Barely able to live, too poor to die

For Zimbabwe’s legions of the sick, the most common treatment is nothing more than hope and prayer. Life here is dominated by the downward spiral into illness and death.

To save the sick, families already struggling with the world’s highest inflation rate scramble to sell what little they have left.

Children with broken limbs must wait until their parents scrape up the money for a cast. Hospitals have nothing, so doctors send families to buy drugs and even surgical gloves. HIV patients seeking antiretroviral drugs are told to come back months later. Accident victims are lucky to get a tetanus shot.

And when the sick and injured die, as many inevitably do, their bodies are stacked high in the morgues until relatives can afford to take them home in the backs of pickup trucks, on ox-drawn wagons or in pushcarts. The funeral alone can cost nearly half a year’s salary, sending the living further into a spiral of poverty, illness and death.

Nothing more clearly illustrates the collapse of what once was one of Africa’s most prosperous countries than the failure of its collective health. In 1990, Zimbabwean life expectancy was 60 years. Now the average woman is dead at 34. Hospital workers have been striking for raises to offset an annual inflation rate of 1,730%. Doctors have to walk or cycle to work, and they can’t afford to send family members to their own hospitals.

The political opposition and many Western nations accuse President Robert Mugabe’s government of rampant corruption and economic mismanagement. Since 2000, it has seized the land of most of the country’s white commercial farmers, who had been the backbone of the economy. Much of the land has gone to Mugabe’s political supporters.

The government blames Britain, the former colonial power, and other Western governments for cutting off its access to international loans.

“Things are so bad,” said one man, Sikhumbuzo Dube, “that it’s more expensive to die than to live these days.” The body of Dube’s nephew, a 39-year-old communal farmer, lay in the morgue for three weeks until the family could come up with the money to rent a truck.

A young Bulawayo doctor named Nqobile Ncube said many of those who end up in hospitals have little chance.

“You do your ward rounds and you see a patient,” Ncube said. “He’s in the same condition as the day before. Why? He’s not been given the drugs. He is trying to find relatives to buy the drugs for him.

“You go to the next patient. He’s dead. It’s written on his card, ‘Fluids not available; relatives to buy.’ It’s just ‘relatives to buy, relatives to buy, relatives to buy.’ ”

Ncube has watched a teenage boy die in a diabetic coma. He has sent the parents of children with broken limbs to buy plaster. They return days or weeks later.

He has seen patients die of strokes because there was no medicine to treat their hypertension. He’s seen surgery days canceled for want of surgical gloves.

“You can’t resuscitate patients. There’s no oxygen. There are no IV fluids,” he said, anger rising in his voice. “The only time when you are guaranteed of having everything there is for death certificates.”Doctors write them out on the back of used bits of paper.

Families are left to cope with the grief of a death that could have been avoided, then must find more money for the funeral.

Dewa Moyo, 60, a gardener, went to the morgue at Mpilo Hospital in Bulawayo late last month to collect the body of his baby girl, Maureen, who had been ill since birth.

“The bodies were just piled up on top of each other like sacks,” he said. “The relatives were just lifting up the bodies to look at the names. You couldn’t see the face. The faces were rotted away.”

Dube’s nephew, Moffart Khumalo, lay in that morgue until his family could raise money to travel the 130 miles from their rural home. They wrapped his body in a blue blanket and put it in the back of a rented pickup, crammed in with about eight relatives.

His mother, Senzeni Dube, sat in the front seat, occasionally wiping away tears.

Eva Ndlovu, 27, died March 18 in a rough mud hut on the outskirts of Bulawayo. A piece of plastic she had picked up at a cement factory became her burial shroud, along with the filthy blankets she had huddled under as she died.

Her husband, Phinias, tore the door off the hut to support her body. Her family wheeled it on a borrowed handcart to the cemetery, three miles away. Three mourners dug the grave. No death certificate was issued.

Eva had been ill for two years with AIDS, but family members said the hospital always sent her home.

An estimated 18% of Zimbabwe’s adults are infected with HIV, the virus that causes AIDS.

Ncube, the doctor, said those who tried to register in Bulawayo as HIV/AIDS patients in March were told to come back in June. They are unlikely to see a doctor before October or November, he said.

The Ndlovu family is among thousands affected by one of Mugabe’s widely criticized policies. They were removed by police from the Bulawayo suburb of Killarney in mid-2005 in a massive government effort to demolish shacks, put informal traders out of business and push the poorest urban dwellers into the countryside.

According to a United Nations report, Operation Murambatsvina, which translates as “clean out the filth,” left 700,000 people homeless.

The family never got back on its feet. The cheapest coffin would have cost Phinias Ndlovu about $15 at the time of his wife’s death, too much for a family that lives on cornmeal handed out by a church.

For the Chinofura family, which also suffered in the crackdown, anger with the government is growing hand in hand with despair.

They remember the 1980s and ‘90s as good times when they could buy clothes, shoes, food, even a radio. But the last time they ate bread and a decent breakfast was in 2004.

Alexander Chinofura, 53, and his wife, Rosie, sat in their tiny concrete house on the outskirts of the capital, Harare, one recent Sunday morning. Their youngest son, Ellington, 6, peered in at the door, hoping for breakfast, his nose and eyes runny. But there would be nothing till nightfall.

Each day, her husband walks 2 1/2 hours to work in a factory. He earns the equivalent of four or five U.S. dollars a month, and inflation is eroding that sum by the day. Her oldest son earns the same amount in another small factory, and once a week she collects firewood to sell. The moment anyone in the family gets money, they buy food before prices go up.

The family rented shacks to several families until 2005, when the government tore the shacks down.

“So many people around here support the opposition because of the difficulties we have been having,” said Rosie Chinofura, 45. But people express their opinions only to trusted family and friends, she added.

Last year, her husband’s brother, Christopher, developed tuberculosis. The family sold old clothes, radios, shoes and other possessions to pay for his treatment.

“I just wanted to get out of that hospital and come home to my family,” recalled Christopher Chinofura, 45. “Every day people were dying in there.”

A few days after Christmas, his mother, Jessica Kasuru, 78, had a minor stroke. The family was so short of food that Christopher took her to his sister’s family in a rural area, where charities were distributing food.

In January, she had another stroke, so he laid her gently on an ox cart and drove 10 hours to the nearest hospital. But he did not have the admission fee, and there was nothing left to sell.

So he propped her back on the cart and took her home, where the family fed her thin gruel until she died March 21. The cost of the funeral and transporting the body nearly totaled the family’s income for five months. They borrowed most of the money.

With her son’s wages garnisheed to repay the debt, Rosie sat on the ground outside her front door, wondering how to live on even less. The only idea that came to mind was to borrow again.

Zimbabwe’s crisis will go on and on, she said. “I have no hope.”

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robyn.dixon@latimes.com

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Begin text of infobox

A troubled land

Zimbabwe has one of the world’s lowest life expectancies and highest inflation rates. Corruption and government policies have damaged the country’s once prosperous economy and displaced hundreds of thousands.

*--* Population 12 million below poverty line 80% Median age 20

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Life expectancy at birth

*--* Males Females Algeria 69 72 Ghana 56 58 Kenya 51 50 Nigeria 45 46 Zimbabwe 37 34 Sierra Leone 37 40 Swaziland 36 39 U.S. 75 80

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Annual inflation

1998 ... 32%

2004 ... 133%

2005 ... 585%

2006 ... 914%

2007 ... 1,730%

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Sources: CIA World Factbook, World Health Organization. Graphics reporting by Julie Sheer