More training means better care
Training and upskilling programmes are key tools for SolidarMed to tackle the skills shortage. In Zimbabwe health workers have been trained in a number of specialist areas, including post-operative care for heart surgery. This has allowed Agness to return to work, Mollet to walk long distances, and Tapiwa to hopefully go back to being a cheerful child in the summer.
Agness Mangenge from Mucheke in Zimbabwe used to earn a living selling tickets at her local bus stop, until her breathing difficulties and mobility issues became increasingly worse and prevented her from doing the job. As her husband was unemployed, the family struggled financially and didn’t always have enough to eat. Just under two years ago, after suffering from her symptoms for eight months, the now 46-year-old was diagnosed with congestive heart failure, a chronic and progressive condition.
It involves the heart muscle becoming increasingly weak or stiff so the heart is unable to pump enough blood around the body. Patients need to take drugs for the rest of their lives to take pressure off their hearts, for example blood pressure medications or diuretics (water pills).
The diagnosis drew hurtful comments from Agness’s community and led to stigmatisation. The medication was also expensive – so it was a difficult time for the mother of two grown-up children, aged 26 and 28. Since January 2024 Agness has been treated and monitored at Masvingo Provincial Hospital, which is supported by SolidarMed. She heard about the programme from an acquaintance.
“My life has been completely transformed. Before, I could barely afford my treatment,” says Agness, who would often have to decide between food or medication. She now receives it free of charge. In order for these measures to have the desired effect, it is essential that medical professionals are properly trained and have the right skills.
After her heart valve replacement surgery in January, she came to see us in February. We measured her INR level. We also checked for any complications and monitored her recovery.
Nurse Christine Mwenje
Last year, SolidarMed helped provide further training to 283 professionals at nine healthcare facilities in Zimbabwe with a catchment area of over 130,000 people. To be able to deliver professional treatment to Agness Mangenge, the nurses and doctors completed various training. For example, they learned how to perform an echocardiogram. This ultrasound scan is one of the most important routine cardiac examinations. As it shows the structure of the heart, a doctor can assess the size of the ventricles, the function of the heart valves, and the thickness of the cardiac muscle.
They were also taught how to measure International Normalized Ratios (INRs). This is a standard method to test blood clotting, allowing care providers to determine whether the blood-thinning medications administered after surgery have allowed the optimal blood coagulation level to be reached. But this is not the only technical knowledge that is vital for patients. The medical professionals also learn about the counselling that patients need.
Tapiwa can undergo surgery in the summer
Little Tapiwa Munaki is able to undergo surgery in Harare in June and can rely on healthcare professionals who have received the right training to be able to care for her. The two-and-a-half-year-old girl can no longer sit up and refuses to be breastfed by her mother Florence Makotore. “Tapiwa suffers from excessive sweating, laboured breathing and palpitations. She used to be a happy little girl but she doesn’t giggle anymore,” says her mother. As a single mother, Florence Makotore has a lot to deal with. Last year, she had to sell avocados from the tree in her garden to pay for her daughter’s medication. She is pleased that she received help from Tapiwa’s grandmother. The family’s expectations of life after the surgery are high. “Without an operation Tapiwa could have a stroke or even die. She is now going to have open-heart surgery. I hope that her breathing and pulse rate will normalise, that she won’t sweat as much, and above all that she’ll be a happy little girl again,” says Florence Makotore.
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Nurse Christine Mwenje Chiravirwa was surprised by the importance of nutrition in such diseases, something she learned during the further training programme. She works at Mashoko Hospital and has completed training courses in post-operative care for patients who have undergone heart surgery. “Patients who have been prescribed an anticoagulant drug need to consume foods low in vitamin K. This is because the liver uses vitamin K to produce clotting factors that counter the effect of the drug,” she explains. Such foods include fruit, wholegrain products and lean protein such as chicken or fish, as well as vegetables other than green leafy vegetables.
Nurse Christine Mwenje Chiravirwa was surprised by the importance of nutrition in such diseases, something she learned during the further training programme. She works at Mashoko Hospital and has completed training courses in post-operative care for patients who have undergone heart surgery. “Patients who have been prescribed an anticoagulant drug need to consume foods low in vitamin K. This is because the liver uses vitamin K to produce clotting factors that counter the effect of the drug,” she explains. Such foods include fruit, wholegrain products and lean protein such as chicken or fish, as well as vegetables other than green leafy vegetables.
Non-communicable diseases
According to the World Health Organization (WHO), non-communicable diseases (NCDs) are of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors.
NCDs disproportionately affect people in low- and middle-income countries, where nearly three quarters of global NCD deaths occur. The main types of NCDs include cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Cardiovascular diseases account for most NCD deaths – more than 19 million a year worldwide.
Thirty-nine per cent of deaths in Zimbabwe – a lower-middle-income country – are due to non-communicable diseases. The authorities use various preventive measures to try and protect public health, such as introducing taxes on tobacco and restricting alcohol advertising. SolidarMed works closely with the authorities to tackle non-communicable diseases.
According to the Federal Office of Public Health (FOPH), cardiovascular diseases are the most common cause of death in Switzerland, accounting for around a third of deaths in the country. In 2023, 137,000 people were admitted to hospital due to cardiovascular diseases. The latest estimates from 2011 assume that the main non-communicable diseases generate CHF 74 billion in direct and indirect costs. The indicator is due to be revised before July 2025.
Delivering economic empowerment
After her heart valve replacement surgery in January, she came to see us in February. We measured her INR level. We also checked for any complications and monitored her recovery,” the nurse explains. If SolidarMed hadn’t covered the costs of the surgery and post-operative care, such an intervention would not usually be affordable for most people in this region. Mollet Mahora recovered well from her operation. “My breathing difficulties have disappeared. I can now do my housework, walk longer distances without problems, and I don’t get lung infections anymore”, she says. The risk of contracting a lung infection is reduced as the surgery stops fluid accumulating in the lungs. Going forward she can continue to rely on the expertise of the trained staff, as she will have to continue to take her medication, undergo INR tests, and attend self-help group meetings.
It is not only Mollet Mahora who is doing better since her operation. Thanks to the treatment delivered by the trained medical professionals, Agness Mangenge is also able to return to work at the bus stop and earn money to feed her family. The further training and upskilling programme therefore not only benefits patients’ physical health, but indirectly also delivers economic empowerment. “This helps me look to the future with optimism,” says Agness.
