Living without essential drugs, story of crisis and inequalities in Africa

Stephen Tsoroti

She looks at the picture with a long drawn gaze, then a tear rolls down, running through her knotted cheek, eventually dropping on the picture frame.

Another comes, she wipes it clear with the back of her hand, as she fights hard to stop them coming. Rudely, they kept on coming and streaming down.

On a table in front of her, a box and two of sachets of medicines lie unopened.

The picture is of her late daughter, whilst the box and two sachets of medicines arrived from the USA a month after her daughter died in a referral hospital, in Harare Zimbabwe in 2021.

It could have slowed the progression of the disease and possibly saved her.

She sobs; “The doctors told us our daughter could have lived if these medicines were available in time.’’

She asks, ‘’Why is our health system unfair, why do we not have essential drugs in our country?”
She seemed to be asking her husband who gazed sadly at his simple home and the open workshop in the background of their home in which stood partially completed straw baskets and sweeping brooms.
He had his own problems, consoling his troubled wife and pacifying customers who frequently appeared at the open door to enquire whether their orders have been meet.

Her furtive glances towards the workshop direction reminded him that the meal bag was almost empty and he should be at work finishing the brooms, thrashing, chopping, and honing, stretching taut the straws over the polished sticks, preparing it for delivery so he could collect from his rowdy customers.

Nevertheless, he had to attend to us, reckons the wife, with his fat body sitting solidly on a sofa besides her.

His slow mind was struggling patiently with a problem for which he could find no answer.

The hot, tropical sun, so typical on the month of October, beat down upon him mercilessly. Beads of perspiration formed upon his brow and trickled down unnoticed to lose themselves in tie hairy jungle on his chest.

Beyond his home, a crane construction tower was visible. A multi-million-dollar traffic by-pass is under construction.

Moline and Tongai Zimunda lives in Hopley, a shanty hamlet on the outskirts of city of Harare.

They came here as evacuees after being displaced by a government sponsored clean up – Operation Muramabtsvina “clear the filth”.

Police burnt their house, and bulldozed and destroyed tens of thousands of other properties around the country.

The destruction resulted in the mass evictions of urban dwellers from their housing on May 19 2005.
When they came here, there were no proper structures, they needed to build their own shelter and put their children back in school.

However, there were none to talk about, and not even water taps to drink from.

The only clinic was constructed by donors- allaying a health crisis that was on the lip of unfolding.

“We were in a turn of many problems,” Moline and Tongai, 35 and 37 respectively, told The Zambian Eye, as they recounted the June events in October.

Their daughter suffered MPS 1, a disease that is caused by genetic changes in the IDUA enzyme (a protein coding genetic is involved in the degeneration of glycosaminoglycan such as dermatan sulfate and heparin sulfate).

These genetic changes lead to reduced levels or complete lack of the IDUA.

Individuals with MPS1 have a short life span but can live into adulthood.
The case of Zimundas shows inequalities in our health delivery system,” relates Trudy Nyakabangwe, adding; ”No disease should be left untreated if it is known.”

”Speaking about 10 cases means there are 1,000 unreported; speaking about 100 means that there are 10,000, just because we don’t have the numbers doesn’t mean the diseases don’t exist,” said Nyakabangwe, a focal point for patients struggling with Rare Diseases (RD), the Rare Diseases foundation of Zimbabwe.

“The inequality that exists in the way we view other diseases, it is very clear that we have diseases that are not given top priority- Nyakabangwe told the Zambian Eye.

“Should we wait for the numbers to become widespread in order to list them as epidemics.” Each year 200 to 250 RD diseases are being discovered throughout the world.

Fifty percent of them are said to manifest first in children, according to a United States Rare Disease Research National Centre for advancing translational sciences, NHS.

On the other hand, the International Rare Diseases Research Consortium reports that, 300 million people worldwide are known to have a rare disease.

Getting official numbers on rare diseases in Zimbabwe has never been easy. This is largely due to a huge concentration on non-communicable disease like cancer, diabetes, Asthma.

The COVID-19 crisis compounded the problem of attending to disease that needed specialist attention, many traditional reporting points such as clinics and outreach points were made inaccessible by COVID-19.

Under resourced and understaffed hospitals struggled to maintain diagnostic and specialist services.

This means patients have delayed access to diagnostic and other forms of emergency treatment needs.

“Most complications are treatable if diagnosed early,” Loyce Hlatswayo, a Piadtric and consultant at Parirenyatwa group of Hospitals, echoes Nyakabangwe sentiments, but quick to add that the southern African region dithers between loss of health experts, care workers and lack of diagnostic equipment and drugs.
“These tend to be a barrier to proper treatment outcomes.”

The United Nations Research Institute for Social Development (UNRISD), Crisis of Inequality: Shifting Power for a New Eco-Social Contract reports point out that if social inequalities are not addressed the world is at the precipices of worse crisis.

“Inequalities compound the impacts of pandemics, and vice versa, rendering them even more difficult to overcome,” said Winnie Byanyima Executive Director, UNAIDS.

By any images who is the Under-Secretary General of the United Nations offers her insights in the UNRISD report; “We need to end inequalities and access to essential services by delivering on guaranteed health and education for everyone, through public systems that integrate community-provided services and that respect and protect all the workers on whom services depend, rewarding them with fair pay.”

“The damage brought by Covid-19, HIV and other pandemics is not the result of the viruses alone, but of how they make space in, and expand, the fissures of our unequal society. We need to end inequalities in access to health technologies by supporting the best science and getting it to everyone,” she added.

The Covid-19 crisis is credited for revealing so many disparities and unequal structures in societies throughout the world.

According to the Crisis of Inequality: Shifting Power for a New Eco-Social report, even before the Covid emergency, two-thirds of African countries were charging user fees for health care at all levels, refusing life-saving care to those who could not pay.

Around the world, 10,000 people were dying every day because they could not access health care.
Africa’s long-standing health worker shortage stems from several factors, including inadequate training capacity, rapid population growth, international migration, weak governance of the health workforce, career changes as well as poor retention of health personnel, poor remunerations, conditions of service and lack of equipment.

Although there is varied data on the internet, more health professionals have left the continent to work, mostly in Europe, America and Australia.
The countries they leave have been forced to fork out a considerable amount to train the health workers in a bid to close the gap.

Africa has been noted as the biggest labor-sending continent, with numbers ranging from, 8 241 Nigeria, 4 192 Zimbabwe, 2 095 Egypt and South Africa 1 719, according to the Tralac organisation blog.

Paul Ladd Director of UNRISD, sums it; “Each crisis plays out in an existing pattern of inequalities. This inevitably means that those who are already disadvantaged or excluded face the worst impacts, while those with more resources are able to shield themselves and recover more quickly.

Many people are excluded and disenfranchised and feel that there is one set of rules for them and another for elites.