Community Working Group on Health

A shortage of pathologists and a culture of corruption have made mortuaries sites of extortion and grief.

By Linda Mujuru

Emily Muchabaiwa comforts her sister-in-law, Antonette Chisango, as she mourns the loss of her husband. Muchabaiwa wasn’t satisfied with her brother’s postmortem results, and like many in Zimbabwe, they were left with more questions than answers in a health system plagued by corruption and understaffing.

HARARE, ZIMBABWE — Blessing Mucharambei’s uncle was just having lunch when he stood up, then collapsed. “[He] started bleeding from the nose,” she says, “and died on the spot.”

As far as his family knew, he had no health problems. As they struggled to make sense of the news, Chitungwiza Hospital — where his body had been taken to a mortuary — told them that a forensic postmortem would be required.

Zimbabwean law mandates postmortems for sudden or unexplained deaths, and public hospitals offer them for free. But there are only five qualified pathologists in Zimbabwe serving a population of close to 17 million people. The wait could stretch for days. And each day the funeral was delayed would add to the cost of hosting mourners, as some traditions require.

A police officer stationed at the hospital offered them a workaround. Instead of a forensic postmortem, they could do a general one — an option when no foul play is suspected, and quicker since it doesn’t require a specialist. But even that, he warned, could take days. He offered to fast-track the process for a US$30 fee. Desperate to bury their loved one, they paid.

“We couldn’t afford the time,” Mucharambei says. “We did it because we had no choice.”
A country in freefall

Postmortem bribes are just one element of a health system — and state — in freefall. Hospitals across the country are plagued by chronic underfunding, obsolete infrastructure and the mass emigration of medical professionals seeking better pay abroad. The government estimates that the country needs more than US$1.6 billion for its health sector to recover.

Underpaid and overstretched health workers have come to rely on informal payments as a means of survival, says Dr. Norman Matara, secretary general of the Zimbabwe Hospital Doctors Association. “People are trying to survive. But over time, corruption becomes part of the culture.”

He says it’s a common problem across hospital services, from the moment a patient is admitted. New mothers, for example, face extortion for birth cards meant to be free. A 2021 study from Transparency International Zimbabwe surveyed over 1,000 people in Zimbabwe and found that 74% had been asked to pay a bribe while trying to access health care services.

In March, a nurses’ protest at Sally Mugabe Central Hospital — the largest referral hospital in the country — exposed how dire the situation is. It was the latest in a long history of strikes by health workers, who have repeatedly protested poor pay and deteriorating working conditions. But their actions are often met with intimidation. In June 2022, the government responded to a strike by passing a law banning health care workers from striking longer than 72 hours, with penalties of up to six months in jail for participants and organizers.

A hospital corridor leads to the mortuary at Parirenyatwa Hospital. Zimbabwe’s public health system faces a severe shortage of pathologists, leading to postmortem delays and widespread bribery. Families say they’re often pressured to pay unofficial fees to expedite the process or obtain basic information about their loved ones.

A manufactured problem

Pathology services are particularly strained, Matara says. The few available specialists are clustered in major hospitals, which creates opportunities for exploitation.

Few medical students choose the career, and those who do face an uphill battle. Training programs are underfunded, mentorship is scarce and working conditions at public hospitals are dismal.

But this is partly a manufactured problem, says Memory, a nurse at Sally Mugabe Central Hospital, who asked to use her middle name for fear of losing her job. Memory has worked at the hospital’s mortuary close to 20 years.

“There isn’t really a backlog but a fake one is created by police officers, the doctors and mortuary staff to pressure families into paying,” she says.

These services are supposed to be easily available, she adds. A Cuban doctor performs the forensic postmortems on Mondays, Wednesdays and Fridays, while the general ones are done daily. But families are often told there are delays. At times, they are asked to pay US$50 to skip it entirely, even when it’s required by law, or US$100 to expedite the process, Memory says.

“It’s a moneymaking scheme at the expense of grieving people,” she says.

Global Press Journal reached out to Sally Mugabe Central Hospital for a response to these allegations. They declined to comment.

