Disability and social suffering in Zimbabwe
Disability and social suffering in Zimbabwe
Abstract and Keywords
This chapter presents the findings of a study that took place from August to November 2005 in Binga District, located in North West Zimbabwe, towards the border of Zambia. As one of the poorest districts in the country, it has been struck especially hard by recent economic developments, and poverty is prevalent. The major aim of the study was to gather knowledge on the situation of rural families with disabled pre-school children in Zimbabwe. The study also gathered information on traditional beliefs about the causes of impairment, as well as on attitudes and behaviour towards children with disabilities in the past and present. Almost all the causes of disability were seen to be present among the Tonga. Some of these were malnutrition, poor child health, poor maternal health, ill-conceived policies, and illnesses such as tuberculosis, malaria, measles, and HIV/AIDS, among others. The two-way causality between disability and poverty was clear.
Poverty and politics
Zimbabwe is a land-locked country in southern Africa. It shares borders with South Africa, Botswana, Zambia and Mozambique. It has a population of 13 million people, 348,861 of whom are people with disabilities (CSO, 2004). Half of the people with disabilities are children (Government of Zimbabwe, 2004). Zimbabwe is mostly a rural country and there is a higher poverty incidence in rural areas (63%) than in urban areas (53%). Most rural households in Zimbabwe are located in drought-prone provinces, for example in Matabeleland North (Binga District). They are subsistence farming households that mainly depend on dry land farming and are therefore affected by drought. It has been noted that although there has been a higher increase in poverty in urban areas, rural households remain worse off. Matabeleland North Province has been found to have the highest poverty incidence, of 70% (PASS, 2006).
In contrast to the development achievements of the first 10 years of independence (1980–90), the 1990s witnessed a turnaround of economic fortunes as economic decline set in and structural problems of high poverty and inequality persisted. Some of the explanations behind this turnaround include recurring droughts and floods, as well as the non-realisation of the objectives of the Economic Structural Adjustment Programme (ESAP, 1991–95).
The period 1996–2005 was marked by accelerated deterioration in the socioeconomic situation. The non-realisation of ESAP resulted in a number of ‘homegrown’ reform packages. The Enhanced Social Protection Project (ESPP, 2000) was launched in response to worsening social conditions that were causing the poor to suffer deepening multi-shocks of escalating prices of basic commodities, high unemployment rates, high number of drop-outs of schoolaged children and high interest and inflation rates. The government also embarked on a land redistribution programme (in 2000) as one of the major strategies for poverty alleviation (PASS, 2006). Its potential has yet to be realised.
Despite all the economic policy-making efforts, Zimbabwe has continued to experience severe macroeconomic instability, characterised by nine digits hyperinflation (231,000,000% and it continues to soar endlessly upwards; see (p.172) The Standard, 26 October 2008). Other challenges faced by the government include general international isolation, the devastating impact of the HIV/AIDS pandemic, high poverty and unemployment (at 80%) levels. The Report on the global AIDS epidemic (UNAIDS, 2006) indicates that Zimbabwe has 1,700,000 people living with HIV.
Poverty in Zimbabwe has increased considerably from 1995 until the present. The proportion of households below the food poverty line increased from 20% in 1995 to 48% in 2003, representing an increase of 148%. This shows that more households shifted into the ‘very poor’ category rather than moving out of poverty. There are now reported cases of people dying from hunger-related illnesses. Nyati (2007) reports that, ‘eight people have died of malnutrition in Bulawayo where hunger-related medical complications have been identified in suburbs previously considered affluent.… Bulawayo resumed publicizing malnutrition deaths last year after it suspended the service in 2004 following threats by the government’. Despite recurrent government denials, there is little doubt that hundreds are perishing weekly as a direct consequence of undernourishment as well as inability to access healthcare. There are good reasons to believe that people with disabilities, even more than non-disabled people, are among the victims.
Sadly, constructive efforts by the government to contain inflation are not visible. It is the magnitude of Zimbabwean inflation, which is fast collapsing all economic sectors, that is the biggest trigger of the nationwide poverty. A Zimbabwean economic commentator, Bloch (2007), states:
The tragedy is that the appalling deterioration in the living circumstances of most Zimbabweans is not due to uncontrollable circumstances, to acts of God, to the ravages of nature, or the sequences of fate. The pronounced poverty that is now near endemic in Zimbabwe has undeniably been occasioned by government, and is being intensified and exacerbated by government's arrogant rejection of culpability, its continued pursuit of destructive policies, and its rigid resistance to any changes of policy which are either recommended by others, or which could be construed as an admission that prevailing and past policies were erroneous and ill advised.
