By Lynette Manzini

Zimbabwe’s health delivery system is ailing, exactly thirty five years after the Mugabe led Zanu pf took the reins of power from former colonial masters Britain and women are bearing the pains and scars of a sector hit by drugs and skilled personnel shortages, dilapidated infrastructure and fraught with fewer institutions especially in rural communities.

The situation is even worse for women resettled in Chingwizi after about 3000 families were displaced after the Tokwe Murkos dam collapsed, leading to flooding around the area. The resettlement area is 150km from Chivi their original homes.

After running away from the flooding, these villagers have now run into a fresh flooding crisis of the country’s failing health delivery system. For 17 year old Sarudzai, who is five months pregnant, abdominal pains forces her up earlier than usual as she has to walk for six kilometres through a thorny and sandy pathway to the nearest make shift clinic as the permanent health facility was still under construction.

The Chingwizi resettlement is a ranch in Mwenezi district located about 500 km Southeast of Harare. Here, Nhamo, just like several other women, wake up early to avoid the scotching sun as well as to ensure she is served early to allow her to walk back home in time. But waking up early and travelling far on foot are smaller problems compared to the horror that await them at the clinic.

Drugs are in short supply and they are often told to come back again after some days. More often, there are too many people to attend for the nurses and worse still, there is no doctor here.

The nurses that assist here seem relaxed and not in a rush at all. They open late and have to gossip about the previous night’s stories while patients impatiently await a crucial health delivery service they can only access in Chiredzi located approximately 50 km away.

‘I don’t understand why they begin working so late while they reside within the perimeters of the clinic’, Nhamo said.

The nurses are evasive and they do not entertain any complaints from patients. Neither do they answer questions from ‘strangers’. Nhamo is unlucky today; she comes out of the clinic dragging her feet with a frown on her face as she has just been referred to Chiredzi hospital.

Asked why she did not seek for clarity from the nurse she said: “You really don’t know these nurses. They are rude. Maybe it’s because we do not pay for services rendered here at the clinic or because they know we don’t have any money’.

A look at Nhamo’s clinic card by this reporter reflects the nurse recorded something against her blood pressure and weight but Nhamo said she was never examined neither was her blood pressure checked.

‘The nurse never laid her hands on me, she just scribbled on my record card and gave me tablets for pain after i had explained about the discomfort i had experienced throughout the night,” said Nhamo.

Her story is in direct contrast to Doreen Mutandwa, 31, who registered for antenatal care at Chitungwiza referral hospital.

“The nurses are pleasant and very cheerful. One feels at home the minute they walk into the antenatal clinic,” said Mutandwa.

“Each woman is allocated their nurse who takes them through questioning and examination process. The service is excellent,” said Mutandwa, revealing that she was thoroughly examined for anaemia, tested for HIV, weight checked and history recorded among other tests.

In contrast Nhamo was not tested for HIV or examined for anaemia at a time government has been celebrating progress against the prevention mother to child transmissions.

“The government should compensate us as soon as possible so that we can choose were to get medical treatment from instead of being forced to deal with these nurses because we are penniless”, Nhamo said.

Nhamo’s husband Francis, a self proclaimed spiritualist reassures his wife that she will have a safe delivery and will not travel to Chiredzi as suggested by the midwife.

Despite Nhamo and her husband having no source of income they are expected to travel to Chiredzi Hospital where they would be expected to pay user fees.

Since the floods rendered them homeless, villagers have been forced to rely on food handouts from donors and well wishers due to their dire financial situations.

‘I will come back if the pain persist otherwise i will seek for medical attention when i am in labour,’ said a distraught Nhamo.

One of the pregnant women in the queue who identified herself as Mai Tendai said, “One cannot expect such treatment from fellow women who understand what it means to be pregnant and the risks associated”.

“No one in their right mind would just want to come to the clinic, i am here because i care about my health and that of my child but it seems i have to wait for a long time to see the nurse” she said.

Mai Tendai, a mother of two said her experience at Chingwizi clinic is completely different from her past experiences before the Tokwe Mukosi dam collapsed.

“When i was pregnant with my other two children i knew that every antenatal care visit i would be weighed and my blood pressure recorded. The nurse would even, listen for the baby’s heart beat but it is not consistent here”, she said.

These are some of the women in Chingwizi who are not receiving equal and quality health care when they visit the clinic to access antenatal care. Unfortunately, women like Nhamo are not going under the necessary procedures to ensure they receive quality care which will assist in ensuring both mother and babies are healthy.

However, the permanent secretary in the ministry of health and child care retired Brigadier Dr Gerald Gwinji said that the country uses one standard protocol that assures quality throughout the country.

“You may find individual variations because of staff shortage and break down of equipment but as a ministry we have a standard were blood pressure and weight are checked, urine testing done at appropriate times including health education and promotion so forth”, he said.

He added there are measures the ministry has in place to monitor quality.

“Shortfalls might arise here and there, and this is why we have the supervisory and monitory visits and spot checks.

“While the women are sitting the district medical officer can just come and pick a card and talk to the nurse finding out why certain procedures had not been done,” added Gwinji.

The World Health Organisation places emphasis on the quality of care rather than the quantity of visits recommending at least four visits for a woman presumed to be having a normal delivery and more for high risk pregnancies.

health promotion and disease prevention, birth preparedness and complication readiness planning.

WHO recommends that on the very first visit to the clinic a healthcare provider should perform a physical examination to check for signs of severe anaemia, record weight, measure blood pressure, chest and heart auscultation, measure uterine height and consider vaginal examination (using a speculum).

At Chingwizi however, health education and promotion is taking place with villagers being taught about safe sex practices.

During this reporter’s visit to the women and men were concretised about the use of the new female condom and its usefulness in preventing disease transmissions to the unborn child.

The Women Action Group (WAG), a local non governmental organisation that deals with sexual reproductive health, compiled a report based on research gender issues at Chingwizi in April. WAG’s report revealed that the clinic at Chingwizi had only one midwife to assist all the pregnant women in the camp with no gynaecologist manning the health facility.

The report goes on to state that approximately 18 women gave birth at the camp clinic every month. There were five nurses at the clinic and it operated from 8 to 4pm.