Feature - A health system on the edge

Zimbabwe's main public hospital, Harare central, does not inspire confidence. Its shabby exterior is dotted with broken windows and leaking pipes. The wards themselves are little better, epitomising the decline of this country's once proud health system. Outside visiting hours the relatives of the patients wander the grounds. Many spend all day at the hospital, simply because they cannot afford the bus fare to make more than one journey. Chido Rugare is typical of those whiling away the time before she can again visit her sick daughter, Maria, in the ward. A round-trip bus ride from her home in the high-density suburb of Mufakose is far too expensive, so each day she walks the 17 km to be with her daughter. Maria has meningitis and can no longer look after herself unassisted. "Every day I have to prepare food from home and come and feed my daughter. I also have to bath her, since she can longer do that on her own," said Rugare. What she also cannot do is afford the Zim $257,000 (US $313) worth of drugs prescribed by the doctors. Zimbabwe has entered its fifth successive year of economic decline, which has whittled away the ability of households to make ends meet. The country faces critical shortages of foreign exchange, inflation has reached 364 percent and is forecast to hit over 500 percent by the end of the year. Five million Zimbabweans, more than half of the population, are in need of food aid. Even if Rugare could afford the drugs her daughter needs, there is no guarantee they would be available in the poorly-stocked hospital pharmacy. Harare central is where the city's poor, who cannot afford health insurance, are forced to come. Within its morale-sapping walls, there seems to be more dying than curing. The high death rate is linked in part to AIDS. Recent estimates indicate that around 34 percent of Zimbabwe's 15 to 40 age group is HIV-positive, and more than 2,500 people die every week of AIDS-related causes. Poverty and poor nutrition accelerate the process. "Most of our beds are occupied by people suffering from AIDS. In the children's wards there are children who are suffering from kwashiorkor," said a senior matron who asked not to be named. She noted that most of the children with kwashiorkor are from Mbare and Epworth, the poorest suburbs of the capital. The morgue at Harare central receives the daily toll of the dead. It is overflowing and the stench is inescapable. "The refrigerators sometimes do not work and they also have no capacity to keep the bodies well," said an attendant who declined to be identified. "We no longer go inside there. If you bring your relative you have to find somewhere to put them yourself, or we will charge you if you want us to do that," he added, leaning on the wall outside the morgue as he ate his lunch. The morgue is also a place of business for a number of undertakers who hang around waiting for clients. When relatives come to claim the body of their deceased, they are immediately propositioned with offers of cheap coffins, body dressings and transport. Harare central, like most other health institutions in the country, is in dire need of medicines, equipment and medical supplies. In addition, there is a serious shortage of professional staff, from nurses and doctors to pharmacists. Nurses at the hospital complain that their working conditions are deteriorating. Apart from salary disputes causing walk-outs, the nurses say they are fed up with seeing their patients die as a result of the shortages. "Almost on daily basis we lose at least three babies in our ward," said nurse Maude Chitambo. "Sometimes we work without gloves, sometimes there are no drugs for patients and food is rationed. When we see patients dying, this affects us as well. "Most of the time there is only one qualified nurse for each ward and the rest will be students. When we face emergencies, students sometimes have to take over duties normally done by qualified staff," she explained. Almost half the nurses trained in Zimbabwe are lost annually to better paying jobs in South Africa, Britain, Australia and the United States. Harare central and Parirenyatwa, the country's two biggest hospitals, share a single neurologist and other specialised staff. The problems at the health institution seem to affect all departments. In the laundry room, the steam cleaners had not been working for a week. "The laundry is just piling and now relatives have been asked to bring clothes from home," a matron said. Heaps of rubbish mount up around the hospital. To cut costs, the hospital retrenched a number of cleaning staff and hired a private company, but the company's workers often strike. Last month junior doctors were again on a work stoppage. Their demand, like the nurses', was that their conditions must be improved. Zimbabwe's parliament has acknowledged the impact of staff shortages on the country's health centres. But Health Minister David Parirenyatwa has argued that the country's economic crisis makes it difficult for the government to invest in health. He concedes that the situation is unlikely to improve in the near future, and the haemorrhage of skilled staff abroad will continue.