By
Gamuchirai
Masiyiwa,
Global
Press
Zimbabwe
HARARE,
ZIMBABWE
—
At
five
months
pregnant
with
her
second
child,
Vimbai
started
bleeding.
She
suspected
a
miscarriage
and
rushed
to
a
public
clinic
for
help.
The
attending
midwife
didn’t
examine
her,
says
Vimbai,
who
chose
to
use
her
middle
name
for
fear
of
stigma.
“The
only
thing
they
did
was
[give]
me
cotton
wool.”
To
Vimbai’s
shock,
the
midwife
wrote
“attempted
abortion”
on
her
consultation
card
and
referred
her
to
the
nearest
public
hospital
about
20
kilometers
away
(nearly
12.5
miles).
But
Vimbai
was
in
too
much
pain
to
make
it
all
the
way.
“I
thought
I
was
going
to
die.”
A
friend
recommended
a
nearby
clinic
operating
illegally
in
someone’s
home.
“I
had
a
conviction
that
this
was
the
only
immediate
option,”
she
says.
Although
the
bed
was
uncomfortable,
the
home
clinic
was
well
equipped.
There
was
a
drip
stand,
boxes
with
cannulas,
drugs
and
medical
supplies
stored
in
a
tiny
spare
bedroom.
The
setup
surprised
Vimbai.
There
were
other
patients
too.
Their
murmurs
seeped
through
the
walls.
Somewhere,
a
child
coughed.
Vimbai
also
noticed
something
else.
She
knew
the
nurse
who
operated
the
backyard
clinic.
He
worked
as
a
midwife
at
the
public
clinic
where
she
had
been
first
treated
after
the
bleeding
incident.
To
Vimbai,
this
meant
he
was
qualified.
It
reassured
her
a
little.
They
confirmed
she
was
having
a
miscarriage,
put
her
on
intravenous
therapy
along
with
some
injections
and
he
cleaned
her
womb,
she
says.
Overall,
the
experience
was
friendlier,
and
the
midwife
followed
up
afterward.
“The
hideout
clinics
are
saving
a
lot
of
people
in
the
communities
[where]
we
live,”
she
adds.
Zimbabwe’s
health
care
system
has
been
crumbling
under
the
strain
of
years
of
economic
and
political
instability,
which
started
in
the
late
1990s.
Health
worker
salaries
have
not
been
spared
by
inflation
and
currency
challenges.
As
a
result,
many
professionals
have
migrated
to
seek
better
opportunities
abroad.
In
2019,
the
United
Kingdom’s
National
Health
Service
employed
4,049
Zimbabwean
health
care
professionals,
including
doctors,
nurses
and
clinical
support
staff,
making
Zimbabwe
the
second-largest
African
contributor
to
its
workforce
after
Nigeria,
according
to
a
statement
provided
to
Global
Press
Journal
by
Zimbabwe’s
Health
Service
Commission
spokesperson,
Tryfine
Rachel
Dzvukutu.
But
not
everyone
leaves.
In
late
2022,
the
country
had
1,724
doctors
and
17,245
nurses,
Dzvukutu
says,
serving
a
population
of
over
15
million.
These
doctors
and
nurses
grapple
with
various
challenges,
among
them
poor
salaries
and
high
workloads.
To
navigate
this,
some
take
part-time
jobs
in
other
health
centers
while
others
operate
illegal
clinics
such
as
the
one
Vimbai
visited.
“Sometimes
we
resort
to
these
hideout
clinics
not
because
we
want
to
but
because
of
the
service
we
get
at
the
public
facilities,”
Vimbai
says,
her
voice
tinged
with
discontent.
A
moral
dilemma
Gladys,
who
has
been
a
health
worker
for
20
years
and
asked
to
use
only
her
first
name
for
fear
of
retribution,
says
that
sometimes
she
offers
services
to
people
in
her
community
outside
of
work,
especially
those
who
might
need
minor
assistance,
such
as
dressing
wounds.
“I
do
charge
for
rendering
that
service,”
she
says.
The
cost
ranges
from
10
United
States
dollars
or
more
per
week,
depending
on
what
patients
can
afford.
In
comparison,
the
clinic
where
she
works
charges
1
dollar
a
day
for
minor
services
such
as
wound
dressing.
But
Gladys
says
her
fees
are
typically
lower
than
the
overall
costs
a
patient
would
incur,
including
transportation.
Other
times,
she
says
she
doesn’t
charge
if
she
sees
that
the
person
cannot
afford
to
pay.
