Mpilo Hospital in Bulawayo used to be one of the best in Africa. The retired Clinical Director who met me remembers it in its heyday and worries that the number who know what it was, what it should be, are dwindling fast. There are still hundreds of patients turning up every day but while diagnosis may be possible, treatment often isn’t. The skeleton staff who work here have virtually no resources and have to work around the power cuts that are a daily occurrence across the city. Last year, their hopes for improvement were raised by the power-sharing agreement between Mugabe’s Zanu-PF and Tsvangirai’s MDC-T and the appointment of Tendai Biti as MDC-T Finance Minister. But where Biti has brought desperately needed financial stability through adopting the US dollar as currency, the huge debts and fractured infrastructure he inherited (that for instance means everything is bought with cash, there are no electronic debit or credit card facilities anywhere) has hampered recovery.
Things are definitely better that they were last year. Supplies that totally dried up pre-February 2009 are now occasionally getting through to the Hospital. The day I was there, pethidine had arrived, the first painkiller for mothers in labour or post caesarean section that they had had for months. But where the facilities were rich in their space and their few dedicated staff, poverty paraded itself in an absence of bed sheets and equipment. There was no monitoring (not even a working blood pressure gauge), no food, no MRI or working CT scanner. The technical manager said he was desperate, if only he had the parts to fix the autoclave sterilisers they could then reduce infections. In the maternity unit, two midwives were seeing to 16 women in labour and simultaneously training eight students. The going rate is $43 for a hospital delivery, but no one is turned away in a country of 90% unemployment. Another two midwives oversaw the 168 post-natal beds with unqualified assistants. A 27 week old baby wriggled in the solitary incubator box but without the vital piped oxygen mask and over-hydrated on an adult drip. Other tiny, malnourished forms were held by their mothers, with the only measure of progress the ingestion of milk and a nod from the head nurse.
The one theatre has no anaesthetist but relies on a (now) specialised nurse who has learned on the job; and an ancient, slow steriliser means that in an emergency equipment in just washed and re-used. We can treat an infection, they say, we can’t treat a dead mother or baby. Amazingly they have delivered 4,850 babies in the last six months and only 151 babies (3%) and 19 mothers have died. 25% are HIV positive (the only HIV screening in the country is done on expectant mothers), which is down from the 50% rates of the 90’s. But the life expectancy remains stubbornly low at about 40 years, and it was only after being in Zim for a couple of weeks that I realised I could count the elderly people I had seen on one hand.
Professionals left the countries in their thousands after the land-grabs of 2000 began. In the rural areas, the clinics that Mugabe had specifically developed to ensure no woman was more than a day’s walk away, could no longer retain their staff who were fearful for their lives. But as the country descended into violence and chaos, there was no money to pay them anyway. By coming to work overseas, including in our NHS, professionals at least had a job and could send money home to parents and children left behind. The distribution of medicines waned with supplies drying up and unstaffed clinics, which is partly why last years cholera epidemic was so devastating and experts are fearing a rise in deaths from Aids as HIV medicines can’t be obtained. Cholera kills more quickly and there simply weren’t the facilities to treat the tens of thousands who became victims of the breakdown of the sanitation and water systems particularly in the east of Zim. Likewise the question of the impact of virtually no public health provision (beyond a successful NGO-run child vaccination programme) on the 70% of the population who are rural, on infections, on child mortality, can only have a heartbreaking answer.
The extra dollars promised for the hospital staff to boost their incomes from $200 a month to $3-400 is only occasionally getting through. But that’s nowhere near enough to lure staff back from the Zim diaspora. There are three general surgeons left in the Bulawayo region who are the only hope for anyone requiring any operation in western Zim. Last year, local people came to see the hospital, and they were so moved by the difficulties they saw that they raised funds for the broken down mortuary and laundry. Both are working again and the ex-Director is convinced that getting local people involved in their hospital is the way ahead, along with a new wave of training up medical staff. The recent relaxation of regulations means that Mpilo can raise its own funds and start to form contracts direct, instead of being stifled under the dead-hand of Harare bureaucracy or waiting for political nirvana. Ideas are bubbling in our minds as to how we can magnify these glimmers of hope as we end our visit in the Chief Execs office. I have left Mpilo, grins the former Director across the table, but Mpilo hasn’t left me. For myself, I can only guess and feel profoundly humbled at the depths of dedication and sacrifice displayed by the staff who are still here, trying to serve, wanting to heal. I am blown away by the tenacious spirit of those I have met. Yet I am also acutely aware that I am only meeting the survivors.
