When an infectious disease ravages your community, and theatens neighboring communities, should you be provided treatment at a hospital? How much should you have to pay? If the disease becomes a deadly epidemic, should treatment be free? Or should only the wealthy few be provided adequate treatment? If a country's whole health system utterly collapses, and an epidemic threatens the peace and security of an entire region, should the international community step in?
If the right to health is universal, and not an unaffordable luxury reserved for the wealthy few, then it's time for the international community to marshal a crisis response to the complete collapse of Zimbabwe's health system.
My Physicians for Human Rights (PHR) colleagues Josephine Lee and Jared Voss have just posted a new video, "Health Care: Zimbabwe's Luxury." Here is a transcript of the video, which Josephine wrote and which she narrates.
Health Care: Zimbabwe's Luxury
Zimbabwe faces a crisis of epidemic diseases.
"Cholera is the tip of the iceberg and it’s emblematic of a collapsed public health system in Zimbabwe," states Richard Sollom, MPH, a Senior Researcher at PHR, at a press conference in New York's UN Church Center.
The collapse was man-made and preventable. Zimbabwe's government, led by President Robert Mugabe, has neglected the country's failing healthcare system to a ruinous state. Now the death toll soars as epidemics of cholera, TB, and HIV/AIDS ravage the country. Worse, TB and HIV drug treatments aren't being properly distributed to patients.
"They’re being switched because of what’s available at the pharmacy," states Dr. Chris Beyrer, a Professor at Johns Hopkins University. "And often this is happening, rather than every three months people picking up their meds, it’s happening on a monthly basis."
Physicians for Human Rights fears that this will lead to drug-resistant strains of TB and HIV. Meanwhile, Zimbabwe's infant mortality rate has risen to 68 deaths per one thousand live births. Life expectancy has plunged to an average of 36 years.
"It has now fallen to among the lowest in the world," states Dr. Beyrer. [The average life expectancy for females in Zimbabwe (which fell to 34 in 2006) is the lowest on the planet.]
In this climate, affordable healthcare is vital.
But Zimbabwe's economy has utterly collapsed. Inflation of the Zimbabwean dollar -- the nation's official currency -- is the highest in the world.
"You find economic failure caused by an uncaring government which has abrogated the obligation to progressively realize the universal right to health," states Jonathan Hutson, a spokesman for Physicians for Human Rights.
Faced with a rapidly depreciating domestic currency, residents are forced to use foreign currency. Most businesses now prefer -- if not require -- payment in U.S. dollars. The Zimbabwean dollar has become so worthless, it's literally strewn on the ground.
But most workers are still being paid in Zimbabwean dollars. Mugabe's government has failed to effectively counter the dollarization of the economy. As a result, employees can't even buy a one-dollar loaf of bread with a month's pay.
"How can he [Mugabe] be proud of a country where we looked at a doctor’s paycheck for the month; we had the stub in our hands for 32 cents for a month’s compensation," states PHR CEO Frank Donaghue.
So imagine the cost of healthcare. Since November [2008], all of Zimbabwe's public hospitals have closed. Mission hospitals are scarce, overcrowded, and lack basic resources like running water. That leaves only private hospitals. But expensive, dollarized fees exclude most people from affording them.
"When you put all this together, it is abundantly clear that there is a crisis of healthcare access, that this system is broken," states Dr. Beyrer.
At a private hospital, an initial consultation costs $200 (U.S.). Patients staying overnight must pay $500. Intensive care costs just as much -- provided the patient makes it to the hospital.
Most people survive on less than one U.S. dollar per day. That makes private healthcare -- the only quality healthcare left in Zimbabwe -- completely unaffordable. And among those left most vulnerable are pregnant women.
"If you have a critical care problem, including a need for interventive obstetric care, operative Caesarean section, you cannot get it through the public sector," states Dr. David Sanders of South Africa's University of the Western Cape.
Zimbabwe now has one of the highest maternal mortality rates in the world at 1,100 per 100,000.
"Five percent of Zimbabwe women need a Caesarean section each year. That equates to 18,000 women each year," states Sollom.
But few women can afford Zimbabwe's obstetric care.
"Two women we interviewed had been told at the Mbuya Nehanda, the main maternity hospital, to go for private obstetric care but each of them separately reported to us that this would cost a total of $3,700 US," states Dr. Sanders.
Zimbabwe was once the breadbasket of southern Africa. Its health system was a model for developing countries. But not anymore. Now residents live in a nightmare of exorbitant healthcare prices that leave them defenseless before raging epidemic diseases.
"I have never in my number of years of working in public health in developing countries seen as extreme an example of closure of a healthcare system," states Dr. Beyrer.
It remains to be seen how the international community will respond to Zimbabwe's healthcare crisis. But one thing is certain: this catastrophe is wholly and completely man-made. So the solution must be as well.