The signs are all around. In the spectre of cholera hauntincg the sewage-strewn streets of Harare’s townships. In the fading bodies of the hundreds of thousands of Zimbabweans surviving on wild fruits because their fields are barren. In the glass littering streets after embittered soldiers smashed their way into shops that no longer accept Zimbabwe’s near-worthless currency as the inflation rate surged through the billions and trillions.
But perhaps nothing is as disturbing a symbol of the collapse of governance in Zimbabwe as the ghostly corridors of the country’s biggest hospital as patients are turned away from its doors to die.
Parirenyatwa Hospital lies at the centre of a complex of hospitals in the heart of Harare, with 5 000 beds. It is named after the first black Zimbabwean to qualify as a doctor, Tichafa Parirenyatwa, and was once one of Africa’s best with a large maternity hospital, a section specialising in eye surgery and extensive paediatric wards.
Treatment was free. Zimbabwe’s doctors and nurses were well trained and renowned for their dedication.
Today the Parirenyatwa’s wards have an air of hurried abandonment. Get-well-soon cards are still pinned above the beds. Patients’ notes hang below. The paediatric wards are decorated with mobiles of dancing animals and biblical drawings. But the absence of children creates a disquieting sense of abnormality.
Water from a burst pipe drops through a ceiling in a darkened corridor and forms a small lake in the general surgery ward. There is no one to repair it or, apparently, even report it.
The outpatient section’s doors are locked. The operating theatres are darkened. The nurses’ stations around them are abandoned. ”A month ago this was overflowing with patients being wheeled in and out of the theatres. Now it is dead,” said one of the few doctors still on duty, who did not want to be identified for fear of retribution for criticising the authorities.
”The staff just stopped coming to work because it was impossible to work and their pay simply isn’t worth anything. Nurses earned less than the bus fare to get here. We’ve been subsidising the government for so long now. The nurses feel abused, misused.
”But I’m surprised that the situation is now where nobody cares. There are lots of people dying for lack of staff. People are hungry. Their sense of public service has gone. There is a loss of humanity.”
The staff at the Parirenyatwa muddled along for years as the government’s incompetence and greed bled the health service of funds and hard currency was pocketed by the ruling elite, while hospitals struggled with growing shortages of medicine, nurses worked to maintain hygiene standards when the water was off for days, and surgeons operated in the midst of power cuts.
The doctors led the walkout, saying that it was impossible to work in such conditions. The nurses quickly followed, driven to the end of their endurance as their pay was consumed by hyperinflation while Zimbabwe’s leaders got rich on the back of the misery.
The maternity hospital stopped doing caesarean sections and life-saving surgery. Harare General Hospital is completely shut. Parirenyatwa’s casualty department is still open but mostly it turns patients away as it cannot offer any major operations or treatment.
”We’ve been witnessing mothers just coming to die,” said the doctor. ”Complicated cases are brought to Pari. These patients have been coming and the doors have been closed. So they sit outside and cry. We know they are going to die.”
‘We wonder what happened to all the kids’
Much of the paediatric ward is abandoned until, down the far end of one corridor, there is the sound of cartoons on a television. Two young boys beam from their beds.
”This hospital has an orthopaedic surgeon who said he will never abandon his patients. He had these two children admitted,” said the doctor. ”We wonder what happened to all the kids we used to see. Many came from Epworth and Hatfield [townships] suffering from malnutrition and related diseases. We suspect these kids are dying at home. Their mothers know nothing happens at Pari now.”
Another doctor said the decline in healthcare could be seen in the statistics. The numbers of women dying in childbirth has doubled and the number of newborns surviving has halved in recent years. ”Cerebral palsy births increased threefold in three years. That’s a very good indicator of the quality of maternity care,” said the doctor.
Even before the hospitals closed, patients often had to buy their own anaesthetic and medicine if they wanted an operation. But pharmacies charged what it cost to import them from abroad, far beyond the reach of most families.
Some doctors have been carrying out illicit operations at the Parirenyatwa out of duty or because the patients can pay. But often they are risky without the full complement of staff and in difficult conditions.
The government has blamed the hospital crisis, like the rest of the country’s problems, on international sanctions, although the measures imposed by Western countries are targeted against Zimbabwe’s leaders.
Few Zimbabweans are taken in. They see the Parirenyatwa’s closure as further evidence of a collapsing state and the fact that President Robert Mugabe no longer so much governs as obstructs.
Tichafa Parirenyatwa’s son, David, is now Zimbabwe’s health minister. Where his father was honoured he is now scorned as in service of a regime accused of killing its people through neglect and cynicism.