Aims, objectives and methodology
The study on which this chapter is based took place from August to November 2005 in Binga District, located in North West Zimbabwe towards the border of Zambia. As one of the poorest districts in the country it has been struck especially hard by recent economic developments, and poverty is prevalent. The major aim of the study was to gather knowledge on the situation of rural families with disabled pre-school children in Zimbabwe. The study also gathered information on traditional beliefs about the causes of impairment, as well as on attitudes and behaviour towards children with disabilities in the past and present. It was of (p.173) particular importance to determine the coping abilities of these families in general and the link between disability and poverty in particular.
The methodology used was in-depth interviews with 30 mothers and two grandmothers, participant observation in the villages and at the district hospital and clinics and three focus group discussions. Content analysis was used for secondary data.
The Tonga: past and recent histories
The mighty Zambezi River used to run through the north and south settlements of the Tonga. They were separated by what was then the Federation of Northern and Southern Rhodesia (now independent Zambia and Zimbabwe). According to the old men and women, the river was then known as ‘Kasambabezi’ meaning ‘it was only those who knew the river who could bathe in it despite the presence of crocodiles’, giving respect to those who knew the waters. In other words, the river belonged to them. Sadly, the river no longer belongs to them since they were forcefully evicted from the valley by the Rhodesian government in 1957 to make way for the Kariba dam (approximately 280km long and 25km wide), which provides electricity for both Zambia and Zimbabwe.
The Tonga is one of Zimbabwe's smaller ethnic groups. They are found in the north west of Zimbabwe near the Zambezi River in Matebeleland North Province, Binga District. For many generations they lived by the fast flowing Zambezi River which connected them to their relatives and friends, known as ‘bamutala’ – those living on the other side of the river. When they were moved from the riverbanks the bond between them was broken and this meant that traditional ceremonies to honour ancestral spirits and other ceremonies came to an end.
In her novel African Laughter (1992) Doris Lessing describes the misery of the Tonga as observed by her during a visit in 1989 (pp 379–87). Since then, the situation of the Tonga has deteriorated. Tremmel and the River Tonga People (1994) state that their life near the river was a time of ‘splendid isolation’. This description needs to be understood in its historical context. They state that the Tonga were basically isolated from the rest of the people of southern Rhodesia and lived a very traditional life of farming as well as catching fish. The absence of government involvement left them free to honour their ancestral spirits and keep their traditions alive. It also resulted in them not having schools, clinics or hospitals, even as late as 1957 (which was unlike the rest of the country at that time). Tremmel states that they relied on traditional medicines, which were effective for some illnesses but not for major illnesses like malaria, tuberculosis, leprosy, measles and others. As a result, life expectancy was low, with 60–80% of children dying from malaria and diarrhea before the age of five.
Binga today is one of the most underdeveloped districts in Zimbabwe. It is approximately 12,500km2 of which 9,000km2 is habitated. It has a population of 300,000. The whole district is a malaria endemic area in which all the population (p.174) is affected. Some areas are more affected than others. Malaria accounts for 60% of total admissions at the district hospital (Ministry of Health, 2005).
‘We had a good life. The soil was fertile and we had more water than we needed. We grew maize, sweet potatoes, bananas, pumpkins, vegetables and other crops – we also herded a large number of cows and goats – life in the valley was good’ (quoted in Muderedzi, 2006). These were words from the old men and women who are now scattered in the villages as well as the Chizarire mountains. A tearful mist could be detected in their eyes as they said the above words. Apparently when the Tonga asked the ‘white man’ how they were going to survive on the dry mainland, they were told to continue moving inland and that ‘the water will follow’. Sadly, the water did not follow them as promised. The Tonga in their new homeland came to suffer from persistent droughts, but the government has not brought piped water to the villages. The Tonga stated that they remember old people, children and those with disabilities getting sick and dying from lack of food, diseases of the mainland and attacks by wild animals. Some died of grief.
The lives of the Tonga since they were taken from their land, their shrines and the graves of their ancestors have been hard and painful, a struggle year in, year out and from season to season (Lessing, 1992). From being able to produce two or more crops a year, they now do not produce anything most of the time. The Tonga are currently on the verge of starvation and have to beg or borrow in order to survive. They are not able to fish as before, quelea birds eat the little that is produced in the fields and elephants just love to eat their maize. It is sad to note how they have had to scatter to look for means of survival such as water, fertile fields and wild animals for food.
The Kariba dam, which deprived the Tonga of their homes, has not benefited them. The lake does not irrigate the land along its long shoreline and the electricity it generates does not benefit the villagers. Their skills in such crafts as carving and basketry are well known but this is of no benefit to them due to the political situation that has brought fewer and fewer tourists to visit the area. Little social progress has taken place among the Tonga. The illiteracy rate is still very high. Health facilities are inadequate as well as clean water and sanitation facilities. Malnutrition is rife. Poverty is not a new phenomenon; the colonial government found it and left it after its rule. The present regime found it and still has not managed to do much about it. Their present situation of poverty includes realities such as excessive drinking, a high unemployment rate, household food insecurity, a high mortality rate, witchcraft accusations, poor health, a low literacy rate, poor self-image, infidelity and AIDS, among other things.
