We have been trying to learn more about Zimbabwe. The population is approximately 13 million. There are 16 official languages but English is spoken throughout Zimbabwe, Shona is spoken by about 70% especially in the north, and Ndebele is spoken by about 20% of the population. The national food is sadza – pounded and cooked maize. The Rhodes museum at the Rhodes hotel (Cecil Rhodes original homestead) gave us some background about Rhodes (a complicated character) and then the movement for the original land owners to take back the land. Independence from Britain occurred in 1980. Prior to that Zimbabwe had been a big agricultural supplier in Africa but now it is a net importer of maize. Tobacco is the most successful crop (which is depressing for a pharmacist who has a strong interest in helping people quit smoking). Milk production has dropped from a peak of 256 to 58 million liters annually, but small-scale dairies are gradually developing. The $US is the official currency. Robert Mugabe has been president since 1980, is now 92, and has promised to live to 100. We have been able to see the work of many excellent sculptors, and are hoping to become more familiar with some of the Zimbabwean painters, musicians, and writers.

 

The healthcare situation is dire. HIV prevalence is about 15% and most of those affected are co-infected with TB. Under 5 mortality was at 84 per 1000 live births and infant mortality at 57 per 1000 live births (ZDHS, 2010-2011). Maternal mortality was at about 960 per 100,000 births in 2010. It is estimated that over five million people are at risk of contracting malaria annually (National Health Strategy 2009-2013) There is continued and increasing incidence of chronic non-communicable conditions such as diabetes and hypertension (Zimbabwe STEPS survey, 2005) Between 1988 and 2005/6, life expectancy at birth fell from 63 to 43 years (National Health Strategy 2009-2013). Health management has weakened as a result of experienced health service (doctors, nurses) and programme managers leaving the country. Medical equipment is often old, obsolete or non-functional. The shelves are bare of surgical supplies such as sutures and drugs (except HIV, TB and anti-malarials supplied from out of country). The health system is grossly under-funded. The current budgetary allocation works out to approximately US$7 per capita per annum against the WHO recommendation of at least US$34.

 

Nonetheless there is progress. Locally at Nyanga District Hospital there was no maternal deaths last year. The new infection rate for HIV is declining, except, unfortunately, in women aged 15-24.

 

We have been staying at the NetOne (government-owned mobile-network company) holiday cottage near Nyanga. Uncomfortably we read in the Mutare newspaper today that the CEO, aptly named Reward Kangai, was recently removed from his post for allegations of swindling millions of dollars.

 

On the work front we’re not sure we contributed a great deal. Lori hung out in the dispensary (trying not to stress out about the fact that the rare medications that are available are all white tablets obtained from Indian suppliers and have no distinct markings so that amoxicillin looks like carbamazepine and are dispensed in small plastic zip-lock bags that are not child-proof and only have the drug name and directions on them – far from meeting the numerous legal requirements for dispensing in Canada). She did have some interesting professional conversations with the pharmacist. When discussing illicit drug use in the respective countries, she learned that one of the antiretrovirals has certain LSD-like properties and is being abused, sometimes in combination with cough syrups, possibly contributing to development of viral resistance. Paul was able to attend some telemedicine meetings with Dr Admore Jokwiro (our host physician) and will follow this up. He spent a bit of time in the OR and helped in the out-patient clinic. One day we accompanied Admore to the nurse clinic at Nyatate and the Mt Melleray Mission hospital. Nyanga doctors visit these more remote sites intermittently. The clinic has a telemedicine link to Nyanga for more urgent consultations. Despite the isolation and small size, the clinic does deliveries and has a very active public health program.

At Mt Melleray, they manage 20-30 deliveries per month and are very proud of their Number 1 ranking for Maternal-Child outcomes for the region. While Paul was seeing patients with Admore at the mission hospital, Lori, Rachelle, and Thea checked out the nearby primary Catholic school (est. 1949). The school has 500 boarders, 200 day students, and 21 teachers. They grow covo (similar to kale) to feed the students and have also started a banana plantation. While we were there we felt like the penguins in the Madagascar movie as we kept ‘smiling and waving’ at all the students staring at us.

On our last day here Paul provided a CPR/advanced life support course for 20 healthcare staff. He had to improvise a resus Annie from a cushion (the Paullow?) and the attendees were able to practice on that. 

 

Our experience on Sunday summed up many of the contrasts in Zimbabwe. We started with a hike up the iconic mountain near the cottage (1800 m). The mountains are very old and covered with Rorschach blots of lichen. The colour variations at this time of year, as the leaves start to come in, are beautiful but very subtle and difficult for the camera to capture. On the drive into town we were stopped by a fire that had sprung up in a stand of eucalypts. The fire was still flickering on both sides of the highway as we eventually drove through the smoke, which was fairly terrifying. No one was dealing with the fire. In fact, those workers employed to cut down the trees, saw them up and then load them into a truck _by hand_ were still working in the smoke! (Each day we seem to see another fire somewhere). That afternoon we visited Nyangombe Falls and toured the local resort of Troutbeck but Paul was “called back” to the hospital just before dinner as the local MP wanted to meet him and Admore and interview them for the local radio! Paul and Admore were still able to join both families for dinner

 

Although we were only here for 10 days, we feel we did get to know some of the locals in that short time and learned a great deal about their circumstances here. So many people at the hospital and at the shops in town were welcoming and open to sharing their experiences and hope for Zimbabwe.