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Zimbabweans pay dearly for cost of health care
Craig Timberg, The Washington Post
May 11, 2006

http://www.washingtonpost.com/wp-dyn/content/article/2006/05/10/AR2006051002308.html

HARARE, Zimbabwe Faris Kungara knows the pain is coming when the top of her head grows warm. The heat stretches downward, past her ears, and becomes an unbearable ache, she said. From the claustrophobic confines of the gloomy, waist-high shelter that serves as her home, Kungara prays for relief.

But none comes, she said, because she is poor in a country where inflation approaching 1,000 percent has pushed the cost of health care beyond the means of all but the most affluent.

"There's nothing you can do," said Kungara, a round-faced mother of three with a gap-toothed smile, "just because you don't have money."

Last month, a physician told Kungara, 41, that she probably had meningitis -- a potentially fatal infection. He slipped a syringe into her spine, withdrew a clear fluid and deposited it into a plastic vial. He said the hospital would test it and begin treatment as soon as she paid the bill.

When Kungara protested that she did not have any money, she said the physician replied, "You go and find it."

Then he handed her the red-topped vial and an invoice for $6.1 million Zimbabwean dollars -- equal to a little more than $60 U.S. dollars. It was an impossible sum to Kungara, who is lucky to earn that much from several months of selling vegetables in the dusty, impoverished township where she lives, she said.

Doctors, patients and human rights activists say such experiences have become increasingly common as Zimbabwe's beleaguered, cash-starved health system refuses treatment to those who cannot pay skyrocketing medical bills up front.

Government hospitals last week raised consultation fees by more than 300,000 percent, from a third of a cent to about $10. The cost of medicine has doubled or tripled every few months. And officials recently announced that they have only a few weeks left of lifesaving antiretroviral drugs for the 20,000 AIDS patients who receive them as part of a government health program.

Health workers say many other AIDS patients have already stopped taking the medicine because of high costs, causing risks not only for those patients but creating ideal conditions for the emergence of drug-resistant strains of HIV, the virus that causes AIDS.

Elopy Sibanda, a physician, says that nearly every day he receives test results labeled "withheld until payment is made."

Most of his poor patients have stopped coming for appointments. For those who do come, Sibanda said he must ask bluntly about their means before embarking on long-term treatments. The result, he said, is a two-tiered medical system reminiscent of the days of white rule before Zimbabwe's independence in 1980.

"They're creating a health care apartheid," Sibanda said. "We're no longer looking at the color of the people. We're looking at the fatness of the wallets."

Combined with rampant HIV, the failing health system has contributed to a falling life expectancy that has become the shortest in the world. The World Health Organization reported in April that the average Zimbabwean man will die by 37 and the average woman by 34.

Information Minister Tichaona Jokonya, speaking by phone from his farm south of Harare, acknowledged the exploding cost of health care in Zimbabwe and blamed it on Britain, the United States and other Western countries that oppose President Robert Mugabe, who has ruled Zimbabwe since 1980. Jokonya said those countries have caused the hyperinflation through sanctions and withheld vital health aid for political reasons.

"What we don't have is the funds," he said. "The economy has been under siege for the last four years."

For Zimbabweans, the economic crunch is affecting every phase of life. School fees, rent, electricity rates and grocery bills are rising far faster than wages. A recently announced increase of salaries for teachers and soldiers still leaves them below the country's official poverty line, and the gains will be eroded in six weeks if inflation is not curbed.

A decade ago, three Zimbabwean dollars were worth one U.S. dollar. The government now puts the rate at more than 100,000 Zimbabwean dollars to the U.S. dollar, and the black-market rate is roughly double that. Bill-counting machines have proliferated as businesses struggle to determine the value of the bricks of currency customers must pay.

Benigna Gonyora, 45, whose husband died three years ago, has seen the value of his pension plummet in the face of hyperinflation. It now is worth about

13 cents a month in U.S. currency, and her entire family must survive on the $90 a month they earn by sharing their home with renters. That leaves little to care for her mentally ill son, Leon, 19.

Gonyora finally attempted to get Leon admitted to a psychiatric hospital in December, she said, but officials there first demanded $250 as a deposit.

A doctor instead arranged for some medication that dramatically calmed Leon's episodes, she said, but those pills ran out in February. They have not even tried to buy more, nor has she asked a doctor to examine the pus oozing from his right ear.

But the most seriously ill person in the house is Benigna Gonyora's brother, Zacharia Mutuma, 48, who was brain-damaged at birth and is prone to violent fits. He spends much of his day babbling and wandering around the house naked.

Sedatives calm him, but, because the cost is prohibitive, the family uses them only when they are donated. When the medication runs out and the violent attacks return, family members say they have no option but to return to a more primitive solution: They shackle Mutuma by his ankles to a rusty post in their yard.

"We can't afford to take him to the doctor," Gonyora said.

The soaring cost of medical care is compounding years of trouble that had already pushed many poor and middle-class Zimbabweans to the brink. The economy has shrunk by 40 percent. Unemployment is estimated at 80 percent. Hunger is chronic in many areas.

Bernard Gidesi, 42, a home builder who has HIV, lost his job during the government's "clean-up campaign last year," when police destroyed supposedly illegal slums and informal markets. The housing construction business has not recovered, and to make matters worse, the room where Gidesi slept -- a former veranda enclosed by walls -- was destroyed, leaving only the roof.

About the same time, a nongovernmental organization that was providing Gidesi with antiretroviral drugs abruptly closed. Without a job, he could not afford them on his own. As AIDS symptoms gradually weakened Gidesi, he took to spending most of his time in bed.

At night, he said, men returning from local bars would taunt him as he slept on a rusty cot on the exposed veranda. In the morning, dogs roaming the neighborhood would enter the yard and roust him from sleep.

Gidesi gained a measure of privacy by hanging cloth and plastic sheets from the roof, but chronic coughing has returned and his body has begun wasting away.

"If I don't get help," he said, "I think I am going to die."

Thoughts of death have begun to preoccupy Kungara as well. She, too, lost her home in the government "clean-up campaign" last year. She also lost the company of her two youngest sons, aged 10 and 15.

After the house where she was renting a room was destroyed, Kungara built a shelter out of the building scraps left behind, but it was large enough only for her rusty metal cot, a few clothes and a small plastic box of medicine. She sent her sons to a remote village to live with relatives.

Kungara attempts to see her sons once every two months. But her headaches have made even selling vegetables too difficult on most days; she has no money for bus fare to visit. Her last visit was three months ago.

"I hope I feel better," Kungara said last week, her head aching and her forehead warm to the touch, "because I want my children to see me while I'm alive."

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