As Hospitals Crumble, the Sick Turn to “Witch Doctors”

As Zimbabwe’s hospitals and health services - until a decade ago among the finest in Africa - deteriorate rapidly, traditional healers are doing brisk business.

The healers, known as “witch doctors” beyond Africa, throw bones and prescribe concoctions made from roots, barks, leaves, animal parts and, sometimes, human organs.

The healers have no formal training and their medicines are neither tested nor controlled by any government body. Black Zimbabweans have always consulted them, but now they turn to them out of sheer desperation.

“You cannot get any help from hospitals these days,” said Bill Tafamombe from rural Zimunya, near Mutare, 350 kilometres east of Harare. “Either the hospitals have no medicines or the charges demanded upfront are way beyond the common man’s reach. Many people simply die at home or consult traditional healers.”

Hospitals throughout the country are deteriorating fast. They are desperately short of medicines, equipment and spares. Doctors, nurses and pharmacists are emigrating in large numbers for better-paid jobs and conditions, usually to Britain, Australia and neighbouring South Africa and Botswana.

“When you’re running out of drugs and drips, what do you do?” said Brighton Chireka, who emigrated to Britain after a young doctors’ strike failed to persuade the government to improve the supply of drugs and renew basic equipment. “You are not serving the people. You have to ask the patient to buy equipment for himself – basic things, like bandages. After two months on strike, we realised the government wasn’t going to do anything. We were just causing patients’ deaths, so we called it quits.”

Zimbabwe’s National Medical Association said that in the past four years, forty per cent of doctors in Harare, the capital, have quit the country. In Bulawayo, the corresponding figure is sixty per cent. Meanwhile, half of the eight new doctors produced each year by the country’s only medical school, at the University of Zimbabwe, leave the country immediately on qualifying: there may soon be no new doctors, because teaching physicians are also quitting.

There are now fewer than 900 doctors to serve a population of 11.5 million. The World Health Organisation estimates that the country needs an absolute minimum of 2000 doctors to provide only a basic health service.

Harare, with a population of more than two million, has the country’s two biggest referral hospitals, Harare Central and Parirenyatwa. Their shabby exteriors are dotted with broken windows and leaking pipes while heaps of rubbish pile up around the buildings.

A nurse at the 1428-bed Harare Central, speaking on condition of anonymity for fear of retaliation, said, “Often we lack such basic necessities as surgical gloves, so it becomes hazardous to treat patients, especially those infected with HIV and suffering from other communicable diseases.”

Most of the hospital’s equipment is obsolete. Five of its elevators are permanently broken following the withdrawal of the elevator company, Otis, from Zimbabwe. Consequently, patients have to manhandled up and down stairs. Many toilets and sinks are blocked. Ceilings leak badly. Three out of five dialysis machines are beyond repair.

At Parirenyatwa, with even more beds than Harare Central, nurses say there have been no HIV test kits since November 2003 – in a nation where more than one in every four people aged 15 to 49 is HIV-positive.

Quite apart from dishearteningly low salaries and deteriorating working conditions, the nurse at Harare Central said, “We are fed up with seeing our patients die daily because of the shortages of essential drugs and equipment.”

Most patients at the two Harare hospitals are rural peasants or urban poor. More than 70 per cent of them are unemployed. Over 80 per cent of Zimbabweans live below the international poverty line of a US dollar a day income; so they cannot afford basic drugs or often the most basic of hospital charges.

Twelve-year-old Linda Mudzimwa lives in the densely populated township of Mbare, south of Harare. She has severe asthma but her mother, the surviving parent, cannot afford to buy either an inhaler or anti-asthma medicines - simple and cheap treatments for her condition in most countries. An attack could easily kill her.

“I make sure I am warm all the time because sudden weather changes can trigger an attack,” said Linda. “I cannot have fun with other children of my age. I can only watch them play because vigorous activity makes me run out of breath quickly.”

The problems at the two hospitals spread through every department. Corpses are piling up in the hospital morgues because the last government forensic pathologist quit eight months ago and returned home to Tanzania. With no qualified personnel to conduct post-mortem examinations, bodies are cleared only slowly from the morgues where refrigeration frequently breaks down and the stench is overpowering.

“We no longer go in there,” said a morgue attendant at Harare Central. “If you bring your dead relative you have to find somewhere to put them yourself, or we will charge you if you want us to do that.”

Laundry is piling up because steam cleaners have long been out of order in the absence of spares. Relatives of the sick are told to bring their own linen from home.

“In 1982, when I was just ten, doctors here saved my life when I was knocked down by a car,” said Givemore Madzudzo, whose own mother died painfully in Harare Central after being run over by a vehicle. “Now I am witnessing a total collapse of the health delivery system. We were asked to buy almost all the drugs during the four months she was in the hospital.

“When the doctors operated on her broken leg they used the wrong clamps and surgical screws to bind her shattered bones. They had to be replaced quickly and we were asked to find the right instruments, which cost us Zimbabwe 1.8 million dollars [about 2000 US dollars].

“In the fourth month her leg became cancerous. We were told to take my mother home. We had to buy her oxygen tanks and a wheelchair. She died a week after leaving hospital.”

However serious the health care crisis in the cities, the situation is worse in rural areas. There, doctors and patients alike say many of the hundreds of the once model local government clinics now have no trained medical workers or working refrigerators and radios. There are few medicines beyond basic antibiotics and pain relievers, and even these come largely from global charities, the European Union and the British and American governments.

No one outside Zimbabwe’s government knows, in the final analysis, the scale of the public health crisis. President Robert Mugabe’s ZANU PF government, paranoid about adverse publicity, has blocked the public release of United Nations appraisals of major health and other social indicators. The network of clinics and doctors has frayed so badly that experts suspect that data once reliably and routinely sent to statisticians are no longer reliable.

Minister of Health and Child Welfare Dr David Parirenyatwa confessed last year that the country’s deepening economic crisis [the World Bank says Zimbabwe has the world’s fastest deteriorating economy] makes it difficult for the government to invest in health. He said the situation was unlikely to improve in the near future and the drain of doctors and nurses to other countries was likely to continue.