Urban patients now referred to rural mission hospitals

HARARE – Rosa Chimbindi, pregnant with her first child, recently went Parirenyatwa hospital, one of Zimbabwe's largest referral facilities, located in Harare, the capital, to have her baby. Instead, staff at the maternity wing told her the hospital was closed because of the health worker boycott.

Her doctor had recommended that her baby be delivered by Caesarean section because she was HIV positive and had previously suffered a hip injury.

In the government guidelines on prevention of mother-to-child transmission of HIV, HIV-positive pregnant women are encouraged to deliver by Caesarean, where facilities are available, to reduce the chances of passing on the virus to the baby.

But even after the doctor’s advice, the senior matron holding the fort in the maternity ward told Chimbindi and other women already in labour to go to the private sector, and if they could not afford this, they should travel to mission hospitals outside Harare for treatment.

"The student nurses at Parirenyatwa hospital referred us to Howard mission hospital in Chiweshe, and Karanda hospital in Mount Darwin. They said there was nothing they could do, as they were inexperienced," Chimbindi told IRIN/PlusNews.

"Can you believe women already with labour pains were being told to travel more than 60 kilometres to Howard, or 150 kilometres to Karanda mission? As I sat there on that hospital bench I felt really lucky – at least I wasn’t in pain, and I had come to admit myself for an elective Caesarean section."

This experience is becoming common as more and more people requiring medical care in Harare are forced to travel long distances to rural mission hospitals for treatment.

Some of the church-run mission hospitals, like Karanda and Howard in Mashonaland Central Province, and Nyadiri and All Souls in Mashonaland East Province, are financed by external funding and still running relatively smoothly because they have not been affected by shortages of drugs, and the staff are better paid than those in government health facilities.

But the state-run rural hospitals are in far worse condition. As a result of the huge exodus of health workers, most rural hospitals and treatment centres are being manned by primary health care workers who are given crash courses in basic nursing care, according to the Community Working Group on Health, a network of civic groups that promote health awareness.

Since October 2008, government hospitals such as Parirenyatwa and the Harare hospital have stayed closed after a work boycott by health workers protesting against poor salaries and working conditions, and because they could not continue to endanger the lives of patients by working in hospitals that were not properly equipped.

Since the walkout, senior staff like matrons have been providing a skeleton service because they are not allowed to take part in strikes, but they are only admitting accident victims and "serious cases".

''For us to get to the extent where big hospitals … are actually referring patients in need of medical care to rural hospitals is the biggest scandal the health system has ever had to take''

All other patients are being referred to the private sector or to rural mission hospitals. People like Chimbindi, who cannot afford the fees in the private sector or the bus fare to hospitals in other parts of the country, are left with little or no access to healthcare.

AIDS activist Chitiga Mbanje noted that people living with HIV were hard hit. "Can you imagine the strain of having to travel two or three hours to remote parts of the country to get treatment for pneumonia? What happens when you don’t even have the bus fare to get there? It means you will just die at home, when under normal conditions one could have been treated here in Harare."

Dr Amon Siveregi, the representative of the Zimbabwe Health Workers’ Association, told IRIN/PlusNews that before the crisis in the health sector, mission hospitals used to send seriously ill patients or those in need of specialised care to referral hospitals in urban centres. Now, it is the other way round.

"For us to get to the extent where big hospitals such as Parirenyatwa, Harare and Chitungwiza [about 30km from Harare] are actually referring patients in need of medical care to rural hospitals is the biggest scandal the health system has ever had to take," said Siveregi.

"These problems in the health sector did not start today – the situation has been worsening over the years and government has been ignoring them, and today the situation is completely out of control."

Health workers have said they will return to work when government ensures that hospitals are properly equipped. They are also demanding salaries of US$1,500 for nurses and US$2,000 for junior doctors.

The UN Children’s Fund, UNICEF, recently injected about US$5 million into Zimbabwe’s health sector, which is expected to go towards incentives for health workers to return to work. In 2008 the UN Population Fund paid out some allowances to midwives to allow the maternity wings of hospitals to reopen throughout the country.