Immediately after independence, Zimbabwe recorded an upswing in quality of life as seen in a declining infant mortality rate (IMR) and maternal mortality rate (MMR) in the 1980s by focusing on primary healthcare (PHC). With the introduction of the ‘pay per use’ cost recovery policies as well as poor services in the 1990s, all these gains were reversed. Programmes like prevention of diseases through immunisation, malaria prevention, water and sanitation, family planning as well as information, education and communication (IEC) have suffered due (p.175) to lack of the required equipment, medicine, limited resources, ‘brain drain’ and other challenges. In terms of child illnesses such as acute respiratory infections (ARI), fevers and diarrhea, only 29% of the children were treated in a health facility (CSO, 2006). The rest supposedly used the ‘alternative’ healthcare system. Such a situation results in suffering and deaths of many children, especially those with disabilities.
Disabilities: Tonga beliefs and attitudes
There were no indications during this fieldwork that present-day Tonga families are purposely hiding or neglecting their children (Ingstad, 1997). We did, however, encounter the assumption that disabled children are left to die or are hidden away in rural areas. This is rooted in early ethnographic accounts. The village elders narrated stories of how people in the past used to dispose of children born with disabilities because they believed that such children would bring bad luck to the village community. This is no longer practised. In spite of being one of the most economically deprived groups of people in Zimbabwe, the Tonga do their utmost, displaying much love for their disabled children.
When expecting a child, the Tonga were more worried about whether or not the child would survive rather than a visible disability. Bodily imperfections were seen as important only to the extent that they impaired normal functioning in society, and life was seen as superior to death. Disability was seen as secondary, as seen in the proverb, ‘kocilema kunywigwa maanzi’ (‘It is better to be disabled than death. Thus, it is better to have a disabled child than a dead one’). This was noted when asked to state their reactions on discovering their child's disability; most of the mothers stated that “it was a life event … one of those things that happen in life.… I was happy but sad for the baby” etc. With the high mortality of children among the Tonga, the sentiment among the mothers was that they should be grateful to have a living child than a dead one. Similar findings have been made by Ingstad (1997) among the Tswana.
The Western concept of disability seeks to improve the lives of people with disabilities. In many African societies, the primary interest is in explaining why these people have become as they are (Devlieger, 1995; Talle, 1995; Ingstad, 1997). The most important issue concerning a disability becomes answering the question ‘why’ rather than the idea of rehabilitation. When misfortune or illness strikes, the traditional healer is the first port of call. The Tonga believe causes of disability to be witchcraft (kuloyiwa), an ancestor's sorrow or anger (mizimu), the will of God, natural reasons or that it ‘just happened’. The first two causes can be termed ‘Tonga diseases’ as they have a Tonga name and can be identified as originating in disturbed social relations, and the rest are caused by external forces.
This results in the immediate family not being blamed for the child's disability. Since the question ‘why’ is central, less attention is given to the person with the disability as an individual. That person is integrated into normal life in an indifferent way, without ceremony, without much medical attention, but without (p.176) being hidden. It is clear that these beliefs function as a strong social control mechanism, as well as a restoration of relationships in the community. This makes disability a condition related to culture and religion.
Tonga attitudes towards disability varied in the study according to whether it caused problems for others and took the mother away from carrying out other household chores. For example, children with cerebral palsy and other neurological disabilities were considered more disabled for being solely dependent on other people for their basic needs compared to deaf children who could carry out chores like herding cattle and other errands. In addition to the above perceptions of various types of disability, each family would have their own constructed notions of disability that might influence the treatment of and relationship with the disabled child. Unlike the Hubeer of southern Somalia (Helander, 1995), looking after children with disabilities was not seen as a religious duty of showing mercy.
As noted before, the child with disabilities as well as the immediate family is not blamed for the disability/misfortune. More importantly, the mother does not blame herself. Family ethno-medical beliefs, childhood experiences, personality factors as well as attitudes were seen to play an important part in coping with a disabled child. We found among the Tonga a kind of ‘natural integration’ of these disabled children in the sense that the families did their best to look after them without reservation. If the child died, it was a result of the family as a whole not having enough food and lack of healthcare. This is in contrast to Scheper-Hughes' (1992) description of Alto mothers from Brazil who perceived disabled as well as weak babies to be predetermined to die, resulting in them withdrawing nourishment as well as care and leaving them to die.
