Cablegate: Embassy Harare

Published: Fri 7 Nov 2008 11:44 AM
DE RUEHSB #1007/01 3121144
R 071144Z NOV 08
E.O. 12958: N/A
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1. While the quality and level of health care available in Zimbabwe
was historically among the best in Africa, it has declined
dramatically in recent years and the decline has accelerated in the
last two to three months. Harare's three public hospitals lack even
basic levels of medical supplies and staff, and there are many
reports of hospitals refusing to provide basic medical services.
Even private hospitals face challenges with unreliable supplies of
water, lack of basic medical supplies, and staff shortages. The
recent hospitalization and medical repatriation of an AMCIT from
Harare shatters any lingering hopes that those with sufficient funds
can still obtain adequate medical care in Zimbabwe.
2. On October 11, a long-term AMCIT resident of Zimbabwe sustained
a complicated fracture of his hip after falling in the bathroom of
his home. He and his Zimbabwean wife attempted to receive medical
care between October 12 and 21, making five visits to Zimbabwe's
flagship public hospital, Parirenyatwa Hospital. During each
attempt, AMCIT and his wife were told to go away and come back,
either because the doctor was not available or because they did not
have sufficient funds to pay for the consultation and x-ray. On
October 20, AMCIT contacted the Consular Section for the first time,
requesting help to pay for an x-ray. The Consular Section
authorized the remaining funds from an Emergency Medical Dietary
Association(EMDA) loan that he had previously requested to pay for
medication to treat his epilepsy. On October 21, with funds in
hand, AMCIT and his wife made their fifth and final attempt to see a
doctor and get an x-ray at Parirenyatwa Hospital, but they were told
that the hospital could no longer provide this service, even with
advance payment. (NOTE: Several doctors who work at the hospital
have since told us that x-ray film is not currently available in any
of Harare's three public hospitals. END NOTE.)
3. After failing to obtain medical care at Parirenyatwa Hospital,
AMCIT and his wife came to the Embassy on October 23 requesting
emergency medical service. Unable to walk, AMCIT remained in his
car near the Embassy, where Conoff and Consular Assistant met him.
AMCIT appeared to be in a great deal of pain, disoriented, and
suffering from memory loss. At Conoff's request, Post Medical
Officer quickly assessed AMCIT's condition and determined that he
needed urgent health care. Post Medical Officer arranged for a
private doctor often used by the Embassy to see him. This doctor
arranged for an x-ray at a private facility and diagnosed a broken
hip; the consultation cost USD 20.
4. The following day, AMCIT met with an orthopedic surgeon who said
that surgery on the broken hip would cost at least USD 3500;
however, the surgeon refused to treat or give AMCIT a painkiller
until AMCIT had been admitted to hospital. Avenues Clinic, Harare's
premier private hospital, advised Consular Assistant that treatment
for 3-5 days would cost USD 4300 and that the hospital would require
either payment in advance or a guarantee letter from the Embassy.
This was in addition to the surgeon's fees and did not include
expenses for the pins and metal plate needed to fix the hip, or for
any necessary blood work, medications, or x-rays.
5. On AMCIT's behalf, Conoff negotiated with the hospital to accept
payment in local currency by check. This quickly reduced the
hospital's demanded payment from USD 4300 by 95 percent to USD 200.
(NOTE: Due to currency fluctuations, the final price was
approximately USD 20. END NOTE.) Conoff and CA/OCS arranged special
authorization for a repatriation loan before AMCIT checked into
Avenues Clinic on October 27. Visiting the hospital in advance of
AMCIT's surgery originally scheduled for October 29, Conoff
discovered AMCIT lying in urine-soaked sheets, without his hip
immobilized; additionally, AMCIT appeared to be more disoriented
than he was at the time of admission. Over the next two days,
despite repeated phone calls and several visits to the hospital,
Conoff and Consular Assistant were unsuccessful in their efforts to
contact AMCIT's attending surgeon.
6. On October 30, the surgeon informed Conoff, Consular Assistant,
and Post Medical Officer that he wouldn't be able to operate the
following day as he had previously planned because AMCIT needed a
blood transfusion. When Conoff asked why this had not been
mentioned before, the surgeon admitted that he had not been able to
locate any blood. After learning of Conoff's proposal to medically
evacuate AMCIT, the surgeon stated that because AMCIT's condition
was so poor he was glad that he would not be performing the surgery
because he did not think there would be a good outcome. Before
leaving, Conoff asked the surgeon to prepare a medical report and to
sign the consent form needed to transfer AMCIT by air. The surgeon
referred Conoff to his office manager, who refused initially to fill
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out the paperwork until the surgeon's consultation fees --
approximately USD 350 -- were paid, but eventually relented after
the surgeon agreed to complete the report prior to payment. A
larger repatriation loan was arranged for AMCIT so he could be
medically evacuated to the U.S. via South Africa.
