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Here in Zimbabwe: Howard’s End

January 24, 2014
December 6, 2005

I CAME TO ZIMBABWE to volunteer at Howard. My first day in Zim, we bought gas in Harare out of the back of someone’s truck as well as several litres of blood from a blood bank, all before arriving at my destination. Desperate times call for desperate measures.

Here, everything is about cash in hand. It is hard for everyone to get money. With the highest denomination currently equal to $0.02 US, redenomination is imminent. Banks can and do cap the amount citizens can withdraw at one time. Today’s official rate for $1 US is 25,000 Zim Dollars (ZWD), but the banks’ rate is 65,000 ZWD and there is a parallel – or black market – rate of 110,000 ZWD. As part of President Mugabe’s recent “Clean Up,” the vast majority of local markets were destroyed, making it more difficult to get goods and driving prices up even more. The price of goods this week is double that of last week. Regular citizens are hit the hardest, having to buy food at inflated rates, while their wages stay the same. At a rate of 800%, inflation hasn’t yet reached the limit.

There is also a major fuel crisis. Fuel has to be imported, and it is hard to get hard currency with which to buy it. Gas stations who manage to get gas put up signs stating, “Only foreign currency accepted.” Queues are around the block. This creates less reliable and less feasible transport throughout Zim.

Howard Hospital

Howard is a rural hospital compound north of Harare, run by a Canadian doctor, Paul Thistle, and his Zim wife, Pedrinah. Lorraine, a Canadian septuagenarian doctor – and whom I came here to volunteer with – has been coming to Zimbabwe and Howard for over a decade, sometimes twice a year, for 2-3 months at a time. I live with a Dutch anesthetic nurse, Jojanneka (Jo) Oudenaarden, who does 6-11 cases in the operating room (OR), or ‘theatre’, a day. A visiting Canadian doctor, Alison Tenant, did four C-sections this week alone. In the theatre, two challenges are the tough dehydrated skin, which make it hard to find veins for needles, and the language barrier between English and local Shona. Children learn both English and Shona in school, but this year enrolment is down 25% due to increased fees. People cannot afford it and the head master expects a drop again next year.

Howard lane

Here, the number one obstacle to treatment is transportation. There is a food program – the hospital doles out sadza, a local staple of maize porridge, and medication is free with testing and counseling. Counselors receive only three months training here. Every Wednesday is HIV day in the clinic, and every second Friday is tuberculosis (TB) day. These are super busy days, long lineups of clients coming from far away for medications and vitamins. For TB, there is a five-drug cocktail and vitamin B compound given out, as well as chloroquine for malaria and antiretrovirals (ARVs) for HIV. Iron used to be given out but is not supplied for free anymore. Some people are so weak, unsteady on their feet, take a long time to walk, sit, stand, or move at all. There is a sense among the Zim doctors, nurses, workers at Howard and the local people that there is all the time in the world. Yet the death rate here from HIV (usually clients have TB or other problems too) is around 10% and the chances of getting HIV are one in three. According to hospital records, out of the 364 people on treatment at Howard since last year, 30 have died and 328 remain on treatment (184 females, 108 males, 36 children). A few nurses at Howard are HIV+ and doing well enough to work. But try learning the smiley, bright-eyed two year-old is HIV+.

OLYMPUS DIGITAL CAMERA

In Canada, we screen for birth defects such as spina bifida (SB), and either direction to abort or if not, the baby can be operated on within a few weeks. Here in Zim, babies born with SB scarcely if ever receive treatment, as it is often unaffordable and inaccessible. There is one doctor in Harare who can do the operation and it is a few years wait. One of the nurses at Howard has a son with SB. “He is very bright, but what is his future here, but to sit at his grandmother’s house?” Some seek sponsorship to pay for treatment, but the first priority is the malnourished, and the list of priorities and need is long. There is a gross lack of opportunity, availability and accessibility in Zimbabwe.

Logistically, things are a nightmare in the clinic too: positives are filed together with negatives, low CD4s (denoting no ARVs need) with high CD4s (denoting ARVs need), individual files note several birth dates or both sexes on different forms, and three-feet-high stacks of unfiled Pap smears line the office perimeter. I input the Pap smear cytology results into the CDC database, only to have Lorraine tell me there was no point without endo-cervical smears, and we lack the brushes needed to conduct those smears. There are several information storehouses and I aim to get the files and databases as accurate and complete as possible. With Lorraine’s assurance that “there is no logic to the system here,” I will be happy with 80% accuracy and some semblance of organization. And this says nothing of the lack of power, equipment, and supplies.

calling Howard

Electricity and phone lines are inconsistent. This week the power has stayed on mostly, but the phone’s been down all week. The water is ‘turning again’ lately. After boiling water two or three times, there is still brown sediment. An ancient Intensive Care Unit (ICU) machine sits in the corner of a room, an archaic ultrasound machine here does not even allow identification of the gestational period, and there is no proper ventilator. According to Jo, 85% of post-surgery deaths are due to a “lack of right equipment/medication, lack of knowledge on the ward and even sometimes a lack of care.” Here at Howard, they do what they can with what they have, and as Jo puts it, they are “always improvising.”

Howard Hospital began with donations from Oxfam and Norwegian “Salvationists”, and for the last twenty years, has been led by a Canadian doctor. It is a Salvation Army hospital, and like many organizations, there is a ranking system, poor resource allocation and corruption. The present administrator takes hospital money and food for his own family.  They have even changed the locks on the food cupboards and use the hospital vehicle for their leisure. The United Nations (UN) has given billions of dollars to Harare to manufacture drugs here in Zim, but only100 patients are treated in Harare. There are more patients at Howard (330) and in Bulawayo. Harare is refusing people. There is no money at Howard, so getting quality doctors at Howard has been difficult. There are two Zim doctors at Howard now. One is known to drink and recently drunkenly anesthetized a patient. He then went home and passed out, leaving the anesthetized patient unattended. The other is known to be very rough. Last night, a woman gave birth, but an hour after delivery, her placenta had not come out. Impatient, the doctor stuck his hand in the woman to try and pull the placenta out before the nurse could anesthetize her. These are not isolated events.

God grant me the serenity…

Zim bricks

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