One of the strengths of an African understanding of disability is the recognition that it is not simply an abnormality of the individual body but also a disruption in the family. Thus, attention should be paid to the relational context in which the person with a disability exists and greater efforts should be made to involve and support other family members. An African approach to disability is concerned with the meaning that biological deviations have for society, for the family and for the individual.
Talle (1995) states that in order to understand the concept of disability, one needs to look at cultural beliefs as well as a contextual analysis in order to grasp the phenomenon in its full social and cultural setting. This is in contrast to the modern Western biomedical approach that is more technical, with a focus on the improvement of functions and activities of daily living.
Consequences of poverty for people with disabilities
Human poverty is commonly defined as the deprivation of basic needs or various social and economic entitlements such as income, health, nutrition, knowledge, water, shelter, security, equity, human rights, freedom of choice, religion and participation in decision making (UNDP, 1990). However, poverty is not simply (p.177) the consequences of a lack of resources. Some people are unable to access existing resources because of who they are, what they believe or where they live. Such discrimination is a form of exclusion and a cause of poverty (DfID, 2000b). Yeo (2001) states that not only do disabled people experience disproportionately high rates of poverty, but being poor dramatically increases the likelihood of getting an impairment, for example due to the hazardous nature of the job. Those living in chronic poverty often have limited access to land, healthcare, healthy food, shelter, education and employment (Despouy, 1993).
The links between poverty and disability are strong and go in both directions. Poverty causes disability through malnutrition, poor healthcare and dangerous living conditions. Disability can cause poverty by preventing the full participation of disabled people in the economic and social life of their communities, especially if the proper supports and accommodations are not available. The United Nations (UN) estimates that at least 10% of the poor in developing countries are people with disabilities. The adverse consequences of disability fall heavily on the poorer sections of the community.
Eide et al (2003, p 27) state, ‘A large majority of people with disabilities live in developing or low-income countries, very often living without optimal technical, medical or social support that could have improved their level of living conditions considerably. Disabled people are often marginalized and belong to the poorest segments of society’. The above statement rings true of the situation of people with disabilities, but for the Tonga with disabilities, this is an understatement. It is among the Tonga that one perceives the symbiotic relationship of disability and poverty. The challenges that they face in their everyday lives must be witnessed.
The majority of people with disabilities find that their situation affects their chances of going to school, working for a living, enjoying family life and participating as equals in social life. Poor nutrition, dangerous living conditions, limited access to vaccination programmes, and health and maternity care, poor hygiene, bad sanitation, inadequate information about the causes of impairments, politics and natural disasters all cause disability. Also, children may be disabled as a result of malnutrition and HIV/AIDS. In turn, disability exacerbates poverty by increasing isolation and economic strain, not just for the individual but often for the affected family as well. Breaking out of the vicious cycle of poverty and disability becomes more and more difficult (DfID, 2000a).
The direct costs of disability impact the rest of the family that makes it reasonable to talk about the ‘disabled family’ (Ingstad, 1997). We found that the burden of care often fell on mothers or other female relatives and siblings. There was a trend of schoolgirl drop-outs looking after their disabled brothers and sisters. Caring for a child with a severe disability further increased the workload of women living in extreme poverty, like the Tonga. This took their valuable time away from the daily struggle to make a living, thus they could not work in other people's fields for food, money, clothes or seeds.
The study of the Tonga families and how they coped with the care of children with disabilities brings about a picture that makes the concepts of ‘structural violence’ and ‘social suffering’ useful tools for analysing their situation. Benatar (1997, p 1634) defines social suffering as ‘a collective and individual human suffering associated with life conditions shaped by powerful social forces’. He further states that unlike physical suffering or mental illness, social suffering is largely unrecorded. It is the result of what political, economic and institutional power does to people, and reciprocally, how these forms of power themselves influence responses to social problems. Included under the category of social suffering are conditions that are usually divided among separate fields: health, welfare, legal, moral and religious issues. They destabilise established categories (poverty, war, torture etc). Social suffering is at the same time about the collective and the individual (Kleinman et al, 1997; Kleinman and Farmer, 1998). Structural violence is the negative impact – beyond their control – of social structures (political, religious, cultural etc) on the lives of individuals and groups. ‘Social suffering’ and ‘structural violence’ bring in a new perspective in that they take politics down to the household and individual level.
The Tonga situation is very similar to that of the Haitians described by Farmer (1992). Both were uprooted from their land and forced to leave behind a culture that was built around their closeness to the river. Both were moved to poor land where they could no longer make a proper living from agriculture. For the Tonga as well as the Haitians the structural violence of the past has been aggravated by the structural violence of recent years' politics. Adding to the suffering for both these people is the AIDS pandemic.
