Posted on 02/05/2004 1:11:26 AM PST by sarcasm
INGA, Zimbabwe — Three days after getting word that cholera was again killing villagers outside this district capital, Binga's political and medical leaders gathered at the town's disheveled hospital to take stock of their arsenal against a potential epidemic.
It did not take long.
They had no intravenous solution for rehydrating patients, a principal weapon against cholera. Water purification chemicals were in short supply. The generator was broken. Of the tents needed to isolate cholera cases, one was missing its tie-down ropes, the other was "in tatters," one man said. The doctors needed large amounts of salt, sugar, bleach, soap and candles; none were on hand. Of 330 gallons of gasoline sought, 44 were available — not that it mattered, as two of three cars were in the shop. The truck was, too.
The needs might be even greater, as might the outbreak's toll — two reported deaths, seven more illnesses. But no one knew for sure: the two-way radio carried by the first doctors who drove to the scene was not working, either. Nor was the radio in the village's medical clinic.
Only a decade ago, Zimbabwe's public health system was, with South Africa's, head and shoulders above those of most of the 40-odd other nations of sub-Saharan Africa. But in a weeklong trip through eastern and central Zimbabwe, both to cities and to remote towns like Binga, it was apparent that health care — like the rest of Zimbabwe's economic and social fabric — is 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 portends 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 defenses are down.
Zimbabwe's government does not discuss details of its public health problems, and Western journalists, derided as tools of the nation's critics, are officially barred from reporting here. With rare exceptions, local medical experts and others interviewed for this article spoke only on condition of anonymity for fear of retaliation, either against them or their organizations.
Nevertheless, the national medical association stated publicly in January that 4 in 10 doctors had already left Harare, and 6 in 10 had left Bulawayo, usually for Britain, Australia or neighboring African states like Botswana.
By one United Nations-financed study, fewer than 900 doctors remain in a nation of 11.6 million people — one doctor for every 13,500 people.
"Basically, the health care system is collapsing on itself right now," said one Harare medical professional with long experience in several parts of Zimbabwe. "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.
Nurses at Harare's Parirenyatwa public hospital, the city's biggest, say that since November there have been no H.I.V. test kits — in a nation where one in four people is H.I.V.-positive. Two physicians said in separate interviews recently 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, Zimbabwe's second largest city, a shortage of sutures and other equipment has closed operating rooms and forced obstetricians to curtail Caesarean-section births. Some women have died in labor as a result, said one medical professional who often works in Bulawayo.
The public health system that remains here, experts say, persists on the astonishing dedication of those health workers who have stayed. Despite President Robert G. Mugabe's withering attacks on what he calls the racist West, it 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. Days ago, 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 in much of this region is abysmal, and some other African nations — neighboring 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.
Take infant mortality, one key indicator of public health: between 1999 and 2002, Malawi's rate dipped by about five percent while South Africa's held essentially steady. Zimbabwe's jumped at least 15 percent, and is believed to have risen further last year.
That is no isolated trend. Overall mortality rates, as well as childbirth-related deaths, also worsened over the decade in Zimbabwe in comparison with its neighbors.
Yet no one outside Zimbabwe's government knows with certainty how deeply the crisis in public health runs here. Mr. Mugabe's government, increasingly wary of bad publicity, has stymied the public release of United Nations assessments of major social indicators. The network of clinics and doctors has frayed so badly that experts suspect the data once routinely dispatched to statisticians are no longer reliable.
On a personal level, the evidence of 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 pediatric 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.
In an interview in late January, 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 paralyzed on one side.
"We took him to Suburban Hospital," a private institution, Thomas said. "They wanted 900,000 Zimbabwe dollars as a deposit for admission" — about $300, a sum laughably beyond average people here.
"So we took him to a clinic, and they wrote a prescription and said to bring him to the clinic every day for an injection."
Thomas paid 250,000 Zimbabwe dollars for medicine, needles and syringes, and ferried his paralyzed father-in-law to the clinic daily for a 10,000-dollar-a-day 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 beyond basic antibiotics and a pain reliever. One person told of seeing a broken leg set solely with the help of acetaminophen, commonly known as Tylenol.
In a remote corner of eastern Zimbabwe, an official of one private charitable clinic said in a recent interview that none of the four closest government clinics currently employed either a doctor or nurse. The charity's case loads have more than doubled in the last year, she said.
"They come here for malaria pills," she said, referring to a standard preventive tablet in high-risk malarial areas like Zimbabwe. "We tell them that they should check at the clinics. And they say, `Uh-uh; we know you have it here.' "
Zimbabwe's economic crisis has made gasoline so costly that vaccines and other drugs can no longer be reliably ferried to faraway villages. "Zimbabwe used to run its own immunization program. In fact, it was the only country in sub-Saharan Africa which could buy all its own vaccines," one global aid official said in a recent interview. "But by 2000, it couldn't afford it."
So Zimbabwe's immunization programs, once exemplary, now provide coverage below 70 percent for some major childhood diseases. Indeed, the official of the charitable clinic said it was expanding its own free immunization program to head off an expected flood of sick children from areas where government immunization programs have stalled.
Some of the same shortcomings were evident in the Binga district, the northwestern region that was the scene of cholera outbreaks in January and late last year. Binga, hard against vast, man-made Lake Kariba, has always been a region of impoverished peasants, with poor services and sanitation, so cholera was not unexpected. The area affected this time, around the remote village of Lunga, is said to have almost no latrines and little access to treated water.
Yet when the disease first struck late last year here and in neighboring Mashonaland West, medical experts said in January, district health clinics had neither the qualified staff nor the radio communications to identify cholera and spread the alarm.
Chris McIvor, the mission head in the region for the charity Save the Children, said in a telephone interview in late January that Zimbabwean health workers responded heroically to last year's three-month outbreak, which sickened 900 people and eventually killed 40 before being brought under control in December.
"Having said that, there's no doubt that there is a shortage of facilities, supplies, fuel, adequate numbers of staff and adequate drugs," he said. "And we're very concerned that in the current environment, further outbreaks of cholera — not just in Binga, but in other places — could be much more serious.
"With the state of health services currently," he said, "I think that the response in 1990 would have been speedier than it is now."
"Pity about Africa..."
There is absolutely no doubt that the racist liberals at the NY Times will demand for Zimbabwe to be re-colonized, though they won't dare utter that word.Send in the UN! Send in the U.S.
Run their country for them, the liberals will whine!
The unspoken subtext being that the liberals at the NY Times all think that Zimbabweans can't run their own country themselves...
You mean it wasn't the long lasting drought?
This is why a free press is so important, without it corruption can run unchecked and undetectable.
Yes, and I note no mention of the President of this country and the staggering results of his policies.
I agree for the most part, but I think you are being a bit generous with the time frame.
I don't know that you can show that race has anything to do with it, but I can tell you that the Christian nations of Sao Tome and Principe in Africa have higher productivity and higher standards of living than do the Chinese, per the CIA Factbook.
It's safe to say that those two small nations aren't going under, either (though they are islands, which makes for interesting word play with the term "under")...
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