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Zimbabwe Experience - Part 3
André Carrel
November 16, 2007

Continued from Part 2

http://andrecarrel.com/cms/modules/news/article.php?storyid=113

A hero is a man who does what he can.
- Romain Rolland

A high HIV/AIDS infection rate is just one of many infamous records claimed by Zimbabwe. The country can also lay claim to the world's highest rate of inflation, the world's lowest life expectancy, and many more equally depressing records. Every sniffle and every toothache has the potential to become a serious health problem in Zimbabwe. The country's entire civic infrastructure is disintegrating, and this has a devastating effect on health services. This is the story of how services in one hospital in Zimbabwe's Eastern Highlands are affected by hyperinflation, food shortages, constant and ever lengthening power and water service interruptions, and many other woes.

There are no adjectives to describe the nightmare of running a hospital when inflation is at 8,000 percent. Annual budgets and government funding formulas are pitiful jokes; credit from suppliers is out of the question, and user fees are a desperate source of revenue. Zimbabwean hospitals charge fees for everything, starting with admission fees for in-patients and out-patients. The hospital requires patients to bring a candle and a pair of surgical gloves on admission. The candles are for bedside lighting during the frequent power failures, and the surgical gloves are for the protection of the medical staff. Every item used in the care of a patient is recorded, not just medication (such as may be available) but every piece of gauze, every centimeter of tape. Everything is measured and recorded and added to the patient's account. If a test is required, such as a blood test or urine test, payment is required in advance. No money - no test. The hospital does not allow a patient to leave until the account is paid in full. This means that, if necessary, a patient's family (immediate or extended) must sell assets, be that a cow, a piece of furniture, food reserves, or anything else the family may own. The family cannot afford to wait; there is no time to argue because the debt continues to grow with every day the patient remains in the hospital.

The hospital will dispatch the only ambulance in an emergency. However, if the hospital is short on fuel or if patients cannot pay for or replace the fuel, people are left to make their own transportation arrangements. I have seen people hauled to the hospital in wheelbarrows.

The hospital has an emergency generator, but the generator does not supply enough power to run the autoclave in the hospital's operating theatre. Staff use and reuse surgical instruments meant to be disposable. Power and water services are intermittent, and soap is in short supply. Nurses clean and disinfect surgical instruments as best they can under these conditions.

The hospital must purchase food at the local supermarket and pay cash at the checkout. The supermarket does not deliver (no fuel) so the hospital uses the sole ambulance to pick up grocery orders. Hospital food consists of tea for breakfast (no sugar, no milk, no bread, no porridge), sadza for lunch (polenta made from white maize flour), and sadza again for dinner, perhaps with boiled covo (a cabbage-like vegetable), carrots, or some other locally-grown vegetable. No meat, no pasta. Nurses report the number of patients in their wards, and the hospital's kitchen prepares just enough food to fill the prescribed rations.

A nurse's monthly salary is ZWD$3 million - I paid ZWD$1,928,000 for one 500g box of bran flakes at the local supermarket. Some nurses, struggling to keep food on the table for their children, have little if any food for themselves. Some nurses are hungry when they report to work. When meals - such as they are - are delivered from the hospital's kitchen to the wards, hungry nurses intercept them. After taking care of their own needs, they distribute what food is left to their patients. Lucky patients are those with relatives or friends who can occasionally spare some food to augment the patients' shortened hospital rations.

Many nurses have left Zimbabwe for South Africa, Britain, or Australia. Many more talk about leaving but find it impossible to abandon their communities. How useful is a starving nurse to patients? The more important question, however, is what do starvation and the state of health services do to the self-esteem, the self-respect, and the sense of duty of registered nurses, nurses who know what patients need but do not have the equipment, the supplies, or the resources to meet patients' needs and, to top it off, are so driven by hunger that they steal food from patients under their care? Is such a nurse a thief? Is this nurse unethical? The answer, repeated again and again by my friends and hosts, is that to survive in Zimbabwe today one has to be practical.

The next column in this series will be on the subject of government secrecy.

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