In Zimbabwe, as in Haiti, young people leave the villages in search of work in the nearby towns of Victoria Falls, Bulawayo and Hwange. On getting to the cities, they find that jobs are not easy to get (as they are generally illiterate) and so they end up taking demeaning, low-paying jobs just to survive. They find housing in the slums where alcohol, drugs and prostitution are the order of the day. After contracting AIDS, they cannot afford hospital fees or pay for anti-retroviral medication. When they get very sick, they return home to be taken care of by parents or relatives until they die. The village mothers and grandmothers take on all the ‘home-based care’, leading to loss of income-generating activities, which in turn results in a family ending up in a situation of chronic poverty.
McDowell (2005) states that displacement disproportionately affects the poor, those who are distanced from the centres of power, who often live outside the formal economic system, are members of minority populations speaking a different language and who generally do not fit a metropolitan national identity. The Tonga fit the above description. Poverty is the central fact of life for most of the people in Binga today. To live in their villages is to witness their struggle as they confront the deepening economic crisis that is currently gripping Zimbabwe.
At the time of research, Binga had not had good rains for the past four years, a common situation for the whole of Zimbabwe. This has led to severe food shortages since 2001. This, as well as the barring of international relief agencies from feeding the hungry, has worsened the situation of the Tonga. At the time of research, the government had stopped non-governmental organisations (NGOs) from participating in the distribution of food aid in fear of NGOs' use of the exercise as a pretext to mobilise support for the opposition party. In the case of the Tonga, politics has resulted in starvation due to previous forced displacement, and the government's current withholding of food aid from the people.
According to Tonga informants, the government stopped NGOs from supplying them with food in 2004, before the parliamentary elections. In an article, ‘No food before elections – Mugabe’, Didymus Mutasa, a government minister, stated: ‘Most of these NGOs play politics with food and they might as well use the food handouts to influence our people to vote for the imperial lapdogs, the MDC. We are busy with the Senate elections and after that we will look at the situation. But it should not be lost that we have the capacity to feed our own people’ (The Zimbabwean, 14 October 2005). Government supplies of grain were erratic: not enough, expensive and not available to those who voted for the opposition parties. From their claim of having plentiful food as well as a good social life in the valley, the Tonga are now on the verge of starvation and have to beg or borrow in order to survive.
Part of the problem seems to be that the Tonga were displaced to resettlement areas that could not support them. Drought has always been a major problem for them because no efforts have been made to supply the resettlement areas with piped water. In some parts of the district, elephants have been known to destroy the crops as well as food in the granaries. These elephants are stray animals from the nearby Hwange National Park. The poor national economy has led to unrepaired pumps for the waterholes in the park, leaving the elephants to seek water and food elsewhere.
On visiting the village of Dumbwe one morning, I (JM) found a village of ‘defeated’ people. The elephants had just visited the night before and wiped out the gardens. This was supposed to be food for the next few weeks before the river dried out. I looked at a disabled child who was already malnourished and wondered what would become of him in the next few days, weeks or maybe months, if he was lucky. ‘We were not threatened by elephants before, but now they are everywhere … we no longer bang empty tins to scare elephants away lest we anger them, but just watch as they descend on our fields and graze on our crops’ (allAfrica.com, 2006). At Siyabuwa village, the villagers told sad stories of school children being attacked and killed by the elephants.
It is indisputable that hunger and famine are largely the result of drought, but in Africa and the developing world there is an evident correlation between hunger and politics. Action Contre la Faim (Action against Hunger) (2001) writes ‘Yet (p.180) hunger and malnutrition are by no means dictated by fate or a case of nature; they are man made. To die of hunger is equivalent to being murdered: while chronic and serious undernourishment and persistent hunger are violations of the fundamental right of life’. It was an insult to human dignity to see so many people starving to death or dying from hunger-related illnesses.
Starvation today mainly occurs when a nation is disrupted by wars or political upheavals and economic crises such as in the case of Zimbabwe or Ethiopia. A nation does not have to starve if drought alone is the cause of famine. For instance, Botswana, Zimbabwe's neighbouring country, is also usually hit by the same, or more severe, drought periods, yet they do not experience famine in the same way. This is because a well-functioning draught relief programme is in place. In the case of Zimbabwe, the European Commission has continued to provide the Zimbabwean population with food and other humanitarian aid exclusively through international and non-governmental structures. However, these food aid efforts are hampered by politics.
On Friday, 1 June 2007, one of the Tonga chiefs was heard on national television (News at 2000hrs) lamenting the poor road infrastructure that has led to families starving due to the long distances that families have to walk to get to the Binga ‘growth point’ where they can purchase maize when available. Women were walking long distances and staying in makeshift shelters on people's homesteads in order to work for food to take back home to their families. Mothers of children with disabilities found this very difficult due to the child's constant sickness and so many stayed at home. Some mothers stated that some employers refused to employ them because the children often died on their premises. It is a Tonga belief that a non-relative's death on one's premises can result in bad luck for the host family. Such a situation meant a shortage of food leading to more problems for the ‘disabled family’.
