LUSAKA, ZAMBIA — In Kanyama, a bustling township in Lusaka, Josephine Mwanza watched in horror last year as her mother, Christine Banda, suffered violent bouts of vomiting, hours after they shared a meal on a hot afternoon. Banda had complained of a stomachache the previous day and her frequent trips to the latrine alarmed her daughter. The dread of cholera, a constant threat in their community, became a terrifying reality as her health rapidly deteriorated.
In desperation, Mwanza turned to her phone, frantically seeking taxis to take her mother to the hospital. Many drivers, driven by a fear of contagion, backed out at the mention of vomiting and diarrhea, well-known symptoms of cholera. As her mother’s condition worsened, Mwanza raced to the roadside, hoping to find a willing driver, only to face rejection.
Left with no choice, Mwanza resorted to transporting her mother to the hospital in a wheelbarrow, navigating the dusty streets of Kanyama to the facility 5 kilometers (3 miles) from her home. But it was too late. Banda, 56, died a half-hour after their arrival.
Mwanza’s story mirrors the plight of many in Lusaka, Zambia’s capital, where late hospital admissions for suspected cholera cases due to transport challenges exacerbate an outbreak that began last year in October. As of June 6, Zambia recorded over 23,000 cases of cholera, with 740 deaths. The outbreak has slowed but is ongoing.
Sylvia Masebo, Zambia’s health minister at the time of the interview, attributes 80% of cholera fatalities in the country to delayed admissions. According to the Ministry of Health, over 400 of those who died during the outbreak never reached a hospital, reflecting the inadequacy of ambulance services that operate at less than 25% capacity. Due to the scarcity, the government had to find other vehicles to transport patients to a special cholera center set up at the peak of the outbreak at National Heroes Stadium, a 50,000-capacity football venue, Masebo says. She says the government, looking ahead to future outbreaks, is working to acquire additional ambulances.
Zambia’s first cholera outbreak was reported in 1977. The disease became a recurring health issue in the country after 1990 with outbreaks occurring every few years, predominantly impacting informal settlements that have limited access to municipal water and sewage systems. These settlements also are often located far from hospitals, making it harder for patients to access timely medical treatment during outbreaks.
A few kilometers away from Mwanza’s home, a family still mourns their grandfather, Edson Phiri, 72, who succumbed to cholera in December 2023.
Reuben Phiri says his grandfather started vomiting and purging at about 11 p.m. They couldn’t find any transport at that hour and the oral rehydration solution — a mixture of salt and sugar — didn’t help.
“In the early hours, I walked to the roadside to find a taxi. But before I could even approach one, I was called to say the man had passed on,” he says.
Masebo says the country’s inability to use ambulances to transport cholera patients stems from the limited number of vehicles and the risk of cross-contamination, which could endanger other patients if vehicles aren’t properly sanitized.
Anthony Mwewa, a taxi driver, says he inquires about a patient’s symptoms and avoids transporting them if they mirror those of cholera. “Cholera’s contagious nature means that any contact with a patient’s vomit or fecal matter poses a significant risk of infection,” he says.
Lazarus, an ambulance driver tasked with transporting patients from local health facilities to the cholera center at the stadium, fears carrying the infection home to his family. Lazarus, who asked to be identified only by his first name because he is not authorized to speak to the press, says he worked about 10 to 12 hours daily at the height of the outbreak and transported more patients than he could count.
“These times have been incredibly hard. Constantly moving from one clinic to another, my appetite has vanished. Upon returning home, I always shower in the outdoor bathroom, disinfect and change clothes before I dare step in the house. Transporting patients has been an ordeal filled with stress and fear,” he said in an interview at the peak of the outbreak.
Lloyd Mulenga, director of infectious diseases at the Ministry of Health, says the drivers’ apprehension is understandable since cholera spreads through consumption of contaminated water or food.
Mulenga highlights the ministry’s efforts to equip drivers who transport patients with necessary protective gear, including disinfectants, gloves and masks.
“Despite the risks, we are facing a crisis that requires mutual assistance. We’re committed to ensuring vehicles are thoroughly disinfected and drivers are provided with gloves after transporting a cholera patient,” Mulenga says.
Taxi drivers often face a tough decision between their health concerns and the urgent need to transport patients to health facilities. Kennedy Kalumbu chose to transport patients, but with heightened precautions. “I consider each patient as if they were my own family member in need,” he says. Kalumbu doubles the regular fee of 50 Zambian kwacha (2 United States dollars) to cover the costs of vehicle cleaning and sanitizing.
President Hakainde Hichilema has mandated each of the country’s 156 constituencies to use the 2024 Constituency Development Fund, a government initiative designed to finance community-led development projects across the country, to acquire at least one ambulance.
But for those who’ve lost loved ones, like Mwanza and Phiri, the aid comes too late. “I hope the government addresses these transport issues sooner. What’s the use of hospitals if we can’t reach them?” Mwanza says.