In Zimbabwe, state hospitals in Harare and the town of Chitungwiza have been closed since October from a walkout by health workers. Today, many of those seeking medical care are going to rural mission hospitals that still offer basic health care. But the influx of city-dwellers has pushed some mission clinics to the brink of collapse.
In times past when the Zimbabwean health sector was one of the best in Africa, patients from rural areas were referred to hospitals in Harare for advanced treatment. But now the flow of the sick is in the opposite direction as those who cannot afford private medical care in the city turn to mission hospitals as a survival tactic.
Mission hospitals are supported by international donors through churches abroad, and in general are better managed than state institutions.
Nurses at Howard Mission Hospital say overcrowding in their wards reminds them
of the post-election period last year when they had to accommodate many victims
of political violence.
Howard hospital is located about 60 kilometers from Harare, in Chiweshe, Mashonaland Central Province - still a stronghold of the ruling party, ZANU-PF. The area recorded the highest number of politically motivated deaths in the terror campaign allegedly waged by the ruling party. But now the patients flocking to the doors of the mission hospital are smartly dressed Harare residents unable to get medical care in state hospitals which remain largely shuttered.
One nurse speaking on condition of anonymity said that although the 35-bed church hospital is overflowing, no patients are turned away as the clinic, operated by the salvation army, is run on Christian principles and would never abandon anyone in their time of greatest need.
She said the overcrowding of wards showed that the hospital is faithful to those principles. A women's ward with 12 beds had about two dozen patients sleeping on the floor on foam mattresses. Hospital staff said the men's ward had at least 25 patients; its capacity is usually 15. The eight-bed children's ward was occupied by 16 people, including mothers.
The nurse said most of those seeking treatment are often very ill and have to be admitted. Accompanying relatives often have to sleep on the hospital grounds for lack of any other accommodation because they cannot afford round-trip transport to Harare.
Elizabeth Murwira of Glen View said she came to Howard with her two-year-old daughter after being turned away from Harare and Parirenyatwa hospitals. She was referred to the mission by a hospital guard who felt sorry for her. When she arrived, her daughter could barely breathe.
Dr. Douglas Gwatidzo, chairman of the Zimbabwe Association of Doctors for Human Rights, said the exodus to mission hospitals shows that the state health care system is badly broken. Other mission hospitals drawing urban patients include Karanda in Mashonaland central province and All Souls and Nyadire Mission Hospital in Mutoko, Mashonaland East.