Inter Press Service - October 10, 2003
Wilson Johwa

The process is meant to stop the cancer in her leg from spreading. But five months ago the only machine used by patients in three provinces - Matabeleland, Masvingo and Midlands - broke down and there is no foreign currency to import spares. Mpilo Hospital has also run out chemotherapy drugs.

Furthermore, 10 of the 12 radiographers have left for better prospects abroad, which means even if the radiology centre's machines were operational, it would still be crippled by the staff shortage.

Now, Noma has to travel to Parirenyatwa Hospital, the biggest referral centre in the country and only other major cancer treatment centre.

However, as the superintendent of Mpilo Hospital, Dr Juliet Dube-Ndebele notes, most patients - including Noma - are too poor and cannot afford the high transport fees for the 480 kilometre journey to Harare.

Specialist surgeon Chad Tarumbwa says there has been no cancer treatment in the country for the past two years, due to machine breakdowns and a perennial absence of drugs. Those who can afford it fork out a lot of money to go to neighbouring Botswana and elsewhere or pay millions still, to get treatment in private hospitals since the drugs are extremely expensive.

"The majority of people with cancer here are not being looked after. It's only those whose cancer is amenable to surgery and it comes early enough for us to operate, be it breast cancer and we remove the breast. But there is still no follow-up treatment," Tarumbwa says.

"That is a disaster because AIDS itself and HIV also increase the risk of cancer," he says. "It opens up a whole lot of cancers that we didn't see before."

As Zimbabwe's political and economic crisis deepens, the health sector has been one of the major casualties of a collapsed currency, runaway inflation exceeding 500 percent, empty foreign exchange coffers and a massive brain drain.

All categories of doctors, nurses and other health personnel have been among the first to leave the country for better prospects in neighbouring countries and abroad. Those remaining complain of inferior pay and conditions of service and are frequently on strike.

While its own locally trained doctors emigrate, the government has relied on doctors from Cuba to ease pressure in the crumbling public hospitals. The latest contingent of 74 arrived in February this year.

In June 54 doctors, 11 pharmacists and three radiographers from the Democratic Republic of Congo arrived in the country on a three-year working programme underwhich they were deployed to provincial and district hospitals.

But in a situation where the government is broke foreign doctors can only do so much, not least because they are Spanish and French-speaking, in itself a critical factor in rural outposts where even the official language English is not well understood.

Throughout the country, patients - already reeling from the prevailing 70 percent unemployment and widening poverty - are also coming to terms with a crumbling health service and the escalating price of available drugs which have shot up by 1 000 percent in the last two months alone.

A shrinking economy has left only about one million Zimbabweans out of a population of 12,5 million on medical insurance. Of those only about half a million people are estimated to be actively using their medical aid privileges.

"The macro-economic position of the whole country is not very good, so budgetary constraints occur in the health sector," says Dr Jimmy Gazi the acting president of the Zimbabwe Red Cross. "We have got shortages in almost all the departments; we've shortages in theatres, shortages in the wards, medicines, pharmacies and food."

The government's failure to pay for coal which is used for heating hospital boilers is one extra problem public hospitals have had to deal with. This month a major central hospital had to have its food cooked at its sister hospital due to lack of coal, which in turn also affected sterilization and laundry.

Since Zimbabwe embarked on its controversial land reform programme three years ago, food production has plummeted and the country has to rely on food aid for half its population.

Malnutrition is now a growing problem, with most households unable to afford three meals a day.

Severely disadvantaged are those living with AIDS. All they can afford are painkillers and hardly the much-needed immuno boosting drugs whose cost per month is several times an average salary.

Last month, the United States government launched a pilot programme a scheme under-which non-Genetically Modified sorghum from the US will be milled in Bulawayo and distributed at subsidized rates to households in low income urban areas. If successful, the programme will be extended to other cities.

"The reason for this programme is that while most food aid is being distributed in rural areas, it is clear that food insecurity has been worsening in urban areas and that a major reason for this has been the lack of access to food in markets," said US ambassador Joseph Sullivan who launched the programme.

The programme complements the rural-based food aid programmes by the World Food Programme and other donors.

Signs of a deepening health crisis were sounded recently when Shangani Hospital was reported to have turned away patients due to a lack of food. Yet it is not the only health institution that can barely feed the large numbers of patients mainly those living with HIV-AIDS.

The Brethren in Christ Church runs two hospitals and a similar number of clinics in the southern provinces of Matabeleland. Its head, Bishop Danisa Ndlovu, says the main challenge is in affording relish to go with the meal.

"Beef has become very expensive and so that leaves the patient with little alternative but to resort to simple green vegetable and beans that are also expensive," he says.

Bishop Ndlovu adds that the problem ultimately boils down to a lack of resources. Promised assistance from the government's supplementary budget is yet to arrive.

In August, the government unveiled an emergency supplementary budget meant to pay civil servants' salaries as well as the importation of food, seeds and medicines. Equivalent to 840 million US dollars, the budget almost doubled the existing budget.

Part of the health part of the budget was earmarked for the national blood bank, the National Blood Transfusion Service (NBTS), particularly the purchase of reagents for use in detecting signs of HIV and Aids, syphilis and Hepatitis C in blood. But NBTS spokesman Emmanuel Masvikeni says funds from the supplementary vote have not yet been allocated. "We are very cash-strapped and we don't even know how much we are supposed to get."

About 75 percent of the blood collected by the NBTS goes to government hospitals hence the organization cannot easily press the government to approve market-based fees. "What they can't give us by way of a fee increase they give us by way of a grant," Masvikeni says.

The NTBS is presently sitting on half its blood requirements partly because school children, who account for the bulk of the blood, have just come out of holidays. However, Masvikeni says too many bleeding sessions have to be cancelled due to the prevailing fuel shortages and water rationing which affects some schools in Harare.

A chilling vindication of the crisis in the country's health system was borne by the recent announced that even before the advent of the rainy season; about 700 people have already died from malaria. Last year, the malaria season was particularly brutal due to avoidable bottlenecks in the importation of drugs.

Just like they are affected the most by the prevailing crisis in the country, rural people have to brace for another difficult mosquito season.

Dr. Tarumbwa acknowledges that sometimes all a doctor can do is watch a patient die for lack of materials. "They get to a hospital and there are no drugs, no intravenous fluids, and they can't purchase them because they have no money. You can watch a patient die." (ENDS/IPS/AF/SA/HE/WJ/SM/03)

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