Crumbling health care in Zim: The silent genocide

PATIENTS are perishing in alarming numbers in Zimbabwe’s crumbling state-run hospitals, as years of gross under-funding, a long-running strike by disgruntled nurses and an unrelenting Covid-19 pandemic take a toll on the country.

BRIDGET MANANAVIRE

Women are dying in labour and stillborn babies are piling up. With senior doctors joining the strike this week, the situation is turning catastrophic. Civil society activists are warning of a silent genocide in public hospitals.

The crisis in the health sector has spiraled into a perfect storm. There is a shortage of essential medicines, medical equipment and protective clothing for frontline professionals. While all this is happening, there is no substantive health minister, no permanent secretary and no hospital chief executives.
The total collapse in the public health system has left many asking whether Zimbabwe still has a government.

“It is when you get sick and fail to get medical attention having made it to the hospital on time when you realise that now only God can save you,” a patient who failed to get treatment for a recurrent condition at a public hospital said this week. “It’s scary. I had to return home untreated to sit and wait for a miracle.”

The government has been accused of failing to treat the situation with the urgency it deserves.

This week, the extent of the crisis in the country’s hospitals was revealed after seven out of eight babies were stillborn on Monday night at the country’s second largest referral centre, Sally Mugabe Central Hospital, formerly Harare Central.

In another incident, a 26-year-old accident victim died in the early hours of Sunday morning in the car of a well-wisher who was trying to get him medical attention after having been turned away from five different hospitals without explanation.

His brother said while trying to locate him, he also witnessed an ambulance being turned away at the country’s largest hospital Parirenyatwa, with a security guard telling them there were no health workers to attend to patients.

“After driving around trying to locate my brother, we got a call from Avondale Police Station around 2am telling us to come and assist with the removal of my brother’s body from inside the car of a well-wisher who had tried to assist him,” the brother, who preferred to remain anonymous for fear of victimisation, said.

“He had died on arrival at Michael Gelfand Emergency Rooms where they had been advised he had better chances of being admitted there. The well-wisher told us they had been turned away from five different hospitals, both private and public.

“While we were still trying to locate my brother, we had been following an ambulance with a sick patient that we had witnessed being turned away at Parirenyatwa. The patient only got medical attention at Harare Hospital where there was one doctor who was doing the rounds. The doctor said there was no nurse or anyone to help.”

The Harare man and his family were not the only ones who suffered because of the chaotic state of affairs in the health system.
Tapuwa Chazanga was turned away at Parirenyatwa with his critically ill 46-year-old sister, with the hospital insisting that they needed a Covid-19 clearance certificate.
They went away and did a rapid test, only to be told the hospital accepts only results from polymerase chain reaction (PCR) tests, which cost US$65 at private laboratories. It takes days for public test results to be released.

The sister, who needed critical care, could not be attended to and her health has since deteriorated.

“Her condition has worsened in the past week, her blood pressure is high, she has cardiac issues,” Chazanga said.

Zimbabwe Association of Doctors for Human Rights secretary Norman Matara attributed the infant and maternal mortality as well as other deaths to lack of access to emergency healthcare and the shortage of professionals in hospitals.

“The situation is really dire and at the lowest. Right now, even access to emergency services is impossible. Maternal care is one of those services that have always been prioritised and treated as emergency care. Expecting mothers need to be checked at least every hour. Those deaths (at Sally Mugabe Hospital) are a result of lack of access to emergency services,” Matara said.

“There are no nurses and the doctors are short-staffed. It is not only the babies but also the mothers who are rapturing uteruses and dying.”
Hospitals, including Parirenyatwa, were this week turning away patients — even those in a critical condition such as road traffic accident victims. Patients were effectively being sent back home to die, rights groups have warned.

“The issue is that there is no adequate protective clothing and that is why you find that they are requesting the medical certificates because health workers are afraid of exposing themselves. So to expect someone to first go and get tested and wait for the results is too much. Also, it is expensive. And people are dying at home,” Matara said.

“We have Covid-19 deaths and we have deaths linked to the Covid-19 pandemic. There has not been an effort from government to solve this crisis; they are not even giving it the priority it deserves. Instead of having a dialogue with workers so that they go back to work, the Health Service Board (HSB) is taking nurses to court. Our government is not serious. We do not even have a substantive minister or substantive permanent secretary and no substantive hospital chief executives.

“Government should be able to provide adequate personal protective equipment so that even without a health certificate you can get medical care. There should also be proper infection control guidelines and the hospitals should be able to offer testing.”

The acting permanent secretary in the Ministry of Health, Gibson Mhlanga, said the government has not implemented any policy of turning away patients with no Covid-19 certificates.

“We have no such policy. Hospitals must establish a Patient Under Investigation (PUI) section to take care of these without a test, that is, care must be given while waiting for results.”

While he would not comment on issues of lack of protective clothing and capacitation of hospitals, Mhlanga said the government is making an effort to get health workers back to work.

“The strike is being dealt with by the HSB and government,” he said, adding that taking legal action against the striking nurses was “an effort to ensure that they come back to work”.

Community Working Group on Health executive director Itai Rusike said President Emmerson Mnangagwa should urgently intervene to restore normalcy in the health sector by addressing the grievances of striking health workers to stop the unnecessary suffering of patients and avoidable deaths taking place in the country’s public health institutions.

“Without a Minister of Health and Child Care and a substantive secretary of Health to lead from the front to deal with the crippling industrial action and considering that the permanent secretary is also in an acting capacity with limited authority to decisively deal with the current health crisis, it shows that the Health ministry is operating on autopilot and lacks the seriousness needed to address the current health challenges,” he said.

“We recognise that the current health crisis emanates from the wider economic collapse and the increasing extent to which people are not accessing basic health services with the negative consequences of high mortality for women and children. The massive decline in our public health sector is thus a major crisis for poor people in the country and leaves people starkly exposed to preventable and avoidable health risks.”

He said there was need to urgently transform HSB into an independent Health Services Commission with authority and a standalone budget to adequately address the perennial challenges of health workers in the country.

Takudzwa Mudzingwa, an obstetrics and gynaecology specialist based at Sally Mugabe Hospital, this week shared the horror health situation, saying it has brought him to tears.

“You get into the ward , pregnant women in labour flocking from all directions telling you, local clinics are closed because of the nurses’ strike and they had no option but to come since private hospitals are charging US$500 and above for normal delivery …,” Mudzingwa wrote.

“Only a team of four exhausted and overwhelmed doctors and one nurse (a matron) running a group of over 40 labouring women. No adequate beds for all, some end up delivering in the corridor waiting for their chance to be seen and admitted into the labour ward.

“During that shift you make up a list of 20 women with pregnancy emergencies who need caesarean sections, you get to the theatre there are no theatre nurses, you get into the theatre the anaesthetist is told there is no anaesthetic, no gases, no propofol, no ketamine. They improvise and you just manage to do that one, leaving 19 women with emergencies who came that day stranded and helpless. They look at you in pain, in tears saka chiremba ndichaita sei? (What do you want me to do, doctor?) and all you do is just look at them helplessly.

“You look at some of them ending up having uterine ruptures, bleeding to death and 80% delivering dead babes, no ICU (intensive care unit) department and you end up nursing a critical patient in a normal ward with no nurse or whatsoever to monitor them and the result is just death.”

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