Some of the households who had seed put aside had mixed the seed with sand. The explanation behind this was so that they did not consume the seed that was meant for the next planting season. Young women climbed huge trees to collect wild okra leaves. These were pounded, boiled and eaten with sadza (thick maize porridge). They also collected a dried sour fruit (busika) that would be sold for cash or exchanged for other foods like vegetables or fish. The dried fruit was mixed with porridge to make it palatable as they did not have sugar for the children's porridge. A daily diet of porridge in the morning and sadza with okra in the evening does not constitute many nutrients. The villagers admitted to drinking boiled ashes when food was scarce. Apparently, this was done just to take away hunger pains, for it is neither palatable nor nutritious.
It was common to come across cows dying by the roadside due to lack of pasture and water. This has resulted in the Tonga today having few or no cows at all. Hungry cows would disturb villagers during the night as they slept out in the courtyard. The cows would come to eat the grass on the newly thatched huts (Muderedzi, 2006). The animals that are seen most frequently scattered around the villages are the drought-resistant goats. Still, many families do not have any (p.181) goats left because they have exchanged them for food or sold them for purposes like cash for hospital fees. One family who no longer had any goats stated: “If someone gets sick in the family, we know that they are going to die because we have nothing left to sell to get them treated.”
Evidence of recklessness on the part of the government of Zimbabwe can be deduced from statements such as Didymus Mutasa's (ZANU, PF Organising Secretary, 10 August 2002) ‘We would be better off with only six million people, with our own people who support the liberation struggle. We don't want all these extra people’. The government's apparent lack of concern for the Tonga speaks for itself
“Go … the water will follow”
The Tonga do not have adequate water for personal use, let alone for other uses. Piped water was only be found in a few villages near the river. The villagers could only get water early in the morning and evenings. At the taps, women had to compete for water with goats that would visit the taps in the evening for a drink. The villagers were being made to pay a monthly fee that they stated they could not afford. When asked what would happen if they were unable to pay, they stated that the council would take a cow as payment. Those who had no animals left simply drew water from dug-up wells in the riverbeds.
Water continues to be a major problem for the Tonga women. Driving along, it is common to see women carrying large containers of water on their heads as well as on their backs so as to have enough water for the day. In some cases, mothers of disabled children brought home less water because they would also be carrying a child on their backs, and yet it is the disabled family who needs more water for the child's constant washing and changing due to diarrhea or vomiting. Women had to go to the river or borehole at least twice a day, around half past four in the morning and four in the late afternoon. Each trip would take an hour or more each way, thus four hours a day was spent just collecting water. Such a situation makes life more difficult for the women who have to work in the fields after this as well as collect firewood, cook and look after the children. To an outsider, these women seemed to spend half their lives collecting water and firewood. Local access to water would mean that the women would have more time with the children as well as time to rest and socialise.
Bathing seemed a luxury in such instances. When it came to toddlers' soiled pants, the mother would shake the faeces out and put the pants out to dry without washing them. Lack of soap and water was a common phenomenon, creating a health hazard. Lack of sanitation facilities was noted among all the families visited. In one village, the villagers used salty water for domestic purposes. They could not grow vegetables because the water was too salty. The village children were noted to have yellow corroded teeth due to the water.
Some parts of the district had boreholes that were functioning, while others were not. The rest of the district did not have any boreholes and people depended on (p.182) dug-out waterholes in the river sands, where women competed with cows, goats and wild animals for drinking water. In the middle of the hot summer, the drop in water supplies in dams and rivers affects the quality of water and this can lead to cholera outbreaks. On record is the cholera outbreak of 2003–04 that claimed several lives in Chunga Ward. This was followed by the August 2008 cholera epidemic that affected the whole country but mainly the urban poor, and left more than 1,100 people dead and more than 20,000 infected (by December 2008) (WHO, 2008). Outbreaks remained high or increased into 2009 (The Zimbabwe Herald, 3 June 2009). The Millennium Development Goal (MDG) 7 (UN, 2000) to halve by the year 2015 the number of people without sustainable access to safe drinking water and basic sanitation seems a far-away goal to achieve in this area. Lack of water for fields, gardens, animals, drinking and sanitation shows how water is connected to poverty in a broader sense in rural Zimbabwe.
Access to healthcare and education
Binga is one of Zimbabwe's most underdeveloped districts. It is linked with Bulawayo by one tarred road; the rest are dust roads in deplorable conditions. As a result, the district is not popular with bus owners who find their repair costs prohibitive. Normally, only two buses alternately ply the main road, resulting in people having to walk distances of up to 30km to get to the district hospital or nearest clinic (Langhaug et al, 2003).
