BY PHYLLIS MBANJE
Established in the early 1920s, Ngomahuru mental rehabilitation centre started off as a jail for prisoners of war (World War 1), but morphed into a quarantine centre for leprosy patients before taking in tuberculosis patients.
It later became a psychiatric hospital to this day.
But over the years the well-meaning facility, which is home to many mental patients has been dogged by serious financial woes ranging from limited budget allocations, shortage of key provisions, drugs, poor administration and downright corrupt practices.
This publication spent the past few weeks at the institution investigating how the poor conditions at the centre are affecting inmates and the general operations of the mental facility.
Investigations revealed that the hospital was in dire need of not only more funding, but a proper audit and overhaul of how the place is being run.
It was noted that staff morale was low at the facility.
Takesure Phiri* a psychatric nurse at Ngomahuru said the environment has become unbearable for both patients and staff, who are demoralised from working with meagre resources.
In a blow by blow account, Phiri and a few brave staff members shared the story of the sorry situation unfolding at one of the biggest mental hospitals in the country.
Investigations established that despite the depleted resources at the centre, some patients brought in by relatives were abandoned and the relatives never returned, stretching the little resources at the institution.
A 78-year-old woman from Chivi has been resident at the centre for close to two years and no one has come back for her.
“The challenges that we face are too numerous. I do not even know where to begin,” Phiri said.
“So some people bring their sick relatives here and actually dump them.
“They never come back. This has resulted in some over-stays which create a huge strain on the little resources that we have.”
Phiri said the patients were treated for free and government was supposed to subsidise the service.
“Government is either broke or they are just stigmatising mental health,” he said.
“The inadequate funds are not being released on time. Ngomahuru is struggling with basically everything.”
Three years ago the institution’s budget was said to be a meagre $400 000, which translated to $6 per day per patient.
“We are approaching winter and many do not have warm clothes, let alone jerseys to ward off the chill,” Phiri added.
This publication observed that none of the patients in the majority of days when the investigation was conducted had any jerseys on despite the chilly weather.
Ngomahuru, which is located on a hilly area some 45km from Masvingo city and 12km from the Masvingo-Beitbridge highway is literally cut off, making it hard for relatives and well-wishers who might want to bring provisions to reach it.
“Some patients sleep on the floor and the number keeps rising,” Phiri said.
Another nurse Takunda Zhou* said the perennial water and power outages were making the situation unbearable.
“At times we are forced to take the patients to nearby rivers for a bath,” Zhou said.
“There is no way you can stay with someone, who has not bathed for four days and so we do not deny reports that we take them to the river for their baths when there is no water, which is quite frequent.”
This publication also found that sanitary wear is not provided to inmates.
“People are not exaggerating when they tell horrific tales of female patients walking around with menstrual blood dripping,” Zhou said.
“No woman should be subjected to this dehumanising way of life. How are they supposed to fully recover?”
Phiri added: “We rely on donations for the sanitary pads, but this is supposed to be the government’s responsibility.
“It (government) has failed women in a big way.”
The hospital is also infested with lice, which is worsened by overcrowding.
A majority of the patients are suffering from skin rashes due to the lice.
“The acute ward carries 100 patients but now exceeds that number. It is out of control, there is lice everywhere,” said Phiri, who is also bitter about their living quarters.
“We stay in a villa, which used to be wards for leprosy patients.
“It was built by white people then and no effort has been made to make it decent that is why Ngomahuru has a high staff turnover.”
The buildings are old with peeling paint and look too depressing for a health institution.
The nurses also revealed that there were serious drug shortages for patients suffering from mental health problems.
“We are supposed to be using atypical antipsychotics, but we do not have them and the ones we use cause more side effects and that is why mental health will remain a big problem,” Phiri said.
The nurses explained that drugs like chlorpromazine (CPZ) and haloperido had too many side effects.
“That is why we have more people with mental health challenges because when they are prescribed another option they cannot afford it and they default,” Phiri added.
The situation has been worsened by growing demand as many young people develop mental health problems associated with drug abuse.
Drug addicts is said to account for over 65% of admissions at mental health institutions in Zimbabwe.
