchment zone as the sewage system.
They have not been maintained a great deal since they were established in 1953,
and there's been a misalignment between water provision and population needs.
In addition to this, the economic crisis and the nationalisation of Xinhua, we have a kind of multi-modal collapse of the water system.
Now I want to say this took me a very,
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,
you know, sewage pipes burst and so forth.
But I this an inadequate explanation to say, Well, how do we go from both sewage pipes to the appearance of cholera?
Or if you're telling me that there's no water flowing through the system? What are people drinking?
And is that where the cholera resides and how does? So what are the actual dynamics of the political economy of collapse?
Two. Cholera getting under the skin So I use inspired by my medical training, I invoke, of course, triad.
Now, the medicks in the world will know that when you're trying to understand fluid dynamics in a system,
they're kind of three key factors to look at. One is phenomena associated with hydrodynamic changes.
So this is about the speed of flow of water within the system.
So here, for instance, I show that because of the economic, the economic collapse that was happening in the country,
the poor maintenance of the engineering works in the city. There was an intermittent and turbulent flow through piping infrastructure.
This matters because in a normal piping system,
you have the accretion of bacteria and organic materials forming a biofilm, which is the natural lining of the pipe.
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.
So if those bacteria now contain diarrhoeal causing organisms, they effectively get delivered into people's household.
When there is a burst of water flowing. So that's one dynamic, another dynamic.
I look at phenomena associated with the integrity of the vessels themselves and their vicinity.
And so here I tried to show how not only do you have this problem that intermittent water supply,
but the leaking of vessels between the water delivery systems and the sewage systems meant there was tremendous scope for cross-contamination.
Not to mention the fact that the bursting of sewage pipes onto the streets of Harare, particularly the townships.
As you see here, the dormitory town of Chitungwiza would then go into pits and gradually seep its way back into the water pipes.
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.
So Harada in particular, has a very complex engineering system for the adequate treatment of water, and this includes,
amongst other things, use of various kinds of acids, activated charcoal, a sodium silicate flatulent eight and so forth.
Usually, when water has been treated in this manner, it's then pumped into reservoirs.
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.
So during the crisis, these processes failed at every step.
So owing to hyperinflation, embezzlement and underinvestment, Xinhua couldn't purchase the required chemicals needed to treat the water as the
mother's water treatment centres before they were then delivered to the reservoirs.
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,
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.
So this is partly what I mean by the systemic collapse being over determined that
there were these multi-point failures that even if you had one or a few of them,
there was still something else that was going to cause the collapse of the water system.
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,
but a crisis in the response. As should be apparent, there is a very glaring omission of data in the scrap.
So this I got from the Ministry of Health and the W.H.O. joint report on the
cholera outbreak and if it goes to trace the epidemic curve of the outbreak.
Yet this year, we think it represents August of 2008, and this year the first couple of blue bars represents December of 2008.
In the middle here was this lack of data reflects the incapacity inability to actually trace what was happening
in the country at the time to have reporting mechanisms of how cases were spreading throughout the country.
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.
I quote here the outbreak spread from China without really, really fast.
It was then included then in Chinhoyi, then in Cordoba, and then just all across the rational lines in particular.
The scale caught everybody off guard. All agencies were behind the curve, literally and figuratively.
We were all behind the curve. We were always chasing it. We needed to be much quicker with chlorination of urban water supplies.
We needed to get points of use disinfection out there. But they went to their partners in the fields to do that.
W.H.O. systems are just totally unprepared and unable to cope.
You had a volatile mix. You had an epidemic that was spreading fast in rural areas and in high density populated areas.
You had public health services that were on the verge of breakdown because doctors and nurses were on strike.
You had the lack of capacity and partners in resources to do simple interventions
like oral rehydration therapy and other key lifesaving interventions.
There were not enough partners. We knew how to do that. We had clinics that were completely overwhelmed.
Now, in addition to the structural incapacitation and entering into the realm of imagination that just that just introduced,
we have this question of a profound hesitancy on the part of the government to declare
that there was a national cholera crisis or to identify cholera as an emergency.
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.
He said, You know, cholera is one of those words which causes things to happen when you say it.
The two other words that have that effect are famine and genocide.
Cholera is the little brother of those big words that changed things.
When you say them, there are all kinds of reasons why the government might want, might not want to announce that there is cholera,
and it's very common for countries around the world not to announce that they have cholera.
And as he says, cholera makes you look like a badly run Dirty Tin Pot country.
And that's why people are so afraid of it. It damages your reputation. It damages your economy and damages tourism.
It's really bad news to have cholera in your country.
So at the heart of many of these political dynamics that followed disasters in general is cholera.
