Matirasa Muronda
24 August 2007
analysis
Nairobi — Ten years ago, Zimbabwe's public hospitals were among the best in Africa until the country's economy started falling apart. There seems to be no end in sight unless, writes MATIRASA MURONDA, the country fixes its politics
Mt. Darwin District Hospital 120 kilometres from Harare.
A group of people queue outside a dilapidated house in Mbare, one of the oldest suburbs in the Zimbabwean capital, Harare. Three sickly looking ones lie on their backs facing the scorching sun while more than five others, who look tired, lean onto the dirty walls.
Relatives flap pieces of cloth just above the faces of their beloved ones lying in agony, some too weak to shoo flies away. Meanwhile, a middle-aged man comes out of a room with two people supporting his wasted body from both sides before a young woman calls for the next client to come in.
Mt. Darwin District Hospital 120 kilometres from Harare.
This has become the order of the day in Zimbabwe where many people are resorting to traditional healers in the wake collapsing health infrastructure as the once-prosperous economy sinks deeper into crisis.
Patients are turned away either because nurses and doctors are on strike or the nurse on duty couldn't make it to work because there was no transport from her home.
This might sound "mischievous" but a crippling fuel shortage means that there is no transport to work. In this southern Africa nation, it is understandable if workers either come to work three hours late or never turn up.
As a spin off of the economic crisis, patients are being diagnosed with various ailments and told to buy themselves medication from expensive, privately owned pharmacies beyond the reach of most Zimbabweans.
With the private pharmacies and hospitals way above the means of salaried Zimbabweans, the option is the traditional healers known as n'angas in the Shona language spoken by the majority of Zimbabweans from the Northern part of the country.
A good number of people suffering from diseases that range from the complicated HIV/Aids to running stomachs are flocking to traditional healers for treatment at a minimal fee.
Many are dying while being attended by the n'angas, which complicates matters because the law considers such deaths as happening in "unclear circumstances", meaning police have to investigate such deaths.
Ten years ago, Zimbabwe's public health sector was among the best in Africa.
But today, people no longer trust their health workers because hundreds of nurses and doctors believed to have been well trained when the sector was still efficient have left the country for greener pastures.
The brain drain aggravates a situation where, in a population eight million, at least 1.7m are HIV-positive.
The Government is trying to provide free treatment to people living with HIV/Aids but according to some health experts, this might just be a dream for many patients have been on hospitals' waiting list to get ARVs for months.
Ironically, the country exports some types of ARVs but owing to a severe shortage of foreign currency, things boil down to a matter of weighing priorities.
Currently, it seems health is not on top of the priority list because of serious food and fuel shortages. Even electricity has to be imported from South Africa and the DRC. As a result people are dying while on waiting list.
Some concerned health experts say the current upsurge in research on herbal medicine might alleviate the impact of the HIV/Aids pandemic on other sectors like agriculture.
Others don't trust the researchers owing to the precedent set by quarks who have introduced ineffective herbal medicines in the market, killing more people in the process.
In spite of the criticism, patients are opting for the treatment they can afford rather than wait for death.
Zimbabwe is not only grappling with HIV-Aids. Of major concern at the moment are kidney diseases. Out of the 18 dialysis machines at one of the country's major referral hospital chains, the Parirenyatwa Group, only eight are working.
In the second largest city in the country, Bulawayo, only one dialysis machine is functional at Mpilo Central Hospital.
Zimbabwe has about 2,000 kidney patients and it is estimated that owing to the HIV-Aids pandemic, up to 500 new cases are being recorded every year.
Patients supposed to be connected onto the haemo-dialysis machine for five hours are there for three hours so that others can also have toxins removed from their blood. Renal patients are supposed to undergo this process three times a week but many are lucky if they are connected twice a week.
Sheer incompetence is also taking its toll. Recently, Vice President Joice Mujuru criticised the Health Ministry for letting 18 dialysis machines to gather dust in Bulawayo as people died of kidney failures. Also, several kidney-related deaths have been reported following the lack of effective assessment and treatment from public hospitals.
