The senior doctors herein represented by the SHDA interim committee, noted with concern some of the statements being made regarding the incapacitation of the senior doctors and other doctors. They would like to set the record straight as to what they mean by “incapacitation.”
The following are the key constraints we are facing at most government hospitals.
1.1. Equipment Major and essential medical equipment is either unavailable or broken down, or obsolete hence requiring urgent replacemant. Life span of procured equipment is often reduced due to la. of service contracts. Specialist doctors have all along struggled to continue offering quality service under these conditions. We acknowledge the initiative by the ministry of health to procure sorne equipment but the impact has been negligible. The rnajority of equipment acquired is not in use either due to missing components, such as the neonatal ventilators or is unusable such as the anaesthetic machines which are completely incompatible with our system. The rest remains boxed and awaiting commissioning by the authorities.
1.2 Dysfunctional hospitals- The fundamentals for safe provision of healthcare are not in place. The central hospitals are prirne referral and specialist centres. Clinicians have gone out of their way to get training abroad in open-heart surgery and rnanaged to resuscitate the service in February 2016. They have sadly since been forced to discontinue the programme since November 2018 due to unavailability of equipment, drugs and laboratory support. The same local doctors who separated conjoint twins have stopped doing such ground-breaking operations for the same reasons. Harare Hospital neonatal unit (NNU) for instance has inadequate numbers of incubators, erratic heating, no oxygen blenders, not enough equipment to monitor babies. The unit is also overcrowded and unhygienic. There is also no working ventilator at the Harare hospital NNU unit and the sister unit at Parirenyatwa is overcrowded. This environment is emotionally draining for the doctors and staff in these units. This is to highlight but a few of the challenges.
1.3 Maternity services- Harare Central Hospital maternity unit is one of the busiest referral centers in the country and receives some of the most complicated cases. This u. has one functional operating theatre of the two available. The equipment received from ministry for this uot included a theatre table with to maximum weight limit of 60kg which is inappropriate for use for rnost of Zimbabwean pregnant women. As mentioned previously, the anaesthetic machine cannot be used. Having only one functional theatre rneans there are inevitable delays in performing caesarian sections timeously to deserving mothers, resulting in delivery of avoidable brain damaged babies, neonatal deaths and endangering lives of mothers.
1.4 Surgical services. There is erratic water supply in theatres. Inadequate supply of cleaning and disinfectant materials making preparation for surgery unsafe. CSSD departments to sterilize linen and utensils frequently break down. There are inadequate surgical consumables such as appropriate suture material resulting in surgeons having to improvise. Inadequate supply of theatre attire and linen. Supplies of simple medical supplies, antibiotics and painkillers are erratic. Protective clothing such as gloves and gowns are not always available. Doctors are forced on frequent occasions to perform emergency procedures, deliveries and resuscitations without protective clothing. We are aware that these problems are affecting other hospitals outside of Harare and Bulawayo to varying degrees.
1.5 Intensive care unit KU) capacity- Parirenyatwa has been reduced from 10 to 4 adult ICU beds over the past years. HCH which has a bed capacity of over 1200, now has only 3 ICU beds. This is due to unavailability of simple ventilators, rnonitors, infusion pumps and staff. As a result elective major surgery has been markedly reduced. Critically ill emergency patients are kept waiting for unduly long periods in the casualty department and on the wards due to the unavailability of beds. 1.6 Cancer units- There are persistent shortages of basic oncology drugs for both children and adults. The radiotherapy machines are frequently and currently broken down and can take up to 4 months to be repaired. This is against a background of an increasing burden of cancer in Zimbabwe.
1.7 Flexi hours- Government sanctioned nurses, radiographers, lab scientists and other support staff to corne to work 3 days per week because they could no longer afford come to work every day. This is called “flexi hours”. This was on a background of an already inadequate workforce and vacancies. This has effectively cut the number of workers available to give service at any given tirne, thereby increasing the workload and compromising on quality. Standard overlap shifts for nurs. have been abandoned compromising effective handover.
1.8 Financial incapacitation- The adjusted health specific allowances announced by the minister were imposed without agreement of the doctors and do not include University of Zimbabwe consultants. UZ consultant have continued to offer clinical services despite the ministry of health refusing to pay them health specific allowances. The adjustrnents referred to are inadequate and are being eroded on a daily basis by inflation. The doctors remain financially incapacitated.
2. The threats for disciplinary action against doctors. We are ready to negotiate to resolve the current crisis and find a lasting solution to the deteriorating standards in the public health sector. We find threats of disciplinary action as unfortunate and are clear signs of negotiation in bad faith.
3. Conclusion Doctors at all levels are being made to watch patients die from avoidable conditions and work in unsafe environments. The oft-mentioned Hippocratic oath states that doctors ought to never give dangerous services, “first do no harm.” We remain incapacitated to deliver safe and effective care to our patients. However, we continue to be available to engage in meaningful dialogue fora speedy and long-terrn resolution to this crisis in the interest of our patients, the communities and the profession.