Outbreak in particular was a kind of frantic competition to gain the legitimacy and public standing,
or else to shy away from being labelled as illegitimate or incompetent or incompetent.
And the political stakes around declaring the outbreak were especially high as the ruling party was involved in a protracted
negotiation for a political settlement with its opposition MDC following highly disputed elections that had happened earlier that year.
In this way, we see cholera as the terrain of polarised political struggle with numerous headlines are.
All of these are just taken from the Herald, in which the national newspaper Zimbabwe open a mouthpiece of the state.
And even here, there wasn't coherence as to what was actually happening.
So we have some versions claiming that Mugabe was responsible for the cholera,
others saying that cholera was the lady that was the West's latest weapon on Zimbabwe.
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.
Only for few admits in the following article that cholera was killing hundreds of people.
And again,
these are the headlines cholera could have been avoided and the government coming out saying that the pandemic is under control and so forth.
So the rumours and reporting around cholera and the battle to shape public narratives around the disease raised a host of different questions.
Where did cholera come from? Who and what was at risk? What could be done to stop it as this was happening?
The international NGO Physicians for Human Rights sent to the team of investigators
to document what was happening in Zimbabwe over just a week in early December.
They conducted a series of interviews trying to document the cholera outbreak and its links to human rights violations producing this report.
In it, they wrote that the health and health care crisis in Zimbabwe was a direct outcome of the
malfeasance of the Mugabe regime and the systematic violation of a wide range of human rights.
These, they argued, constituted at minimum violations of the rights to life, health, food and water.
And when examined in the context of 28 years of massive and egregious human rights violations against the people of Zimbabwe,
Robert Mugabe and Zanu Piaf were guilty of the Commission of Crimes against Humanity.
Responsibility to protect No was invoked with an international commentariat calling for
military intervention in Zimbabwe to stop cholera fighting bacteria with guns and [INAUDIBLE],
as one commentator put it. And on the flip side, you had an entirely belligerent counter-narrative.
The late, the now late and former Minister of Information Dr Stiglitz on Global,
wrote or said at a press conference in Harare in December that cholera is a calculated
racist terrorist attack on Zimbabwe by the unrepentant and former colonial power,
which has enlisted support from its American and Western allies so that it can invade the country,
install their stooge Morgan Tsvangirai, the leader of the opposition, who will allow them to repossess our resources.
British operatives are in the country now under disguise and have increased cholera and anthrax seeding.
There's been a replanting of cholera and anthrax.
This is serious biological and genocidal warfare on our people by the British still fighting to recall the name symbolic.
So you basically have all the words genocide, racism, sovereignty, invasion and so forth.
And this is just a narrow slice of the different ways in which cholera became quite common in a range of humanitarian discourses.
Discourses about human rights, about state media, about security.
All the while revealing a certain fundamental level.
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.
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,
but that cholera itself, the cholera epidemic itself had multiple ontologies.
It meant not only does it mean different things to different people,
but different sorts of institutions were responding to and acting on different versions of cholera that are all interrelated,
but not exactly the same thing. Now, overcoming this divisive politics kind of cohere around a sort of bottom line
agreement that there was nothing else more important than the saving of lives.
I call this in the book The Salvation Agenda.
It was one of the ways of understanding the cholera epidemic, not within the frame of its larger structural consequences,
or even its myriad political meanings, but rather through the narrow prism of cholera as a public health emergency.
Now, there are compelling reasons to think about the epidemic in this way. I'm just going to quote.
One actual church leader, a very pompous and charismatic white American Republican,
was making a fortune through a charismatic church in Harare, but that's a separate story.
And he had been visiting some of the cholera treatment centres in the country, including the one that appeared to wrote Infectious Disease Hospital.
And as he put it to me, I've visited Beatrice wrote infectious disease hospital and could not believe what I saw.
There are about 300 people outside with drips that were hanging from trees or from the fence.
I wanted to know why they were not in hospital. We went inside the hospital itself.
The place was covered in vomit and diarrhoea. We have to wear gumboots to walk through the mess, which was several inches deep.
The smell, blood, vomit, diarrhoea in Europe, there were bodies piled on top of bodies piled on top of bodies.
There were 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 they were not on drips and I was told they only had outlawed drips and these children would be dead in the morning.
And so the salvation agenda, I argue, Drew together the a host of different humanitarian, governmental,
legal medical organisations together and focussed minds on addressing cholera as a public health emergency
all across the country after the formation of the government of national unity in February 2009.
With cholera now recognised as a public health emergency, treatment centres were set up.
Large groups of volunteers did tremendous outreach work, both treating cholera, promoting safe hygiene practises,
distributing water treatment tablets, drilling boreholes and erecting water tanks where there wasn't a communal supply of water.
