The blazing heat of the noonday sun beats down on the vehicle as we make our bumpy way down the dusty road en route to The Salvation Army's Howard Hospital in Zimbabwe. The land is parched; the air is dry and hot with a hint of smoke. Locals smile and wave, or glance quizzically as we go by.

We drive past animals gently grazing in the fields, a river where groups of women busily wash their clothes, while others transport bulky bundles of firewood on their heads and children freely roam, clambering over rocks and playing in groups. Eventually we arrive at Howard Hospital at the end of a rutted road. As we make our way to the places we will stay for the duration of our visit, delightful children shout out eager greetings in tuneful chorus: “Fine! Fine!” “How you?”—desperately wanting to practise their English on us.

A History of Hope

The Salvation Army has served the people of the Chiweshe community since 1923 when Howard Institute, a school, was founded some 80 kilometres north of the Zimbabwean capital, Harare. The need for quality medical services became apparent as Salvation Army officers with little medical training initially carried out these services, so the hospital opened in September 1928, with a nurses training program being added a year later.

During this time the hospital offered first-rate medical care to the people of the area in conjunction with nurses, support staff and a succession of health practitioners. Today, Howard Hospital offers its services to more than 250,000 people in and around the rural community of Chiweshe.

The 144-bed hospital runs a considerable number of community-based programs, in-patient and out-patient care, as well as a mobile clinic that provides immunization programs and family health programs in the rural areas. With the advent of the HIV-AIDS pandemic in sub-Saharan Africa, the hospital gave hope by offering wide-ranging treatment at the Tariro clinic through its counselling centre and antiretroviral therapy. In addition there are a number of orphaned and vulnerable children's programs and child sponsorship programs for children affected by HIV-AIDS.

The local headman, Thomas Mudyiwa, is well respected in his community and has been headman for 27 years. He told me: “Howard Hospital is our hospital and it helps the community very well.” He went on to say that he prayed the hospital would maintain its valued position in the community because, in helping this rural area, it helps the whole nation. He explained that people travel for quite a distance to access the medical services provided by the hospital.

Patients even travel from Harare. One told me: “I come here because the staff really care!” Howard Hospital has a reputation as a centre of excellence and it is common practice for government hospitals to refer patients there.

People wait to see doctors in the out-patient department. Many travel for quite a distance to access the medical services provided by the hospital

Hope for Today

Howard Hospital has a nurse training centre offering three residential training courses: a primary care course, a diploma in midwifery and a six-month upscaling midwifery course. The first is two years and prepares nurses to work in clinics in rural areas, at a grassroots level, which is vital in this area. It enables young men and women to embark on a career serving people who are in great need of medical help and care, but who live in remote areas. There are currently 40 student nurses involved in the training program.

Major Joan Gibson, originally from Scotland, is a highly experienced clinician and outstanding teacher who heads up the program. She has worked as a nurse in Africa since 1977 and at Howard Hospital since the 1980s.

The student nurses, who come from across Zimbabwe, undergo a rigorous selection process through the local health and medical council to train at Howard. They apply to train at Howard Hospital because of the quality of teaching and facilities, and the ethos of the hospital. Dr. Tshuma, provincial medical director, praised the facility, saying: “The training centre has a high pass rate. Nurses who have graduated at Howard are well qualified.”

As I visited the labour ward, I learned that approximately 1,000 babies are safely delivered at the hospital each year. They have a mothers' shelter for women who are 34-35 weeks pregnant but who live some distance from the hospital. It is more beneficial for them to await the birth of their baby in the shelter rather than in a rural area, where there is no medical provision.

The pregnant women, or “ladies in waiting” as they are fondly referred to, are also able to stay in the shelter until after the birth of their babies. When they go into labour in the shelter the other women offer support and take the mother-to-be to the labour ward while they eagerly await news of the arrival of the baby. The hospital also has a small neonatal unit which provides more specialized care for up to eight babies.

Mothers are kept in the hospital for three days to ensure that they make a full recovery after the birth, and during this time are taught basic hygiene and how to care for their babies. Great emphasis is placed on breastfeeding.

The hospital also provides Family Child Health (FCH) programs that include antenatal and postnatal clinics, family planning, immunizations, good nutritional information and general support and guidance.

Howard Hospital is not exempt from problems or political and social upheaval. However, despite this it is running well and treating patients as usual. Medical cases with complications are referred to Parirenyatwa Hospital in Harare (the largest hospital in the country) but rural clinics continue to refer patients to Howard Hospital for care.

From left, Dr. Chikwenjere, Mjr Joan Gibson, Dr. Museka outside the training centre

Continuing its fine reputation for good facilities, practice and staff, Howard's medical team treats a significant number of people. In the first half of 2013, some 60 in-patients were treated at the hospital each night, the majority in the maternity ward. On average, 150 people daily attend the out-patient department, the antenatal clinic and the Tariro clinic, which supports HIV-AIDS patients and other community-based services such as home-based care and programs for orphans and vulnerable children.

Following the departure of the previous chief medical officer (CMO) in July 2012, Howard Hospital has been in a state of transition, with the number of patients and surgical procedures reduced as complicated cases were referred to the provincial hospitals in Harare and Bindura, an accepted practice for a rural district hospital.

Howard Hospital has maintained a surgical capacity throughout 2012 and 2013 since the two Zimbabwean doctors, Dr. Museka and Dr. Chikwenjere, are trained to perform a number of surgical procedures, including Caesarean sections. Historically, it has not always had a trained surgeon on site.

