By Norman Chitapi in Harare (AR No. 110, 25-Apr-07)
Parirenyatwa Hospital in Zimbabwe's capital Harare is the biggest referral hospital in the country. It looks majestic from the outside. Inside, its grand wooden staircases run alongside elevators that have long ceased to function. One could safely drive a bus through its wide French doors and vast, spotlessly clean corridors.
But there is a sinister aspect to the cleanliness. Like the health system in the country generally, this great hospital is dying. There are no qualified and experienced doctors, nurses, technicians or drugs here. Parirenyatwa Hospital is a fitting monument to the country's relentless economic decline over the past eight years.
The western entrance to the hospital, called the Casualty Department, is symbolic of the collapse of this once proud institution, formerly named Andrew Fleming Hospital when it was built to serve the white Rhodesian community under Ian Smith's regime. (In 1965 Smith, the white minority leader of then Rhodesia, declared unilateral independence from Britain.
The hospital reception is a theatre of agony: adults weep, the injured groan and women who have just lost loved ones wail as new arrivals line up to be served by a group of listless nurses. Along the corridors, the nurses and their assistants babble about their personal affairs, seemingly oblivious to the patients they took an oath to serve.
Above the benches where the patients wait, computer-generated cards, with the message "Get well soon", are stuck on the wall. There is a macabre irony to the message. There is hardly a doctor at Parirenyatwa to attend to patients. The auxiliary nurses and student doctors manage the best they can. But much of the time they stand around in the corridors unable to treat patients who require urgent specialist attention. "You get well soon or you die" is the real meaning of the card's message.
Betty Choto recently went to Parirenyatwa Hospital with a kidney ailment. For two days, she writhed on a bed without treatment. On the third day, she was told by a nurse that she needed to be put onto an intravenous drip before she could be operated on. Treatment was on a cash upfront basis. Each sachet of the precious liquid cost 180,000 Zimbabwe dollars (about nine US dollars on the black market), out of reach of many in a country where 80 per cent of the adult population is unemployed and more live on less than one US dollar a day.
Relatives who visited that evening found Choto in agony. Fortunately, she was able to narrate her story and as soon as the money was paid a junior doctor wheeled up a trolley to administer the drip. She underwent an operation the following day and was quickly discharged to recover at her home in the poor township of Kuwadzana, 15 kilometres west of Parirenyatwa.
But her problems were not over. The following day she was driven to Kuwadzana council clinic to have the wound dressed. After waiting in the queue for two hours, she was told the clinic didn't have drugs to clean the wound. "You bring your own drugs and we dress you," she was told. They used an over-the-counter medication trading as Betadine to clean up and bandage the wound before she left in search of the necessary drug for the following day. Even the nurses did not have it on the black market!
The practice of health personnel sourcing essential drugs from neighbouring countries and selling them at exorbitant prices to desperate patients is on the increase.
Another resident of Kuwadzana, Netsai Juru, was taken to Kuwadzana clinic when she thought she was in labour. The nurse on duty briefly examined her, pronounced the foetus dead and called a council ambulance to take her to Harare Hospital, the main referral centre for the capital's poor.
On the way to Harare Hospital, two other patients were picked up. She was kept for a day in the ante-natal wing of the hospital and although no baby arrived yet, there was no talk of a dead foetus.
On the second day, Juru was told the baby was getting tired and she needed to be induced to speed up the delivery or a Caesarean would have to be performed. She was told the pill to induce delivery would cost 150,000 Zimbabwe dollars and only one nurse had it. After paying two-thirds of the cost, she was given a portion of the pill. It didn't do the trick and on the third day of worsening agony she went in for a Caesarean, which produced a baby boy. The total bill was one million Zimbabwe dollars. Her salary as a civil servant is close to 400,000 Zimbabwe dollars a month. She paid a third of the bill and was released with a reminder to pay off her debt.
Things were not always this bad. In the early 1980s, government introduced a policy, which promised "health for all" by the year 2000. But as spending on social services such as health and education began to outstrip revenue generation, the country was forced to turn to the International Monetary Fund in 1991, which called for an economic structural adjustment programme that demanded a reduction in spending on social services.
The austerity measures adopted by the government forced it to recoup its costs. The result was a huge reduction in government grants to hospitals and council clinics, leading to a shortage of drugs and equipment.
As the economic situation deteriorated, qualified doctors, nurses and other support staff deserted the health sector in droves for the United Kingdom, South Africa and Botswana. The few remaining doctors and nurses have been on strike for better pay and working conditions since December last year.
Although the strike ended last month, health professionals are on a go-slow, meaning they are not offering a full service and are opting to work at their surgeries or do locums elsewhere.
Meanwhile, HIV and other treatable diseases like malaria are also proving fatal in the absence of basic drugs and a committed and trained workforce.
The promise and euphoria after independence has faded into a long and debilitating wait for many. The government's announcement last week that it wanted to take over council clinics "to improve service delivery" was met with universal cynicism. "Why are they unable to improve service at their own hospitals first before spreading the few resources they have?" people are asking.
Norman Chitapi is the pseudonym of an IWPR contributor in Zimbabwe.