IN Zimbabwe, a country faced with numerous health challenges, a silent epidemic is affecting thousands of lives.
Multi-morbidity, the coexistence of two or more chronic conditions in an individual, is a growing concern that remains shrouded in secrecy.
Uritah Nyambuya (65) is not happy with her life.
Her daily life is a constant balancing act, juggling medications, dietary restrictions, doctor’s appointments, frequent hospital visits and the emotional toll of her conditions.
Nyambuya has been living with hypertension, diabetes and asthma for over a decade.
Her day begins with a tedious routine of medication and monitoring, a constant reminder of her fragile health.
“I am tired of being sick. Most of my days I spend them in the hospital. I often feel overwhelmed. I am struggling to cope with the physical and emotional toll of my conditions,” she said, her voice laced with frustration and her eyes filled with tears.
“Living with these chronic diseases is very hard. I am suffering each and every day of my life. I feel like I am a burden to my family and friends and it’s stressing me.”
The impact of multi-morbidity extends beyond the individual.
The financial burden of managing multiple conditions is crippling, forcing families to make difficult choices between healthcare expenses and basic necessities like food.
The economic burden is staggering, with many households pushed into poverty.
Tendai Sithole, a family member staying with Nyambuya, said her condition is challenging.
“Her condition worsened early this year. Since then, we are struggling to cope with her daily life. It is now hard for me to take care of her,” she said.
“I do not go to work, so taking care of her now is becoming hard due to the expenses. She needs medication and at the same time, we need food.
“We are now forced to choose between her medication and food. The emotional toll is really depressing and devastating.”
Added Sithole: “These multiple diseases are affecting her. At one point, she stopped taking her tablets, the reason being she thought she was now a burden to us since we were struggling to buy her medication and food at the same time.”
Community Working Group on Health executive director Itai Rusike said the burden of multi-morbidity is strained by limited resources, a shortage of medical professionals, lack of specialised care and medication.
“The current quadruple or indeed multifaceted burden of multiple chronic diseases is unmatched by the prevailing Institutional capacities, management and health staff skills to adequately detect and manage,” he said.
“These have individually or in combination translated into premature and excessive mortalities across the ages, which in our view requires immediate attention.”
Medical practitioner Pugie Tawanda Chimberengwa gave the analogy, highlighting that people living with multi-morbidity are facing so many challenges.
“Take for example a woman living with HIV, who develops non-invasive cervical cancer, who then is diagnosed of hypertension and unfortunately develops cervical cancer. She needs to go to the OIC [opportunistic infection clinic] for her ARVs [antiretrovirals], seen in the OPD [outpatients department] for hypertension review, then to the ANC [cancer treatment process such as chemotherapy to reduce the absolute neutrophil count (ANC)] for her cervical cancer screening/ management,” he said.
“Interestingly, most of these clinics are run by specialists who may do their clinics on different days for example, diabetes clinic (Tuesday), hypertension clinic (Wednesday), cervical cancer clinic (Thursday) and so on, to cap it all their scheduled OI [opportunistic infection] clinic visit will be on a Monday. Technically they spend almost the whole week being seen at the same hospital.
“This analogy typifies the challenges faced by people with multi-morbidity. This is because the health system is arranged to manage disease specific conditions rather than an individual.”
What can be done?
Added Rusike: “We hope that the government will develop concrete actions not only to address the current and pressing health sector requirements, but ensure that the impending transition out of major funders that has been announced is factored into the national planning for domestic resources mobilisation for health and its determinants for the long haul.
“In Zimbabwe, community health structures exist to assist in health promotion, uptake of preventive services and provision of health care services close to where the people are. We, therefore, urge the government to fundamentally support and strengthen the role of local leadership and community structures for health interventions to bear fruit.”
According to Chimberengwa, there is the concept of integration of care for clients with multi-morbidity.
“This is done through chronic care clinics or chronic disease management clinics (terminology varies depending on location). We can ride on bringing in other chronic conditions into OI clinics, fortify traditional OPD to manage all conditions, ride on PEN+ clinics (for non-communicable diseases) being fronted with support from WHO [World Health Organisation]. Whatever we decide we need to ensure we manage a patient with multi-morbidity wholesomely at a ‘one-stop shop’,” he said.
“This will save them time, money for travel and food as they attend multiple clinics as well as reduce the risk of drug-drug interactions being missed.
“Chronic conditions mostly are a lifetime illness and the cost of care is huge. We need the policymakers to ensure that much of their care is covered by the government and service delivery models are developed to ensure the patient uses less of out of pocket savings which are in-turn for the family sustainability.”
The story of multi-morbidity in Zimbabwe is one of resilience hope, and the urgent need for change.
It’s a story that demands attention, action and compassion.