Given the current economic conditions in Zimbabwe and pathologies in the public healthcare system, Karanda Hospital is seen as a beacon of hope and people generally believe they can access sophisticated medical care at the mission facility.
There’s some truth in that, yet the situation is far more complicated.
The hospital in Mount Darwin, Mashonaland Central province, was established in 1961 to serve mission stations in the Zambezi Valley which were mainly churches, clinics or small dispensaries. It has 150 beds and on an average work day performs between 15 to 30 surgeries (4 000 surgeries a year) and sees 200 to 300 outpatients. Annually it deals with over 100 000 patients from within the country and the region.
The facility is known for the large number of surgical cases it handles as well as treating HIV/Aids, TB, obstetrics, and hydrocephalus. It has two fulltime surgeons, a physician’s assistant and a general practitioner. It also usually has interns and volunteers.
In a bid to keep the hospital serving people and making a difference to communities, Karanda’s medical director Dr Paul Thistle, a Canadian obstetrician and gynecologist who came to Zimbabwe in 1995 as a Salvation Army volunteer initially stationed at Howard Hospital in Chiweshe, also Mashonaland Central, before relocating to the facility in 2012 with his Zimbabwean wife Pedrinah, a midwife instructor, is currently back home on vacation in Canada – and also on a fund-raising mission.
Paul Thistle (PT) spoke to The NewsHawks’ North American correspondent Ngoni Donald Muzofa (NDM) in his hometown of Scarborough in Toronto, Canada, while on holiday about his mission and various associated issues.
Find below interview excerpts:
NDM: Can you start by telling us about how you came to be Zimbabwe and why.
PT: I was born and raised, as well as attended medical school in Toronto. The driving force behind my journey was to serve God and the underprivileged in any part of the world where there might be a need.
I am a soldier in the Salvation Army, and when I finished my education and specialty in obstetrics and gynecology, it was my intention to serve in an underserved part of the world. I asked the Salvation Army to send me anywhere they chose, including Canada. They requested that I serve in Zimbabwe. It was the mid-90s and at the peak of the HIV/Aids pandemic where there was no therapy available to treat HIV-related illnesses. I became an obstetrician and gynecologist primarily to serve mothers and try to do something about maternal mortality and that landed me at the Salvation Army Howard Hospital north of Harare.
NDM: For how long were you supposed to serve or stay in Zimbabwe?
PT: It was a three-year contract, but after seeing the needs and opportunities to serve and to expand the work, I extended my contract. Fast forward to 2022, and I am now serving at a mission hospital in Karanda. I met my wife at Howard Hospital, and we got married in 1998. We have three children, all born at a mission hospital in Zimbabwe. My family has grown up in the beautiful atmosphere and culture of rural Zimbabwe. As you continue to work, you develop a vision to provide holistic medicine. It means serving the body, mind and spirit.
In terms of body, there is always pressing medical needs in underserved parts of the world like HIV/Aids, tuberculosis as well as maternal and child health. These are ongoing needs. There are also underlying psychosocial difficulties the average rural person faces and therefore at Howard and then subsequently at Karanda, we work alongside community leaders to support the community with income-generating projects. In the early days, they were centered around HIV/Aids, but now they are independent of that. It involves looking after widows and orphans by providing income generation activities so they may have a better life and sustainability. That’s always a challenge in rural Africa in general, and rural Zimbabwe in particular. But you take one step at a time. You cannot save the world. You try and improve the lives of one family and one person at a time. We combine that with education, child sponsorship and support for postgraduate and trades education.
NDM: Why is holistic healthcare so important?
PT: Whether it’s downtown Toronto, downtown Harare, or rural Mount Darwin district where Karanda is situated, there is a need to be attentive to holistic healthcare. People come to physicians with the obvious physical ailments, yet there are deeper underlying psychosocial and spiritual issues. And sometimes there are limitations of time and expertise to address everything. We cannot do everything for everybody all the time, but we can do what we can with what we have. And that is what I believe attracts patients from all over the country.
NDM: What medical services does Karanda provide?
PT: We provide general medical and surgical care. We don’t have specialists and subspecialists to address some of the more complicated illnesses. We also don’t have all the machinery and technology to diagnose all the illnesses that we would wish to assist our patients with, but we do what we can. We have 4 000 surgeries a year in our operating rooms or theatres in the British lexicon. Sometimes we refer patients to tertiary care such as a university hospital when we cannot manage a case.
Given the current economic challenges in Zimbabwe and the difficulties in the public healthcare system, Karanda is seen as a beacon of hope and people believe they can access complicated medical care at a mission hospital. There’s some truth in that. We do pay attention to everybody’s needs. We welcome everybody who comes to our doors, regardless of what their illness may be. The reality is there are some ailments we cannot do well such as renal care and oncology, which require chemotherapy and radiation. Oftentimes, people come with severe illnesses and with their conditions advanced. So, we try to cure sometimes and comfort always. Hopefully, patients and their relatives come away from a visit to Karanda with a better understanding of their illnesses and underlying conditions. Through counseling and education, they can get a realistic prognosis, instead of using scarce resources running from one place to the next and holding out some hope there is a cure.
NDM: How do you fund your operations?
PT: If you were to look at Karanda from a satellite map, you would not be able to compare us in terms of standards to a community hospital in Canada let alone a tertiary hospital in Toronto. Our budget is 1% of a similar sized hospital in North America. That’s where our friends come in and our supporters all around the world such as Rotary Clubs in Harare and Canada. Large and small organisations and well-wishers help us to fill the gap by helping us to bring up the standard of care. The Ministry of Health and Child Care is also a major partner. They provide approximately 25% of our hospital operating costs such as basic salaries for some of our paid staff. But that’s not sufficient.
