Missing Money, Missing Drugs and Missing Jobs

One of the consequences of the suspension of funding to Zambia by the Global Fund to fight AIDS, Tuberculosis and Malaria, has been an increasing number of stock outages and drug rationing that has affected all hospitals nation-wide, Mwandi Mission included.

Stock outages at clinics and hospitals have been so far fairly short term, but Central Medical Stores have sometimes run out of stocks for a considerable period as they wait for emergency shipments to arrive. In cases of low stock levels, drugs are rationed.

Regular readers will remember in an earlier blog the covering of the allegations of corruption at the Zambian Ministry of Health (MoH) uncovered by an investigation by the auditor general. The audit found that the ministry could not account for more than US$7.2 million. The repercussions from this are still being felt.

Another audit undertaken by the Global Fund* reported on poor financial management at the MoH, Ministry of Finance, the Christian Health Association of Zambia (CHAZ) and the Zambian National AIDS Network. These bodies used to receive Global Fund monies directly for programme implementation and then pass funds on to other organisations called sub-recipients. The audit found that $10.7 million of Global Fund money was not passed on and, to date, none of it has been repaid. The alleged financial mismanagement includes the purchase of vehicles for personal use, inflated salaries - sometimes more than double the going–rate locally, and funds disbursed to sub-recipients who could not provide auditors with financial records.

The Global Fund only funds CHAZ directly now; the MoH no longer receives funds, its responsibility in this area has gone to the United Nations Development Programme (UNDP) in Zambia. Teething troubles with these new procedures have brought delays for us on the ground in receiving funding for our AIDS Relief Programme. We have also suffered two major stock-outs of antiretrovirals (ARVs) recently. Fortunately we had a Hospital vehicle in Lusaka at the time that waited for one of the drugs to arrive in the country. We are relying on UNICEF and USAID who are scrambled to bring in more expensive emergency supplies until the new bodies get their procurement procedures properly functioning. TB drugs have also been in short supply. A week’s supply of the children’s ARVs was borrowed from the District Hospital.

The knock-on effects from this was that we could only give a week’s supply which meant the children and parents having another walk in a week’s time to the Clinic to receive the rest of the month’s supply. This meant further unbudgeted transport costs for the rural poor with an increased risk of defaulting and subsequent resistance.

Those responsible for the misuse of funds are still not being held accountable. It will be up to local courts to prosecute those suspected of fraud or the misappropriation of funds. Civil Society and some NGOs are pressing for this. Patients and clients in this area rely on these funds to provide their medication; if there are no drugs available or they are in short supply they need to know why. They have a human right to universal and equitable access.

Linked to this we have four workers facing immediate redundancy. The Government has recently been recruiting mission workers and has put on their payroll some who were formerly paid by CHAZ through a grant from Government which came originally from outside donors. The Government is keeping that grant to pay workers directly. CHAZ workers who are under 45 years of age and in possession of a Grade 12 School leaving Certificate were eligible to apply. The grant to the Hospital to pay the CHAZ workers is being cut in proportion to the number of workers put on Government payroll and linked to the ‘on paper’ establishment. So we now have four over-aged or under-qualified workers with many years of good experience and loyal service who are about to be thrown on the scrap heap as surplus to requirement. The change-over was supposed to be done over time and using where possible natural wastage. The Hospital cannot at the moment generate enough independent income to pay them or pay their retrenchment package.

Like our clients and patients living with HIV and Aids, these four people are another set of victims of the world’s greed and injustice, their dignity in work destroyed. Wealth that has been given generously is not shared fairly but kept in the hands of a few and misused to promote inequality and injustice.

*The full report can be found by googling 'Global Funding Country Audit Zambia'

A day in the life ...

On Tuesday morning I received a phone call from the Home Based Care (HBC) Coordinator. One of their clients who was bedridden was refusing to go by taxi to keep her Pre Art appointment at the Hospital. Could I help? I agreed and drove through the village, along the very narrow sandy road between pole and dagga houses with their thatch roofs. Young children came running out to wave and chase the car. I stopped and picked up Lilly the HBC carer for the clients in that area. We drove on together a very short distance.

I knew the client, Namatama, as we had had her in the hospital and recently discharged her. Namatama contracted TB four months ago and was also at that time tested for HIV. Because of the TB she could not start Anti Retroviral Therapy (ARVs). She had also recently been in the hospital suffering from PCP, a lung-disease linked to Aids. The usual dusty and ill-clad children greeted us excitedly. The family rushed around to bring chairs to her tiny mud and thatch house. I went in to a dim room with a metal bed in the middle with a thin mattress and chitenge ‘sheets’ (cotton wraps) barely covering the bed. In the middle was Namatama skeletally lying with her face to the wall. We sat down and gave the traditional Lozi greetings. I got up then and insisted on greeting Namatama. This broke the ice with Namatama. I think most people discuss her rather than include her.

She proudly said that the bedsores that she got in the hospital had healed thanks to Lilly. Then she told me that she was hungry but could not eat the food that the family prepared for her as they kept frying everything and the Nshima (thick maize porridge) the staple was too heavy. The bag of soya that she was given by the project remained unused, as it was too strong for her. We then tried to discuss what she could eat and the answer was nothing. Anything the family offered her just gave her diarrhoea. She said that the ORS which Lilly had given her was making her stronger. I then tried another tack if she could choose what would she most like to eat? I smiled at the answer, a boiled potato. We are probably one of the few homes in Mwandi that has potatoes!

I then broached the subject of her appointment. She said that to ride in the car would be too painful for her lungs. We continued our discussion for a short time longer but Namatama was adamant that she would die if she went back to the clinic. I then frankly told her that if she did not go she would die anyway!
I stood up and said that we would pray but before I prayed would she agree to come back with me to the Hospital? She agreed and then we prayed.

