news in depth: BY ALFONCE MBIZWO/PHYLLIS MBANJE
The late broadcaster Zororo Makamba never worried about the flu-like symptoms when he returned home from a visit to the United States.
Makamba arrived in New York for a visit on February 29 and returned to Harare on March 9.
He reported flu-like symptoms three days later, but apparently did not think much of it.
But a few days later his condition took a turn for the worse and on March 20, he was tested for Covid-19. The results came out positive the next day.
Alone, afraid and desperate for oxygen, the young man realised that his country was about to fail him in a big way and no one was coming to save him.
Two days later, he was gone without ever being put on a potentially life-saving ventilator. Belated efforts by family and friends to secure one were in vain.
Why is the late young broadcaster’s tragic tale important?
Makamba’s horrific experience exposed just how ill-prepared Zimbabwe was to fight the coronavirus.
As shocking details about how he struggled to be admitted at Wilkins Hospital unfolded, it became clear that the country had no strategy, zero equipment and that there had been no preparation whatsoever to deal with a disease, which was causing havoc across Europe, Asia and the rest of the world.
This was dereliction of duty of epic proportions by President Emmerson Mnangagwa’s government and this exposed former Health minister Obadiah Moyo’s limitations in a crucial portfolio.
Makamba was the country’s first Covid-19 casualty and it shocked Zimbabwe.
The fact that Makamba came from one of the wealthiest families and was a high-profile personality did not save him.
Before the advent of Covid-19, Zimbabwe’s public health facilities were in a semi-comatose state.
Public hospitals operated with skeleton, poorly paid and disgruntled staff with no drugs and equipment to treat the patients.
Years of repeated industrial actions by the health workers to get the government to resolve these challenges failed to yield results.
Nurses at public hospitals had walked out of their jobs earlier in March because they lacked personal protective equipment (PPE) to fight the coronavirus.
Then Covid-19 happened.
While many countries rushed to put measures in place, Moyo kept assuring citizens that all was well and that government was ready.
“We are ready and will ensure we keep Zimbabwe clean,” he said confidently.
But a few days later he was forced to eat humble pie as shocking details emerged after Makamba’s death.
The only isolation centre at the time, the Harare City Council-owned Wilkins Hospital, had no equipment and staff had no PPE.
Sources at the hospital told tales of how Covid-19 patients were neglected largely due to fear.
“After Zororo died we realised how ill-prepared we were and we got scared.
“The officials were telling lies and we decided to take matters into our own hands,” said a source at Wilkins.
Harare city health director Prosper Chonzi tried fire-fighting, but it became clear Zimbabwe had no plan, no equipment, no drugs and no staff.
Health workers’ nightmare
At the time of Makamba’s death, Zimbabwe had two cases of Covid-19.
The number of infections has since grown to 6 678 as of Friday.
Cases spiked as Zimbabweans started returning from neighbouring countries to escape restrictive lockdown measures, especially South Africa, which has become the epicentre in Africa.
And health workers have been feeling the heat.
On March 30, Mnangagwa imposed a total lockdown, but torn between starving in their homes and venturing out to look for food, many people opted for the latter and local transmissions started to shoot up.
Health workers were now overwhelmed with no PPE.
Then their colleagues started getting infected by the virus.
Underpaid and scared, the nurses downed tools.
“Without adequate PPEs, we will not return to work because our hospitals are Covid-19 hotspots.
“The unprotected health workers have become the most vulnerable people,” said Zimbabwe Nurses’ Association president Enock Dongo.
Senior doctors too joined the strike, unable to deal with the increasing burden.
Doctors’ groups have twice taken the state to court to force it to provide PPE, but government has remained intransigent.
To date over 480 health workers have been infected in the line of duty.
“It had become scary handling patients and at times we would literally run away to avoid contact,” said a nurse who requested anonymity.
“I was terrified that I could get infected and in turn infect my two-year-old son.
“I would watch for symptoms every day.
“If my throat became sore or if I had a slight headache, I would be beside myself with worry.”
For now, she is “safe” after downing tools along with other nurses.
State of hospitals
Zimbabwe’s public health sector was already on shaky ground due to years of government neglect, but six months since the first case of Covid-19 was reported in the country, it is on the brink of collapse.
The impasse between the striking health workers and the government has escalated, and without doctors or nurses to attend to patients, most of whom cannot afford private medical care, public hospitals have become death traps.
A recent report based on an audit at Parirenyatwa Hospital showed that its Covid-19 centre was being manned by two inexperienced nurses due to a critical shortage of staff while essential drugs were not available.
The level of monitoring patients was minimal.
Clinical director at Sally Mugabe Central Hospital, another of Harare’s major public health facilities, Christopher Pasi said the strike and the Covid-19 outbreak had stretched resources thin.
In late July, the hospital recorded seven deaths of babies in one night with a few nurses on the job.
