Community Working Group on Health

THE Ministry of Health and Child Care (MoHCC) does not encourage traditional midwives to deliver babies nor offer maternal health related services to pregnant women, a top government official has warned.

By Michael Gwarisa

The development comes in the wake of what has been described as “heroic works” of one Mbare traditional midwife, Mrs Esther Gwena who has since delivered more than 100 babies at her home. However, the babies are being delivered in the absence of critical health sundries such as, disinfectants, safe delivery kits, running water and proper waste disposal facilities a situation health experts fear could trigger an even worse health crisis.

In an interview with HealthTimes, Director Family Health in the ministry of Health and Child Care (MoHCC), Dr Benard Madzima said traditional midwives were not qualified to offer midwifery services and it was against the World Health Organisation (WHO) international guidelines.

In Zimbabwe, the program for maternal health is guided by the World Health Organisation (WHO) recommendations and the current recommendations are that traditional midwives are supposed to give health education to pregnant women and encourage them to go to established health facilities.

“This is because if a women then complicates or needs further help other than a normal delivery, traditional midwives will not be able to offer that help. For example, if a women suffers from post-partum hemorrhage, they will not be able to stop the bleeding, neither will they be able to give blood,” said Dr Madzima.

He added that Zimbabwe does not allow traditional midwives to offer services as this could result in even worse health complications.

“This is the background why it is not encouraged to have traditional birth attendants attending to pregnant women. They are not able to solve the complications which might arise. They are not able to give caesarean sections, the issues of integrating with other programs like HIV program like the immunization programs also come into play.

“So we don’t encourage traditional birth attendants delivering our women in Zimbabwe.”

In the early 80s Zimbabwe was advocating for the use of traditional birth attendants as part of the health delivery package. However, that was stopped in 1994 soon after the International Conference on Population Development (ICPD) following evidence that traditional midwives were not capable of handling birth related complications and other services that require skilled personal such as blood transfusions among others.

According to evidence based research, women who develop complications while at a traditional health attendant are most likely to lose their lives or that of  the baby.

Community Working Group on Health (CWGH) Executive Director, Mr Itai Rusike said government should address concerns of doctors and stop issuing licenses to traditional midwives.

“By endorsing Traditional Birth Attendants (TBA) instead of addressing the concerns of the doctors and other health workers, the government risks losing all the gains achieved in Maternal Neonatal and Child Health programs as the TBAs are not equipped with the requisite skills needed in the event of a complication or excessive bleeding.

“This is a tragedy and  the government is failing women and new-borns as the home deliveries are going to derail the country’s PMTCT programs and the postnatal care services that are supposed to be offered to both the mother and new-born. It is going to be very difficult to stop or discourage the TBAs from continuing practicing even after resolving the incapacitation crisis as they have been given a license and go ahead to operate and the long term consequences are going to be dire,” said Mr Rusike.

He added that the only noble thing to do was to get skilled health workers back in the clinics and hospitals so that the public health institutions can become functional again instead of celebrating medieval health practices that have long been forgotten in other parts of the world.

“We are not blaming the TBAs that are capitalizing and filling in the gap created by the non-availability of health workers in public health institutions but we need to hold the government accountable for sleeping on duty and failing to resolve the prolonged impasse and incapacitation crisis.”

Zimbabwe is currently battling numerous health challenges at the back of the obtaining industrial action by medical doctors and council nurses due to incapacitation. According to the latest Zimbabwe Demographic Health Survey, an estimated 614 women from every 100 000 who give birth die in the process, making it one of the highest in the world.

Public Health Expert, Mr Enock Msungwini however said engaging traditional midwives was not the best option to resolve the prevailing maternal health burden but government could capacitate them to ensure they complement qualified healthcare workers.

“It is not in the best interest of the public health context to engage traditional birth attendants. Factors like the reasons why women go there may vary. Is it about money, privacy, care, myths etc. These fall under the social determinants of health where one social system life style. Beliefs, economic status place of stay, diet and food have a bearing on health.

“The way forward however is to train them so that they complement the health system no to abruptly cut them completely,” said Mr Msungwini.

ORDINARY citizens whose pockets are not deep enough to afford private medical care continue to bear the brunt of the ongoing stand-off between medical doctors — who have been on industrial action for over two months now — and government.

People with various ailments are gambling with death as many have since stopped going to seek medical attention at public hospitals, where they are routinely turned away due to the unavailability of doctors.

Hope in the public health system recuperating and going back on its feet has been lost and the pain has been worst felt by chronically ill patients who rely on the doctors’ services from time to time.

Faina Guruuswa (not her real name), has suffered from anal cancer for 11 years, having been in and out of hospital since 2008, seeking services to at least ease her recurring ailment.

