Maggots are squirming from the old man’s foot, but he is just laughing at the ceiling. The latest patient to enter one of Bulawayo’s main hospitals has suspected beri-beri, a disease caused by vitamin deficiency.
He is also mentally ill, and seems undisturbed at the prospect of having his foot amputated due to the gangrene that has set in.
Abandoned, alone and often incoherent, Zimbabwe’s mentally ill are taking the brunt of the collapse of the health services once regarded as one of the best in Africa.
At the nearby mental hospital of Ingutsheni, the grass is waist-high and paint is peeling from the walls. Patients wander the grounds unattended, old food and saliva smeared on their faces.
Those lucky enough to have wealthy families nearby are dressed in reasonable clothes, but many are barefoot, wearing ragged shirts. One man’s neck and face are covered in open sores.
“We get a lot of cases from Ingutsheni,” sighed one Bulawayo doctor, who asked that neither he nor his hospital be identified. “Patients are often injured fighting each other, or they get burned when they are put in hot baths by negligent staff or climb in themselves unsupervised. I don’t think the diet can be very good either.”
“It’s porridge in the morning, then rice for lunch and dinner, sometimes a little meat or vegetables. At least they’re getting fed, not many people are,” said one Ingutsheni staff member, who enquired about a job in Britain. About 2 000 Zimbabwean nurses are estimated to leave the country every month, and roughly 90% of doctors have left the rural areas around Bulawayo.
Even those medical staff who have refused to join the exodus face enormous problems due to a lack of equipment.
“We have all this cheap Chinese stuff that breaks or leaks and some of the new staff don’t know one end of an instrument from another,” fumed the doctor, who has begun asking friends to carry tumour samples back to London in their hand luggage for testing.
A lack of technicians and equipment make it nearly impossible to get results from tissue tests. Cancer patients must seek treatment in neighbouring Botswana or South Africa, because there are no longer the drugs or facilities to give them radiation treatment or chemotherapy.
A woman who broke her leg two weeks ago was asked to bring her own plaster-of-paris to hospital for the cast; another who gave blood was told to put her finger on the puncture wound since there were no Band-Aids available.
In a room a few yards from the fly-blown foot of the old man, a 20-year- old youth has had most of his lower arm amputated following a car accident. The stump, a few days old, is gently oozing blood onto the blankets; there are no more crepe bandages to wrap it in.
“He’s probably HIV-positive too, did you notice the inflammation of his carotoid glands?” sighed the doctor.
Zimbabwe places a 3% tax on all salaries to pay for HIV treatment, but there is no attempt to account for where the money goes. Last October and November, no testing kits were available in the city’s government hospitals. There is a five-month waiting list for Bulawayo residents to get anti-retrovirals, and no plan at all to provide drugs for those in the worst-affected rural areas.
Roughly a third of all Zimbabweans have HIV or Aids and nearly a fifth are affected by malaria, but the Global Fund for Aids, TB and Malaria rejected the Zimbabwean government’s application for funding last year because it feared the money would simply disappear.
The International Monetary Fund predicts that, based on current trends, Aids-related infections will have killed 10% of all current teachers by 2010.
Three-year old Ntokozo will not live long enough to miss having a teacher. Sitting at a table with other orphaned children, the young girl has HIV and an infection in her lungs that has filled one of them with fluid.
There is no film for the X-ray machine, so the doctors are hoping that it will clear itself. There are no drugs to treat her.
Another baby is being comforted by his great-grandmother; Aids has already claimed both his mother and grandmother. The brightly painted pictures on the walls and a few toys scattered around seem like a cruel deception of those whose childhoods will be cut short so suddenly.
Aids is not the country’s only problem. Cases of malaria have risen five-fold in the last 12 years, according to a report released earlier this month by the Johannesburg-based group Africa Fighting Malaria. Malaria control teams “not only lack insecticides, but also cannot obtain the fuel they require to drive into the malarial areas.”
The victims are people like 32-year-old Harvest Mavhunga, shivering on a bed in a rural hospital run by foreign donors. She lay at home for a month while her mother brewed batches of beer, desperately trying to sell enough to pay for a bus ticket for herself and her daughter to get to hospital.
Now foreign money is paying for Mavhunga to be treated, fed and sheltered, but her mother is sleeping on the hospital’s veranda and eating their bus fare home. While they are away, the rest of the family are relying on hand-outs from Save the Children.
“The government medical services are total mayhem: no auditing, no idea of requirements, and no finance,” said the Bulawayo doctor bitterly. “What a complete balls-up. We used to be the best.”