Tendai Terrence Mautsi, the public relations officer at Parirenyatwa Hospital, the largest public hospital in Zimbabwe, says there are occasional delays with forensic postmortem cases, mostly due to demand. The hospital, he says, has responded by increasing forensic postmortem days from two to three. They’ve also cut the average waiting time from up to two weeks to just three days. To address the national shortage, Mautsi says, the hospital has partnered with Cuban doctors to fill the skills gap.

He acknowledges that corruption has plagued the process. But, he says, it’s part of a much bigger unravelling, and everyone has become complicit.

“At times you can’t find evidence,” he says. “When you want to investigate it, the patient is complicit. The service provider is also complicit.”

In the end, corruption harms people in need, says Tafadzwa Chikumbu, the executive director of Transparency International Zimbabwe. “For those who can’t afford to pay [a bribe], it means being left unattended,” he says, which erodes the integrity of public institutions.

The solution, he says, is to make ethical conduct — including fair hiring and honest service delivery — the standard.

Emily Muchabaiwa, in hat, Antonette Chisango and Keldon Muchabaiwa sit at their home in Harare. The sudden death of Emily Muchabaiwa’s brother — Chisango’s husband — was marred by irregularities, including the absence of a written report and the lack of a clear explanation from medical staff.

A cover-up?

Postmortem corruption means some families never find out what happened to their loved one. When Emily Muchabaiwa’s brother was found dead in Harare’s industrial area, his family was desperate for answers. The circumstances of his death weren’t clear, and the family hoped a postmortem at Parirenyatwa Hospital would offer closure.

Per standard procedure, a medical doctor or the pathologist should explain the results to the family, Matara says. There should also be a written report. But it was a police officer who delivered the results, verbally, to Muchabaiwa’s family. There was no official report.

“[He] told us my brother had died from tuberculosis and a cold in the lungs, but he struggled to explain the medical terms. Prior to all this, my brother had no signs of sickness,” she says.

The family was suspicious. Muchabaiwa says they believe the death involved foul play and the process was compromised. It would cost the family money to delay the funeral, so they buried her brother, who left behind a young son.

“We had no choice,” she says, voice trembling. “The postmortem failed us. Corruption failed us.”

The article was first published in the Global Press Journal.
Photos Credit: Linda Mujuru

Linda Mujuru is a Reporter-in-Residence for Global Press Journal in Zimbabwe, where she covers foreign direct investment and its effects on local communities. She holds an MBA from Midlands State University and Master’s and Bachelor’s degrees in Journalism and Media Studies from the National University of Science and Technology. Linda is one of Global Press’ most widely read and syndicated journalists and won the Community Champions Award from the Nonprofit News Awards for her story “Push for Gold Leaves a Toxic Legacy.”

ZIMBABWE recorded at least 38 new suspected measles cases last week from all provinces except Bulawayo metropolitan.

The disease re-emerged several weeks ago and according to the Health and Child Care ministry, 15 suspected cases and zero deaths had been reported by April 3 this year.

The ministry said the cases were reported from Mashonaland East (6), Masvingo (2), Harare (2), Mashonaland Central (1), Mashonaland West (1), Matabeleland North (1), Matabeleland South (1) and one case in Manicaland.

The cumulative figures are 93 cases.

Experts who spoke to NewsDay expressed concern over the re-emergence of the medieval disease.

Johannes Marisa, a medical expert, said there was need for more awareness so that people knew how to prevent the disease.

“Measles has always been there and it can come in outbreaks which can be sporadic like what you highlighted above. What matters for now is for people to be cognisant of the fact that they have to receive a vaccination against measles, especially those that have not been vaccinated,” he said.

Marisa said children should be vaccinated at all costs to limit the risk of contracting the disease.

“Children should not escape vaccination. If one is not vaccinated, they are at a very high risk of mortality since the severity of the disease can be very high.

“I encourage everyone to take vaccination seriously so that we have a milder disease or we can stop the spread of the viral disease,” he said.

Marisa expressed concern over religious sects that do not embrace vaccination, saying this complicates healthcare delivery as it leaves people exposed to preventable diseases like measles.

Community Working Group on Health executive director Itai Rusike described the outbreak as unfortunate, adding it was sad that young Zimbabwean children, mostly those under the age of five, continued to contract measles despite the availability of a vaccine.