The growth is often cut, but it grows again at a slightly different spot. She has had to become a permanent resident at one of the country’s biggest health institutions, where she is being attended to.

When NewsDay visited her, she was fearful that speaking to the media would attract severe backlash from hospital authorities.

Sometime in September soon after the doctors downed their tools, she had to go for an incomplete chemotherapy treatment.

Chemotherapy treatment may be a single drug or a combination of drugs. The drugs may all be given on a single day, several consecutive days, or continuously.

Guruuswa was given three doses, instead of five, and was told it was just a favour being accorded her since doctors were on strike.

Such is the case for many in her situation. Scheduled treatment is no longer guaranteed, further worsening their situation as cancers are bound to spread rapidly.

Guruuswa said she was now living in uncertainty over how long she would be stuck at the hospital awaiting services in the face of the doctors’ prolonged strike.

“My condition started in 2008 soon after I started anti-retroviral treatment. I developed small pimples in my anal area and I sought treatment which was not entirely successful,” she said.

Five years down the line, she said it started growing again and she received medical attention, but it recurred again in 2015 and she had to go to Karoi General Hospital to have it removed.

“The growth started again and in 2016, I went to a bigger provincial hospital for another operation, but the growth wasn’t completely healed and I was in excruciating pain. I have had to live on painkillers until now. I am on morphine to help ease the pain,” she said, barely being able to conceal the pain gnawing at her as she narrated her ordeal.

She came to Harare in winter this year because she felt she was now being a burden to her sister, who had accommodated her in Chiredzi, but was also struggling.

Things turned for the worst when the doctors’ strike began and her dream of ever getting better have been shattered.

“Things have changed. Before this, we did not have problems getting treated. It was timely and straight-forward,” she recalled.

Guruuswa has had to endure the harsh economic conditions and is living off the hospital after authorities availed a shelter for those in her situation at the Annex Psychiatric Unit.

She, however, keeps holding on to the last straw of hope that the doctors will return to work and she gets her scheduled treatment before things turn for the worst.

A visit to Parirenyatwa Group of Hospitals on Thursday evening last week proved that things were far from normal.

As the NewsDay crew sat in the casualty area trying to figure out how people were being served in the wake of the ongoing doctors’ strike, one of the senior doctors finally came after close to two hours of waiting.

“Doctors are on strike, but I am here to assist you with your next step,” the doctor said.

He told one woman who had brought a young man who had drunk poison, to take him back home and force him to drink lots of water because there was no doctor to deal with his condition.

Two women who had a baby with an ulcer on the thumb were told to rush to a private practice as their case was an emergency, which, under normal circumstances, would have been quickly dealt with at the hospital.

Several others were told to go back home.

Zimbabwe Hospital Doctors Association spokesperson Masimba Ndoro told NewsDay that while they drew no pleasure in seeing their patients suffering, the onus was on government to ensure that the basic right to health was upheld.

“We really want to be with our patients. We don’t draw any pleasure from their suffering. It is quite sad that people are being deprived of their right to health as a result of the impasse.

“It is the government’s responsibility to make sure that people are accorded quality health. The government should quickly come to terms with regards to accepting that we have a problem,” he said.

Community Working Group on Health (CWGH) executive director Itai Rusike said the ongoing impasse between government and the doctors was taking its toll on patients and there was need to resolve the crisis urgently.

“CWGH is greatly worried by the incapacitation crisis and prolonged impasse between the doctors and their employer, which has resulted in untold suffering of patients and even deaths that could have been avoided under normal circumstances,” he said.

“While we acknowledge the genuine grievances of the doctors and the financial position of government, we would like to urge the two parties to put patients first and at the centre of their dialogue to save lives and stop the suffering.”

The doctors have remained adamant and have vowed not to return to work until government offered a meaningful remuneration, among other things.

Government has already fired 211 striking doctors after conducting disciplinary hearings, albeit boycotted by the medical practitioners.

At least 516 doctors face the axe as the disciplinary hearings continue.

Meanwhile, Guruuswa’s life, and that of other patients in critical conditions, remain in the balance.

GOVERNMENT yesterday fired 211 doctors at public hospitals for going o strike to demand better pay, with another 500 at risk.

Doctors have been on strike since September 3 demanding salaries that are indexed to the United States dollar to escape triple digit inflation that has ravaged wages.

The Health Services Board fired the doctors after holding disciplinary hearings which the striking doctors did not attend and said it planned to hold another round of hearings for at least 516 out of the 1 601 doctors employed in the public sector.

The Zimbabwe Hospital Doctors Association, which represents junior and mid-level doctors, has accused government of intimidation to force its members to return to work.

Health Services Board (HSB) executive chairman, Paulinus Sikosana yesterday said the disciplinary hearings were set to continue.

