Zimbabwe police Sunday clashed with vendors who were resisting being removed from streets as part of the country’s efforts to fight the cholera outbreak, which has claimed more than two dozen lives in the past two weeks.
Vendors were alerting each other of armed riot police and municipality officials coming to confiscate their wares Sunday in Harare. As soon as police officials left, the vendors would resume their business.
One of them is 34-year-old Maria Mange, a mother who three children who says unless she gets employed, she will remain selling vegetables and fruits in Harare’s CBD.
“I am refusing to leave the streets on the basis that we cause the spread of cholera,” she said. “Our wares are cleaned or boiled before being consumed. It is dirty water which causes cholera, their failure to collect refuse, plus flowing sewage in the streets and blocked sewer pipes. Why concentrate on vendors and not criminals?”
Another vendor is Ronald Takura who says he has to find a way to make a livliehood.
“No, vendors are not causing the cholera. You are disturbing [our] search for money in our country,” he said. “I do not have a job and I do not have work to do. So do not send us out. I do not understand what is happening in this city. E.D. Mnangagwa, we supported, we do not see what he is doing for us.”
He adds in Shona language, Zimbabweans voted for President Emmerson Mnangagwa in the July 30th elections, but he is not supporting the vendors.
But Zimbabwe’s minister of health, Obediah Moyo, says there is no going back.
“The issue of food vending is another issue, we all agreed that has to stop, especially in the area of epicenter [of the epidemic], that the police are helping us to stop the vending of food,” he said.
Zimbabwe’s cholera outbreak has since spread to several parts of the country from its epicenter in Harare’s densely populated suburbs.
International organizations such as UNICEF, WHO, and MSF have since moved in with assistance. But critics say the long-term solution is improving water supply, sanitation and regular waste collection by Zimbabwean authorities.
A cholera outbreak is the second since a 2008-09 epidemic claimed almost 5,000 lives. (VOA)
Worldwide cesarean section use has nearly doubled in two decades and has reached “epidemic” proportions in some countries, doctors warned Friday, highlighting a huge gap in childbirth care between rich and poor mothers.
They said millions of women each year may be putting themselves and their babies at unnecessary risk by undergoing C-sections at rates “that have virtually nothing to do with evidence-based medicine.”
In 2015, the most recent year for which complete data is available, doctors performed 29.7 million C-sections worldwide, or 21 percent of all births. This was up from 16 million in 2000, or 12 percent of all births, according to research published in The Lancet.
It is estimated that the operation, a vital surgical procedure when complications occur during birth, is necessary 10-15 percent of the time.
Varying country rates
But the research found wildly varying country rates of C-section use, often according to economic status: In at least 15 countries, more than 40 percent births are performed using the practice, often on wealthier women in private facilities.
In Brazil, Egypt and Turkey, more than half of all births are done via C-section.
The Dominican Republic has the highest rate of any nation, with 58.1 percent of all babies delivered using the procedure.
But in close to a quarter of nations surveyed, C-section use is significantly lower than average.
Reasons to opt for surgery
Authors pointed out that while the procedure is generally overused in many middle- and high-income settings, women in low-income situations often lack necessary access to what can be a life-saving procedure.
“We would not expect such differences between countries, between women by socioeconomic status or between provinces/states within countries based on obstetric need,” Ties Boerma, professor of public health at the University of Manitoba, Winnipeg, and a lead author on the study, told AFP.
Jane Sandall, professor of social science and women’s health at King’s College London and a study author, told AFP that there were a variety of reasons women were increasingly opting for surgery.
These include “a lack of midwives to prevent and detect problems, loss of medical skills to confidently and competently attend a vaginal delivery, as well as medico-legal issues.”
Doctors are often tempted to organize C-sections to ease the flow of patients through a maternity clinic, and medical professionals are generally less vulnerable to legal action if they choose an operation over a natural birth.
Sandall also said there were often “financial incentives for both doctor and hospital” to perform the procedure.
The study warned that in many settings young doctors were becoming “experts” in C-section while losing confidence in their abilities when it comes to natural birth.
Income a factor
It also identified an emerging gap between wealthy and poorer regions within the same country. In China, C-section rates diverged from 4 percent to 62 percent; in India the range was 7-49 percent.
While the U.S. saw more than a quarter of all births performed by C-section, some states used the procedure more than twice as often as others.
“It is clear that poor countries have low C-section use because access to services is a problem,” Sandall said. “In many of those countries, however, richer women who live in urban areas, have access to private facilities have much higher C-section use.”
Risks to mother, child
C-sections may be marketed by clinics as the “easy” way to give birth, but they are not without risks.
Maternal death and disability rates are higher after C-section than vaginal birth. The procedure scars the womb, which can lead to bleeding, ectopic pregnancies (where the embryo is stuck in the ovaries), as well as still- and premature future births.
The authors suggested better education, more midwifery-led care and improved labor planning as ways of ensuring C-sections are only performed when medically necessary, as well as ensuring women properly understand the risks involved with the procedure.
“C-section is a type of major surgery, which carries risks that require careful consideration,” Sandall said.
In a comment accompanying the study, Gerard Visser of the University Medical Centre in the Netherlands, called the rise in C-sections “alarming.”
“The medical profession on its own cannot reverse this trend,” he said. “Joint actions are urgently needed to stop unnecessary C-sections and enable women and families to be confident of receiving the most appropriate care for their circumstances.”