Secret tour of Zimbabwean wards shows collapse of health system

Driving into one of the main public hospitals in Bulawayo, you pass a wide, curved roundabout outside casualty. It was carefully designed to allow several ambulances to drop patients off as close to the door as possible, before driving off seamlessly to another emergency.

Driving into one of the main public hospitals in Bulawayo, you pass a wide, curved roundabout outside casualty. It was carefully designed to allow several ambulances to drop patients off as close to the door as possible, before driving off seamlessly to another emergency.

But now, the driveway is empty. Most patients who can afford the hospital fees come in on rickety minibuses, with every jolt making their pain worse. The wealthier come in borrowed cars that belch fumes, making the passengers cough.

One doctor remembers exactly when the ambulances disappeared. "During the constitutional referendum [in early 2000] Zanu-PF commandeered all parastatal transport, including ambulances, to go and campaign," he recalled. "The vehicles were completely wrecked and a viable hospital referral system, which brought patients in from the countryside at regular intervals, disappeared."

Zimbabwe's health sector was once the envy of other African countries, but two decades of mismanagement, neglect and theft have left the country short of medical care. The government realises that the health sector is something to be ashamed of - it rarely allows foreigners to enter public hospitals unless they are on an official, state-approved tour.

One doctor, who asked not to be identified, agreed to show me around his hospital as long as I pretended I was searching for a relative. "Maybe your 'uncle' is in here," he said, opening the door to the emergency operating theatre. "Though I hope for his sake he isn't."

It was clear what he meant - the furniture was broken, and the overhead light, needed for surgeons to see what they are operating on, needed a new fuse. Technically, the hospital still had a functioning casualty unit but anyone needing emergency surgery risked being killed by a collapsing operating table.

The other wards were just as chaotic. The maternity ward has a working ultrasound machine, but the person who knows how it works only comes in two days a week. The store-room was alarmingly bare. The hospital was short of the basic medicines needed to treat heart disease, fevers and malaria. Expensive drugs like anti-retrovirals did not exist. Most of the shortages appear to be caused by erratic financing.

"There is a different excuse for everything, but I'm not interested," the doctor said. "In one case, the contract is given to an indigenous supplier who could not deliver, another company was not paid for 12 months so stopped shipping medicines, or the manager simply has no idea how many canulas he needs to order each month."

Well-trained medical staff have already fled the country. The doctor who showed us around the hospital said five of his colleagues have left in the past few years - some because they were offered better salaries elsewhere, others because they were car-jacked or fed up with the working conditions. Inflation is so high in some areas that the government has recruited Cuban doctors and paid them in foreign currency to cope with shortages.

Now, the wealthy in Zimbabwe go to private hospitals. The poorest have simply given up on medical care. Since the government reintroduced an upfront fee in the same year that it gave large payouts to war veterans, at least half the hospital beds have lain empty. The staff say patients cannot afford the bus fare to the hospital, never mind the admission fees. And since the 1990s, standards in hospitals have fallen so much that most patients know that, even if they are seen by a doctor, they will not be cured.

"People have lost faith in the system," said the doctor. They think: 'Why spend money on a sub-standard, ineffective service?' Now, if they really want to be cured, they go to a witch doctor." Life expectancy in Zimbabwe is 33 years, compared to 63 in 1988.

The decline of the health sector coincides with a rapid rise in the rate of HIV infection. A report by Unicef shows that the country has the fourth highest level of HIV/Aids in the world with at least one in every four people being infected.

The government in Harare has added a 6 per cent Aids levy on income tax to combat the problem, but it is not clear where this money is going. Only two clinics in Bulawayo can supply anti-retroviral drugs, and the waiting time just to be seen is five months.

Most staff remember the better days. At independence, Zimbabwe boasted that it had the best medical system on the continent after South Africa - all the new government had to do was make it accessible to everyone. "At independence, Zimbabwe had a very viable medical system," said the doctor. "The whites had the biggest share of the cake. That was obviously bad. The government pushed through measures to equalise things for a halcyon period before things were messed up. Now, after all that, we have a health system on a par with Burkina Faso."