DR DAVID T C MUKWEKWEZEKE | Zimbabwe’s health sector has now officially totally collapsed. Make no mistake about this. It is not ‘near-collapse’ as some sections of the media are categorizing it as but it is now a TOTAL collapse. A health system is like a human body with many living parts that play a unique but vital function. Nurses are the spine/backbone, junior and middle-level doctors are the arms and legs, senior doctors/consultants are the brain and HSB (Health Services Board) are the appendix, a vestigial organ that serves no real purpose but may cause the death of the entire body if it becomes diseased.

The complete withdrawal of services by senior doctors means the body is now functioning without a brain. Cessation of brain function is the core feature of death. The lungs and heart might still function but without the brain, all that is left is a collection of organs waiting for transplantation (i.e. emigration). There are only two options when managing a brain-dead patient; either you pull the plug to switch off the ventilator or you keep the patient on life-support waiting for a miracle. The government’s futile attempt at recruiting replacements for fired and resigned doctors in the form of 150 Cuban doctors, expedited upgrading of nurses to clinical officers (6000 is the aim) and recruiting 700 more nurses is shocking.

I have personally had the honour of working alongside some Cuban doctors and I have to warn my fellow Zimbabweans to try their level best to stay away from these people. Their greatest impediment is communication. Most of them only know a few English words and all of them have absolutely no appreciation of any of our local languages. I am not saying they are bad doctors. Most of them have clinical skills comparable to our high standards but one has to understand that 80% of a diagnosis comes from history-taking therefore if there is a communication barrier between the doctor and a patient then the outcome is invariably ineffective and sometimes fatal. Recruiting more nurses is no better solution either. The nurses that are already in the service are also incapacitated and burnt out; we share the same grievances. The third proposed solution, training 6000 clinical officers, is just outright ludicrous. I have also worked with some clinical officers and while I appreciate their enthusiasm and dedication the truth is they can never come close to being doctors in terms of knowledge and skills.

This is not the first time junior doctors have gone on strike in Zimbabwe and it is also not the first time there have been mass firings of doctors in this country, a similar act of madness occurred in 1996 and led to a mass exodus of local doctors to the UK. Doctors have been fighting the government for the past 30 years and all the strikes have been characterized by the same grievances. This in itself is evidence enough that the government has never been sincere when dealing with our doctors’ welfare. The current episode stands out in being the most poorly handled on the government’s part and the most radical on the doctors’ part.

The public health sector employs just over 1500 doctors; 524 at the junior level, 818 middle level and 220 at the senior level. A third of these (448 being the exact number to date), just like in the great celestial battle of old when a third of angels were banished from heaven, were fired from government service. However, it appears a paradoxical analogy is apter in our case; a third of doctors were delivered from hell. What is clear is that as long as the government continues to shun a humane approach in preference to the current legalistic approach then a resolution will never be found. Our health system is now in ICU and it is now brain-dead. Perhaps it is now time we pull the plug and create a brand new body altogether.