Undoubtedly, tens of thousands of people were saved from the disease, and it's likely that many more,
many hundreds and thousands of lives were spared from being infected at all.
And nevertheless, the resources and energy poured into the salvation agenda could never be anything more than short term after the outbreak.
No serious efforts were undertaken to change that health.
The public health and hydraulic infrastructures that were underlying the outbreak, especially since such fundamental and long term development,
were what seemed to fall out of the purview of responding to an epidemic as an as emergency.
And so I tried to raise the question in the book of what happens when we pluralistic conception of
what epidemics are and situate them within the depth of their historical and structural complexity.
So finally, I just want to reflect on a few of the narratives that people told me the meanings
and memories with which cholera has come to be built years after its occurrence.
And I point out that for the majority of my performance,
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.
Yet this anger has not translated into any effective political mobilisation for permanent change.
And so what I show in the work is the sense of both indignation and impotence that cholera has left in its aftermath.
Moreover, I argue that the multiple ontologies of cholera also appeared in the popular stories,
talked about it as cholera came to be discussed or committed to social memory as a health crisis,
a political economic crisis, a social crisis, as well as the crisis of expectations, history and social identity.
So to illustrate this with just a couple of examples, it's cholera ravaged the Harare's high-density areas.
Many Zimbabweans watched with concern and disbelief and eventually horror as scores of people succumb to infection.
And the first three months of the outbreak, before it was declared a national emergency,
the Ministry of Health promoted individual health behaviours extolling the virtues of personal hygiene as a way of dealing with the outbreak.
And yet. As one informant put to me, look at it this way,
if you have the power to give me water and you give me dirty water, I would say that you were killing me.
In other words, it was all good for the government to talk about health promotion and personal hygiene.
Yet all of that meant very little in the face of overwhelming structural conditions.
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.
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.
Look at the national railways and look at in itself.
It is a very important arm of the government that is supposed to deliver in terms of water and sanitation.
But there is nothing.
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.
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.
Yet there is no money for simple purification treatments. There is a lack of accountability, he says.
When you look at the situation with Xinhua, there was an accountability when when municipality was taking responsibilities of such issues.
But now that's gone. Xinhua is a corruption. It's a non-performing entity.
It's a white elephant, as it were. Now, this interlocutor of mine called favour unleashed this diatribe,
and I think it's less important for the veracity of his claims and more for what this reveals about the social welfare occupies.
The forms of frustration that he discusses show that the actions of Zen were no straightforward dereliction of duty for him.
Zimbabwe's once ruled by an expert, bureaucracies have self cannibalised through institutionalised greed that emanates from the
highest ministerial level and trickles down to even the most local forms of government.
This greed enriches those with access to power and leaves the poor to wallow in their own [INAUDIBLE].
Quite literally. And so the implacable ruthlessness of cholera left behind a spectacle of death as the bodies of its victims, the friends, lovers,
family and neighbours of my informants laid bare the political and class fault lines that marked the difference between
those who have full citizenship rights and those who felt they'd been excommunicated from the sphere of political concern.
So here we see an all too common sight, which was the number of people who are being delivered,
the number of cholera patients being delivered to hospitals in wheelbarrows because of the lack of ambulances.
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,
right? Key emphasis on the notion of no longer carrying.
These township residents vigorously questioned the nationalist narrative of liberation and sovereignty,
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.
This narrative came to be questioned in quite a profound way.
A teenage girl in Glen Norah complains that politicians in Zambia will talk about colonial times, but those times past long back, she says.
Even if you worked for the white people, they gave you everything you needed.
They understood some of the problems. Politicians don't understand our problems.
Similarly, a focus group participant I spoke to in the last quarter expressed her frustration
with Zimbabwe's post-colonial trajectory when she said I would rather be
banned from working on forced streets under the segregationist laws of the
Rhodesian regime and keep my dignity than live in a free Zimbabwe without water.
Now I think that these and other references to the more effective public service
delivery under colonial rule are hardly nostalgia for the Rhodesian era,
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,
development and nationalism. And the census is captured in the satirical cartoon that appeared in The Guardian in 2008.
It depicts a once you write police officer asking permission from then President Robert Mugabe for permission to arrest or cholera sufferers.
And in a sense,
the notion of arresting cholera sufferers was getting out the ways in which vast swathes of Zimbabwe's population had been left disposable.
How being hidden from public view was designed to make a socially and politically embarrassing disaster less
visible and a way of hiding the shortcomings of the multiple infrastructural failures that produced this moment.
I do want to say, though, that it would be a mistake to conclude that when my informants make forceful critiques
of the Zimbabwean government that they all uniformly agree about where the blame lies.