There
has
been
an
increase
in
these
practices,
even
though
it
is
illegal,
says
Simbarashe
James
Tafirenyika,
president
of
the
Zimbabwe
Municipalities
Nurses
and
Allied
Workers
Union.
It’s
also
unethical,
since
the
workers
offering
these
services
don’t
have
sterile
equipment
or
other
necessities,
which
is
risky,
he
adds.
The
Health
Professions
Act
prohibits
health
institutions
from
operating
without
registration.
Doing
so
is
an
offense
liable
to
a
fine,
imprisonment
up
to
two
years
or
both.
(Gamuchirai
Masiyiwa/Global
Press
Journal)
Gladys
doesn’t
think
she
is
bending
the
rules
or
posing
any
additional
risks
to
patients;
if
they
visit
the
clinic,
she
is
still
the
same
person
who
will
assist
them,
she
says.
However,
she
says
those
who
operate
more
robust
backyard
clinics
put
people
at
high
risk
due
to
a
lack
of
sterilized
equipment.
It
is
a
criminal
offense,
she
says,
given
the
potentially
fatal
consequences,
such
as
bleeding
to
death
following
an
abortion.
Rueben
Akili
is
a
program
officer
with
the
Combined
Harare
Residents
Association,
an
organization
that
advocates
for
the
rights
of
residents.
He
confirms
health
care
workers
are
operating
illegal
clinics
in
various
high-density
suburbs
of
Harare.
“It
is
an
issue
which
we
have
noticed
for
the
past
five
years
due
to
the
continuous
deterioration
of
health
service
provision.
They
offer
a
range
of
services
such
as
maternal
health
care
provision,
treating
of
sexually
related
diseases
and
to
some
extent
general
health
care,”
he
says.
He
sees
it
as
a
worrying
trend
as
it
puts
people’s
lives
in
danger.
In
a
written
response
to
Global
Press
Journal,
Stanley
Gama,
the
head
of
corporate
communications
for
Harare
City
Council,
says
the
council
isn’t
aware
of
illegal
clinics
but
will
carry
out
investigations
and
enforce
the
law.
He
adds
that
health
workers,
like
every
citizen
in
Zimbabwe,
haven’t
been
spared
by
the
challenges
of
the
struggling
economy.
Extra
shifts
Gladys
says
her
salary
at
the
public
clinic
where
she
works
is
low.
In
March,
the
government
paid
her
6
million
Zimbabwean
dollars
(about
195
US
dollars).
(At
the
time
Global
Press
Journal
interviewed
sources
for
this
article,
the
Zimbabwean
dollar
was
still
the
standard
currency
in
Zimbabwe.
The
country
has
since
transitioned
to
a
new
currency,
called
Zimbabwean
gold.)
Gladys
also
receives
an
allowance
of
112
US
dollars.
The
total
amount
she
receives
varies
each
month
depending
on
the
exchange
rate.
To
make
ends
meet,
Gladys
takes
extra
shifts
or
works
as
a
substitute
nurse
at
private
institutions.
She
prefers
shifts
at
private
institutions.
The
government
clinic
pays
her
4
US
dollars
for
a
full
day
of
work,
from
7
a.m.
to
7
p.m.,
and
converts
the
payment
to
local
currency
at
the
prevailing
exchange
rate.
The
government
also
taxes
this
overtime
pay.
But
the
private
health
facilities
pay
her
more
money
for
fewer
hours,
at
20
US
dollars
for
a
day
that
ends
at
4:30
p.m.
While
extra
work
means
more
money,
Gladys
is
always
exhausted.
She
ends
up
working
about
53
hours
per
week,
well
above
the
recommended
45
hours
for
health
care
workers.
“The
body
needs
to
rest.
When
you
get
home,
all
you
want
to
do
is
sleep
—
you
can’t
do
things
that
you
would
normally
do
like
cooking,
assisting
your
child
with
homework.
We
are
overwhelmed,”
says
the
mother
of
two.
Her
social
life
suffers
too.
She
knows
colleagues
who
have
quit
the
public
clinic
to
work
in
private
institutions
and
others
who
have
immigrated
abroad.
Around
2017
and
2018,
the
public
clinic
had
22
midwives,
she
says.
Now,
it
has
14.
She
considered
leaving
Zimbabwe
for
better
opportunities
abroad,
but
when
she
wanted
to
start
the
process,
the
government
stopped
issuing
certificates
of
good
standing.