7. The same day, nurses at Avenues Clinic informed us that they had
very few basic medical supplies. They said the surgeon operated
almost every day and was overworked, like most other doctors at the
hospital. Earlier in the day, Poloff learned from the doctor in
charge of emergency medical services at Avenues Clinic that the
hospital had no saline and could not even do intravenous drips for
patients who were dehydrated.
8. In anticipation of a medical evacuation, Consular Assistant
first contacted Zimbabwe's primary medical evacuation company,
Medical Air and Rescue Services (MARS), on October 27 for a quote
for their services and a timeline as to when the AMCIT could be
evacuated. MARS was unable to give us a written quote until close
to 5pm on October 30. They stated in their initial conversations
with Consular Assistant that they would be unable to provide a
medical escort. MARS also would not evacuate AMCIT without a report
from the attending surgeon -- something that proved extraordinarily
difficult to attain because of increasingly unreliable phone
service. MARS declared that a report from Avenues Clinic would be
insufficient for transportation. We investigated using a commercial
airline as an alternative, but they require 48 hours notice and a
hospital and doctor's report. Ultimately, the commercial airlines
refused to board AMCIT because the doctor's report stated that he
needed oxygen -- a requirement that the commercial airlines will not
9. On October 31, AMCIT was flown from Harare to Johannesburg in a
MARS-owned private plane. He was attended to by a nurse during the
flight and arrived at approximately 1:30 p.m. MARS had recommended
that AMCIT be checked into Milpark Hospital, one of the premier
hospitals in Johannesburg. MARS stated that they would notify
Milpark requesting admission. Neither MARS nor Milpark told Conoff
or ACS Johannesburg that a guarantee letter would be required for
admission, which delayed AMCIT's admission for five hours.
10. The admitting nurse told us that on admission at Milpark
Hopsital, AMCIT was severely dehydrated, delusional, and suffering
from malnourishment and a bed sore. The nurse believed that AMCIT
hadn't been bathed in more than 5 days. She stated AMCIT's
condition was serious and that he would not be able to travel for a
minimum of 10 days. The nurse was concerned by AMCIT's delusional
state and his very low hemoglobin level. She told Conoff that it
was quite possible that AMCIT would suffer a stroke or require
further emergency medical services or intervention given the poor
care he had received in Zimbabwe.
11. Conoff also spoke to the Director of Alliance International
Medical Services (a South Africa-based company), Bernadette Breton,
who said that AMCIT's condition was "appalling" and that MARS had
not followed the proper procedures for medically evacuating him to
South Africa. She said MARS should have contacted Alliance
International Medical Services prior to AMCIT's arrival and arranged
for the embassy to provide a guarantor letter for AMCIT's care. She
said that Milpark Hospital initially refused AMCIT's admittance
because they were concerned by the severity of his medical condition
and that the American Embassy would not pay the potential USD 20,000
that AMCIT could incur if he had a stroke or required further
medical intervention.
12. On November 3, the nurse in charge of AMCIT's care reported
AMCIT was doing much better. The hospital had been able to
successfully treat his bedsore and AMCIT was no longer delusional
after receiving two days of epilepsy medication. ACS Johannesburg
has arranged for AMCIT to have his hip repaired in South Africa
before medically evacuating him to the United States.
13. The dearth of medical services available in Harare and the
apparent disregard by the treating physician and hospital staff for
the AMCIT's welfare in this case makes Consular Harare believe that,
except for the most basic medical services, AMCITs in Zimbabwe will
need to be medically evacuated in the future to ensure they receive
adequate medical attention. Since AMCIT's repatriation, ACS Harare
and Poloff have been meeting with doctors and other local medical
contacts. Poloff and Conoff have confirmed that saline, blood,
clean bandages, and other basic necessities, including water, are
not consistently available at any medical facility in Harare, even
the premier private hospital. This, coupled with very low wages has
resulted in many doctors, nurses, and support staff no longer
showing up to work. Those who do are overworked, under-motivated,
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and sometimes give sub-par medical care unless they are paid "extra"
by the attending doctor or patient's family. The result is that
Zimbabweans -- and now Americans -- can no longer count on receiving
even the most basic medical care during a life threatening accident
or illness.
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