Dr. Angus Macleod

Mbuma, in a rural part of Zimbabwe near the Shangani River, is an unlikely location for a busy hospital. After a long drive north from Bulawayo, the nearest city, along corrugated dirt roads through mopane forest and past scattered villages, Mbuma Mission Hospital appears suddenly out of the African bush. I recently visited and witnessed first-hand how it plays an important role in the prevention and treatment of illness in a large rural area while bringing a remarkable number of people into contact with the gospel. Clinical work at Mbuma. The hospital consists of four inpatient wards: a female adult ward, a male adult ward, a children’s ward and a labour ward. These are usually full, often with extra patients sleeping on mattresses on the floor under other patients’ beds. The outpatient clinic has nurse-led clinics five days a week and the doctor’s clinic three days a week, often running until 9 or 10 o’clock at night. The maternal and child health department is busy with antenatal and postnatal clinics. Elective surgery takes place in the operating theatre one day a week, with further emergency operations at other times, as needed. Minor procedures, such as setting fractures in plaster or tooth extractions, take place in the procedure room. Compared with hospitals in any Western country, the available diagnostic investigations are basic. Digital x-rays and ultrasound are readily available but more sophisticated scans, such as CT or MRI imaging, require a journey to Bulawayo (about three hours’ drive) and a fee of several hundred US dollars, which many patients simply cannot afford. There is a laboratory on site, where testing for TB and HIV is readily available, but many simple blood tests, such as kidney function testing, are not available at present due to lack of necessary reagents. The staff at Mbuma often therefore have to rely on their clinical skills in situations where tests would otherwise give a ready and reliable answer. The Mbuma Mission is a hive of activity. About 100 staff members live and work on the site. Most inpatients have an accompanying family member to help care for them, who will sleep on the concrete veranda at night with only blankets for a bed. Long queues of outpatients are present in the clinic during the day, and at any one time about 50 pregnant women live in a dormitory at the hospital. These women come to be near the labour ward in the last month of pregnancy, given the lack of transport to get them to the hospital expeditiously when they go into labour. The church and the primary school are on the same site as the hospital. Dr Snoek has been the doctor at Mbuma since 2005; more recently assisted by Dr Janse, who was on leave while I visited. Dr Snoek has a remarkable breadth of skill. By contrast to most Western hospital doctors, who are increasingly specialised, she ably combines the role of general physician, infectious diseases physician, emergency physician, general surgeon, urologist, gynaecologist, obstetrician and paediatrician. Working long hours, and dedicated to the work at Mbuma, Dr Snoek has built up the reputation of the hospital, together with Sister Geurtsen and the many others who work so hard at the hospital, so that people come from far beyond the catchment area. Some even come from neighbouring provinces and from Bulawayo seeking good healthcare. One patient I met had travelled home from South Africa to be seen at Mbuma. Medical work also takes place in several nurse-led peripheral clinics and many community workers provide basic health care and health education over a wide area. Many patients seek medical attention later than is common in the UK and often come with multiple problems. One sad case I saw was a seven-year-old boy who came to the outpatient clinic looking very ill. Not only had he HIV (transmitted from his mother at birth, but previously undiagnosed), but also tuberculosis and anthrax in the skin, the latter from eating meat from an infected cow. It was good to see him looking cheerful after a few days of appropriate treatment. A young man had a tumour growing slowly in his neck for 11 years before he came to the hospital. He eventually came because he had developed severe weakness in all his limbs and was unable to walk. A scan showed that the tumour was invading the spine, with compression of the spinal cord causing the weakness, but it had also spread into the brain. Unlike the seven-year-old boy, who was doing well with treatment, sadly nothing could be done about this lad’s tumour. Some diseases are much more frequent there than in the UK. Gastro[1]intestinal infections are common in those who drink dirty water from the river or from dams. Pneumoconiosis – damage to the lungs from breathing dust – is common in mine workers due to inadequate personal protective equipment. Mortality before and after birth is higher than in richer countries: one morning I was there two babies died, one still born and the other only hours old, though this was unusual. On the other hand, there were many similarities to the UK: chronic diseases such as high blood pressure and diabetes, injuries due to drunkenness or accidents, and various cancers are all common. One