For many people, I spoke to the state, the ruling party, the opposition, national government, local government are not monolithic homogenous entities.
So while some discussions were dismissive of all and sundry, we're talking about Zimbabwe's myriad political failures.
Many others drew astute distinctions between different political, individual and institutional bodies.
Whereas Venmo was squad, people pitted the beleaguered Ministry of Health.
One of my informants, a middle aged woman called City, who's made her life growing up in the high density areas,
works as misuse and vendor and an all round street hustler, she describes herself.
And I asked her over an informal conversation. I was sorry.
I let slip in an informal, informal conversation with her. My disgust and how badly our government had mismanaged the cholera crisis.
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,
she will continue to support Mugabe until, as she puts it, death to us support for her.
The freedom that came as Zimbabwe's independence was an act of possession.
It was hard and patient and imbued with historical agency for her.
Mugabe remained the vanguard of liberation,
even as she looked at the born free generation and understood their sense of abandonment in contemporary Zimbabwe.
Come and talk to friends, Chibok were less sympathetic to this other government.
Speaking of their old lives and the truncated horizons of youth that they faced, they said We were born in poverty.
We will live in poverty and we will die in poverty.
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.
And so. And this presentation I've tried to highlight, I think.
Four key themes that come out through the book. One is try to understand the long term makings of an epidemic, right?
Epidemics have history that they do not appear from nowhere.
The other is I try to show how the cholera outbreak actually reveals the interconnections through many different facets of Zimbabwe's crisis,
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.
And here I argue that epidemics are many things at the same time.
They are biological phenomena that is an infectious disease occurring through a given population, an excess of normal expectancy.
They are a social phenomena as they spread through populations in socially patterned ways.
They are historical phenomena.
Often, the combination of multiscale political and economic processes that obtain over time, and they are political phenomena.
The declaration of an epidemic is almost always followed by political contests over the attention,
resources and priority that that epidemic should receive.
So epidemics have never only just public health emergencies or security threats.
Such a limited take on epidemics, I argue, should be challenged to the wider purview that this book suggests.
And I've also said here that outbreaks like cholera always produce and reflect social difference,
marking the contours of abandonment, rejection and exclusion.
So if you'll indulge me, I'm just going to try to conclude she has some very final reflections from the book.
And this is how I've chosen to close this. To close this study.
Disastrous epidemics such as Zimbabwe's cholera outbreak in 2008 and 2009 deserve our attention for what they
contribute to a general history of society as much as for what they contribute to the history of illness and medicine.
By listening to, reflecting upon and compiling the stories documented in this book with affect and connexion,
I hope that I provided a new perspective on a very dark time in Zimbabwe's recent history.
Through this work, I've immersed myself in the stories of how people suffer from treat, manage and argue about a hideous disease.
I've also shown how a disease touches virtually every aspect of social and political life,
thereby making the dense and intricate linkages between history and political economy,
infrastructures and public services, social relations and individual bodies.
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.
In the introduction, I describe cholera as a visceral experience, one that induces tremendous physical pain.
One whose ugly symptoms evoked shame and humiliation. And one that may explain how vulnerable and resilient bodies can be.
Writing about such experiences in a reflective and considered way over a long period
of time is a far cry from confronting the immediacy of cholera in the laboratory,
in the clinic, in the home or in official buildings where policy decisions are made.
Each of my informants spoke to me with depth and candour,
with sharpness of memory and with expressions of disgust and remorse that cannot be conveyed adequately by words on a page.
Indeed, I am not sure how well I grasped just what it was like to live through such an experience.
Perhaps it was simply ineffable. Nevertheless, the analytical distance afforded to me by such a project comes with its own unique perspective.
What I lack in the depth of anyone experience I came back through a more panoramic view of how cholera infiltrated different social,
institutional and political settings.
This Wide-Ranging view has impressed upon me that cholera outbreaks are most salient, not for the dramatic character of its particular events,
but for its exposition of how terrifying and fatal Zimbabwe's post-2000 political economic crisis was,
and of how deep into history the origins of seemingly short term emergency can extend to naivety,
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.
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.
So it's my sincere hope that this book presents vital lessons from yesteryear such that we,
as Zimbabweans, prevent the tragic loss of another cholera outbreak as a final thought.
This book has been about suffering and about political failures, but it has also been about hope.
When disaster occurs, when political life appears bleak, bleak when deadly illnesses strike with callous disregard.
There is always hope to be found in the qualities of compassion,
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.
So for these reasons, and to paraphrase, I'll be coming for the last time.
What I have learnt in a time of pestilence is that there is much more to admire in humanity than to despise.
Thank you very much.