Zimbabwe's health sector operating in a 'war zone' environment

Harare - Last month doctors embarked on industrial action for the second time this year, after returning to work in March from a stay-away called late last year, in protest against salaries that equate to less than US$1 a day.

The government has said it hands were tied in the dispute as it was broke, an explanation that received little sympathy and saw ancillary departments, such as morticians and administrative personnel, embarking on industrial action with the striking medical staff, severely crippling public health facilities.

The International Committee of the Red Cross (ICRC) recently said the deterioration of health delivery had reached "war situation" levels. Sebastian Brack, the ICRC representative for southern Africa, told a human rights workshop in Zimbabwe's second city Bulawayo, that his organisation was compelled to source US$4.5m to alleviate the situation, citing the shortage of personnel, drugs and equipment as the major problems bedevilling the sector.

He said although it was not the organisation's core mandate in Zimbabwe, the ICRC was establishing clinics and training health personnel across the country, a facility normally availed to countries affected by war.

In the capital, Harare, both Parirenyatwa and Harare hospitals, the city's major referral centres used mainly by the poor, a skeleton staff was in operation, but vital units such as the maternity department were closed by the industrial action and the operation of the mortuaries severely disrupted. The hospital's kitchens were not operating, while a few nurses were turning people away from casualty, insisting only cases deemed as an emergency would be attended to.

Zimbabwe's seven-year economic recession has gradually seen strike action becoming the norm, as the more than 3,700% inflation rate - the highest in the world - rapidly erodes salaries and wages for the one out of five people who have jobs.

Municipal health workers have also embarked on strike action, in a bid for higher wages, in Harare and the dormitory town of Chitungwiza and similar industrial action has been reported in Bulawayo and the eastern city of Mutare, about 300km from Harare.

Bodies pile-up in mortuaries

Cosmas Dauti told IRIN about the "go-slow" at the mortuary attached to Harare hospital, which caters for the populous and capital's mainly poor south-western suburbs, and the problems he had experienced with the death of his 75-year-old mother.

His mother was admitted to the Harare hospital seven days ago after she had suffered heart complications, but there was no consulting doctor, only a few student nurses supervised by a senior nurse.

"When my mother died, I was told that I would have to help carry her body to the mortuary because of the shortage of staff but then, that was the beginning of my nightmare. The mortuary was overcrowded, with bodies lying on top of each other on the floor and we had no option but to dump her in a corner to wait for a post-mortem, which has not been conducted up to now," Dauti told IRIN.

For three days after her death, Dauti - employed as a municipal toilet cleaner on a monthly salary of a Z$250,000 (US$5 at the parallel market rate of Z$50,000 to US$1) - was having to feed scores of mourners gathered at the family home.

"I strongly believe that my mother would not have died if the situation was normal. We are losing many of our beloved relatives and friends because health centres are now rotten," Dauti said.

The collapse of health services

When an IRIN correspondent visited two Harare hospitals, under the pretence of visiting a sick relative, he was advised by hospital staff that he should bring food for the patient, as no food was being prepared for the sick. Wards had not been cleaned and beds remain unmade, while the few staff at the clinics spent their time basking in the sun.

Unemployed, Stella Ncube, 29, had registered at a relatively affordable council clinic in the Harare suburb of Warren Park for the delivery of her baby, and with the onset of labour pains was rushed there by her elder sister, only to be told on arrival that there were no midwives on duty. A midwife was traced to assist with the birth of the child, after they had agreed to pay the midwife Z$1,5 million (US$30) for her services.

"Even though the delivery was carried out successfully, I am still concerned about my child's health since he is always coughing and is refusing to take breast milk," Ncube told IRIN. "The midwife did the job hurriedly and my son's umbilical cord seems to be developing an infection."

A nurse at Parirenyatwa hospital, who declined to be named, conceded to IRIN that embarking on strike action had been a difficult decision, "but my welfare comes first". Junior nurses earn a monthly wage of about Z$600,000 (US$12).

"My heart bleeds when I see a patient writhing [in pain] on the floor but cannot get help because we are on strike. But there is a limit to charity. I have a family to feed, children to send to school, and if I remain on this kind of salary, we will all end up in hospital," the nurse said.

The Zimbabwe Association of Doctors for Human Rights (ZADHR), said in a statement this week, that "inadequate remuneration and unacceptable working conditions for health workers across the country have resulted in a crisis that has left the country's major referral hospitals unable to function."

"ZADHR considers that it can no longer be said that the health service is near collapse. The emptying of central and other hospitals of staff, and therefore patients, means that the health service has collapsed," the association said.

Article courtesy of IRIN