Dr. Tshuma told me: “Generally, the situation at Howard is improving. The workload has changed and there has been a decline in patients, but this is due to misinformation, since the community believed that there was no longer a doctor at the hospital, so they went to other hospitals looking for one. When they presented at the other district hospitals in the area, the staff informed them that there were two well-qualified and able doctors at Howard!

“People have now returned to Howard Hospital and are utilizing the general services there. This affected the general wards, not the maternity care provided by the hospital. This is reflected in the increase in the Performance Results Based Financing.

“The hospital no longer has a specialist gynecologist, but it is now the same as the other district hospitals in terms of referral levels. District hospitals do not necessarily offer specialist obstetrics services. Patients are referred to hospitals in Bindura or Harare for this specialist care.”

The Salvation Army in Zimbabwe is a member of the Zimbabwe Association of Church-related Hospitals (ZACH), whose executive director, Vuyelwa T. Sidile-Chitimbire, recently confirmed that Howard Hospital is “fully functioning and providing health care and service delivery for the poor and vulnerable communities within its district.”

People wait to see doctors in the out-patient department. Many travel for quite a distance to access the medical services provided by the hospital

Mjr Sandra Welch (left) visited the labour ward, where approximately 1,000 babies are safely delivered each year

Bright Hope for Tomorrow

Plans to complete the construction of the new Howard Hospital buildings, which commenced in 2000, are now underway and have been agreed by the hospital management team, the Zimbabwe Territory and International Headquarters (IHQ). While this capital project is taking place, the Canada and Bermuda Territory is ensuring the effective operation of Howard through an agreed sustainability plan. With the construction project now in its second phase (working with plans approved by the Ministry of Health and Ministry of Public Works in Zimbabwe), a project manager has been retained, a contractor identified and final contract discussions are underway. It is hoped that the new building will be completed in 2014.

The funding to complete the new hospital has been donated by the USA Eastern Territory and is being held at IHQ. These resources will be fully utilized once plans for the building are finalized. The move to the new premises will result in changes which will improve the quality of sustainable care, and plans will be developed locally.

The theatre wing of the new hospital is being restructured. There will be two theatres offering surgical procedures based appropriately on the capacity of resident staff.

The hospital's volunteer program, which drew in medical staff from overseas, was unexpectedly halted in 2012. A few volunteers have worked at Howard in 2013, albeit fewer than in the past. The hospital plans to restart the program in the future, but not at the same level of intensity as in the period of 2005-2012.

Initially, the desire of the Zimbabwean Salvation Army leadership was to appoint a Zimbabwean Salvationist as CMO but this did not prove possible. IHQ approached Dr. Zairemthiama Pachuau, the CMO at The Salvation Army's Chikankata Hospital in Zambia, in October 2012.

Dr. Zaia (as he is known) was willing to move but it took time for him to obtain a visa. When he arrived in Zimbabwe, the Medical and Dental Council did not accept his Zambian registration and required him to work for three months in government hospitals. The lengthy probationary process is now complete and Dr. Zaia took up his appointment as CMO on August 29, 2013.

Dr. Zaia brings a number of skills to his new role, including post-graduate diplomas in HIV management and hospital administration, a master of philosophy in health-care management and industrial psychology and an MBA in leadership and entrepreneurship. He worked as CMO at Chikankata for five years and is a highly skilled physician.

Dr. Zaia says that practising medicine in rural Africa presents difficult and challenging circumstances, yet he and his team have a high success rate in meeting patients' needs. He says: “I see miracles every day. I don't only believe, I see.”

A Swedish surgeon, Dr. Per-Göte Lindgren, has also been appointed to join the team at Howard to train the existing medical team in more advanced surgical procedures and to strengthen the health system at the new hospital. The Medical and Dental Council has assured the Army that it can register him for this work.

Dr. Lindgren will not work as a general medical officer; his focus will be surgical training. He will also oversee the move into the new building and the development of management and clinical systems to improve the quality of care and services.

The period of 2004-2012 saw the development of an extensive surgical program at the hospital which stretched the hospital's capacity. Before 2003, the hospital operated at the level of a rural district hospital with some additional services depending on the capacity of the staff at the time. The intention is to return to this sustainable level of working.

The Tariro HIV program has worked without disruption since September 2012, as has the tuberculosis prevention, treatment and care program. Changes in government policy have meant that more people can access their antiretroviral drugs closer to home, so there is some reduction in patient numbers at the Tariro clinic, but this is not driven by shortages of supplies or staff.

The program for expectant mothers with HIV to receive antiretroviral treatments prior to the birth of their babies is unchanged and is implemented by staff who were in place before 2012. Having commenced in January 2013, the numbers of recipients of this five-year USAID-funded program are independently confirmed through project reports submitted to USAID, and funding is only released if the program is meeting its objectives.

A soon-to-be launched Howard Hospital website will enable people to follow the progress of the hospital and provide information about programs and services.

So the story of tariro (hope) which began more than 80 years ago continues in the Chiweshe community as The Salvation Army works to improve the services at the hospital, remaining committed to its future and serving the complex and challenging country of Zimbabwe.

Major Sandra Welch was born and grew up in South Africa. She is currently editor-in-chief at International Headquarters.

(Photos: Major John Murray, IHQ communications secretary)

New and expectant mothers wait to see the nurse at the hospital clinic