“There are too many substance abusers and mutoriro (crystal meth) tops the list,” Zhou said.
“Many patients are from Harare actually.”
Ngomahuru employees also confirmed that there were cases of corruption at the hospital involving medical staff.
Speaking on recent reports of corrupt practices where relatives were conniving with doctors to get patients admitted, the nurses said it was a regrettable situation.
“This is a result of poor salaries and mismanagement of funds and now people are finding other means to survive,” Phiri said.
“While the doctors pocket between US$100 and US$140 the nurse, who is actually on the ground with the patient gets nothing. We will not take this lightly..no ways.”
This publication observed patients being served sub-standard meals without any nutritional value.
“For breakfast there is porridge with no sugar, lunch it’s sadza and vegetables and the same for supper,” Phiri said. “A meal served with meat is rare.”
There are also concerns about security at the hospital with one patient identified as Douglas Kamoto said to have escaped from the institution.
Kamoto drowned in February this year while trying to cross the flooded Tugwi River in Bangomwe.
Earlier in the year another patient, Courage Mutsaru was attacked by a crocodile while attempting to cross the same river.
Police, who were searching for his remains only managed to retrieve a hospital gown in the river.
“There is no security because the fence is broken. It has not been renewed in years,” Phiri said.
The infrastructure has collapsed with the buildings looking old and deserted with the ceiling peeling off and falling in many places.
“The Health ministry has neglected this place and funds are not being allocated in tandem with what is on the ground,” Zhou said .
After breakfast and check-ups the patients spend the day doing nothing since there is no entertainment or facilities to help them relax.
Constant drug outages mean many are no longer patients, but prisoners who are just locked up.
“The government should wake up now,” Phiri weighed in.
“Mental health is a huge challenge and almost 70 to 80 percent of the population suffer from some form of mental illness.
“That is why we have so many cases of substance abuse and suicides spiralling out of control.”
“Staff members are demotivated and many nurses now regret ever taking up this job. It is now a curse.
“We are stigmatised along with our patients and miss out on workshops and locums.”
The brain drain due to the economic downturn has also negatively impacted on mental health institutions with the few remaining nurses now bearing the brunt of the chaos.
“The patient/nurse ratio does not tally with our laid out guidelines . We are suffering,” Phiri said.
Masvingo provincial medical director Amadeus Shamu said the government was aware of the problems at Ngomahuru.
“I’m aware of the challenges at Ngomahuru,” Shamu said.
“The main problem is that unlike other hospitals Ngomahuru does not charge for services, so they rely on the government budget.
“Sometimes when there is a delay in the disbursement of funds we encounter these challenges.
“Water challenges are mainly due to electricity cuts.”
According to a report by Transparency International Zimbabwe, many of the challenges facing the country’s health sector have been worsened by misappropriation of public funds for private gain in the form of illicit finance.
Illicit economic activities contribute to the loss of wealth for the government and citizens, depleting resources that could otherwise be invested in the public health system for healthcare worker salaries, procurement of medical supplies, and the rehabilitation and development of health infrastructure.
Anesu Isabel Chinoperekwei, a Harare-based psychiatrist, said mental health institutions in Zimbabwe faced many challenges, which included lack of infrastructure.
“There are not many such places,” Chinoperekwei said.
“Violent patients cannot be treated at district hospitals while in the acute phase.
“The non-violent ones need places which are bigger and allow them to fully rehabilitate through normal chores like gardening relearning household duties and slowly being reintegrated.
“But sadly the available places do not have these in place.”
Chinoperekwei said there was an essentials drug list, which specified all drugs that were needed at all times but many times the drugs were not available.
“This has resulted in institutions ordering other drugs, which may have serious side effects,” she said.
“This is the reason why there is so much stigmatisation around mental health medication.
“Some end up saying you will look like a zombie if you take the drugs.
“It is because most of the drugs are not part of the recommended first line treatment plan.”
*Names changed to protect hospital employees
- This story was made possible with support from the Voluntary Media Council of Zimbabwe (VMCZ) investigative journalism initiative