Zim’s home-based-care gamble

Zim On Line
by Chris Anold Msipa
HARARE – At Mavise village, 170 km south of Zimbabwe’s capital, Harare, Tambudzia Zinyere recalls how one day, two years ago, the three men approached her homestead.

Two of the men, she had never seen before but the third she was sure she had met before. But, for the man’s emaciated and sickly features, she could not, from the distance, immediately tell who he was.

As the visitors drew closer and as Zinyere could see more clearly who the third and sickly man who appeared to walk with the support of his colleagues was — the earthen pot she was holding slipped from her grip and crushed to the ground. Zinyere said the shock was just too much for her to handle.

The sickly figure was her husband Samson Chemhere who had left the village three years before to go to Harare to look for work. He never returned – until the two strangers brought him back.

“They said he was their friend. He had been discharged from Parirenyatwa (Group of Hospitals in Harare) and was to be on home-based care,” said the 23-year old Zinyere, now a widow.

Samson had left the village a tall, heavily built and handsome man. The gaunt and sickly figure lying on the reed mat where his friends from the city had put him was more than enough Zinyere needed to know what disease was, to use the rural parlance, eating her husband.

Nightmare

Having witnessed other families in the village care for their HIV/AIDS-afflicted relatives, Zinyere knew that her husband would need help in simple tasks like bathing, feeding or attending the call of nature. But that was the least of her worries.

Zinyere’s biggest nightmare, as she put it, was just how and where to get the various nutritious foods that, according to a list attached to Samson’s medical papers, he was to be fed regularly to help boost his immune system.

“I could not buy that kind of food,” she said, “what I only managed to do was to feed him on chicken meat for the first couple of days (then there was no more chickens to slaughter).”

Zinyere, who had single-handedly fended for their two sons, Tawanda (five years old) and Farai (three), for the three years that Samson had been away in the city said she tried hard to provide for her children and sick husband, selling fish and home-made peanut butter to raise cash to buy food.

But in crisis-hit Zimbabwe of 2008 – the year her sick husband returned to the village – Zinyere’s labours simply could not raise enough. Or on the good days she made enough money from her vending business, she could not find food in the shops or medicines at the nearest government hospital.

“My children and I managed to survive on wild fruits, which everyone had resorted to in the villages. But he couldn’t,” she said. “He died last year.”

Home based care

It was a sad ending to a story that – sadly — you will encounter many times over across Zimbabwe, as public hospitals continue to discharge more HIV/AIDS patients into the care of relatives under a home-based-care scheme that once worked – but barely does after a decade of acute recession that left many families too poor to provide for the sick.

In a largely conservative and christian society such as Zimbabwe, caring for sick family members is more second nature than duty to many.

But the formation in 1989 of Zimbabwe’s first HIV/AIDS support group by Auxilia Chimusoro — the first Zimbabwean to go public with her HIV-positive status – quickly catapulted home-based-care for the sick into one of the country’s foremost devices against the scourge.

Chimusoro’s HIV/AIDS support groups, there are now hundreds of such groups across the country, helped to train family and community members to give care for the infected, allowing hospitals to discharge AIDS patients into the hands of relatives they knew were well able to look after the sick.

The government quickly embraced the home-based-care idea seeing in it a cheaper way to relieve pressure on public hospitals that were by the early to mid-90s were already showing signs of decay and collapse after years of under-funding and mismanagement.

For sometime home-based-care worked for HIV/AIDS patients just as it had been one of the primary means to care for mental patients and those with terminal conditions such as cancer and hypertension over the years.

Economic meltdown

But HIV/AIDS continued to kill more breadwinners fell ill or died, leaving child-headed families unable to care for themselves let alone sick relatives. Then came Zimbabwe’s economic meltdown that left the publics health sector on its knees and families too poor to provide for the sick.

By the time Zinyere’s ailing husband returned to the village two years ago, home-based-care – like the public health delivery system — had virtually collapsed, with families short of food to feed themselves let alone sick relatives requiring special diets.

The exodus of the best skilled or trained Zimbabweans to neighbouring countries in search of jobs also saw not only nurses and doctors leaving the country but some of the community based health workers that had been the backbone of home-based-care.

All this at a time HIV was wrecking havoc killing about 3 000 people every week while the number of orphans was estimated at nearly a million.
Caregivers

Without enough adequately trained or experienced caregivers in communities and families, the home-based-care is a shadow of its former self. Many home-based patients are known to skip treatments because either there was no one to fetch drugs from the hospital for them or there was no one at home to ensure they took the medicines.
For example, Zimbabwe’s biggest referral centre, Parirenyatwa Group of Hospitals, is concerned that some home-based patient might not stick to treatment plans that it insists patients collecting drugs from the hospital must be accompanied by someone who will ensure that they actually take the medication at the prescribed times.

“We insist that (HIV) patients should be accompanied by someone when they come for treatment. The other person is meant to monitor the patient’s intake of the medicine,” said hospital group public relations officer Jane Dadzie.

But Dadzie admitted it was all hospital authorities could do. Once out of the hospital gates it is back to home-based-care  — and whether patients will stick to prescribed times for taking drugs is anybody’s guess! – ZimOnline.