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Zimbabwe's health system profits from the dead
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Blessing Mucharambei's uncle was just having lunch when he stood up, then collapsed. "[He] started bleeding from the nose," she says, "and died on the spot."
As far as his family knew, he had no health problems. As they struggled to make sense of the news, Chitungwiza Hospital - where his body had been taken to a mortuary - told them that a forensic postmortem would be required.
Zimbabwean law mandates postmortems for sudden or unexplained deaths, and public hospitals offer them for free. But there are only five qualified pathologists in Zimbabwe serving a population of close to 17 million people. The wait could stretch for days. And each day the funeral was delayed would add to the cost of hosting mourners, as some traditions require.
A police officer stationed at the hospital offered them a workaround. Instead of a forensic postmortem, they could do a general one - an option when no foul play is suspected, and quicker since it doesn't require a specialist. But even that, he warned, could take days. He offered to fast-track the process for a US$30 fee. Desperate to bury their loved one, they paid.
"We couldn't afford the time," Mucharambei says. "We did it because we had no choice."
A country in freefall
Postmortem bribes are just one element of a health system - and state - in freefall. Hospitals across the country are plagued by chronic underfunding, obsolete infrastructure and the mass emigration of medical professionals seeking better pay abroad. The government estimates that the country needs more than US$1.6 billion for its health sector to recover.
Underpaid and overstretched health workers have come to rely on informal payments as a means of survival, says Dr. Norman Matara, secretary general of the Zimbabwe Hospital Doctors Association. "People are trying to survive. But over time, corruption becomes part of the culture."
He says it's a common problem across hospital services, from the moment a patient is admitted. New mothers, for example, face extortion for birth cards meant to be free. A 2021 study from Transparency International Zimbabwe surveyed over 1,000 people in Zimbabwe and found that 74% had been asked to pay a bribe while trying to access health care services.
In March, a nurses' protest at Sally Mugabe Central Hospital - the largest referral hospital in the country - exposed how dire the situation is. It was the latest in a long history of strikes by health workers, who have repeatedly protested poor pay and deteriorating working conditions. But their actions are often met with intimidation. In June 2022, the government responded to a strike by passing a law banning health care workers from striking longer than 72 hours, with penalties of up to six months in jail for participants and organizers.
A manufactured problem
Pathology services are particularly strained, Matara says. The few available specialists are clustered in major hospitals, which creates opportunities for exploitation.
Few medical students choose the career, and those who do face an uphill battle. Training programs are underfunded, mentorship is scarce and working conditions at public hospitals are dismal.
But this is partly a manufactured problem, says Memory, a nurse at Sally Mugabe Central Hospital, who asked to use her middle name for fear of losing her job. Memory has worked at the hospital's mortuary close to 20 years.
"There isn't really a backlog but a fake one is created by police officers, the doctors and mortuary staff to pressure families into paying," she says.
These services are supposed to be easily available, she adds. A Cuban doctor performs the forensic postmortems on Mondays, Wednesdays and Fridays, while the general ones are done daily. But families are often told there are delays. At times, they are asked to pay US$50 to skip it entirely, even when it's required by law, or US$100 to expedite the process, Memory says.
"It's a moneymaking scheme at the expense of grieving people," she says.
Global Press Journal reached out to Sally Mugabe Central Hospital for a response to these allegations. They declined to comment.
Tendai Terrence Mautsi, the public relations officer at Parirenyatwa Hospital, the largest public hospital in Zimbabwe, says there are occasional delays with forensic postmortem cases, mostly due to demand. The hospital, he says, has responded by increasing forensic postmortem days from two to three. They've also cut the average waiting time from up to two weeks to just three days. To address the national shortage, Mautsi says, the hospital has partnered with Cuban doctors to fill the skills gap.
He acknowledges that corruption has plagued the process. But, he says, it's part of a much bigger unravelling, and everyone has become complicit.
"At times you can't find evidence," he says. "When you want to investigate it, the patient is complicit. The service provider is also complicit."
In the end, corruption harms people in need, says Tafadzwa Chikumbu, the executive director of Transparency International Zimbabwe. "For those who can't afford to pay [a bribe], it means being left unattended," he says, which erodes the integrity of public institutions.
The solution, he says, is to make ethical conduct - including fair hiring and honest service delivery - the standard.
A cover-up?
Postmortem corruption means some families never find out what happened to their loved one. When Emily Muchabaiwa's brother was found dead in Harare's industrial area, his family was desperate for answers. The circumstances of his death weren't clear, and the family hoped a postmortem at Parirenyatwa Hospital would offer closure.
Per standard procedure, a medical doctor or the pathologist should explain the results to the family, Matara says. There should also be a written report. But it was a police officer who delivered the results, verbally, to Muchabaiwa's family. There was no official report.
"[He] told us my brother had died from tuberculosis and a cold in the lungs, but he struggled to explain the medical terms. Prior to all this, my brother had no signs of sickness," she says.
The family was suspicious. Muchabaiwa says they believe the death involved foul play and the process was compromised. It would cost the family money to delay the funeral, so they buried her brother, who left behind a young son.
"We had no choice," she says, voice trembling. "The postmortem failed us. Corruption failed us."
Linda Mujuru is a Reporter-in-Residence for Global Press Journal in Zimbabwe, where she covers foreign direct investment and its effects on local communities. She holds an MBA from Midlands State University and Master's and Bachelor's degrees in Journalism and Media Studies from the National University of Science and Technology. Linda is one of Global Press' most widely read and syndicated journalists and won the Community Champions Award from the Nonprofit News Awards for her story "Push for Gold Leaves a Toxic Legacy."