Maternal deaths in Zimbabwe are increasing and continue to be a major problem. Officials in the Ministry of Health and Child Welfare stated that maternal healthcare has declined deplorably, as seen in the increase in the maternal mortality rate, which is up to 684 per 100,000 births in 1999 from 283 per 100,000 in 1994 (Government of Zimbabwe, 2004).
In Binga, lack of family planning, HIV/AIDS and women having children in their teens results in more women dying of pregnancy and birth-related problems. Stories of pregnant women giving birth by the roadside on their way to the nearest clinic were common. Pregnant women are not monitored for conditions such as diabetes, hypertension, malnutrition, bacterial and viral infections, which can complicate pregnancy and affect fetal development. Supplements such as folic acid and iron, which can prevent some deformities in unborn babies, are not available. Such a situation exacerbates the number of children born with disabilities. Economic constraints lead to home births, which in some cases puts the mother and baby at risk, making child disability, such as cerebral palsy, a byproduct of unsafe delivery. In this case, the relationship between poverty and disability is very apparent.
In 2005 The Zimbabwe Herald (14 December 2005) stated: ‘Hospital goes without doctor for six months’. A reporter wrote that Binga rural hospital had been without a doctor for more than six months, forcing thousands of patients to travel as far as Bulawayo, about 450km away. The reporter's interview with Binga District administrator, Mr Cephas Mutale, said that the situation was further (p.183) compounded by a critical shortage of qualified nurses at clinics throughout the remote district, noting ‘Our clinics are being manned by unqualified nurses; mainly school leavers, who are elevated to nurse aides after sometime – the situation is particularly difficult for women as they often develop complications during pregnancy’. In the same paper the Minister of Health's response was: ‘We are fighting at least to have two doctors in the district – It pains us as a government to have such a situation, but we are trying our best to address the situation’. A year later the situation had worsened.
Binga has an exceptionally high infant mortality rate as well as other deaths from otherwise preventable causes. Giving birth by the roadside on their way to the nearest clinic was a common cause of child disability and infant mortality. This usually took place after delivery complications at home. Respondents accorded malnutrition as the number one cause of deaths in children and remembered the food hampers that they used to receive from NGOs. This has resulted in child rights organisations stating that ‘nearly one in three children has stunted growth’ (The Standard, 27 May 2007). The second cause of death was lack of health services. Fuel shortages had stopped or made erratic the provision of the Expanded Programme of Immunisation (EPI), which may have caused deaths and disabilities due to measles complications such as encephalitis, pneumonia and diarrhea.
Malaria is rife and results in 60% of hospital admissions per year. Most parents who had received mosquito nets from NGOs and the government admitted to having sold them to get treatment for their sick children or to buy food for the family. Appropriate dressing of long-sleeved garments and socks as well as repellents was a luxury, making malaria a social disease or a ‘disease of poverty’. Due to the shortage of malaria drugs, cerebral malaria was seen to cause disability as well as deaths, especially among the under-fives and pregnant women. The Zimbabwe Demographic and Health Survey (CSO, 2006) reports that 50% of pregnant women in the rural areas access anti-malaria prophylaxis, while only 6% of children in rural and urban areas receive it. Children with disabilities were reported to suffer most due to perpetual opportunistic infections and malnutrition. It was common to come across children suffering from diarrhea and skin problems. Epilepsy was another condition that went untreated due to financial constraints.
Traditional medicine was the treatment readily available, whereby families could pay in installments and did not have far to travel. Despite the installment scheme, some families could not afford this due to lack of chickens and goats to pay for the medication. A few families were turning to Christian interventions such as prayers, laying of hands and ‘holy’ water.
Access to education is a key poverty indicator. The Convention on the Rights of the Child mandates that states should make primary education compulsory and available free, for all children. It also requires that children with disabilities should have access to and receive education in a manner that will help each child to achieve the fullest possible social integration and individual development. However, the current situation for children with disabilities from developing countries is not encouraging (Price, 2003).
(p.184) In Zimbabwe, the major reason for non-enrolment at both primary as well as secondary school is financial constraints (PASS, 2006). The second most important reason for non-attendance is long distances to school; third comes ill health.
Situated in a high poverty rural province, Binga has a higher proportion of households further away from primary and secondary schools. Primary schools were as far apart as 14km, whereas secondary schools could be 25 or more kilometres (there are fewer secondary schools). This fact alone prejudices the child with disabilities who has mobility problems. Save the Children UK (2002) stated that 50% of Tonga disabled children did not attend school. The ones attending school at the time of this fieldwork were those living near a school where they either walked or were escorted by parents or siblings.
Tonga girls get married at an early age, for example from 12 years onwards, resulting in fewer girls enrolled at secondary school.
