/ 13 August 2022

Zimbabwe hospital workers plot stillbirth burials

Labour: A pregnant woman at the Harare home of midwife Angeless Kanzara. Zimbabwe’s health system has been affected by the economic crisis. Photo: Tafadzwa Ufumeli/Getty Images

When Faith Mthimkhulu* lost her pre-term baby shortly after giving birth last month, it was emotionally draining. The tragedy would also take her through frustrating hospital red tape and “fast buck” schemes initiated by hospital employees. 

As Mthimkhulu mourned her loss, she was told by hospital officials that she and her husband would have to arrange a burial for their minutes-old baby.

 “I couldn’t believe it. How can you buy a coffin for a child born prematurely that had only lived for less than an hour? Are there coffins for such babies? I was hearing it for the first time,” she said. 

It was “hospital policy”, she was told by officials at the government referral hospital in Bulawayo, one of the largest public health facilities in Zimbabwe. 

According to the 2019 Multiple Indicator Cluster Survey, Zimbabwe’s neonatal mortality rate stood at 32 deaths per 1 000 deaths. This figure is likely to be understated, as it is known that there continue to be unregistered home births administered by midwives.

Neonatal deaths are classified as deaths within 28 days of birth.

According to the World Health Organisation (WHO), in 2020, 47% of the deaths of children under the age of five were of babies in the first 28 days of life. Sub-Saharan Africa accounts for the highest neonatal mortality rate in the world, at 27 deaths per 1 000 live births.  

It is how health institutions and families deal with such losses that could make a difference for Mthimkhulu and other women who are already faced with a litany of socioeconomic problems. 

After speaking to other women in similar positions, Mthimkhulu said she found out that she would experience a wormhole that would take her through the corrupt underbelly of government-run hospitals. 

If she could not afford it — or did not want a funeral with all its attendant formalities and protocols — she was told she could leave everything to the hospital staff members who would “know what to do”. 

Whether the baby would be cremated or added to other bodies being prepared for anonymous pauper’s burials, Mthimkhulu says she settled to have the matter off her hands and privately deal with her loss. 

“I agreed to the scheme,” she said. It cost her $50. Organising a funeral would only add to her agony and would require more than $50. “What else could I do?” 

For people working in the industry, it is easy money.

“It makes sense helping [for a fee] the distressed mothers instead of adding more misery by asking them to bury their babies,” said one mortuary attendant.

By Mthimkhulu’s account, when she was referred to the person who would pocket the money, that person at first “acted tough”, telling her what she had been told was illegal.

“But it wasn’t long before I was told, ‘It’s going to cost you, how much do you have?’ And that was the end of it,” Mthimkhulu said. 

Yet hers became a story not only about the implications of suspending hospital cremations, where old electricity-powered incinerators have not been spared the wrath of decades-long economic turmoil, but also just how much the country’s once efficient health services have declined. 

Outside the same mortuary of the government referral hospital, a group of older women wrapped in thick blankets to protect themselves from the winter cold sat on hard benches as they waited to be attended to. 

They whispered how they had been told to organise the burial for a stillborn child. 

“Where is the money going to come from?” one of them asked in exasperation, although it became clear that such experiences are routine at a time when families are already struggling to bury adults because of rising funeral costs

“The way things are going, we are going to be fed to wild animals when we die,” an older man among the women commented bitterly. 

Families report government hospital mortuaries stacking bodies on top of each other and being asked to identify relatives amid the odour of death. 

For years now, mortuaries at the city’s two referral hospitals, the 1 000-bed Mpilo — the second-largest in the country — and the 600-bed United Bulawayo Hospitals are unable to cope with the number of corpses, with reasons including families failing to collect bodies for burial because they have no money. 

In Zimbabwe’s major cities, there are numerous cases where patients die in hospital and relatives disappear. Pauper burials then become the order of the day in an effort to decongest mortuaries. 

The holding capacity at the Mpilo Hospital mortuary is about 100 bodies but the number has been known to exceed 200, according to officials

In 2020, it was reported that the Mpilo mortuary had 446 bodies, with 195 being stillbirths, which had to be given pauper’s burials on already scarce municipality-run cemetery space. 

“The addition of stillbirths and babies who die shortly after birth to the mortuary as they await burial has made an already bad situation worse,” a mortuary attendant said. “It wasn’t always like this because in the past we used to incinerate them, of course with the knowledge of their families.” 

For years government hospital mortuaries have not been spared the routine power outages, and the insistence by hospitals on burying infants has added to the burden. 

Stillborn and neonatal corpses making their way to poorly refrigerated or unrefrigerated mortuaries has led to the city experiencing a shortage of burial space

“Bulawayo is actually running out of land for residential and industrial purposes and also for cemeteries,” said Mlandu Ncube, Bulawayo’s deputy mayor.

“Burying stillborn babies is contributing to the shortage of burial space and we ask those in authority to consider such decisions,” he said, acknowledging that in the past hospitals maintained incinerators and some families have not been keen on the council’s suggestion to embrace cremation.

But there appeared to be no choice for mothers of stillborn babies and deceased neonates because cremation was the official hospital policy. 

“The city has tried to encourage the public to embrace cremation, however, cultural and religious beliefs have hampered this,” said Nesisa Mpofu, the city spokesperson. “The failure to embrace cremation has seriously affected sustainability and availability of burial space in the city.” 

Yet it is that same space that is being taken up by stillbirths and minutes-old pre-term babies. 

“Definitely there is a disconnect between what Bulawayo city council is advocating for [cremation] and what the health institutions encourage [burial],” said Thembelani Dube, the Bulawayo Progressive Residents Association secretary for administration.

Attempts to get answers from provincial and senior referral hospital administrators were met with responses that the officials were no longer allowed to address media queries. 

Questions sent to the ministry of health and child welfare were not answered. 

*Identity protected