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The surge in diarrhoeal diseases over the past few weeks as rains set in shows the gaps in sanitation and hygiene that must be fixed if we are to avoid the loss of lives, which so far are fortunately few, and the burden on our health resources or treating eminently avoidable diseases.

Typhoid used to be a serious killer in many countries. Fortunately it is a bacteria that is not only treatable by antibiotics, but the time lapse between first symptoms and death, more than two weeks, means there is time to get patients to medical treatment and time for this treatment to work. 

This is different from, say, cholera where there is so little time to act in between first symptoms and death.

So on one sense the fact that Harare has seen at least 20 cases of typhoid this month, with more than 80 more suspected cases, is not that worrying. 

But in another sense it is extremely worrying, because the only known way typhoid spreads is from food or water contaminated by the faeces of infected people. There are no other possible lines of infection. 

Unlike some related salmonella diseases, infected animals cannot be involved.

So typhoid is a major indicator of when such contamination can occur, and any centre of infection is also a point where sanitation has broken down and hygiene is not religiously followed. 

The problem is that is remarkably easy in much of Harare Metropolitan. Sewage overflows and sewer leaks are common, so we do not have to search for potential sources of contamination. 

They are easy to find in Harare and Chitungwiza, let alone the septic tank and latrine set ups in parts of these major authorities and in other places throughout the province.

Hygiene should mean that even with contamination from broken sewers, people will not eat contaminated food or drink contaminated water. 

And here we come to the next service breakdown. There is a lot of good advice on simple hygiene floating around. Basically they involve washing vegetables and making sure hands are properly washed, “under running water” before you cook or you handle food or touch other people.

But washing involves water, and moderate amounts of it especially if you are using running water. Yet much of the metropolitan area does not get 24/7 water supplies, a fair swathe do not get daily water, some get weekly water, but not always, and some get nothing. 

When you are using wells or other sources that can be contaminated for your water supply you risk contamination yourself.

While the Government has started drilling boreholes in several suburbs, which is a major help, there will be people who either could not be bothered or, when decent rains are falling, are willing to risk scooping water from a small stream down the road rather than pushing a wheelbarrow for even a few hundred metres. 

This was in addition to the scheme to drill boreholes in every rural village. Rigs are already working on the borehole drilling, with more rigs on order.

But while the rural scheme is a fundamental leap for rural communities in giving them assured water supplies, the urban component is the Government stepping in to ameliorate some of the failures of urban authorities, who are all supposed to have a 24/7 water supply for all residents.

The one major urban authority with a good reason for intermittent water supplies, Bulawayo City Council which faces acute shortages of raw water in its supply dams, is the one authority unable to fulfil its 24/7 mandate that does have an effective and workable rationing scheme that ensures everyone receives water two or three days a week. 

That contrasts with the hodgepodge of water delivery in say Harare where some get it every day, some sometimes and some never. Hence the Government’s inclusion of suburban boreholes in its village water schemes.

This fairly obvious failure to keep sewage and available water supplies, which might be informal, separate breaches the basic public health requirements. 

An extra problem, again in Harare, is the intermittent collection of garbage. The target at present is once every two weeks, but there is no adherence to specific days. 

There was a time, more than 20 years ago, when a household could expect a collection early on Wednesday mornings, for example, and had the bins and bags lined up for the truck. Now it can be any time on any day of the week, and only approximately once a fortnight. 

Even the most committed household, the one that carefully bags its garbage in sealed bags, which each cost more than a loaf of bread, finds that flies breed and smells can become quite bad. 

Those that rely on bins face additional problems, and find the cost of a large bin bag being more than a loaf of bread more than they can afford. 

So there is the temptation to sneak out and dump it in the nearest public semi-open space, and the flies just go and breed there. So besides the actual unsightly mess, and the clogging of streams and open drains, there is also the risk of fly-borne diseases, and there are quite a few of these. Some observant people have even noticed dumped disposable nappies, which can be a sign of contamination of water-borne disease.

We are once again up against the problem of a range of local authorities unable to fulfil the basic services they were set up to run. 

Harare City Council started as the Salisbury Sanitary Board, which gives an indication of what its main job was. 

The board had to organise the removal of sewage and garbage and ensure that public wells and water courses were not contaminated, and that is where the city council must start.

A large city in the 21st century should be able to do these basic functions almost automatically and as a matter of course, not as some sort of special favour to residents, and be concentrating its creative energies on providing the higher level of services. 

Instead the present council in 20 years has halved the water supply, allowed ever more sewage faults, and halved the collection of garbage. 

This is with the growing population in the background, which probably demands that these services available to 2 000 needed to be doubled.

The result is the health problems, which are sort of controlled at present, but when an outbreak of typhoid is treated as something normal, as if sewage-contaminated food and water can ever be normal, we have reached a very low expectation of what life should be like in our capital city.