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COVID-19: Pandemic Grounds Medical Tourism

Harare, Zimbabwe – The just concluded lockdown in Zimbabwe, which began on January 5 and ended on February 15, has left Gladys Marima, a 23-...

Harare, Zimbabwe – The just concluded lockdown in Zimbabwe, which began on January 5 and ended on February 15, has left Gladys Marima, a 23-year-old woman with albinism, battling cancer alone.

She had to flee 400km from her home in Harare, after her family kicked her out because her cancer, which is linked to her albinism, has caused a deep, septic wound on her left cheek that has become infected with maggots.

“My relatives kicked me out of their house in December, saying my wound was too stinky,” she explains.

By @Comic24Derick

Now, the very frail Gladys is dependent on the charity of other relatives in Chipinge, who have taken her in, but for the duration of the lockdown she was unable to receive treatment because the only two public hospitals which normally offer chemotherapy and radiotherapy treatment in Zimbabwe. 

Both Parirenyatwa Hospital in Harare and Mpilo Hospital in Bulawayo – were forced to close these departments in January because they had become overwhelmed by patients with COVID-19.

Gladys has received some support from Noble Hands Zimbabwe, a charity which helps people with albinism, after it heard of her plight on social media. Marvellous Tshuma, deputy director of Noble Hands, says: “We went [with her] to Parirenyatwa Hospital but the cancer department was closed and they were not attending to cancer patients.” All they could get from the hospital, she adds, was some pain medication, food handouts and sun cream to protect Gladys’s skin.

Had she been wealthy, in the past Gladys might have had the option of travelling overseas to seek treatment as a medical tourist, but today even rich Zimbabweans are finding these avenues closed because of the pandemic. They, too, are now being forced to confront the reality of a public healthcare system that has been underfunded for decades.
Gleneagles Hospital in Singapore Where Robert Mugabe Travelled for Cancer Treatment (Image: Reuters) 
Before his death, former president Robert Mugabe regularly travelled abroad for medical reasons. When he died from cancer in 2019, it was at the Gleneagles Hospital in Singapore.

Medical tourism – a booming industry

An estimated 20,000 Zimbabwean citizens have spent $4 billion on medical tourism over the past decade – mostly in India. This translates to $400m each year, or $20,000 per person. “We are losing millions each year through these referrals,” said finance minister Professor Mthuli Ncube, who highlighted these figures during his mid-term budget review in 2019.

Health Minister Constantino Chiwenga responded by promising to ban health tourism, saying it was “bleeding forex reserves”, and instead to improve health facilities in Zimbabwe. “We will not export our patients. We will not make referrals to our patients. It is everybody, [including] ministers. Those who have been going out, it is you and me. Is it not? Altogether that export bill was too high and that is what we want to do away with,” he said on his appointment to the post in September 2020.

He added: “We will have hospitals that will specialise in different treatment services across the country. We are restructuring from the village health worker right up to the top hospital.”

However, no law against health tourism has as yet been passed and the healthcare system remains dilapidated. Furthermore, the newly-installed minister himself allegedly skipped the country for treatment in December, defying his own proposed medical travel ban.

While each medical tourist leaving the country to seek treatment overseas spends on average $20,000 each year, Zimbabwe’s own spending on healthcare was just $21 per citizen in 2020 (nearly 1,000 times lower) – showing the stark inequality in healthcare between rich and poor.

Healthcare spending in Zimbabwe has historically been poor compared to other countries in the region, according to a 2013 report on the state of health financing in the African region conducted by the World Health Organisation (WHO). A minimum spending level of $44 per capita was recommended by the High Level Task Force on Innovative Financing for Health Systems in 2009. The WHO overall recommends a spending level of $86 per person – more than four times what Zimbabwe allocates.

