Zimbabwe economic crisis hits care work volunteers hard

Date: January 1, 1970
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The prevailing social, political, and economic crisis in Zimbabwe has dealt a hard blow to home-based care (HBC) initiatives for people living with and affected by HIV/AIDS in the country. In mid-February Medecins Sans Frontieres (MSF) head of Mission in Zimbabwe Manuel Lopez noted that, “Public hospitals are turning away people, health centres are running out of supplies and equipment, there is an acute lack of medical staff, patients cannot afford to travel to pick up their HIV medication or to receive treatment.À

The closure of public health institutions at the end of 2008, coupled with a cholera outbreak, worsened the plight of many HBC beneficiaries. Public hospitals and clinics closed down, citing widespread shortages of staff and basic medical materials such as syringes, gloves, and drugs. The development left many people living with HIV and AIDS (PLWHA) with no affordable source of life-prolonging anti-retrovirals (ARVs). 
Because of economic challenges, fewer women are volunteering for HBC programmes, as they must spend most of their time trying to find their next meal.  While home based caregivers were struggling to meet their existing client needs, the deepening cash crisis forced many who had previously accessed private care to also turn to home based care volunteers. When public hospitals closed down some PLWHA turned to private suppliers for their ARVs but hyperinflation quickly made this option unaffordable. Once off ARVs, an increasing number of PLWHA succumbed to opportunistic infections at home which HBC volunteers were ill equipped to treat.
The collapse of water reticulation systems in most major towns and cities left many PLWHA highly susceptible to water borne diseases especially cholera.  HBC volunteers lacked enough clean water to offer bed baths and do laundry for patients.  In some instances, caregivers reported failing to find time to help the sick as they were forced to spend time searching for water for personal use.
The Roman Catholic Church in Zimbabwe runs the Mashambanzou AIDS Care Centre. According to the church’s Social Communications Officer, Oscar Wemter, getting enough volunteers to take care of patients is now their biggest challenge.  With almost nine out of 10 adults unemployed, many women turn to cross-border trading which takes them away from home for long periods leaving them with little or no time to volunteer for HBC duties.
Some volunteers explained that that supporting organisations would give them food rations similar to those given to the sick and orphans. When this practice stopped because of political and economic challenges, caregivers had little incentive to volunteer when they have the time.
Volunteers also pointed out that with limited resources, they can render little care to patients. Some feel they are no longer making a difference to the quality of life of their patients. Instead, they are simply “watching patients with no clothes or blankets waste away due to hunger, disease and the cold.”
The cholera epidemic raging through Zimbabwe also forced medical personnel and humanitarian organisations to shift their focus from HBC programmes towards containing the cholera outbreak described by the World Health Organisation (WHO) as the “deadliest outbreak of the disease in Africa in 15 years.” This shift has consequently increased the burden on HBC volunteers. 
In Harare, for instance, the Beatrice Road Infectious Diseases Hospital that normally admits tuberculosis and HIV patients is now exclusively admitting cholera patients.  As a result, some very ill people who should be hospitalised are at home where relatives who are either not willing or not capable of caring for the sick neglect them.  Few can afford the fees demanded by private hospitals.
With inadequate surgical gloves and disinfectants, caregivers worry about contracting cholera themselves and often leave without rendering proper care.  Caregivers have the added task of helping the sick access safe water by going to collect water purification tablets in addition to actually fetching water for their patients.
The net effect of the Zimbabwean crisis on HBC programmes has been to reduce the effectiveness of such initiatives in both rural and urban settings.  Widespread poverty and a breakdown of the public health delivery system means that more PLWHA succumb to opportunistic infections. Overall, while the demands for service grow, the ability of volunteers to operate diminishes. Without an end to the economic crisis, this is unlikely to change any time soon.
Miriam Madziwa is a freelance writer from Zimbabwe. This article is part of the Gender Links Opinion and Commentary Service that provides fresh views on everyday news.

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