As far as his family knew, he had no health problems. As they struggled to make sense of the news, Chitungwiza Hospital - where his body had been taken to a mortuary - told them that a forensic postmortem would be required.
Zimbabwean law mandates postmortems for sudden or unexplained deaths, and public hospitals offer them for free. But there are only five qualified pathologists in Zimbabwe serving a population of close to 17 million people. The wait could stretch for days. And each day the funeral was delayed would add to the cost of hosting mourners, as some traditions require.
A police officer stationed at the hospital offered them a workaround. Instead of a forensic postmortem, they could do a general one - an option when no foul play is suspected, and quicker since it doesn't require a specialist. But even that, he warned, could take days. He offered to fast-track the process for a US$30 fee. Desperate to bury their loved one, they paid.
"We couldn't afford the time," Mucharambei says. "We did it because we had no choice."
A country in freefall
Postmortem bribes are just one element of a health system - and state - in freefall. Hospitals across the country are plagued by chronic underfunding, obsolete infrastructure and the mass emigration of medical professionals seeking better pay abroad. The government estimates that the country needs more than US$1.6 billion for its health sector to recover.
Underpaid and overstretched health workers have come to rely on informal payments as a means of survival, says Dr. Norman Matara, secretary general of the Zimbabwe Hospital Doctors Association. "People are trying to survive. But over time, corruption becomes part of the culture."
He says it's a common problem across hospital services, from the moment a patient is admitted. New mothers, for example, face extortion for birth cards meant to be free. A 2021 study from Transparency International Zimbabwe surveyed over 1,000 people in Zimbabwe and found that 74% had been asked to pay a bribe while trying to access health care services.
In March, a nurses' protest at Sally Mugabe Central Hospital - the largest referral hospital in the country - exposed how dire the situation is. It was the latest in a long history of strikes by health workers, who have repeatedly protested poor pay and deteriorating working conditions. But their actions are often met with intimidation. In June 2022, the government responded to a strike by passing a law banning health care workers from striking longer than 72 hours, with penalties of up to six months in jail for participants and organizers.
A manufactured problem
Pathology services are particularly strained, Matara says. The few available specialists are clustered in major hospitals, which creates opportunities for exploitation.
Few medical students choose the career, and those who do face an uphill battle. Training programs are underfunded, mentorship is scarce and working conditions at public hospitals are dismal.
But this is partly a manufactured problem, says Memory, a nurse at Sally Mugabe Central Hospital, who asked to use her middle name for fear of losing her job. Memory has worked at the hospital's mortuary close to 20 years.
"There isn't really a backlog but a fake one is created by police officers, the doctors and mortuary staff to pressure families into paying," she says.
These services are supposed to be easily available, she adds. A Cuban doctor performs the forensic postmortems on Mondays, Wednesdays and Fridays, while the general ones are done daily. But families are often told there are delays. At times, they are asked to pay US$50 to skip it entirely, even when it's required by law, or US$100 to expedite the process, Memory says.
"It's a moneymaking scheme at the expense of grieving people," she says.
Global Press Journal reached out to Sally Mugabe Central Hospital for a response to these allegations. They declined to comment.
Tendai Terrence Mautsi, the public relations officer at Parirenyatwa Hospital, the largest public hospital in Zimbabwe, says there are occasional delays with forensic postmortem cases, mostly due to demand. The hospital, he says, has responded by increasing forensic postmortem days from two to three. They've also cut the average waiting time from up to two weeks to just three days. To address the national shortage, Mautsi says, the hospital has partnered with Cuban doctors to fill the skills gap.
He acknowledges that corruption has plagued the process. But, he says, it's part of a much bigger unravelling, and everyone has become complicit.
"At times you can't find evidence," he says. "When you want to investigate it, the patient is complicit. The service provider is also complicit."
In the end, corruption harms people in need, says Tafadzwa Chikumbu, the executive director of Transparency International Zimbabwe. "For those who can't afford to pay [a bribe], it means being left unattended," he says, which erodes the integrity of public institutions.
The solution, he says, is to make ethical conduct - including fair hiring and honest service delivery - the standard.
A cover-up?
Postmortem corruption means some families never find out what happened to their loved one. When Emily Muchabaiwa's brother was found dead in Harare's industrial area, his family was desperate for answers. The circumstances of his death weren't clear, and the family hoped a postmortem at Parirenyatwa Hospital would offer closure.
Per standard procedure, a medical doctor or the pathologist should explain the results to the family, Matara says. There should also be a written report. But it was a police officer who delivered the results, verbally, to Muchabaiwa's family. There was no official report.
"[He] told us my brother had died from tuberculosis and a cold in the lungs, but he struggled to explain the medical terms. Prior to all this, my brother had no signs of sickness," she says.
The family was suspicious. Muchabaiwa says they believe the death involved foul play and the process was compromised. It would cost the family money to delay the funeral, so they buried her brother, who left behind a young son.
"We had no choice," she says, voice trembling. "The postmortem failed us. Corruption failed us."
Linda Mujuru is a Reporter-in-Residence for Global Press Journal in Zimbabwe, where she covers foreign direct investment and its effects on local communities. She holds an MBA from Midlands State University and Master's and Bachelor's degrees in Journalism and Media Studies from the National University of Science and Technology. Linda is one of Global Press' most widely read and syndicated journalists and won the Community Champions Award from the Nonprofit News Awards for her story "Push for Gold Leaves a Toxic Legacy."
Source - This story was originally published by Global Press Journal.
