The Zim Doc

A 27 year old female patient was admitted into one of our wards at a state hospital in Harare. Brenda* was diagnosed with Infective Endocarditis. This means she had a vegetative growth on her heart valves which could lead to heart failure and other complications. I have to explain that the investigation to make this diagnosis is an expensive one. One that Brenda could not afford. Our medical team managed to get it done for free, sort of a social services waiver. Not everyone is lucky enough to be granted such favours. The treatment for Infective Endocarditis, besides treating heart failure, is 14 days of intravenous antibiotics. Just 14. And because it is intravenous, the patient has to stay in the wards to receive the injections. But Brenda couldn’t stay for all those days. She had 5 young children at home, abandoned by their father and starving. It had been Brenda’s responsibility to collect food vouchers for the children from a food-donor organization. So she requested to leave before her full dose of medication. Her prognosis was poor without the meds. But her children needed her. What would you have done?

Doctors in Zimbabwe work very hard. Let me speak for myself. I work very hard. I have been at this state hospital in Harare for almost two months having recently relocated from Kenya. Not very ‘diaspor-ey’ but far enough. I worked for two years in the Kenyan government and private health settings and decided it was time to pack up and go home. Because it was time.

Moving back to Zimbabwe after 8 years in East Africa gives you a different insight. There are a lot of similarities because African problems tend to flow from the same source but it is the differences which are startling. Every country has unique economic and political situations and Zimbabwe has had its fair share of problems. There are, however, some amazing positives that many Zimbabweans may not realize about our health care system because there’ve been staring so closely at the negatives.

Bad publicity is a dangerous thing. If someone hears the same negative thing enough times they can start to believe it. If you google ‘Health Care Delivery in Zimbabwe’ right now, 8 of the 10 links on the first page have not been updated since 2010. This is an excerpt from a paper written from the University of California:

In Zimbabwe, the level and quality of health care delivery has been drastically affected by broader economic and political conditions. Of the 2,086 physicians working in Zimbabwe in 2006 only 800 are estimated to remain: that is one physician for every 12,000 people in the country. Less than 25% of medical posts in the national health system are filled. Many government or public health services have closed in recent years and shortages of drugs and essential medical equipment have brought many hospitals and rural clinics close to ruin. In this context, the country also faces a number of severe public health threats. Zimbabwe’s HIV epidemic is amongst the worst in the world while the recent cholera outbreak claimed over 3,000 lives. Tuberculosis and malaria are also widespread and the maternal mortality rate is, at 1,100 per 10,000, the highest in the world.

How can this be what comes up when you look up ‘Health care delivery in Zimbabwe’? One wonders what the actual statistics are. And why is it being written by people at the University of California? In 2009 the BBC claimed that Zimbabwe’s women had an average life expectancy of 34 years and that men on average did not live past 37. That information was duplicated by countless websites including the one above. Other BBC reports were republished word by word by thousands of news and reference outlets, including Wikipedia. Not one glimpse of diversity, no arguments from ‘the other side’.

It is time doctors and researchers and public health specialists and journalists painted the actual picture of the state of Zimbabwean health care because the one that is reported and the one I have experienced in 2013 are not the same thing.

Dr Vivek Solanki, owner of the ‘Trauma Centre & Hospital Harare’ one of the most elegant medical facilities in the city spoke recently about their policies in providing health care to the poor:

“I have introduced a new concept here”, he explains, passionately. “Of course this is a private hospital, but we are determined to serve the Zimbabwean people.  So, in contrast to what happens in the US, here, when the ambulance, taxi or the relatives bring a patient to us, a patient who needs emergency treatment… no matter how complicated the case is, we treat the patient, regardless whether he or she has money or insurance. We never ask, and never check whether he or she can pay. We stabilize the patient first, and only after he or she is out of danger, the choice is given: if he or she chooses to pay, we keep the patient. If not, we transfer him or her to a state hospital, and charge nothing for saving their life. We also treat babies under 6 months, as well as elderly over 70, for free.”

Which takes us back to Brenda, and ultimately to what I see is the greatest strength of health care in Zimbabwe. It is the doctors. The Zimbawean doctor fights for their patient. Amidst poverty and daily obstacles to give ideal health care, these doctors do their best and go beyond what is expected. They attend 6:30am ward rounds, will do 36-hour calls and still patiently explain treatment to that last patient in casualty. They will see every patient in that clinic queue and if they travelled from very far, will walk back into the office as they were just leaving. The Zimbabwean doctor is resourceful, seeking ways to transfuse blood to that patient who needs it even though it is for sale and the patient cannot afford it. Asking colleagues for favours to give discounts for CT-Scans, collecting forgotten left-over stocks from different centres of chemotherapy to help a patient who needs it. The Zimbabwean Doctor goes the extra mile. I am proud to be a Zimbabwean Doctor.