Zimbabwe Experience - Part 3
- From: "Zvakanaka" <lalapansi@xxxxxxxxx>
- Date: Mon, 7 Jan 2008 10:45:12 +0200
Zimbabwe Experience - Part 3
andrecarrel.com
Audi Alteram Partem :
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.
November 16, 2007
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