This week brought the strike of the junior and senior resident medical officers (JRMO and SRMO). They have gone on strike for a number of reasons, including salary, but also because there is no guaranteed job once they finish the first two years of post-graduate training. Typically, after these two years doctors will work in a rural area for at least a year, a way of “giving back” to the government. Unfortunately, although there are not enough open posts for the graduating SRMOs, the government will not issue permits to work in private practice leave the country. As a result, after seven years of training, a large proportion of them will not be able to find work. I’m not sure of the salary of the JRMOs, but I learned that a registrar (who enters further training after completing the JRMO, SRMO years, along with several years in a rural district) makes about $220 per month, less than $3000 cumulatively in a year. For the amount of work they do, the amount of training they have undergone prior to their registrar post, and the cost of living in Zimbabwe, this salary is insulting. I learned that frequently, weeks pass between their reported payday and the day they actually receive their checks. This discrepancy has prompted strikes in the past.
In many ways, the hospital runs because of the work of the JRMOs and SRMOs. On our team, we have two JRMOs that do all of the blood draws, IV catheter insertions, LPs, paracenteses, thoracenteses, etc. that are ordered on rounds or at the patient’s admission. On Wednesday,the first day of the strike, we rounded with a single fourth year registrar. Between deciding on patient management and writing the daily progress note, he was placing IVs and drawing labs. We approached one patient admitted with pneumonia who appeared very ill. She was taking deep, fast breaths as we pulled up labs that had come back from the day previous showing a dangerously low bicarbonate level. Our registrar immediately placed an IV and attached a bag of normal saline, along with bicarbonate. We discussed what could be causing this acidosis, but eventually moved on to round on the remaining forty patients. The registrar mentioned drawing an arterial blood gas, but we just didn’t have time to do anything else. In speaking with another registrar, she brought up an important question about deciding how long to keep patients in the hospital, and whether to admit them during a JRMO strike: Is it better to admit patients to a hospital without the necessary staff to take care of them or to send them home with antibiotics and let their family take more attentive care of them?
I had a conversation with one of the floor nurses that will stay with me for a long time. We were talking about the strike and how difficult it can be working at Parirenyatwa Hospital with limited resources and limited funding from the government. He started explaining the level of corruption in the government – where there are weeks of delayed salaries, while the son of the president has a house in Dubai that he pays over $40 million annually for in rent. President Mugabe’s is hosting a birthday party soon that will cost the government multiple millions of dollars. This is unfathomable given some of the shortcomings I have seen at Parirenyatwa, and truly around the city and country, both within and outside the hospitals.
“If you really want to make money in Zimbabwe,” he said, “you go into politics.”
This is such a sad and difficult system to change. In many ways practicing medicine in Zimbabwe is significantly more fulfilling than in the United States. But seeing first-hand the difficulty of working in such a broken system is disheartening. How could one person ever do anything? In many ways this feeling echoes back home, where we struggle to care for patients in a system that does not always serve them.