The coronavirus has wreaked havoc on many individuals, communities, systems and countries the world over. With over one million cases of COVID–19 having been recorded around the world, health systems are undisputedly overwhelmed. Unfortunately, Zimbabwe has not been spared by the wrath of this pandemic.
People living with chronic illnesses have been particularly impacted by the health, social and economic effects brought by this virus, and the restrictions imposed because of it. This article focuses on the impact of the lockdown imposed in Zimbabwe in order to contain the COVID-19 on people living with diabetes in the country, as both writers of this article are living with the condition.
The coronavirus is an infectious disease caused by a newly discovered virus (coronavirus). It was first discovered in the City of Wuhan in China at the end of 2019, and has since spread throughout the world, affecting millions. In order to contain the virus and limit the number of new infections, many countries in the world imposed restrictions on their citizens including mandatory quarantine and lockdowns. Zimbabwe was placed under lockdown on March 30, 2020 which meant that a restriction of travel was imposed with only professions considered to be essential services allowed to move further than the five-kilometre radius which the government of Zimbabwe gazetted prior to the lockdown.
Initially, the lockdown was for 21 days, which was then extended by 14 days and at the time of writing had been extended indefinitely, albeit on more relaxed terms.
Even though the lockdown was welcomed by some parts of society, it was an unwelcome move for most people mainly because Zimbabwe has a very large informal sector.
With most people living from hand to mouth, this in turn meant that most households were left vulnerable. Many of the people living with diabetes unfortunately also fall into this bracket, and the lockdown has had disastrous effects on their ability to move around and access healthcare and medication.
The affordability of medical care during this period also left many people living with diabetes stranded and without adequate care.
If one takes time to look at the Zimbabwean scenario, it becomes clear that the lockdown has left the already disadvantaged people more vulnerable, with those living with chronic conditions compromised.
Anecdotal discussions with fellow people living with diabetes revealed how in the first four weeks of the lockdown most people were failing to access their medicines, even when availability was not an issue.
Many were turned back at roadblocks by security forces, save for those with letters stating that they worked in the essential services sector, thus denying passage to access essential medicines to the layman. Lately, the security forces have tried to rectify this issue by stating that people with valid medical records would not be denied passage at roadblocks (even though this is still happening in some instances). While this is a very welcome move for communities such as people living with diabetes, what will happen to the patient who does not have readily available medical records on them? One wonders how they would be able to prove their case to the security details at these traffic stops.
Outpatient clinics play a very big part to a significant number of people living with chronic conditions and common sense would tell one that if people with chronic conditions are unable to visit outpatient clinics or hospitals regularly during the lockdown, then it becomes difficult for them to access their prescriptions or receive urgent advice about managing their conditions in a reduced service environment.
Unfortunately, lockdown support measures around outpatient clinics and other medical services do not appear to have been communicated effectively and widely with people reporting variedly the extent to which messages about clinic closures had reached them for instance, with some patients reporting that they only learnt of the suspension of services upon arrival at the medical centres.
Patients are, therefore, forced to turn to private pharmacies because of lack of hospital access but because private pharmacies charge much higher prices, this leads to some patients rationing their supplies or defaulting altogether on taking their medication.
This can possibly mean the death of the already vulnerable people on essential medicines, or at the very least more severe complications to those who already have complications.
The implications on Zimbabwe’s compromised health system will be severe as it will not be able to handle the extra burden of dealing with people with diabetes complications in the long run.
To put this into context, Parirenyatwa Group of Hospitals ran weekly endocrine clinics on Wednesdays before the beginning of the lockdown, where staff saw approximately 50 patients. Assuming only a handful of patients managed to attend their review sessions, but with the closure of outpatient clinics, the effect on the health of those who fail to attend might be difficult to reverse.
Potentially, patients could be missing out on vital updates to their medication because of a lack of communication by the relevant authorities.
This may also lead to a situation where patients are forced to turn to private pharmacies because of lack of hospital access. Because private pharmacies charge much higher prices, this then leads to patients rationing their supplies or defaulting altogether on taking their medication regularly. All this can possibly mean the death of the already vulnerable people on essential medicines, or at the very least severe complications to those who already have compromised immune systems. The implications on our already compromised health system will be severe as it will not be able to handle the extra burden of dealing with people with diabetes complications in the long run, leading to a further collapse of the economy.
The prices of medication, particularly insulin, have been a matter of concern during this period with some pharmacies charging double the prices that they had been charging before the lockdown was implemented. CIMAS Medical Aid Society is a case in point as one of the authors experienced their price gouging on one of the drugs she uses which was dispensed at their Rowland Square Clinic pharmacy. After consulting several pharmacies, it emerged that CIMAS pharmacies were charging double what the rest of the market was charging at the time. On April 20, 2020, one of the authors got a prescription processed at Rowland Square Clinic for RTGS$8 600, a price which was almost double the price of RTGS$5 250 that she was charged at Greenwood Pharmacy on May 8, 2020. This was given that the rate that private pharmacies were using had not altered between April and May.
One is left wondering if the medical aid society is following the pricing guidelines set by the Retail Pharmacists Association which gives its members pricing policies and guidelines, allowing pharmacies to charge not more than 25% above their supplier`s price on insulin and diabetes related drugs. In a country where the unemployment rate is over 90%, the number of people who will be able to afford these drugs will be very low. With no one seemingly addressing the issue of ensuring price caps, the diabetes community wonders if anyone actually cares for their welfare. One even goes on to wonder how many of their members have been overcharging without them noticing.
We have also heard of cases of people being turned away at pharmacies because they have “exhausted” their drug funding for the year which is again determined by the medical aid package they are on. This is happening well before the insurance year would be due to be exhausted, causing people to either ration supplies or opt for cheaper alternatives which may affect their health in the long run. Some people who were using insulin flex pens, which are easier to use, more flexible even when travelling and friendlier, have had to downgrade and start using vials which are generally cheaper but less convenient, reflecting a clear case of unaffordability of insulin, something that people with diabetes regard equal to oxygen, without which they will die.
After hearing about a situation where one person living with diabetes was turned back from a local clinic because they were only attending to “emergencies”, one wonders if insulin; a lifesaving drug is not emergency enough for a health practitioner to send a patient back home without it. One is left wondering what an emergency looks like given such a scenario. One is also left wondering if COVID-19 has made our health officials neglect other health conditions because of the pandemic.
The devastation will not be felt only at an individual or family level, but also on the economy in the long run as we may start having more people presenting health complications than those that are actually working. This not only means that the health system may be crippled by complications, it would also mean that many young lives will be cut short. The crippled health system will lead to a vicious circle of increased health complication in a young population, people dying and potentially orphaning children all because of the high cost of lifesaving drugs in a very informal economy. There is no wisdom in waiting for more complications and fatalities before the plight of those living with diabetes and other non-communicable diseases is taken seriously.
It is, therefore, important for policymakers, health authorities and organisations to ensure the protection of the populations whose vulnerability has been increased by this pandemic and the lockdown restrictions that come with it. It is high time we start advocating for and implementing provisions to ensure wider accessibility, affordable prices and ease of movement for people living with diabetes and other non-communicable diseases.
Yemurai Machirori is a mentor in the International Diabetes Federation’s YLD Programme and writes in her capacity as a diabetes advocate in Zimbabwe.
Heather Koga has been living with type 2 diabetes since 2013. She is passionate about diabetes awareness and education, and has been involved in a number of diabetes projects locally and internationally under the banner of the IDF_Blue Circle Voices Network.