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No soap in a hospital? Can you believe it? But this is Zimbabwe, a country whose public health system was once the envy of neighbouring countries and that now has the lowest life expectancy in the world: 34 for women and 37 for men. This statistic continues to shock and disturb me; Zimbabwe is, after all, not a country at war.
Of course, HIV has had a great impact. But it is mainly the policies pursued by Robert Mugabe’s Zanu PF party that has moved Zimbabwe, once the bread basket of this part of Africa, to a basket case.
In late October 2007 I spent 10 days in Zimbabwe. I am a trustee of a charity, Zimbabwe Health Training Support, whose aim is to support the training of health professionals and medical students in Zimbabwe. During my stay I ran workshops on medical ethics for junior doctors and consultants. I gave a talk to GPs in Bulawayo on how quality is assessed in general practice in the United Kingdom. While in Bulawayo I stayed with a physician and spent part of my week shadowing him. I also shadowed a GP.
HIV seemed to pervade all healthcare encounters. As many as 70% of inpatients in the public hospital in Bulawayo had an HIV related disease. Many people present with advanced disease—a death sentence. The HIV clinic in Bulawayo is supported by the Clinton Foundation, but a shortage of drugs and resources has meant that it has been closed to new entrants since August, except for children, pregnant women, and healthcare workers. I spoke to a pharmacist concerned about the future supply and reliable delivery of antiretrovirals.
Some Zimbabweans who work in South Africa get their antiretrovirals there. One young man had fraudulently been given painkillers as part of his triple regimen therapy. He presented with an immune reconstitution syndrome. He needed chemotherapy, but this wasn’t easily available and anyway he didn’t have the money to pay for it.
The HIV clinic has 2500 children on its register. A morning spent with the paediatric nurses revealed the human tragedy. I met numerous orphaned children with HIV being cared for by aunts and grandparents. Because of the food shortages in Zimbabwe a charity was donating food to people with HIV to help feed their families.
I wondered why there seemed to be so many small children and babies with HIV, given the availability of treatment for pregnant women. A paediatrician said one reason is that there is no easily accessible milk in Zimbabwe, so mothers continue to breast feed beyond six months, putting their babies at further risk of acquiring HIV.
Shortages of medical equipment and drugs are severe. Thermometers were being shared between wards, no glucose sticks were available for monitoring diabetes, and certain antibiotics could not be obtained. A lack of catheter bags and pads meant that incontinent and immobile patients had to lie in urine. One patient had metastatic pancreatic cancer. There was no morphine to control his pain or dexamethasone to reduce his brain swelling. Patients in outpatient clinics told us they had difficulty getting basic drugs for ordinary medical conditions such as heart disease, diabetes, and asthma. One patient couldn’t afford to buy a steroid inhaler. A girl was walking around for a week with a fractured arm not in a cast as neither of the public hospitals had plaster of Paris. The tragedy is that it never used to be like this.
Healthcare professionals are leaving their work daily. A paediatrician and a physician had left the week before I arrived. No one begrudges them for leaving, but work schedules inevitably become more intense for those remaining. Non-governmental organisations try not to poach health service staff, but they pay in hard currency. Inflation continues to soar—during my short stay prices increased by a third. Nurses I met couldn’t afford to eat on their pay. A typical nurse’s monthly salary of 17 million Zimbabwean dollars (£290; €385; $570) doesn’t go far when transport to and from work costs $Z400000 each day. One nurse I met relied on financial support from a relative (a nurse) working in Britain.
Simply surviving in Zimbabwe is exhausting. People spend a lot of time searching for and queuing for food. Basic foodstuffs such as bread, sugar, and flour are hard to find. Many people survive on one meal a day. There is a desperate shortage of fuel, and people have to go to Botswana to get it. Every day there are cuts in power and water supplies—one part of Harare had not had any running water for six weeks.
I have great admiration for the healthcare staff I met. They had to be so resourceful and were constantly having to solve problems. I was impressed by the clinicians’ skills. As is the case in many developing countries, doctors’ clinical and interpretive skills are often very sharp as so few tests and investigations are available.
In spite of all my experiences I was left with a lasting impression of people who, in spite of incredibly difficult circumstances, had not lost their humanity, sharing food and water and helping each other out in whatever way they could.
A lack of catheter bags and pads meant that incontinent and immobile patients had to lie in urine . . . the tragedy is that it never used to be like this