The incident shocked one doctor, who wrote an anonymous editorial opinion for a regional publication: “From the maternity register that night, you can see that the infants were on average a healthy weight.
“They should have survived.
“The reason they died is because Zimbabwe’s health system is simply not functioning as we speak.
“Many doctors, like me, are afraid to say this because our government only knows how to use force.
“But the reality here is that the tragic case of those babies is just one of many.
‘There are many more people dying.”
Currently, public hospitals are unable to take in many patients and most are turned away.
Private facilities cannot cope
With public health facilities unavailable, patients are now turning to private care.
But few can afford it and the facilities themselves are barely managing to contain the numbers.
Private medical providers are failing to cope with the influx of patients and fear becoming new hotspots to spread the coronavirus.
“With the unavailability of affordable and easy testing, many people are going for long without being detected of Covid-19, making it a life-threatening risk on the part of the private practitioners, who have lately assumed the number one position on the frontliners list,” Medical and Dental Private Practitioners of Zimbabwe Association interim president Johannes Marisa told The Standard recently, adding that members of his association were desperate for PPE donations.
“The scourge is really with us. “We need all minds together.
“The corporate world can chip in, especially on provision of PPE to medical staff regardless of whether one is in private or public practice.”
Early this month, the owner of Borrowdale Trauma Centre and Milton Park clinic, Vivek Solanki, let on just how expensive preventative care had become
“As every patient that goes to a clinic or hospital now is a potential Covid-19 positive case, nurses and doctors attending to a patient have to don in full personal protective equipment for each patient respectively,” Solanki said.
This is an added cost burden on the patient as the PPEs are imported and expensive, he said.
A Covid-19 test is another added cost burden depending on the type of tests to be done as well as additional tests like X-ray or CT scan that may be required for co-morbidity conditions.
“Some patients who are Covid-19 positive may have been to see several doctors previously; what does one do? We have to send them to Covid-19 centres.
“The few private so-called Covid-19 centres have opened with inadequate staff and poor protocols and charge upfront admission fees of between
US$3 000 and $5 000,” he said.
Solanki explained that this was a major dilemma for patients, who may not all be able to afford such costs.
“I do not admit coronavirus patients; I manage them on outpatient basis and have not had problems with them as of yet,” he said.
“We have had to send patients requiring hospitalisation to appropriate hospitals.”
Solanki said affordability was a big problem because all medicines and PPEs are imported and have to be paid for in advance.
“Staff have to be paid as well including risk pay. The patients going to the private doctors and facilities have to understand that,” he explained.
A major problem, said Solanki, is when a Covid-19 positive patient is diagnosed late and they have co-morbidity.
“It is fatal and no hospital will willingly accept them regardless of payment,” he said.
“This is because when a Covid-19 patient dies at a facility, it has to be shut down for several days for disinfection.
“This creates additional costs and anxiety among staff. Who would bear that cost?
“What does one do with the rest of the inpatients, who are not Covid-19 positive being attended to by the same institution?
“These are some of the numerous issues that have to be considered before people become judgmental.”
In Makamba’s case, his quick death may have been because his immune system had been compromised by myasthenia gravis, a chronic neuromuscular disease, and by surgery last year to remove a tumour, according to his family.
Obadiah Moyo was fired as Health minister after being implicated in a US$60 million tender scandal which also sucked in Mnangagwa’s family and friends, and was replaced by Vice-President Constantino Chiwenga.
Chiwenga has been tasked with reforming and restructuring the health sector, task critics say appears beyond him.
In April 2018, Chiwenga fired 18 000 nurses for going on strike over poor working conditions, a decision government later recanted.
In his new reincarnation, he promised a new era of cooperation.
“The striking health workers are not demanding anything out of this world,” said Itai Rusike, director of the Community Working Group on Health (CWGH).
Rusike challenged Chiwenga and his new permanent secretary, Jasper Chimedza to urgently attend to the chaos in the health sector.
Marisa said government needs to look for a quick solution to the issues raised by the striking health personnel.
“We cannot boast of a robust health delivery system in this pandemic when public hospitals are almost dysfunctional, with nurses and senior doctors being on strike,” he said.
“It is understandable that our national purse is shrunken at this juncture, but engaging the clinicians is the most respectable way of finding lasting solutions.
“So many non-monetary benefits can be negotiated, which include free duty for their cars, and residential stands to at least incentivise them.
“Government should move with speed on such critical issues which affect virtually everyone in this country.”
Marisa said it was clear that government alone had no capacity to deal with the challenges in the sector and urged private enterprises to play a big role.
“There are multi-million-dollar organisations or corporates in our country, which have the capacity to even donate all the required PPE,” he added.
“There are many church organisations that have the capacity to source all the medical requirements for the country.
“Where are these organisations when the country is in need?
“Where are non-governmental organisations when the medical sector is on its knees?
“This is the best time to move together as a country.”