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The legal consequences of having intercourse without disclosing her status unnerves Sharon.
International Activity Report 2017

Zimbabwe

Sharon, a patient in a psychosocial support session with an MSF counsellor in Mbare.
© Charmaine Chitate
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MSF in Zimbabwe In 2017, MSF continued to provide treatment for HIV, tuberculosis (TB), non-communicable diseases (NCDs) and mental health issues, in partnership with the Zimbabwean Ministry of Health and Child Care.
MSF in Zimbabwe in 2017

The health sector in Zimbabwe faces numerous challenges, including shortages of medical supplies and essential medicines. MSF continued to run water, sanitation and hygiene projects, provide cervical cancer screening and treatment, care for victims of sexual violence, and respond to emergencies.

Harare

MSF offered treatment and psychosocial support to 1,356 victims of sexual violence and comprehensive youth-friendly sexual and reproductive health services to 2,454 adolescents in Mbare.

MSF improved the provision of clean water to vulnerable communities in Harare by rehabilitating and upgrading 13 boreholes and drilling five new ones. The team also supported the response to an outbreak of typhoid in Harare.

Treatment for HIV, TB and NCDs

In Manicaland province, MSF supported the scale-up of viral load testing in 40 health facilities and the management of patients whose antiretroviral therapy had failed. Staff also assisted with the treatment of NCDs such as asthma, hypertension and diabetes, and piloted the integration of treatment for HIV-positive patients living with NCDs. A total of 1,861 patients were followed up for NCDs in Chipinge and 550 diabetics were registered for treatment in Mutare. In addition, MSF is supporting a pilot programme of nine-month treatment for patients with drug-resistant TB. At the end of 2017, three patients had been initiated on this treatment.

MSF continued to run HIV outreach programmes using patient-friendly, empowering models of care for hard-to-reach communities whose nearest health facilities can be up to 180 kilometres away.

MSF supported the health ministry to provide cervical cancer screening and treat patients with early-stage cervical cancer in Epworth and Gutu. A total of 5,925 women were screened for cervical cancer and 597 received treatment.

Staff training and handovers

In collaboration with the health ministry and the World Health Organization (WHO), MSF offered WHO Mental Health Gap Action Programme training to around 250 nurses from various health institutions.

MSF also provided coaching and mentoring services to the Ministry of Health and Child Care, Zimbabwe Prisons and Correctional Services and City of Harare health staff in preparation for the handover of MSF's mental health projects at Chikurubi maximum security prison and Harare central hospital at the end of the year. In five years, MSF teams had cared for 4,250 people in the psychiatric unit. MSF’s Harare community psychiatry intervention was handed over to the University of Zimbabwe in October.

MSF teams also provided training on advanced HIV/TB, DR-TB and paediatric and adolescent care for newly recruited doctors at Epworth clinic, and on treatment for victims of sexual violence for nurses in Harare polyclinics.

After 11 years of offering treatment, care and support to more than 24,406 HIV patients and 9,197 TB patients, MSF handed over the Epworth HIV/TB project to the health ministry at the end of 2017.

Although MSF handed over its viral load monitoring activities at the national microbiology reference laboratory and Beatrice Road infectious diseases hospital, the team continued to support the implementation of viral load monitoring in its projects.

Group of male inmates waiting for their  consultation in the courtyard of the Chikurubi maximum security prison. 

MSF treated male and female inmates with mental illnesses at Chikurubi maximum security prison and Chikurubi female prison in Harare from 2011 to 2017. This included the diagnosis and treatment of HIV and TB, and training staff in other prisons in the Mashonaland region, while improving water and sanitation at Chikurubi Psychiatric unit. The program also included a peer-to-peer counseling strategy for patients in prison for HIV/AIDS care.
As part of the medical programme MSF set up at Chikurubi maximum security prison, an inmate weighs himself in the courtyard while others await their turn.
Ikram N'gadi/MSF

Patient Story

Joel* was working as a cleaner at a company in Harare when he suddenly became very violent at work. He was taken to hospital and admitted to the psychiatric unit for treatment.

When he eventually returned to work, he realised his workmates knew he had been admitted to the psychiatric ward. They started to look down on him. He felt stigmatised and finally resigned.

“Stigma is still rife in the community and even in the workplace,” he says. “I always see mentally ill people in the community and it really pains me because I realise they did not get the kind of help and assistance that I got.”

Despite training as a welder, Joel couldn’t find a job because people did not want to employ someone with a history of mental illness. He finally got one after referrals from a psychiatrist.

Joel’s condition has now stabilised due to the medication he continues to take.

“I would like to appeal to the government to assist mentally ill patients so that they can start income-generating projects,” he says. “If they are occupied and have something to do, they will remain occupied and avoid substance abuse that can in turn cause them to relapse.”

*Name changed at patient's request

During his spare time, Joel* coaches mentally ill patients to play soccer so that they have time to relax. He feels that he is able to relate to them because he understands their needs.

Joel* was working as a cleaner at a company in Harare when he suddenly became very violent at work. He was eventually taken to the Harare Central Hospital psychiatric unit where he was admitted and treated. 

When his condition stabilised, Joel went to Tariro halfway home where stable mentally ill people can stay before returning home.

He later went back to work but things had changed. Word had circulated that he had been admitted to the psychiatric ward. His workmates started to look down upon him. He felt stigmatised and frustrated until he resigned from work. 

“Stigma is still rife in the community and even in the workplace. I always see mentally ill people in the community and it really pains me because I realise they did not get the kind of help and assistance that I got.”

He was sent to a vocational training centre where he studied welding. Despite his training, he could not get a job because people did not want to employ someone with a history of mental illness. He later got a job after referrals from a psychiatric doctor. 

Joel says there needs to be increased awareness of mental health conditions to reduce stigma in the community. 

“If you have suffered from mental illness, you are not allowed to be emotional. If you become angry or even if as a manager you caution your subordinates at work, they will continue to say, ‘forgive him because he or she is a psych patient"

Joel had been going to Harare Central Hospital psychiatric unit for his medication, but is now accessing his medication from the nearby Highfields Polyclinic. He is happy that he can now receive his medication from the nearest clinic, thanks to the community mental health program that was initiated by the medical humanitarian organisation, Medecins Sans Frontieres/ Doctors Without Borders (MSF) in collaboration with with the Ministry of Health and Child Care (MoHCC), the City of Harare health department and the University of Zimbabwe College of Health Sciences, Department of Psychiatry. This has eased the burden of transport costs and is less stressful because there are fewer people at the clinic.

"MSF reminds us to go and collect our medication at the clinic when it is time to do so."


*Joel is not his real name, it was changed on his request.
Joel* coaching football for people with mental illnesses.
© Ikram N'gadi

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