Defenceless as health delivery system collapses

Three days after the outbreak, Binga's political and medical leaders had gathered at the town's hospital to discuss and see if they were well placed to deal with the epidemic.

But nothing was in order. The hospital had no intravenous solution for rehydrating patients, a most important tool in the battle against cholera. Like many other towns in the country, it had no water purification solutions.

The tents used to isolate cholera cases were, according to one old man, "in tatters". The doctors needed large amounts of salt, sugar, bleach, soap, fuel and candles but none was on hand.

The hospital's ambulance was in the garage and the tow-way radio used to communicate with rural clinics was not working.

Only a decade ago, Zimbabwe's public health system was the best in the sub-Saharan Africa. But like the rest of Zimbabwe's economic and social fabric, the health delivery system is now in the state of dissolving.

Three years of economic free fall and inflation, now averaging 620 percent a year, have left Zimbabwe desperately short of even basic drugs and medical equipment, pushing a once robust network of hospitals and hundreds of rural clinics close to ruin.

Experts say the decay omens potentially far more serious problems - outbreaks of diseases like cholera and anthrax that spread when preventive measures are poor, and deadly childhood epidemics like measles, which exist only when public health defences are down.

Zimbabwe's government does not discuss details of its public health. In January, an association of medical doctors said there were 10 doctors left in the capital Harare and the second largest city, Bulawayo.

According to a World Health Organisation-financed report, fewer than 600 doctors remain in the country to serve a population of 13.5 million, the rest having moved to such countries as Britain, Australia or Zimbabwe's neighbours, Botswana and South Africa.

"Basically, the health care system is collapsing on itself right now," said Richard Chidowore, a Harare medical professional. "There's an exodus of health care professionals from this country. And most of the rural health structures have been left under the supervision of nurses' aides who have nothing to treat patients with."

The human toll of such breakdowns is difficult to measure precisely, but the anecdotal evidence is chilling with health professional estimating over 1 500 deaths a week due to AIDS.

Two physicians who sought anonymity told NewsfromAfrica in separate interviews in January that
in the space of six months last year, half of Harare's kidney-dialysis patients died, all because the government did not spend its scarce foreign currency to buy catheters for blood-cleansing equipment.

In Bulawayo a shortage of sutures and other equipment has closed operating rooms and forced obstetricians to curtail Caesarean-section births. Some women have died in labour as
a result, said Doctor Lulu Phiri, who often works in the town.

The public health system that remains here, experts say, persists on the astonishing dedication of those health workers who have stayed.

Despite President Robert Mugabe's withering attacks on what he calls the racist West, the country also depends even more on the kindness of Western strangers- many of them
relentless critics of his authoritarian government.

Foreign aid, largely from global charities and the United States, Britain and Europe, has saved Zimbabwe from running entirely out of drugs and medical supplies.

Recently, the European Union pledged $30 million in aid to buy medicine and equipment for clinics. Only in December, the United States made a last-minute donation that enabled the government to buy the chemicals that keep the municipal drinking water used by more than two million people in Harare and Bulawayo pathogen-free.

Zimbabwe, of course, is hardly alone in its misery. Public health neighbouring Zambia and nearby Malawi, to cite two - face even worse problems.

What distinguishes Zimbabwe, however, is the depth and rapidity of its fall from the top rank of healthy nations to near basket case.

Yet no one outside Zimbabwe's government knows with certainty how deeply the crisis in public health runs here. The network of clinics and doctors has frayed so badly that experts suspect the data once routinely dispatched to statisticians are no longer reliable.

But evidence of the decay in health care is overwhelming. A recent stroll through the Parirenyatwa public hospital in Harare showed that staff shortages had shuttered whole
corridors. At a second major hospital, Harare Central, the laundry has stopped working. In the paediatric wards, blood work-ups are no longer performed in-house because of equipment and staffing problems.

Refrigerators in the overstuffed morgue, where corpses can remain for up to six months, are not working.

A Harare resident who gave his name only as Thomas told how his father-in-law was rushed to a city hospital in November with high blood pressure and breathing problems, only to discover there were no doctors to see him. Shortly after Christmas, a stroke left him paralysed on one side. "We
took him to Suburban Hospital," a private institution, Thomas said. "They wanted Z$900,000 (approx. US$300) as a deposit for admission."

Thomas could not raise the amount and so he took him to a clinic where he was given a prescription and asked to take him every day for an injection.

Thomas paid Z$250,000 (approx. US$80) for medicine, needles and syringes, and ferried his paralysed father-in-law to the clinic for the daily injection. Within days, he was dead.

But Zimbabwe's crisis is most painfully apparent not in the cities, but in rural areas. There, doctors and patients alike say many of the hundreds of local government clinics
now have no working radios, refrigerators or trained medical workers, and often few medicines are inadequate.

Zimbabwe's economic crisis has made fuel so costly that vaccines and other drugs can no longer be reliably ferried to faraway villages.

"Zimbabwe used to run its own immunisation program. In fact, it was the only country in sub-Saharan Africa which could buy all its own vaccines," said Chris McIvor, an official from Save the Children, a Canadian global aid organisation. "But by 2000, it couldn't afford it."

So Zimbabwe's immunisation programs, once exemplary, now provide coverage below 70 percent for some major childhood diseases.