Zimbabweans Pay Dearly For Cost of Health Care

Hyperinflation Pushes Medical Treatment Beyond Means of Most

HARARE, Zimbabwe Faris Kungara knows the pain is coming when the top of her head grows warm. The heat stretches downward, past her ears, and becomes an unbearable ache, she said. From the claustrophobic confines of the gloomy, waist-high shelter that serves as her home, Kungara prays for relief.

But none comes, she said, because she is poor in a country where inflation approaching 1,000 percent has pushed the cost of health care beyond the means of all but the most affluent.

"There's nothing you can do," said Kungara, a round-faced mother of three with a gap-toothed smile, "just because you don't have money."

Last month, a physician told Kungara, 41, that she probably had meningitis -- a potentially fatal infection. He slipped a syringe into her spine, withdrew a clear fluid and deposited it into a plastic vial. He said the hospital would test it and begin treatment as soon as she paid the bill.

When Kungara protested that she did not have any money, she said the physician replied, "You go and find it."

Then he handed her the red-topped vial and an invoice for $6.1 million Zimbabwean dollars -- equal to a little more than $60 U.S. dollars. It was an impossible sum to Kungara, who is lucky to earn that much from several months of selling vegetables in the dusty, impoverished township where she lives, she said.

Doctors, patients and human rights activists say such experiences have become increasingly common as Zimbabwe's beleaguered, cash-starved health system refuses treatment to those who cannot pay skyrocketing medical bills up front.

Government hospitals last week raised consultation fees by more than 300,000 percent, from a third of a cent to about $10. The cost of medicine has doubled or tripled every few months. And officials recently announced that they have only a few weeks left of lifesaving antiretroviral drugs for the 20,000 AIDS patients who receive them as part of a government health program.

Health workers say many other AIDS patients have already stopped taking the medicine because of high costs, causing risks not only for those patients but creating ideal conditions for the emergence of drug-resistant strains of HIV, the virus that causes AIDS.

Elopy Sibanda, a physician, says that nearly every day he receives test results labeled "withheld until payment is made."

Most of his poor patients have stopped coming for appointments. For those who do come, Sibanda said he must ask bluntly about their means before embarking on long-term treatments. The result, he said, is a two-tiered medical system reminiscent of the days of white rule before Zimbabwe's independence in 1980.

"They're creating a health care apartheid," Sibanda said. "We're no longer looking at the color of the people. We're looking at the fatness of the wallets."