Postcard from Africa: Where the chains of debt keep children on death row

THERE was not a single cloud in the expansive blue African sky. Through the trees, the waters of the grey-green Zambezi River could be seen only 50 yards off. The great silence was punctuated only by the song of birds and the occasional bellow of a hippopotamus.

As we walked into the clinic the staff were, with proud anxiety, raising a World Bank flag. Perhaps white faces could only mean to them that the funders had arrived.

It was a splendid new hospital, with walls of baked mud and a shiny new roof. The only thing was that it had no beds. And cuts in the Zambian health budget meant that the number of doctors had been halved and the drugs cupboard was bare.

A pretty girl with long dark braided hair, wearing a dusty maroon and brown print dress, stood barefoot before the admissions table. She was aged about four. Her mother, a tall stately figure whose poverty seemed only to enhance her dignity, spoke anxiously to the paramedic.

Suddenly the child retched violently and spewed a stream of vomit all over her mother and the medic. She was, a doctor diagnosed, in the grip of the latter stages of malaria. "This is a very sick little girl," he said.

It may have been too late to save her in any case. We would never know. The clinic had no anti-malaria drugs. She was given paracetamol and taken away to die.

It was a routine event. Later I met a doctor at another clinic who said that the monthly box of drugs which clinics receive from the Ministry of Health usually lasts only a fortnight.

The health budget is just one area in which extensive "adjustments" to the budget have been made under an IMF-backed programme to help Zambia find enough money to pay the interest on its debts to the rich world - a world whose leaders meet at the G8 summit in Birmingham to discuss Third World Debt this weekend. Such programmes are in operation all over the Africa. Today, Zambia spends three times as much paying interest on its debts as it spends on healthcare.

That is not all. At the behest of the Western creditor governments, the Zambian health service has been reorganised along the purchaser/provider system which has caused such controversy in the British NHS.

So there is a familiar air to the complaints. "There are too many managers and not enough doctors," one medic told me, from the 80-bed Chikuni mission hospital, which under the restructuring has been told to downgrade itself to a health centre and send its doctors nearly 200 miles to the nearest official hospital.

Fees have been introduced. Fees for hospital registration, fees for each blood test, and more fees for the medicine.

As a result, one survey - financed by the Catholic aid agency Cafod - has shown that in Lusaka the number of outpatients has dropped by two- thirds since fees were introduced.

Infant mortality, once diminishing, is on the increase. Today one child in five dies before its fifth birthday.

According to the IMF there are supposed to be waivers for the poor. In theory. In practice some hospitals refuse to administer them; others make them so complicated that the poor are too bemused to apply.

In any case there is not always time. In a village near Lisutu recently an eight-month-old baby developed malaria. It took her parents two days to raise the 3,000 kwacha in hospital fees.

Eventually they collected it by going round relatives and friends and then walked for three hours to the hospital. The child died in her mother's arms at the hospital gate: 3,000 kwacha is pounds 1.02.