Disease outbreaks are her forte. She joined the Department of Epidemiology and Disease Control in the Ministry of Health and Child Care in 2006 as a programmes manager for malaria. Her experience in dealing with outbreaks includes SARS (2003), H5N1 Avian flu (2005), H1N1 Influenza (2009) as well as Ebola (2013).
On the local front, she has dealt with cholera, typhoid and measles epidemics since 2008. Our Gender and Community Editor, Fatima Bulla, caught up with Dr Portia Manangazira, whose work, particularly in light of the crisis caused by the deadly coronavirus pandemic, is under the spotlight.
Q: So, you are responsible for the health of Zimbabweans . . .?
A: My directorate has some of the core functions of the Ministry (of Health and Child Care). I have four sub-directorates — the health information and surveillance; health promotion; communicable diseases control; and non-communicable diseases control. The ministry has 17 directorates, so there is a lot of other work that we do, but my work depends a lot on their functioning.
Because of the nature of the work, you end up doing a whole lot of other things. For example, planning and utilising results of key surveys/research within the country. Which means I have to sit on the Medicines Control Authority of Zimbabwe and Medical Research Council boards, and also do a lot of other work.
Q: What are some of the highlights of your work?
A: In 2008 we planned the prevalence survey for bilharzia and intestinal worms, and then we managed to get resources for that survey in 2010. And in 2012 we started the programme. It is recognised by the World Health Organisation (WHO). So in terms of responding to challenges of the health status of the nation, I have managed to come up with programmes that are very effective. The challenge we faced with the 2008 cholera outbreak is that it was huge and unprecedented, and we were chasing after the outbreak.
So this is why we lost a lot people and a lot of the districts, except seven, had cases of cholera. It lasted almost a year. And yet an outbreak is supposed to last for a short duration. We should have done the controls within two weeks and by the time it finishes, you have not lost too many people. So because of those challenges we have managed to draw up programmes for cholera and typhoid.
For measles, we had a major challenge. We had an outbreak in 2010 up to 2012, with 55 of our 63 districts reporting cases. We scrutinised our data and statistics, which come from the health facilities. We discovered that we had pockets of objectors, resistors and vaccine hesitators.
So that information allowed us to talk to our principals and our legislators for assistance. We realised we had to vaccinate five million children, so we did not want to miss those resistors. We hit 98 percent coverage and from 2012 up to now, there has not been a single case of measles in the population.
The Human Papilloma Virus programme is a major crisis in this country and, again, I hold the non-communicable diseases portfolio. You read the national statistics and it makes you want to cry.
And you hear that there is a vaccine that can protect our little girls from getting cancer when they are older. Why not introduce it? So again when we prepared for that programme of vaccination for HPV, we now have more than one million girls protected in this country. And WHO recognised it, they actually call it a star programme at their regional office. And that is the fuel that keeps me going.
Q: At what level do you place the battle against coronavirus compared to other outbreaks that Zimbabwe has had to deal with?
A: We were not prepared for what Covid-19 has now become. Unlike some of the above-mentioned outbreaks like cholera, we planned for Covid-19 before it happened. Our health delivery system might be having challenges but it has a very firm foundation and structural integrity in terms of its arrangement; the way we have central, provincial and district health facilities.
The way central Government works with local government, faith-based institutions and uniformed forces to form a public health delivery system is also quite massive. So we always can get information from almost 80 percent of the country on health events; that is, the national health information and surveillance system. We also have partners that we work with and we already have a coordination arrangement, outbreak or no outbreak. So when it comes to preparing for outbreaks, it is really just about revitalising and activating those systems that exist.
So for Covid-19 we have already been having a lot of alerts and we are following up whoever came from a Covid-19-reporting country.
And we are responding to the threats. But now we are in the process of ensuring that all provinces are equipped so that people do not travel long distances when they are not well. Also making sure that the health personnel are trained and with the Presidential declaration, it takes it much higher, everybody is on board.
We are not done yet, we are still thinking there might be a few cases but the job is to make sure the system is ready, staff has been trained and have done the necessary drills so that we do not lose staff in the process of monitoring or treating of Covid-19 cases. We have also been fortunate to team up with the Chinese government and their team of doctors who had already been in the country working with us closely.
Q: Public spaces are teeming with people. Is this not a ticking time bomb as far as Covid-19 is concerned?
A: The urban arrangement is too overcrowded and it has become too unregulated. Urban areas are supposed to promote health. We have urban environments that are killing people by putting them in a very limited space and then denying them even basics like a road so that garbage can be taken out. Housing is not in line with our urban planning. The housing standards contradict the Public Health Act.
Water must never be fetched from a hole in the earth when you are living in town, it’s contravening the Public Health Act. Even borehole water is not for drinking, it must be pumped into a tank and treated, and periodically analysed for quality checks. You never know what is happening underground. Some boreholes are on the downside of cemeteries, sewage works, dumping sites — so there will be seepage.
You might taste your borehole water today but in the next three weeks it’s totally different. If you don’t have potable water in urban environments where there is crowding of people, you are inviting a whole array of public health challenges. So we have invited a lot of problems into our lives.
Q: There is a belief that you conceal information, especially about outbreaks like Covid-19. What is your comment?
A: When people speak, it is a reflection of their own thoughts. We have a lot of goodness in this country, but we have quite a number of bad eggs. I have seen a lot of this suicidal thinking and activities. For me, these are the people who want to teach me how to do public health and how to maintain professional integrity. I have issues with that. We have a very firm grounding in terms of our systems for health delivery.
We have seen a lot of this kind of wickedness and carelessness on social media. Somebody just posts something and they start laughing about something of the magnitude of Covid-19. They trivialise it. We have a lot of lived experiences. China overcame this pandemic and we have good collaboration with them. They came up with 15 temporary hospitals and today they have been closed. And this is less than two months.
Q: If an outbreak happens with 55 beds available, how will you manage?
A: Those are important questions and considerations. But what we should also remember and we do not quite talk about it, is the importance of maintaining continuity of operations. You would want to make sure that the services that are usually rendered at Parirenyatwa or even Mutare Provincial hospitals continue.
According to the ministry management, we would want to make sure that at least every district hospital has an identifiable space. But our key points of entry have an isolation facility and a conduit to moving those patients as fast as possible to the case management facility. So we are happy the alerts have been good from the public.
Q: How well are health personnel protected from Covid-19?
A: I suppose this is part of the nationwide and system-wide challenge to say the health delivery system has not been in a good state. Perhaps this crisis is an opportunity to improve because we have put forward a budget to make sure that the isolation facilities have requisite infrastructural adjustments for infection, prevention and control, but we have also requested for those health workers to have allowances and adequate personal protective equipment. The only challenge is most of those things come from outside the country, some of the supplies take a bit of time. But something is being done, especially now that there is the Presidential declaration.