The WHO report also noted that rural health centres are particularly at risk in the country. These were allocated $16 million in 2012, just 5 percent of the total health budget, despite the fact that 70 percent of people live in rural areas. The country had 214 hospitals, of which 120 are government hospitals, 66 mission hospitals, and the remaining 32 are privately owned. There were six central government hospitals and 63 district hospitals, with the balance being rural hospitals, according to a 2015 tally.

“There is a need to boost government spending on rural health centres to avoid dependence on donor financing to be able to better cater for over 70 percent of Zimbabwe’s population that lives in the rural areas,” said the 2020 Health Budget Brief from UNICEF. The COVID-19 pandemic has only piled more pressure on Zimbabwe’s crumbling healthcare system.

‘Don’t catch the virus if you can avoid it’

Now, with a second wave of coronavirus raging through the country, this health tourism has stalled, further stretching a health care system that government spokesman Nick Mangwana described as “overwhelmed and overrun” in a tweet on January 1. 

“Let me tell you about our own situation, don’t catch the virus if you can avoid it,” he added.

The influx of patients to public hospitals caused by the pandemic in the second wave which began in December had not been anticipated. Death figures have risen during the second wave; the highest number of deaths in a day was 70, recorded on January 25. As of mid-February, cumulative figures for the pandemic were 35,222, with 1,410 deaths, within a population of 15 million.

“Some of these fatalities would have been avoided if we had a functioning healthcare system, hospitals, doctors, nurses, drugs and equipment,” says Tendai Biti, an opposition MP for the Movement for Democratic Change (MDC) Alliance party.
A Hospital Staffer Cleans a Ward in Bulawayo (Image: Getty Images)
“We don’t have all the basics, the system is a shell. That’s why people are dying like this. We could have partly avoided this situation. Inadequate stocks of basic medicines and corruption have caused more suffering to users of public hospitals.”

For the first time, the wealthy elite must also endure the pain of underfunded hospitals that has traditionally been reserved for the poor. Private hospitals demand $3,000 for treatment – if you can get into one – and deaths continue to spike.

“President Emmerson Mnangagwa, his ministers and their cronies are marooned locally, they can’t go to South Africa, Singapore and China, but they have destroyed hospitals, [and are] now facing the consequences,” says Biti. “They should have invested in health, but they didn’t, hence people are dying.”

In 2008, 65 percent of healthcare services were provided by the public sector. This was a time when the healthcare infrastructure was deteriorating and qualified health personnel were leaving the country citing poor remuneration. For every 10,000 people in Zimbabwe, there were 1.6 physicians and 7.2 nurses, according to a 2010 Zimbabwe Ministry of Health and Child Welfare, Human Resources information sheet.

Three years later, Zimbabwe had 2.6 doctors for every 10,000 patients. By contrast, for every 10,000 people in South Africa, there were 40.7 doctors in 2018. This has translated into an inefficient response to the coronavirus pandemic in Zimbabwe.

“I am not satisfied with the way the coronavirus has been handled because our testing levels have been low, hospitals are not equipped to manage COVID patients and people are unable to get proper and advanced medical treatment,” says Dr Mthabisi Bhebhe, a government medical officer at Plumtree District Hospital.

Plumtree town is at the southwestern tip of Zimbabwe, near the Botswana border, 110km from Bulawayo. The hospital caters for poor, rural people in Matabeleland South Province. The decaying healthcare facilities are similar to most hospitals in Zimbabwe.

“The current health system in Zimbabwe is in crisis. COVID-19 has made obvious all the shortfall in the system, poor funding, corruption, shortage of health workers and lack of adequate vital medicines, poor referral system and dilapidated health infrastructure,” says Dr Bhebhe.

“The current situation is that cases [of COVID] continue to increase, isolation centres are full, health workers have no adequate personal protective equipment (PPE) and are poorly paid. SARS-COV2 testing capacity is unacceptably low and people are scrambling for hospital beds and oxygen. The ordinary man in Zimbabwe is generally unable to enjoy their constitutional right to access healthcare.”

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