The age of starting school ranged from five to sixteen years, with the majority starting grade 1 between six and nine years. A fraction of children with disabilities as well as other vulnerable children have their school fees paid for by the government's public assistance scheme, the Basic Education Assistance Module (BEAM), whose funds constitute a small proportion of the full fees. Parents have to pay the difference, especially at the present moment, whereby school fees can be increased twice or more per term. For a disabled child coming from a poor family, a place in a day care centre was out of the question unless donations could be found. This meant that mothers of children with disabilities had to care for their children for 24 hours of the day with no respite at all. These children were also losing out on early learning as well as stimulation activities. The district does not even have one special school. Only one primary school was said to be practising ‘inclusive education’ without specially trained teachers to handle disability. This was a class with children of all ages and different abilities.
The numerous problems faced by the Tonga have made them one of the population groups least likely to have educated children. The children have no role models and their parents still do not appreciate the importance of education due to lack of education on their part. The socioeconomic and political situation leads to the denial of educational opportunities for girls as well as disabled children. Poverty among the Tonga gets passed on from one generation to the next. The implication of lack of education is a tragedy in a community let alone a matrilineal society, seeing that education is the vital tool not only to empower women and girls but also to eradicate poverty.
In Binga, disability-related needs such as assistive devices, physiotherapy, special education and social involvement were disrupted because their basic needs of food, shelter and survival were not being met. There were no community-based rehabilitation activities in the district and the families had to make food and survival their first priority. They could not afford to travel to get such services.
Almost all the causes of disability were seen to be present among the Tonga. Some of these were malnutrition, poor child health, poor maternal health, ill-conceived policies and illnesses such as tuberculosis, malaria, measles and HIV/AIDS, among others. The two-way causality between disability and poverty was clear, thus in order to alleviate poverty it requires taking people with disabilities into account.
As noted among the Tonga, poverty is an attack on human rights. It is morally and politically intolerable that basic human rights are being violated in such a massive and constant way. People need to be empowered so as to make positive changes in their situation. Investment in education and health is one of the most effective measures for combating poverty, which is why any government have strong policies in these areas. In the light of the current economic and political crisis, it is evident that Zimbabwe currently does not operate on the basis of medium-term development plans. Rather, short-term economic stabilisation plans have become the hallmark of development planning.
A look through the lens of history shows the way a people – a social group, a subculture, a community or a whole country – is laid open by the course of important economic, political and ideological changes to new patterning of behaviour and belief, new ways of seeing what is happening to them (Mintz, 1960, p 253). On entering the villages, both the violence and the vulnerability that characterises the life of the Tonga are apparent. They are pawns in an economic and political scheme that has left them laid open. Their suffering is associated with life conditions shaped by powerful social forces. ‘Government pushes out NGOs in Binga’ (Zimbabwe Independent, 8–14 June 2007): ‘the government has ordered three quarters of NGOs operating in Binga district Matabeleland North to pull out as they are accused of influencing people to vote for the opposition during the elections … they do this every time when we are heading towards elections’, stated Ngirande, advocacy officer for the National Association of Non-Governmental Organisations (NANGO).
Achieving the international development targets for economic, social and human development will undoubtedly reduce the levels of disability in many poor countries. However, general improvements in living conditions will not be enough. Specific steps are still required, not only for prevention, but also to ensure that people with disabilities are able to participate fully in the development process, to obtain a fair share of the benefits and claim their rights as full and equal members of society. An integrated approach is required, linking prevention and rehabilitation with empowerment strategies and changes in attitudes (DfID, 2000a). This shows the significance of disability as a key development issue and its importance in relation to poverty. The MDG of reducing poverty by half by 2015 is unlikely to be achieved in Zimbabwe, and especially not in Binga, unless the rights and needs of people with disabilities are taken into account.
The case of the Tonga brings forth a situation of social suffering due to structural violence. They have been the victims of such violence for a long time, since the (p.186) building of the Kariba dam and their forced move from fertile to unfertile areas. The division of their tribe between two countries has added to their suffering by dividing kinsfolk and making important traditional rituals difficult to perform. The present-day politics of Zimbabwe, and especially the lack of interest in relieving the suffering of the poorest of the poor, has added further to their suffering and created a situation where the Tonga people of Binga are close to starvation. Being harassed by stray, thirsty elephants from Hwange, only one of many consequences of political and economic disasters, only adds to this picture.
In the midst of this, people with disabilities, especially children, are double losers. On the one hand, in many instances their medical impairments are a direct result of the failure of the government to secure healthcare and proper nutrition to vulnerable groups. On the other hand, they are the ones to suffer the most and die first. Thus any programme to alleviate suffering in Zimbabwe and countries in similar situations should make it a priority to prevent disabling conditions and give people with disabilities the best possible care – supporting not only them but also their struggling families.
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