Ignatius Banda

BULAWAYO, Zimbabwe, Aug 24 2009 (IPS) – Before, Zimbabwean families would take their ill relatives to rural clinics where medication was readily available and payment plans lenient. But now they are taking them there to die.
Millions of Zimbabweans already have no access to basic health care, and the health services have been in decline over a number of years. But the three-week strike by doctors has only magnified their dire circumstances. The situation has forced many families to make these impossible life and death decisions about their loved ones.

In Bulawayo desperate patients go to hospital only to be attended to by trainee nurses. Already life-saving machines have stopped working and the intensive care units have become nothing but empty shells.

This situation has highlighted the increasing desperation of millions who have resigned themselves to succumbing to otherwise treatable diseases over the years.

No one goes to hospital anymore and some families because they fail to get adequate health care are sending sick relatives to die in the rural areas, said Tabeth Gumpo who works with a group of about 20 women as home-based care givers.

A few years ago as the country entered the troubled waters of rapid economic decline, people readily ferried relatives to rural clinics as these did not demand payment up front and could also provide drugs which were not readily available in city clinics and hospitals.
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However, all this has changed. The trip to rural homes has become more about how to reduce the expense of medical treatment for sick relatives and also about reducing funeral expenses. In rural Zimbabwe families do not have to buy items like coffins and a burial ground plots as in urban areas, said Simoso Macheke, a nurse who is among the many who joined the doctor s strike.

People in urban areas know funerals have become an expensive affair, so once they see a relative is critically ill and they cannot afford health care, they simply ferry them to their rural home, Macheke told IPS.

Of course this is no way to treat a human being, but these are the times we live in, she said.

Some faith-based non-governmental orgranisatioins working in the country s southern rural parts of Matebeleland said while families look after ailing relatives, they are limited in their efforts by the absence of trained professionals to assist them. This has been compounded by the fact that clinics are situated far away from the villages where these patients live.

The situation has worsened (as) we also have no drugs. (And) the list of people who seek anti-retroviral drugs keeps growing, said Gillian Sibanda, head of the Catholic Church s Department of Health in Bulawayo. There is very little that these families can do but watch relatives die, Sibanda told IPS.

The strike by doctors that has since been joined by nurses comes despite earlier commitments made by the coalition government at its formation that one of its immediate challenges was to ensure the reconstruction of the health sector, run down by years of poor funding.

Agencies such as the United Nations Development Programme have committed themselves to funding part of public service salaries that would meet essential services like health but have yet to step in to avert a brewing humanitarian crisis as the country s largest hospitals remain palpably empty of doctors.

With donor funds still not forthcoming, the health sector s reconstruction is likely to take much longer and claim many lives.

There is nothing as painful as watching a sick relative wasting away not only because you cannot afford hospital fees but more painfully because the hospitals have no doctors, said Johanes Lubimbi as he ferried home his sick and visibly frail brother by wheelbarrow. He and his brother were on their way home from the Mpilo Hospital where his brother had not received any medical treatment.

My brother was told he has TB and has to regularly go to the hospital for treatment. But no one looked at him today as there are no doctors. These young nurses have no clue about what they are doing, Lubimbi complained, as his 30-year old brother coughed weakly, his body covered with heavy clothes despite the scorching sun.

What can we do? We are going to wait for the strike to end and maybe then we will also be able to get enough medicine for him, Lubimbi told IPS.

This has become a typical story for many families who cannot afford the fees demanded by private clinics which still have doctors, nurses and life-saving drugs.

Mpilo is one of the country s largest central hospitals and has been hard hit by the doctor s strike as they press for monthly salaries of up to USD2,000, an amount that has set the stage for a protracted impasse with the government of national unity that formed the coalition against the background of bankruptcy.

Presently doctors, much like other government employees, get a little over USD100 a month.

We are looking for a situation where government pays salaries above USD1,000 and USD500 in allowances. The current flat USD170 they are paying is inadequate and has no provision for on-call allowances, transport and housing allowances, says Brighton Chizhanje, president of the Zimbabwe Hospital Doctors Association. About 300 of the association s doctors have joined the strike.

The government s Health Services Board said it does not have the financial wherewithal to meet these demands set by doctors and other professionals, and on Friday government announced it had fired all striking doctors. This (poor salaries) is what forced many of us to leave the country, said Owen Hadzisa, a 31-year-old doctor now based in South Africa who recently returned home on holiday.

But it is always the poor people who suffer as many in this country cannot afford private health care and medical aid schemes cannot be covered by the paltry salaries the majority earn, Hadzisa told IPS.

It has become a phenomenon of Third World countries that people die of otherwise treatable ailments and this strike by doctors only worsens matters yet I feel it is government s responsibility to address this as a matter of urgency, he said.

Home-based care givers have become the vanguard of the current crisis in the absence of trained health professionals. We are seeing what we know should not be happening to patients who are dying before their time because they fail to access adequate health care, said Gumpo who works in Tshabalala, one of Bulawayo s high density townships.

It is here that the pulse of the health crisis is acutely being felt. Gumpo says from a list of about thirty patients littered across the township at the beginning of the year, their records now show nineteen remain as the rest have died.

Home-based care givers have tried to fill the gap in the absence of qualified health personnel. But they have met with limited success, says Gumpo.

There is very little we can do and some in our home-based care group are increasingly complaining that they do not get support from health professionals from whom we ideally should receive guidance, Gumpo told IPS.

Families know we are doing our best, but there is little we can do when they tell us they are taking a sick relative to their rural home to die, she said.

The strike by doctors comes as humanitarian agencies like Médecins Sans Frontières say they are bracing themselves for another possible round of cholera as the country prepares for the coming rainy season. A cholera outbreak last August went on to claim more than 4,000 lives at a time when the bulk of the country s health professionals had left to seek better paying jobs in other countries.

With the government still struggling to attract international financing, the strike by doctors and absence of life saving drugs could well mean more families send their relatives to die quietly in their rural homes.