major problem, which is worthy of note, is the difficulty of retaining trained nurses and midwives at the hospital. Many leave to work in the UK, where pay is much higher than in Zimbabwe, and their skills are sought to fill gaps in nursing rotas here. When we hear people talk about shortages of nurses in the UK, we should remember that relative to Zimbabwe we have an abundance of nurses. Given their vastly greater need, it seems deeply unfair to the people of Zimbabwe that a rich country such as ours should steal their doctors, nurses, midwives – and teachers. Spiritual work at Mbuma. While the medical work of the hospital is important, the spiritual work is much more so. The aim of the Mission is that everyone who comes to the hospital will hear about the gospel. At the two services on Sabbath, the gospel is preached to a large congregation, and more attend the Thursday morning prayer meeting, when the benches at the front of the church are filled with primary school children. For those of us who are used to very small congregations in Scotland, it is encouraging to see so many hearing the true gospel being preached and particularly that so many are present who belong to a variety of sects or churches where a false gospel is preached. There is no minister in Mbuma at present, so the services are taken by an elder, divinity student, or visiting minister. Another part of the spiritual work is the morning and afternoon worship. Every day, at 7.15 am and at 4 pm, the staff members and patients who are able, together with patients’ relatives and the women in the dormitory, gather in the veranda of the outpatient clinic for worship. Well over 100 people gather for these times of worship – for Psalm singing, prayer, and a Scripture reading – and the hearty singing can be heard all over the hospital. The catechists have a vital role in the spiritual work at the hospital. I previously visited Mbuma in 2002 and was disappointed that no one was focusing on the spiritual needs of people at the hospital, so I was pleased to find that there are now four catechists working at the Mission, who have many valuable roles. They speak to the patients about sin and salvation – both inpatients and outpatients, often one to one – during their time at the hospital, pray with them and read the Scriptures with them. They take morning and afternoon worship, and lead Bible studies. They also have a role in counselling particular patients where needed, such as a teenage girl I met who was in hospital after making an unsuccessful suicide attempt when she discovered she was pregnant. They also play a part in health education, such as warning people about the dangers of harmful traditional practices. One of these is to hold babies in the smoke over the fire, supposedly to help the closure of the soft parts of the skull. The smoke, unsurprisingly, can damage the baby’s lungs, but these efforts have been successful in leading to a marked reduction in the number of babies with health complications from this practice. A particularly enjoyable aspect of spending time in Mbuma was the Bible studies. I attended three in the week I was there, although others also took place. On Sabbath afternoon, there is a Bible class for everyone at the hospital, with a similar attendance to the daily worships. They are currently going through Revelation, and the discussion on the occasion when I was present was about the locusts in chapter 9. While this may seem an obscure text for a mixed gathering, it was a profitable discussion, in which the locusts were considered as a picture of false teachers. Mr Nkiwane, the head catechist, used his personal experience of being under false teachings in the past to warn those present about the dangers of false prophets. It was clear that most present were listening intently, including the pregnant women, who mostly do not belong to the Free Presbyterian Church. On Thursday evening there was a Bible study for the senior management at the hospital, when we profitably discussed a verse in Jude. On Saturday morning I was invited to join the trained nurses’ Bible study. All the nurses present participated in the discussion on John 17:24. The questions asked and points made were thoughtful and pertinent. Some of them gave evidence of spiritual understanding and appreciation of the profound truths relating to the glory of Christ. Conclusion. A remarkable work is going on at Mbuma, which is worthy of our support and prayers. There is a continual need of financial support, for which we have the encouragement that “God loveth a cheerful giver” (2 Cor 9:7). But, more importantly, there is a need for prayer: that those who work there would be helped and encouraged; that those who are sick might have suffering eased and recover, where it is God’s will; that a minister would be provided for the congregation; and, above all, that an abundance of spiritual blessing would follow the gospel work there. We should seek grace to be assiduous in prayer for the Mission and to be kept from formality in asking for God’s blessing on its work. “The effectual fervent prayer of a righteous man availeth much” (Jas 5:16).

Taken from Free Presbyterian Magazine, July 2023.