An outbreak of cholera in
villages outside Binga, a small town in north-western Zimbabwe, in January has
exposed the present state of affairs of the country health delivery system.
by Rodrick Mukumbira
Three days after the outbreak, Binga's political and medical
leaders had gathered at the town's hospital to discuss and see if they were well
placed to deal with the epidemic.
But nothing was in order. The hospital had no intravenous solution for
rehydrating patients, a most important tool in the battle against cholera. Like
many other towns in the country, it had no water purification solutions.
The tents used to isolate cholera cases were, according to one old man, "in
tatters". The doctors needed large amounts of salt, sugar, bleach, soap, fuel
and candles but none was on hand.
The hospital's ambulance was in the garage and the tow-way radio used to
communicate with rural clinics was not working.
Only a decade ago, Zimbabwe's public health system was the best in the
sub-Saharan Africa. But like the rest of Zimbabwe's economic and social fabric,
the health delivery system is now in the state of dissolving.
Three years of economic free fall and inflation, now averaging 620 percent a
year, have left Zimbabwe desperately short of even basic drugs and medical
equipment, pushing a once robust network of hospitals and hundreds of rural
clinics close to ruin.
Experts say the decay omens potentially far more serious problems - outbreaks of
diseases like cholera and anthrax that spread when preventive measures are poor,
and deadly childhood epidemics like measles, which exist only when public health
defences are down.
Zimbabwe's government does not discuss details of its public health. In January,
an association of medical doctors said there were 10 doctors left in the capital
Harare and the second largest city, Bulawayo.
According to a World Health Organisation-financed report, fewer than 600 doctors
remain in the country to serve a population of 13.5 million, the rest having
moved to such countries as Britain, Australia or Zimbabwe's neighbours, Botswana
and South Africa.
"Basically, the health care system is collapsing on itself right now," said
Richard Chidowore, a Harare medical professional. "There's an exodus of health
care professionals from this country. And most of the rural health structures
have been left under the supervision of nurses' aides who have nothing to treat
patients with."
The human toll of such breakdowns is difficult to measure precisely, but the
anecdotal evidence is chilling with health professional estimating over 1 500
deaths a week due to AIDS.
Two physicians who sought anonymity told NewsfromAfrica in separate interviews
in January that in the space of six months last year, half of Harare's
kidney-dialysis patients died, all because the government did not spend its
scarce foreign currency to buy catheters for blood-cleansing equipment.
In Bulawayo a shortage of sutures and other equipment has closed operating rooms
and forced obstetricians to curtail Caesarean-section births. Some women have
died in labour as a result, said Doctor Lulu Phiri, who often works in the town.
The public health system that remains here, experts say, persists on the
astonishing dedication of those health workers who have stayed.
Foreign aid, largely from global charities and the United States, Britain and
Europe, has saved Zimbabwe from running entirely out of drugs and medical
supplies.
Recently, the European Union pledged $30 million in aid to buy medicine and
equipment for clinics. Only in December, the United States made a last-minute
donation that enabled the government to buy the chemicals that keep the
municipal drinking water used by more than two million people in Harare and
Bulawayo pathogen-free.
Zimbabwe, of course, is hardly alone in its misery. Public health neighbouring
Zambia and nearby Malawi, to cite two - face even worse problems.
What distinguishes Zimbabwe, however, is the depth and rapidity of its fall from
the top rank of healthy nations to near basket case.
Yet no one outside Zimbabwe's government knows with certainty how deeply the
crisis in public health runs here. The network of clinics and doctors has frayed
so badly that experts suspect the data once routinely dispatched to
statisticians are no longer reliable.
But evidence of the decay in health care is overwhelming. A recent stroll
through the Parirenyatwa public hospital in Harare showed that staff shortages
had shuttered whole corridors. At a second major hospital, Harare Central, the
laundry has stopped working. In the paediatric wards, blood work-ups are no
longer performed in-house because of equipment and staffing problems.
Refrigerators in the overstuffed morgue, where corpses can remain for up to six
months, are not working.
A Harare resident who gave his name only as Thomas told how his father-in-law
was rushed to a city hospital in November with high blood pressure and breathing
problems, only to discover there were no doctors to see him. Shortly after
Christmas, a stroke left him paralysed on one side. "We took him to Suburban
Hospital," a private institution, Thomas said. "They wanted Z$900,000 (approx.
US$300) as a deposit for admission."
Thomas could not raise the amount and so he took him to a clinic where he was
given a prescription and asked to take him every day for an injection.
Thomas paid Z$250,000 (approx. US$80) for medicine, needles and syringes, and
ferried his paralysed father-in-law to the clinic for the daily injection.
Within days, he was dead.
But Zimbabwe's crisis is most painfully apparent not in the cities, but in rural
areas. There, doctors and patients alike say many of the hundreds of local
government clinics now have no working radios, refrigerators or trained medical
workers, and often few medicines are inadequate.
Zimbabwe's economic crisis has made fuel so costly that vaccines and other drugs
can no longer be reliably ferried to faraway villages.
"Zimbabwe used to run its own immunisation program. In fact, it was the only
country in sub-Saharan Africa which could buy all its own vaccines," said Chris
McIvor, an official from Save the Children, a Canadian global aid organisation.
"But by 2000, it couldn't afford it."
So Zimbabwe's immunisation programs, once exemplary, now provide coverage below
70 percent for some major childhood diseases.
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