This is an important and timely book that offers a compelling account of the lived experience of Zimbabwe’s 2008–09 cholera outbreak, with a careful analysis of its origins and development, the politics surrounding the response, and the epidemic’s aftermath in Zimbabwe’s townships. The book’s core contention is that the epidemic – and the multiple crises it reproduced – was a result of the interconnection of history and politics surrounding the transformation of the Zimbabwean state, its public health infrastructure, structural inequalities and political-economic crisis.
Through a nuanced historical and political analysis, Chigudu makes three key arguments: first, in Chapters 1 and 2, he argues that the epidemic was a ‘man-made disaster’. Historical and political decisions (by both colonial and postcolonial states), including urban planning defined by racial segregation and spatial inequalities, failed public health infrastructure, and the postcolonial government’s struggle to maintain political power ‘converged to create a “perfect storm” for a ruinous cholera outbreak’ (p. 86).
Second, Chigudu discusses what he terms ‘multiple ontologies’ to show the different forms, experiences and meanings the cholera epidemic took. For Chigudu, these produced ‘fraught and contentious politics’ among different actors (p. 192). As he persuasively argues in Chapter 4, these different ontologies shaped a ‘salvation agenda’ that offered short-term responses to the epidemic, but both perpetuated existing social hierarchies and failed to provide long-term structural development.
Third, the exploration of historical memory and political subjectivities generated by the epidemic illustrates political consciousness amidst feelings of abandonment by the state. In Chapter 5, we see a complex shift from a politics of disposability to that of expectations, adaptation and survival. What I find striking here is how the cholera epidemic shaped new experiences of citizenship and claims making among Harare’s township residents despite disturbing histories and existing structures and layers of inequalities and violence. Alongside cynicism, political failure and feelings of dispossession by the state there is a sense of expectation and optimism. Chigudu himself affirms that the book is about both suffering and political failures as well as hope (p. 204).
This suggests that the cholera epidemic shaped new political possibilities and directions by feeding into aspirations for substantive citizenship and inclusion and concerns about rights in Zimbabwe. While the book offers an excellent discussion of the interconnection and convergence of the politics of disposability, expectations and adaptation, it does not provide much interpretation or explanation for the reasons for hope. Why are people optimistic where little social transformation has been observed and ‘patterns of risk and vulnerability, [and] pre-existing social inequalities have barely shifted’ (p. 183)?
In his concluding remarks, Chigudu uses Zimbabwe’s cholera outbreak to offer insights into other major epidemics in Africa, such as the 2014 Ebola outbreak in West Africa. Indeed, studies on Ebola, such as Paul Farmer’s Fevers, Feuds, and Diamonds,Footnote 1 reiterate Chigudu’s concern about epidemics as social and political phenomena. Farmer, for example, traces social and health inequalities to the colonial period and discusses historical material conditions and the lack of public health infrastructure as factors that influenced the spread of Ebola in West Africa. As in the case of Zimbabwe, the humanitarian response and a focus on epidemics as public health emergencies left the material context that produced and influenced the spread of disease unchanged. But there has also been room for innovation. As Chigudu shows, following Zimbabwe’s 2008–09 cholera outbreak, the country’s Ministry of Health ‘formulated a comprehensive and sophisticated detection and control plan for epidemic disease through the use of its Integrated Disease Surveillance and Response protocol’ (p. 185). Although Chigudu argues that this strategy was ‘reactive’ rather than ‘preventive’, over a decade since its formulation and in the light of the ongoing Covid-19 pandemic, I wonder whether this has provided any impetus for new configurations? Or has it simply reinforced the same historical patterns of epidemic control and response?
The world over, the global pandemic (just as was the case for Zimbabwe’s cholera outbreak) has revealed the vital role of a robust public health system and the importance of the state in public health and social protection. It has also led to the reconfiguration of livelihoods, care, kinship and family. Clearly, epidemics and their responses have the potency to interrupt and transform people’s social and economic lives. Livelihoods are severely curtailed and interrupted, affecting families and the wider social networks on which people rely for financial and social support. Epidemics also bring us closer to the intimacies of everyday life by affecting and reshaping kinship, religion, burial practices, sexuality and relations with strangers and health workers. I am curious to know more about how cholera epidemics have redefined social solidarities and the ways people relate to and care for others in Harare’s townships.
Overall, Chigudu’s is a fine and timely book offering insights into critical public health issues amidst the global Covid-19 pandemic. The books opens up important questions about urban public health, citizenship, political power and humanitarianism.