This week, doctors working at the hospital named after his father marched to the building to present the minister with a petition.
”We are forced to work without basic health institutional needs like drugs, adequate water and sanitation, safe clothing gear, medical equipment and basic support services,” the letter said.
David Parirenyatwa, who was meeting foreign donors, responded by unleashing the police on the protesters. Some doctors were badly beaten.
The doctors also wanted to know when health workers’ pay would be restored to its former value. Salaries change by the month because the Zimbabwe dollar loses value by the minute.
A nurse’s basic monthly pay at the end of November was Z$120-million. At the time it was worth about Â£40 if changed the same day with the black market currency dealers on the street. By Friday afternoon the same amount was worth just Â£6, enough to buy 10kg of maize.
Money is a complicated business in Zimbabwe, even if most people do not have much. Cash has been in desperately short supply because the government cannot print fast enough to keep up with hyperinflation. Officially inflation stands at 231-million percent, but that was in July. Since then the central bank has regarded economic statistics as a state secret.
John Robertson, one of Zimbabwe’s most respected economists, has accurately estimated the rate of inflation in the past. He says it shot through the billions, trillions and quadrillions between August and October until it reached 1,6-sextillion percent last month. A sextillion has 21 noughts.
Robertson says the number is almost meaningless. ”Inflation at the present rate is academic. Nobody says they’ll increase salaries on this figure. It’s impossible to work with it.”
As the government grappled with the cash shortage caused by hyperinflation, it severely limited the amount Zimbabweans could withdraw from their bank accounts.
After soldiers rioted in central Harare on Monday, looting stores charging in United States dollars and snatching money from the illegal currency traders in an informal market known as the Copacabana, the central bank raised the withdrawal limit to Z$100-million — the equivalent of Â£5 a week — from Thursday, though the real value was falling rapidly by the day. But, far from alleviating the crisis, the extra cash in the system drove the Zimbabwe dollar to new depths. It fell from Z$3-million to the pound on Wednesday evening to Z$22-million on Friday.
Prices went the other way, tripling on Thursday alone. Robertson says it is further evidence of a government unable to govern. ”They issue these new notes thinking it will solve the problem and it just makes it worse,” he said. ”You’d think that these numbers would cripple us, that we might as well stay in bed. But people find other ways and the way is to sell in US dollars.”
‘I come to work out of duty’
Mugabe’s most dramatic recent concession to reality was the recognition of the US dollar and South African rand as the real national currencies of Zimbabwe these days.
The government spent months trying to suppress trading in foreign currency but underground supermarkets sprang up in garages and warehouses stocked with imports from South Africa.
Restaurants and shops took foreign money under the counter. With rapid devaluation and the shortage of Zimbabwe dollar notes, the middle-class began to pay their domestic workers and gardeners in hard currency.
Eventually, the government faced the reality that there was only anything in the shops at all beyond a few vegetables and eggs because of trading in foreign currency — in part driven by the three million Zimbabweans who have fled the country, mostly for South Africa, sending money home. It legalised the use of US dollars and rand in September but the effect of that has been to make it impossible to buy almost anything without foreign currency.
So Parirenyatwa’s nurses and doctors are forced to swap part of their salaries — when they can get money out of the bank — because it is the only way to buy most foods, including the staple, maize.
That is not all they have to cope with.
One of Parirenyatwa’s nurses who still goes to work lives in Epworth, a poor township to the east without most basic services. It has been hit by the cholera that has claimed about 600 lives across Zimbabwe and infected more than 12 000 people, according to official figures, although doctors say the death toll is probably much higher.
”I come to work out of duty. My country paid for me to become a nurse, trained me for nothing, and so even if times are difficult and I make no money, I have a duty to my country. But I cannot say I’m really helping anyone. All the wards are closed. It makes me cry because I see the people in Epworth who need help. Now there is cholera but there has been sickness for a long time because there is no food,” she said.
Although the cholera outbreak has added to the burden it is a symptom, not a cause, of the collapse of the medical system. Instead, the cholera is further evidence of the collapse of government.
Health workers have been warning about the risk of cholera for more than a year. Parts of Harare and its outlying townships have been without water for long periods over the past two years. People took to digging shallow wells but they became contaminated by the sewage running openly in the streets because burst pipes were not repaired and blockages were not cleared.
Children grew sick from the filth. Some died for lack of treatment. When cholera struck, it hit a hungry population reduced to one meal a day at best. ”We’ve gone from some of the best healthcare in Africa to people dying because they are living in their own sewage,” said the doctor at Parirenyatwa. ”And the people who run this country act as if it has nothing to do with them or what they’ve done to this country.” — guardian.co.uk