Namatama sat in the front to the Hospital with her younger sister and Lilly in the back. Her real fear was that we would insist that she was admitted to hospital yet again. When we arrived I fast-tracked her to see the clinician. She weighed only 33kg. She had lost 10kgs in a month.

I left Namatama with the Clinician and went home and found some potatoes, carrots and a litre of milk.

As I was going back into the clinic I was stopped by a nurse to say that there was a mother and baby waiting for assessment. Mum had stopped feeding the baby at six months because she was HIV +. The baby was now 8 months looked very small and anaemic. The nurse said there is a slight problem in that she is from Namibia. She had come across the Zambezi in a mukolo (wooden canoe). I still enrolled the baby in the formula program as the border is only a colonial border. The people are all of the same tribe and often have relatives on both sides.

Namatama had had bloods done the CD4 was now 22. The clinician felt that she might not manage to take the ARVs as Namatama had said that the family were going at the moment to their fields to clear and plough all day and they did not believe that she was HIV+. The clinician and myself went and spoke to the Doctor. I put forward my case that Lily could step in and give the medicine in Namatama’s home until Namatama could manage to take it herself. It was agreed that Namatama would start on ARVs. Lily went with Namatama’s sister to the Pharmacy for Adherence Counselling and to learn about the medicine. Lilly herself is HIV+ so she understands. Triumphantly after two and a half hours we brought a tired but serene Namatama home.

A lesson was learnt. The food on the project did not suit everybody. We will have to buy for our clients what is best for them.

I came home in time for my Lozi lesson. The Lozi teacher, a retired English teacher, was waiting patiently for me. We have been translating together a pamphlet in English about TB into Lozi. The teacher then has lunch with us as he too is in need of a meal.

Keith came home from school worried. Kandiana the old folks home has run out of food. The government have not sent any money since August. He had been eking it out since then but there was no money left. Can the Guild project help? Fortunately, over half of the residents are HIV+ so beans , kapenta(dried whitebait) and a few other things are purchased. The Mission Farm promises to supply maize ,eggs and meat. They have also run out of firewood. We had a storm the night before that caused a large branch to fall just missing our car, so at the end of the day there is the sound of axes chopping up the branch and the old people who are able dragging the wood away.

The day is another testimony to the grace and providence of God in our lives here.

(We changed people's names for confidentiality)

Awaiting

Greetings from a dry dusty and roasting Mwandi as we await the rains at the end of the month, we hope. Duncan and Ina, our daughter Kirsten’s in-laws have been collecting pre-school equipment being disposed of in Edinburgh and taking it through to Kildrum to be stored until a container is organized. Our thanks go to Kildrum for putting their dunnie at our disposal. We are so pleased to have been given those wonderful toys and look forward to their being used here.

We are well but kept busy with duties at the school and hospital. The latest good news is that US$40 000 has been pledged by a US Foundation to build a classroom block at Sikuzu. This will save children a 10 mile round trip to school.

We are about to leave on Saturday for Mongu to the Western Presbytery Meeting where the new Bishop will be elected. Before the Covenanter in you chokes on your coffee, a Bishop here is in effect more of a Moderator than the priestly prelate of Presbyterian prejudice! The United Church of Zambia is actually an amazing and working mixture of Presbyterians, Congregationalists, Methodists, some Baptists and French Protestants; so there are several forms of baptism, child and adult believer, sprinkling and immersion depending on your 'tradition' and three forms of communion: the Scottish- passed around, the Methodist- on your knees at the front or the French - a series of horse-shoes around the Communion Table. Services too can be very liturgical, others are more like ours from the Common Order. Some services are more traditional and rather staid while others are quite charismatic. It is wonderful how all these manage to be accepted and welcomed by all. There is a lesson here for the Scottish Church(es).

The new Minister for Mwandi will also be elected there. Presbytery is followed by a 4- day Church Camp Retreat on an island in the Zambezi. So we have packed our camping equipment with our tents and sleeping-bags.

We will be using the inaptly named M10. Some of you, Scots of a certain age, will remember in 1970s and 80s, the A96 Aberdeen to Inverness road being referred to as the ‘goat-track’; well the M10 takes that place here in Western Province. Mongu is only 400km away but the tar runs out at Sesheke and it is sand dust and dirt to the pontoon ferry at Sitoti. After crossing the Zambezi, a dreadful drive ensues across the floodplain to Senanga., another pitted and pot-holed causeway with washed out culverts. At Senanga we enjoy tar again for the last hour to Mongu. There are only tarred roads in Western Province. We’ll leave at 0700h and get to Mongu at around 1600h

Unfinished building work

Finally, Nick has asked us if we would make urgent enquiries to try and find an individual or a small team of builders who could come now or in the near future to work on the roof of the Church of Scotland house. He is desperately needing assistance to get the roof put on before the advent of the rains and before he goes on leave at the end of November.

If any of you know of anyone who might be able to help, please let us know and get them to contact us as soon as possible. This really is a pressing need.

Prayer requests

The Government has started restructuring at District and Hospital level now and we are affected too. The authorities have sent a Hospital Administrator to take over that position here (the post that Ida is currently 'acting' in). As a result, the Memorandum of Understanding between the Government and CHAZ in which Hospital Administrators are Church-appointed positions, is being revisited. So please keep us in your prayers. We keep in touch with Synod and the Church of Scotland regularly to update them on our situation.

Prayer:

- We give thanks for the successful Church Retreat and the blessing it was for many people.

- We give thanks for the provision of three new doctors for the Hospital and the 15 new nurses and Clinical Officers promised to help increase staffing levels here.

- We pray for wisdom for ourselves and all the parties involved in the Health Restructuring, that righteousness and justice may prevail.