As the health delivery system fails, patients suffering from other life-threatening diseases usually beg from well wishers for assistance to get treatment in South Africa where facilities are better.
Just a few are lucky to get this kind of assistance while many die at home.
Hospital administrators in urban centers have always indicated that the rural-urban influx exerts pressure on health facilities that were never meant to cater for huge populations.
In the past 20 years, there has not been any significant expansion of the health facilities even as new suburbs cropped up in all major five cities.
The rural to urban migration has presented several public heath challenges as more people live in squalor, unable to afford decent urban shelter. The result has been the outbreak of water-borne diseases, such as cholera, and indulgence in prostitution hence aggravating the HIV-Aids situation in the country.
Harare has three squatter camps, Epworth, Hopley and Caledonia, which were created after the popular operation clean up two years ago.
The operation targeted unplanned settlements.
Five years ago, it could safely be said that the residents of such settlements were classified as poor. But now, with inflation estimated at 10,000 per cent, 70 per cent of people living in towns.
They are poor because it is difficult for a teacher or a nurse to look after a sick child or relative when he cannot afford household basic necessities.
Courtesy of the inflation, the cost of burial is sometimes more painful than the death.
At least one needs up to $500 (Sh33,000) to cover burial costs, which includes taking the body for burial at one's rural home as is the norm.
But because many workers earn far below what is required to buy them food for a month, they end up burying their beloved ones in the cities, exerting pressure on urban cemeteries.
In desperate situations, especially in the illegal settlements, there are horrific incidents of illegal burials on open spaces or in some cases, people discreetly taking bodies to a nearby cemetery, digging up another grave and burying the body on top of another.
Last year two people at Hopley settlement were arrested for burying an uncle in another person's grave after failing to raise money for a burial site.
Mortuaries are also teeming with uncollected bodies. Consequently, Hospitals are not accepting bodies of people who die at home. Also, relatives disappear on receiving death notifications to escape shouldering the cost of burials.
Under the laws of Zimbabwe, public hospitals are expected to keep unclaimed bodies for at least six months but owing to the high death rate, they are disposing of them after three months.
Health facilities in the rural areas are better although they are still very few and inaccessible to many people. There is a good number of Church hospitals, which are now more reliable because they don't rely on the Government for supplies.
But Zimbabwe's problems are all over.
Because economic problems replicate themselves in all sectors, there is a serious shortage of food in the country. Clothing retailers have even run out of stock following an edict that requires manufacturers and retail shops to slash prices to the June 18 level.
As poverty bites, Zimbabwe is churning out economic refuges. It is estimated that over a million Zimbabweans are living in South Africa and Botswana, a good number as illegal aliens.
As happens in such circumstances, the hosts have become hostile to Zimbabweans, many of whom are suspected of engaging in crime.
There are multiple reasons why there seems to be no end in sight to Zimbabwe's problems.
As is the case elsewhere in Africa, ruling parties enjoy overwhelming rural support, which is the case with President Robert Mugabe's ZANU-PF. In the last Parliamentarian elections in 2005, when again the ruling party won almost all the rural seats, the general consensus was that with all the suffering a round, there was need for serious voters education.
It is apparent that for many people voting simply meant, casting your vote for ZANU-PF, with the interpretation of voting and what it meant misunderstood.
Many still do not understand the effects of where they cast their votes. Intimidation and torture also frightened them into voting for the status quo.
The opposition Movement for Democratic Change enjoys urban support but it has been very difficult for urban people to engage in mass action because of the government's highhandedness.
Demonstrations are brutally broken using live ammunition hence fatalities. Not spared has been the Movement for Democratic Change's Morgan Tsvangirayi who, months ago was bludgeoned by police.
As things stand now, Zanu-PF's grip on the country is far from loose. Zimbabweans are pinning their hopes on the Zimbabwe crisis talks currently being chaired by South Africa's Thabo Mbeki. However, Mugabe's regional clout means that not even Mbeki can take him head on.
Africa Insight is an initiative of the Nation Media Group's Africa Media Network Project.
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