Without
one,
she
would
only
be
able
to
work
as
a
care
worker,
which
pays
less
than
a
professional
nurse.
GAMUCHIRAI
MASIYIWA,
GPJ
ZIMBABWE
As
Zimbabwe’s
health
care
crisis
worsens
with
a
mass
migration
of
health
care
workers
in
search
of
better
opportunities
and
low
pay
for
those
who
remain,
Gladys
occasionally
takes
on
extra
shifts
at
her
workplace
or
in
private
clinics.
The
solution
for
Gladys
is
for
the
government
to
employ
more
workers
and
offer
better
pay.
Although
health
care
workers
left
behind
like
Gladys
are
finding
solutions
—
sometimes
illegal
—
to
navigate
the
challenges
of
a
crumbling
health
care
system,
these
arrangements
are
unsustainable,
says
Tafirenyika,
the
union
president.
“What
they
are
doing
is
bad
and
we
do
not
recommend
it
at
all,
but
they
are
looking
for
survival
skills,”
he
says.
He
blames
the
local
councils,
which
employ
public
health
workers.
The
solution,
he
says,
is
to
ensure
an
adequate
health
care
workforce
and
offer
them
good
pay.
Gama
says
the
Harare
City
Council
has
been
recruiting
more
health
workers.
He
did
not
provide
any
figures.
Enock
Dongo,
president
of
the
Zimbabwe
Nurses
Association,
agrees
Zimbabwe’s
health
workers
are
overwhelmed.
The
union
is
pushing
the
government
to
improve
health
workers’
pay
and
welfare,
he
says.
“It’s
not
only
money
that
can
solve
the
issues
we
are
facing,
but
there
are
also
many
non-monetary
benefits
that
they
can
provide
like
housing,
land,
farms,
among
others,”
he
says.
Side
gigs
Although
some
health
workers
operate
illegal
clinics
or
take
extra
shifts
to
sustain
their
livelihood,
others
take
up
side
gigs.
Moyo,
who
prefers
to
use
his
clan
totem
for
fear
of
retribution,
is
a
nurse
at
a
public
hospital
in
Harare.
He
says
his
low
pay
gives
him
sleepless
nights.
It
is
so
low
that
he
couldn’t
add
his
fourth
child
to
his
medical
insurance.
“I
was
told
that
my
income
was
too
low
to
have
another
dependent
added
on
my
insurance.
I
can’t
even
afford
health
care
for
my
child,”
he
says.
In
February,
his
salary
inclusive
of
allowances
was
3.6
million
Zimbabwean
dollars
(163
US
dollars)
plus
a
foreign
currency
component
of
270
US
dollars.
According
to
the
latest
Zimbabwe
Statistical
Agency
report
on
poverty,
the
minimum
monthly
income
needed
in
March
for
one
person
stood
at
916,255.50
Zimbabwean
dollars
(41.54
US
dollars).
A
family
of
six
requires
about
249
US
dollars
for
food
and
non-food
items
to
be
above
the
poverty
line.
Like
Gladys,
Moyo
tried
taking
extra
shifts
at
private
clinics.
He
says
lately
they
have
been
hard
to
come
by.
“Because
of
the
economic
situation
in
our
country,
the
private
health
institutions
are
not
getting
as
many
clients
as
they
used
to,”
he
says.
In
2023,
he
registered
a
consulting
agency
to
assist
students
with
their
applications
to
private
nursing
schools
in
Zambia.
“If
I
enroll
10
students,
I
get
20%
commission.
But
because
my
company
is
fairly
new,
last
year
I
managed
to
enroll
three
students
and
I
was
paid
200
[US
dollars],”
he
says.
Despite
the
challenges,
Moyo
still
wants
to
advance
in
his
career.
“I
recently
completed
my
bachelor’s
degree
in
nursing
science,
majoring
in
training,
because
I
have
a
passion
to
teach.
And
if
conditions
of
service
improve,
I
intend
to
work
in
a
nursing
school
locally,”
he
says.
Although
he
could
have
relocated,
he
had
someone
close
to
him
who
was
not
well
and
he
chose
to
stay.
Home
is
best,
he
says.
But
those
who
leave
are
simply
forced
by
circumstances.
This
story
was
originally
published
by
Global
Press
Journal
https://globalpressjournal.com/africa/zimbabwe/amid-zimbabwes-mass-exodus-meet-doctors-nurses-stayed-behind/
Global
Press
is
an
award-winning
international
news
publication
with
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than
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across
Africa,
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and
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America.
Post
published
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