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Life-saving drugs out of reach for most
Institute for War and Peace Reporting (IWPR)
Nonthando Bhebhe (AR No. 141, 31-Oct-07)
October 31, 2007

http://iwpr.net/?p=acr&s=f&o=340278&apc_state=henh

Many seriously ill patients can no longer afford prescription charges.

As the prices of drugs and healthcare continue to soar to astronomical levels, many Zimbabweans with life-threatening conditions are going without the treatment they need.

Spending an afternoon at one of Harare's busiest pharmacies is heartbreaking, as patient after patient walks in and out without collection their prescription because they just can't afford it.

Barely able to stand without leaning against the wall, Martin Sibanda, a self-employed welder, waits anxiously for the pharmacist to give him the prices of the five drugs that were prescribed to him at a clinic close to his home in Harare's poorest suburb, Mbare.

After a two-minute wait, the pharmacist hands him a piece of paper with the total cost of the drugs. He looks at the paper and as if in slow motion, he shifts his gaze to the pharmacist, who repeats the figure and asks if he should supply the drugs.

Sibanda whispers the figure and shakes his head in bewilderment, "My son, are you saying 28 million [Zimbabwean dollars, ZWD - 28 US dollars at the black market rate]? Did I hear you right? Please check again, you must be mistaken."

But it is not an error. It is the cost of three life-prolonging drugs for his two chronic illnesses, and two others for a new infection.

Sibanda suffers from high blood pressure, stomach ulcers, and diabetes. A month's supply of nifedipine to treat hypertension costs an average of five million ZWD; drugs for diabetes go for about six million ZWD and ulcer medication costs ten million ZWD.

In addition, Sibanda has developed a chest infection and was prescribed an antibiotic and cough mixture. The antibiotic, erythromycin, costs about 2.5 million ZWD and the cough mixture, 4.5 million ZWD.

With a teacher's monthly salary at 14 million ZWD a month as of October - a figure still below the official poverty line which was set at 16.7 million ZWD in August - Sibanda's pharmacy bill of 28 million ZWD is way beyond the reach of the majority of Zimbabweans.

Sibanda stares blankly at the pharmacist and then turns to his wife. He tells her that they will just have to go back home and pray for God's healing.

His predicament mirrors that of millions of other Zimbabweans, suffering as a result of a collapsing public health system.

Zimbabwe's health service used to be the marvel of the southern African subcontinent, with the government's vision of "Health for All by 2000" almost within reach.

By the turn of the millennium, each of the nine rural provinces had a well equipped referral hospital. District clinics were complemented superbly by mission hospitals scattered all over the country.

However, a declining economic situation attributed to government's ruinous policies has seen the situation deteriorate to pre-independence levels.

Zimbabwe is going through a severe economic crisis with serious fuel and food shortages which are blamed on recurring droughts as well as the government's fast-track land redistribution programme, which has disrupted agricultural production and slashed export earnings.

This has taken its toll on the health service. Now drugs are scarce, those which are available are exorbitantly priced, medical equipment is dilapidated and there are persistent strikes over poor salaries on offer to health workers.

In recent years, those who can afford it have been forced to turn to private medical practitioners for services no longer offered by government clinics and hospitals. However, as private hospitals now demand an upfront cash deposit of 50 million ZWD before admission, this is out of the reach of most people.

Touched by Sibanda's plight, IWPR sought an interview with him. He seemed to have resigned himself to whatever fate awaited him.

When IWPR visited his home four days later, his condition seemed to have worsened and his breathing was strained. He tried to sit up on his small wooden bed, but this made breathing more difficult.

"I am in a lot of pain. If I had money, I would seek private medical care or buy those drugs I was prescribed. But I have nothing and I'm now waiting for my death. My condition is getting worse every day and I just don't know anywhere to turn to," he said.

Asked why he does not go to any of the government hospitals, Sibanda smiled and said, "Government hospitals are now deathbeds - people are referred there to die. There is no medication and they are filthy and you can almost smell death as you enter their buildings.

So, no, thanks - I would rather be with my loved ones and die surrounded by love."
The high costs of medical care are affecting everyone, including those with medical insurance, who still have to meet more than half of the medical costs.

Commonly prescribed drugs are unaffordable to most. For example, Ranferon - which is recommended for pregnant women to increase circulation and avoid birth complications - now costs more than 13 million ZWD.

One pharmacist told IWPR that although they understood that most Zimbabweans can no longer afford medication, there was nothing they could do because they have to sell drugs at profit.

"I tell you many people are dying in silence without medication and proper health care. I have to develop a hard skin to deal with the situation in Zimbabwe. My heart bleeds every single time when a patient walks out without her medication," he said.

"You can almost feel or even touch the helplessness in people. I am sure if we were to do a proper survey, we will find that hundreds of people have died when they should not have. The government has to address this issue; otherwise, it is presiding over a dying and hungry nation."

Many of those worst affected by the rising prices of drugs are those with HIV.

In a country with the world's fourth highest rate of HIV infection, many infected people simply cannot afford the antiretroviral, ARV, drugs they need, said Lynde Francis, who runs The Centre - an HIV/AIDS non-governmental organisation with 4,500 registered clients.

"People are giving up [taking their] drugs - they have to choose between feeding and educating their kids or taking ARVs," she said. "It's becoming more of a struggle to get the basic necessities. ARVs are way down on their list of priorities."

* Nonthando Bhebhe is the pseudonym of an IWPR journalist in Zimbabwe.

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