When I finally had some spare time to see my family, I was greeted with hugs, smiles, and a familiar warmth that I only get to experience once every few years. This time was different though. This time I came not solely for the purpose of seeing my family, however, they ended up playing a larger role in this trip than I anticipated. Last August my cousin Munyaradzi, who is a physician, married Nyasha. When I arrived, Munyaradzi was off specializing in the United Kingdom. Little did I know how relevant this fact would become later on in the journey. Grateful to still see Nyasha, I engaged in a conversation with her.
The conversation consisted mainly of small talk at first, basic things you ask someone when you have not seen them in months. Then I remembered, she too is a physician just like Munyaradzi. Ceasing the opportunity, and recalling how important it is to obtain local perspectives, I asked her how work was. A seemingly innocent question evoked a devastating response. She sighed, “Depressing.” Depressing? I wondered. How could something so amazing, my dream profession that I have been working my entire life towards, be described as “depressing”? Curious to learn more about her perspective, I asked her why she felt that way. The response was straight forward. There is an overwhelming lack of resources, even at the nationally recognized, governmental run Parirenyatwa Hospital in the heart of Harare. Imagine a patient dying during an operation because you did not have access to saline. Imagine having to take used cloth rags used for bandaging exposed wounds and rewashing them so that patients do not bleed out. This encounter set the tone for the rest of my time in Zimbabwe.
On the first day at Harare Central Hospital, where my mother was born, I saw the ghost of what used to be a force to be reckoned with. Helicopter pads covered by cracks from erosion, grass threatening to cover the pad entirely. What appeared to be a large and spacious campus was littered with buildings past their prime. When we arrived at the Children Rehab Unit, I was both dismayed and impressed. All of these parents took the time to seek a treatment plan for their children with disabilities. One by one they entered the doctor’s office awaiting their child’s diagnosis and treatment plan. As they came in, I saw a trend. The vast majority of patients who were seen were accompanied solely by their mothers. Their fathers were nowhere in sight. Later on a group of therapists and a counselor held a session for us. It was there that I learned of the extent of the situation.
If a child is born, and they receive a red “R” sticker on their growth and development passport, it is already too late. The red “R” sticker symbolizes that a child was born with a disorder or physical disability that will remain with them for a lifetime. Oftentimes the children would come in with cerebral palsy, a neurological disorder that affects communication, mobility, and muscular contraction. Some fathers see their child with a disorder such as cerebral palsy, and they instantly blame the mother. She failed the marriage contract by not bearing him a healthy child. Others will whisper that this is a result of the ancestors punishing them or God’s wrath. As a direct result, some fathers choose to ignore the existence of their child all together and leave the “problem” with the mother. To make matters even worse, sometimes the physicians were unable to make an official diagnosis because they lacked an MRI machine, and their CT scans lacked contrast. Instead they resorted to images and descriptions in an official diagnosis book. Furthermore, genetic counseling is nearly impossible considering that there are not many genetic counselors available to do so. Even if the counselors were there, they would not have the tests they would need to provide more accurate advice based on biological facts.
Fast forward a week later to the Chidamoyo Christian Hospital (CCH), and you see that there is still room for improvement. All documentation is done by paper to pen. They have these giant books that they use to record patient information such as HIV status. For those they suspect to be HIV positive they then have to track down during outreach and try to convince them to take the test. The topic of HIV is so taboo that people would rather not acknowledge that it is a problem until it becomes one. By that time it is too late, and they have brought into this world a child who is also HIV positive and in need of treatment. The medical professionals at CCH had to correct maltreatment done by traditional healers, which is seen in the case of puff header bites when patients wrap a cloth around the wound, increasing the potency in that one area of the body and leading to an even more critical situation.
I will say that it is wonderful that there is a maternity ward at the CCH so that mortality rates among women in labor who walk kilometers to get to the hospital decrease. Once they enter labor at the CCH they have to rely on one of the three physicians available to help them deliver their baby. If there are too many mothers giving birth in proportion to the doctors on staff, sometimes the physicians have to bounce back and forth between three or so patients at a time, which is draining. Most of these doctors end up leaving the country for more lucrative opportunities elsewhere. Following the birth the child is placed on a table after the medical professionals have assured that the child has cried. The child is placed on a table rather than in the arms of their father because they are nowhere to be found.
All of these challenges are made worse considering the current economic and political situation. The price of gas is so unaffordable right now that even going into the community through outreach is slowly becoming an expense that is too hefty of a bill to pay. Furthermore, with the currency crisis, paying for medication has become unrealistic, especially since most pharmacies push for USD over bond notes. In the next 10 years the problems facing Zimbabwe’s health care system will be largely dependent on who swears in as the new President. The government has an obscene amount of power when it comes to divvying up financial resources to institutions of their choosing. Right now the health sector is suffering as a result of this. This course has shown me the harsh reality of the world. Something that should be as fundamental of a right as health care is only working for the few who can afford to go to private hospitals. The only difference between the private hospitals and public hospitals is the amount of resources within them. The quality of health professionals has nothing to do with this disparity. I was given the opportunity to witness a side of medicine that is heartbreaking and unjust. However, through this experience I have also met some of the most brilliant, tenacious health professionals. I hope to model their compassion and adaptability in my career as a physician in the future.
by VONGAI TIZORA
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