Zimbabwe's Health Time Bomb

Zimbabwe’s isolation by the West following the recent disputed parliamentary election, in which President Robert Mugabe’s Zanu PF clinched a two-thirds majority, has accelerated the decline in living standards of ordinary people.

Although every aspect of life is affected by the implosion of the economy, the already ailing health sector has been hit hardest.

A crippling manpower shortage - as doctors, nurses, pharmacists, radiographers and laboratory technicians quit in large numbers to take jobs abroad - has combined with an inadequate supply of essential drugs in the midst of a ravaging HIV/AIDS pandemic to throw the country’s health delivery system into disarray.

The general economic decline, which has seen the country’s gross domestic product decline every year for the past seven years, has hastened the departure of qualified medical personnel, leaving junior doctors and nurses and trainees to run the country’s collapsing health institutions.

At Masvingo General Hospital, which serves hundreds of thousands of people in an area 300 kilometres south of the capital Harare, only two doctors are still in service. The country’s health ministry has decreed that 14 doctors are the absolute minimum necessary to serve the needs of the people.

In addition, the hospital’s infrastructure is collapsing. An awful smell emanates from the dimly lit morgue, as its refrigeration system broke down several weeks ago and cannot be repaired because of lack money and spares.

Maggots are now devouring the bodies, including that of Petros Jeka, an activist for the Movement for Democratic Change, MDC, who was allegedly murdered by youths loyal to the ruling ZANU PF party three years ago. No post-mortem has been carried out on Jeka’s body, as required before any trial can be held, because all the pathologists have left.

In addition to the flight of health professionals, the hospital’s boilers and laundry machines have broken down. The toilets have ceased to work because of lack of spares, and junior nurses carry water buckets to flush them.

A senior hospital official, who declined to be named, said, “We are failing to cope because we are understaffed and the situation is worsening by the day. If this continues, we are heading for disaster.”

Reports to the health ministry from Marondera General Hospital, 80 kilometres southeast of Harare, say rats are devouring corpses awaiting collection from the morgue, where again the refrigeration unit has broken down.

The situation makes a cruel mockery of ZANU PF’s slogan during the first decade of independence – “Health for All by the Year 2000”.

Many doctors and nurses who have left the country say they took the painful decision to go because patriotism does not put food on the table. Senior state hospital doctors earn little more than the equivalent of around 100 US dollars a month, while nurses’ salaries are around one-third that level.

“How can nurses work for peanuts while others live lavishly with hefty salaries and good perks?” said a nurse, now working in the United Kingdom but visiting her family in Harare.

Declining to be identified, the nurse told IWPR, “If you continue to labour in Zimbabwe today, you won’t achieve anything in life. You will be working for food only.

“I have managed to buy a house and a car in the short two years I have worked in London. If I had remained here, I would never have bought them.”

Low morale has taken a toll in health institutions countrywide. In rural areas, it is common to find health staff at clinics basking in the sun or doing their own private work because the centres have little equipment and drugs are in short supply.

The United Nations Children’s Fund, UNICEF, says the general decline in health services has been exacerbated by the HIV/AIDS pandemic.

Its statistics show that the under-five mortality rate has risen 50 per cent since independence in 1980. A spokesman said that one Zimbabwean child dies from AIDS-related infections every 15 minutes, while each day an estimated 100 babies are born HIV-positive from infected mothers.

UNICEF predicts that by the end of this year, some 160,000 children will have recently lost one or both parents to the syndrome, taking the AIDS orphan population to nearly one million in an overall population of just 11.5 million.

Lovemore Kadenge, chairman of the semi-autonomous Hospitals Association Trust that monitors delivery of services at state hospitals, said every hospital doctor is now doing the same work that five years ago was performed by at least seven doctors.

At Chitungwiza Hospital, on the outskirts of Harare, a single doctor has the impossible task of coping with 300 casualty and outpatient cases each day. Kadenge said the doctors’ and nurses’ workloads were multiplied because their departments are not computerised to help with administration.

Dr Agnes Mahomva is one of only two doctors at a rural hospital serving a quarter of a million people at Glendale, 100 km north of Harare. Inside, three-quarters of the beds and many pallets on the floors are filled with gasping emaciated people with AIDS.

Dr Mahomva is one of the diminishing number of doctors who refuse to give up. “As a technical person, I could go out and bang my head, or I can say, ‘What is it that I can do?’” she said. “There is still a lot we can do with the little we have.”

The Reserve Bank tried recently to throw a thin lifeline to the collapsing health sector. It allocated a million dollars of scarce foreign exchange to the state’s National Pharmaceutical Company, NatPharm, to purchase drugs to supply public sector health institutions for the next nine months.

But even the Reserve Bank itself admits this is an inadequate sum when measured against the scale of the need. And against a background of widespread hunger and food reserves that have almost run out, foreign currency will in future have to be diverted to grain purchases in an attempt to avert widespread starvation.

While hospital conditions deteriorate, the Community Working Group on Health, CWGH - a network of non-governmental civic groups - has described overcrowding and lack of proper sanitation in poor areas of Zimbabwe’s cities a health “time bomb”.

Itai Rusike, CWGH’s executive director, said overcrowding in Harare’s high-density poor suburbs had reached crisis levels, creating potentially “explosive disease epidemic situations”. Ailments such as scabies, last reported more than a quarter century ago, are reappearing, he said.

“This is a classic indication of the collapse of the health sector. It is a time bomb, a huge problem indeed,” he added.

Ngoni Mudege, the engineering director of the Harare-based Institute of Water and Sanitation Development, said that in the capital’s teeming suburbs, some houses designed to accommodate families of six were housing, on average, more than fifteen people.

He added that as a consequence of the overcrowding and lack of investment, the capital’s sanitation systems are breaking down, with waste piling up in sewage pipes. He told IWPR that many toilets no longer flush and said that in one area, some 1,300 people were sharing one communal toilet.

Bill Saidi, a distinguished Zimbabwean journalist who edited the Sunday edition of the Daily News until it was banned last year by the ZANU PF government, said that he was shocked by his recent visits to Harare’s two main hospitals, Parirenyatwa and Harare Central.

“The hospitals’ decline struck me as almost inexorable, as incurable,” he said.

“They were not pretty sights, and I came away wondering if this was not the beginning of the end of the world.”

Chipo Sithole is the pseudonym of an IWPR journalist in Harare.