“The current measles outbreak in almost all the provinces may be as a result of a drop in vaccination coverage or depressed vaccination coverage post-COVID-19 and other health systems coverage.

“There is a need to accelerate immunisation activities to reduce measles cases and a deliberate effort should be made to reach out to the leadership of the various religious groups so that they can appreciate the benefits of getting their children vaccinated against measles,” he said.

Zimbabwe suffered a severe nationwide measles outbreak in April 2022 that proved to be deadly, particularly for children.

More than 750 children died from the disease within first six months of the outbreak.

By Nhau Mangirazi, Newsday

CWGH Executive Director Itai Rusike

DESPITE putting up a brave front while attending to patients, one of the few doctors assigned to a district hospital in rural Zimbabwe is unhappy.

Speaking in a hushed tone, he confesses that all is not well for the medical staff.

They normally face harsher realities of mental health challenges.

“The sad reality is that many doctors are undergoing mental health challenges fuelled by poor working conditions and lack of innovation and medical equipment to use,” he said, speaking on condition of anonymity.

“We are working under stressful conditions.”

Three medical doctors, instead of seven, man the hospital, making the workload unbearable for them.

According to a random survey, doctors have not been spared by mental health challenges which have become a growing concern, amid an economic crisis gripping the nation.

Key stakeholders have challenged government to invest more in the recruitment of medical personnel to ease the burden on the few who are working in the health sector, many of whom are considering migrating to stable economies.

The calls were made as the country commemorated the World Doctors Day on March 30.

Zimbabwe Association of Doctors for Human Rights executive director Calvin Fambirai confirmed that all is not well in the health sector.

“There is poor and limited recruitment, retention of skilled healthcare professionals,” he said.

“This can be achieved through improved working conditions and fair remuneration.”

Fambirai further explained that shortages of essential medicines and medical supplies have worsened the situation.

“Generally, doctors face shortages of personal protective equipment and it’s a battle for survival,” he said.

“We are committed to doing our best, but these limitations affect our operations.”

Community Working Group on Health executive director Itai Rusike acknowledged that in Zimbabwe, the standards have fallen really low, where doctors suffer burnout, low self-esteem due to the system-wide poverty, limited management support and lack of staff health support.

“While this mostly pertains to the public sector doctors, those in the private sector are also suffering from fatigue and sometimes late or non-payment of claims by medical aid companies, which take advantage of both the service providers and the patients,” Rusike said.

He, however, noted that by design, the work of a physician is mentally challenging as one is always expected to be in the know and to provide solutions, including support to junior staff.

“When no one cares for the carer, this becomes a tall order and results in mental breakdown. The family and other societal expectations also add rather than subtract from this burden,” Rusike said.

“Furthermore, doctors work as multi-professional and multi-disciplinary teams if they are to deliver comprehensive patient management.

“The current situation of a multi-systems collapse exerts undue pressure on clinical and public health physicians and their respective teams as they fail to provide optimal care and yet they too have numerous insufficiencies at personal level.”

According to Rusike, the work of a doctor comes as a package and gets severely disrupted should the tools of trade be unavailable.

“While medical doctors require a hospital environment to deliver effective services, the population health specialists require a conducive framework combining socio-economic, political and environmental provisions in order to function optimally and deliver the full basket of preventive, promotive, therapeutic and rehabilitative services.”

The World Health Organisation (WHO) said the commitment of doctors around the world was under silent crisis.

“Doctors worldwide face high levels of burnout, depression, anxiety and suicide. They dedicate their lives to healing others, yet their own mental health is often overlooked,” the global health body said in a statement on World Doctors Day.

It noted key facts affecting the doctors, including workload, low pay, unsafe environment and stigma that see many struggling in silence.

“WHO warns of a shortfall of 11 million health workers by 2030, where female doctors are 76% more likely to die by suicide than other women,” the statement said.

Globally, there are only 35% of countries that offer national work-related mental health support programmes.

“On this day, let’s raise awareness and celebrate doctors everywhere for the care and dedication they bring to their work everyday,” WHO concluded. -Newsday