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ith Health System in Tatters, Zimbabwe Stands Defenseless
By MICHAEL WINES
Published: February 5, 2004
INGA, Zimbabwe Three days after getting word that cholera was
again killing villagers outside this district capital, Binga's
political and medical leaders gathered at the town's disheveled
hospital to take stock of their arsenal against a potential
epidemic.
It did not take long.
They had no intravenous solution for rehydrating patients, a
principal weapon against cholera. Water purification chemicals
were in short supply. The generator was broken. Of the tents
needed to isolate cholera cases, one was missing its tie-down
ropes, the other was "in tatters," one man said. The doctors
needed large amounts of salt, sugar, bleach, soap and candles;
none were on hand. Of 330 gallons of gasoline sought, 44 were a
vailable, not that it mattered, as two of three cars were in
the shop. The truck was, too.
The needs might be even greater, as might the outbreak's toll,
two reported deaths, seven more illnesses. But no one knew for
sure: the two-way radio carried by the first doctors who drove
to the scene was not working, either. Nor was the radio in the
village's medical clinic.
Only a decade ago, Zimbabwe's public health system was, with
South Africa's, head and shoulders above those of most of the
40-odd other nations of sub-Saharan Africa. But in a weeklong
trip through eastern and central Zimbabwe, both to cities and
to remote towns like Binga, it was apparent that health care,
like the rest of Zimbabwe's economic and social fabric, is
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 portends 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
defenses are down.
Zimbabwe's government does not discuss details of its public
health problems, and Western journalists, derided as tools of
the nation's critics, are officially barred from reporting here.
With rare exceptions, local medical experts and others
interviewed for this article spoke only on condition of anonymity
for fear of retaliation, either against them or their organizations.
Nevertheless, the national medical association stated publicly
in January that 4 in 10 doctors had already left Harare, and 6
in 10 had left Bulawayo, usually for Britain, Australia or
neighboring African states like Botswana.
By one United Nations-financed study, fewer than 900 doctors
remain in a nation of 11.6 million people-- one doctor for every
13,500 people.
"Basically, the health care system is collapsing on itself right
now," said one Harare medical professional with long experience
in several parts of Zimbabwe. "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.
Nurses at Harare's Parirenyatwa public hospital, the city's
biggest, say that since November there have been no H.I.V.
test kits, in a nation where one in four people is H.I.V.-positive.
Two physicians said in separate interviews recently 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, Zimbabwe's second largest city, a shortage of sutures
and other equipment has closed operating rooms and forced
obstetricians to curtail Caesarean-section births. Some women have
died in labor as a result, said one medical professional who often
works in Bulawayo.
The public health system that remains here, experts say, persists
on the astonishing dedication of those health workers who have
stayed. Despite President Robert G. Mugabe's withering attacks on
what he calls the racist West, it also depends even more on the
kindness of Western strangers, many of them relentless critics
of his authoritarian government.
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. Days ago, 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
in much of this region is abysmal, and some other African nations,
neighboring 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.
Take infant mortality, one key indicator of public health: between
1999 and 2002, Malawi's rate dipped by about five percent while
South Africa's held essentially steady. Zimbabwe's jumped at least
15 percent, and is believed to have risen further last year.
That is no isolated trend. Overall mortality rates, as well as
childbirth-related deaths, also worsened over the decade in
Zimbabwe in comparison with its neighbors.
Yet no one outside Zimbabwe's government knows with certainty how
deeply the crisis in public health runs here. Mr. Mugabe's
government, increasingly wary of bad publicity, has stymied the
public release of United Nations assessments of major social
indicators. The network of clinics and doctors has frayed so badly
that experts suspect the data once routinely dispatched to
statisticians are no longer reliable.
On a personal level, the evidence of 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 pediatric 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.
In an interview in late January, 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 p
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David Polewka wrote:
With Health System in Tatters, Zimbabwe Stands Defenseless
By MICHAEL WINES
If you think that's bad, you should see their cricket squad....:)
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