“To date, 279 doctors have been served with charge letters, 213 hearings completed and 211 doctors found guilty of absenting themselves from duty without leave or reasonable cause for days ranging from five or more,” he said.
“The 211 doctors found guilty have been discharged from the health service. Three doctors appeared in person before the disciplinary tribunals and two doctors had their determinations reserved pending verification of their cases.”

Sikosana said at meetings aimed at ending the impasse, doctors had “demanded the pegging of their salaries to the prevailing interbank rate as a precondition for their return to work.”

Zimbabwe is facing its worst economic crisis in a decade, with inflation, estimated at 353% in September, playing havoc with salaries and prices.

Community Working Group on Health (CWGH) executive director, Itai Rusike said the decision by government was very frustrating considering efforts made to facilitate dialogue with hope of reaching an amicable decision that is comfortable for both parties.

“We have been facilitating dialogue for the past two weeks only to wake up to this. How do you negotiate for dialogue when on the other hand you are holding a knobkerrie? The government is not sincere and its attitude is uncalled for and unnecessary,” Rusike said.

“This intimidatory attitude is not the way to go. The Constitution gives them the right to withdraw their labour and firing the doctors in a country with poor health standards will not improve the situation.”

He said they had done their part in trying to get the two parties to dialogue in search of a solution to the impasse.

“We thought that the government was going to set aside the hearings and uphold dialogue. Without human resources we cannot achieve universal health coverage,” he said.
ZHDA executive members said they were not commenting on the latest developments for fear of victimisation.

“Senior doctors remain incapacitated and hospital drugs and equipment remain inadequate. No meaningful service is being offered at central hospitals,” the union said in a statement.

“Training of both undergraduate and postgraduate doctors has been severely impacted by lack of clinical teaching.

“Flexi-hour system remains in place as policy. This has greatly affected quality and continuity of patient care Junior and middle level doctors have been dismissed from work for not being able to report for duty due to incapacitation. Some on maternity leave and others who are training outside the country have also been served with letters accusing them of absenteeism.

ZHDA said the ‘punitive disciplinary hearings’ should stop while the dismissals must be reversed.

“Robust dialogue in good faith should take place with key stakeholders to help direct the capacitation of the workers and the public health institutions. These must be given timelines to yield results,” ZHDA said.

BY VANESSA GONYE

BY VANESSA GONYE

Public hospital doctors have lashed out at the Health Services Board (HSB) for firing 77 doctors since Tuesday. Addressing Zimbabwe Hospital Doctors’ Association (ZHDA) members and the media at Parirenyatwa Group of Hospitals yesterday, the association’s vice-president Masimba Ndoro said the move by government was costly, especially on citizens who have no healthcare givers.

“This is an abnormal situation which requires solutions not to waste taxpayers’ money. It is a move we have anticipated; we knew they would take that route as we started our strike. It will not capacitate our doctors and it won’t change the situation in our health system,” he said. Ndoro said the doctors would stick to their guns even in the face of more threats from their employer until they reach a reasonable agreement.

ZHDA acting secretary-general, Tawanda Zvakada said the decision of the HSB was proof that they were not in their right senses and as an association they would wait for them to come to their senses and reach a meaningful conclusion on the matter that has been hogging the limelight for a number of years.

“We hope this is the last strike, we want a long-lasting solution to prevent these impasses and we have proposed that the salary is paid at interbank rate to avoid situations where our earnings are eroded just a month after they would have been reviewed,” he said.
ZHDA treasurer-general Tapiwa Mungofa, questioned HSB’s credibility as they have diverted from their mandate of representing them and to act on issues that pose a threat to their calling.

“The decision to fire doctors came as dismay to the doctoring profession; the HSB is mandated with a very simple task, but it’s a shock they have been barbaric, firing the few doctors the country has,” he said. Mungofa said the doctors remain open and available for dialogue.

Community Working Group on Health (CWGH) executive director Itai Rusike said the dismissals will neither address the problems affecting the doctors nor boost their morale.

“CWGH has learnt with great concern the dismissal of the doctors that are currently affected by incapacitation. We strongly urge the government to find amicable ways of dealing with the doctors’ incapacitation crisis without sacrificing the health of the masses,” Rusike said.

He said the country has a pathetic doctor-patient ratio that has left the available human resources stretched to the limit, thereby compromising quality of care.

“We implore the HSB to reconsider its decision and fully take advantage of the dialogue process being facilitated by CWGH,” Rusike said.

Rusike called on the two parties to find amicable ways of dealing with such problems while prioritising the lives of patients and the general public that depend on the public health institutions.

Trevor Chivandire, one of the fired 77 doctors, said as professionals who have their country’s interests at heart they were going to try and re-engage their employer and would try other avenues if the move does not yield results.