NDM: Since there are so many patients and relatives coming to Karanda, are there accommodation facilities for them?
PT: Overnight accommodation is available in the surrounding villages for patients and relatives who cannot make the trip back and forth from their home. Their home might be 200km to 300 km away if it’s Harare for example. Many people cannot be seen in one day. If you get up early in the morning and arrive early enough, you may be able to get medical attention in one day. We call it one-stop shopping, and it may include registration, screening, nursing care, doctor consultation, investigations including X-rays, ultrasound and laboratory work, and then treatment plans. It may even include day surgery. Most often the investigations are delayed, or patients arrive late due to transport challenges. Buses that reach Karanda only run once or twice a day.
NDM: What advice can you give to other medical centres to emulate the way you are running Karanda?
PT: I think it goes back to the concept of holistic medicine; that people have a variety of needs. We cannot always meet all their needs with a one-stop-shop approach, but through our other allied professionals at Karanda such as our chaplain, social workers, nursing care and community care coordinators who follow up in the villages. So, you need to have a team approach. You cannot do it alone. There’s a Shona expression chara chimwe hachitswanyi inda (one thumbnail cannot crush a louse by itself). We are fortunate to have dedicated professional staff and general hands to keep our hospital running. The most important hospital worker is the cleaner who gets up at 5am and cleans the hallways and offices before the patients arrive. So, this collegial approach and a partnership extends outside of our walls to the community. We get in-kind donations during the harvest season from the local community, farmers and businessmen. These partnerships extend to the industries and businesses in Harare.
NDM: How are you able to mobilise and inspire people to support the Karanda cause?
PT: With partnerships based on trust and mutual respect. It’s built on asking and receiving views of the community on what their needs are. We call it needs assessment. But it doesn’t come easy. It requires longevity. Rural hospitals in Zimbabwe – and even elsewhere in the world – have a history of a rapid turnover of staff. People use them as a steppingstone to something bigger like working in the urban areas or abroad. The good news is Karanda has a core nucleus of staff that have committed themselves to working in a difficult environment. And I think that’s one of our strengths. It doesn’t come easy, and it can change overnight. But that leads to a collegiality that is not found easily in other working environments. So that partnership extends to urban areas because people who get treated at Karanda bring a good message back to their families. Our outreach and influence extend to overseas. And one of my jobs during my holiday in Canada is to spread the news and raise awareness about the work at Karanda. I am always keen to reach out to new partners. By reaching out to people, figuring out how people might be able to help you, how you can have a mutually beneficial relationship in the community, in the country and abroad.
NDM: Do you have volunteers at Karanda and where do they usually come from?
PT: We have visitors and volunteers who take their precious time, often during their holidays, from their businesses and medical practices, to come over. Given my Canadian connection, many come from Canada. We also have many from America, Europe and Australia. All of them bring their own experiences and skills set. They say many hands make light work, and they encourage us and embrace the vision we have for the community.
NDM: Do you have medical students from Zimbabwean institutions coming to your facility?
PT: We have a training centre, specialising in nursing and midwifery. My wife is a nurse and midwifery instructor. And we have trainees from all over Zimbabwe coming on attachment, not just healthcare, but in administration and other fields. We feel comfortable to provide the training, which is called supervision on site.
NDM: What are the pressing needs for Karanda right now?
PT: We have ongoing hospital operational costs. It doesn’t sound attractive, but the more support we can receive from well-wishers in Zimbabwe and abroad, the less we have to charge our patients. We have a patient fee schedule to balance our budget, and it’s currently about US$1.5 million annually. Right now, we have four doctors and 40 to 50 nurses. Including grounds and maintenance staff, cooks and cleaners would get us to about 180 staff. Half of those get their basic salaries from the government through the Ministry of Health. We pay salaries for half of our workers. We get support from friends in South Africa and local pharmaceutical companies in Zimbabwe. We have partners here in Canada that send containers of medical surgical supplies and hospital equipment. That fills a huge void. Donations come in the form of cash, food, equipment or online contributions. There are always more needs than there are resources. We are talking about rural Zimbabwe where the average income is still probably a dollar a day. Hospital care is expensive everywhere in the world. We try to run on a shoestring budget, but it still costs money to buy the shoes.
NDM: What strategies are you employing to get more Zimbabweans involved?
PT: Karanda has traditionally been a missionary hospital supported by missionaries or mission sending organisations in the traditional West. But I think moving forward, we are looking at transitioning. We have already made steps to having a national Zimbabwean board of directors supporting the hospital, working alongside national professional health care staff, supported by businesses and well-wishers in Zimbabwe. We also intend to strengthen our partnership with the Zimbabwean diaspora, those who are working and living abroad, and give them an avenue; a trustworthy avenue, a worthwhile cause to give back to.
NDM: If someone wants to assist in whatever shape or form, how can they contact you or how do they go about it?
NDM: Any final thoughts on this issue?
PT: We have all been through a healthcare crisis with the Covid 19 pandemic. We have all seen how critical healthcare is around the world and the contrasts between those who have and have not.
In rural Zimbabwe, the contrast is even more striking between the need for healthcare and the resources. I would like to think that at Karanda Mission Hospital we are doing our best with what we have, but through your partnership we can do more and provide an even better standard of care to our underserved, deserving patients. There are a lot of challenges, but there’s always joy. There’s job satisfaction in doing the little things in life. I think Mother Teresa said we cannot always do great things. But we can do small things with great love. There is satisfaction in doing what you can, whether it’s a mother saved during childbirth, whether it’s a malnourished child restored to health through our nutritional supplementation, or a person living with HIV/Aids on treatment, and back to work as a fully functional member of society.