Zimbabwe – A Future Resurrection?

By Jackie Olson

About 20 miners a year die from the desperate efforts to find gold within the caverns in Johannesburg, South Africa. Called “Zama Zama” from the Zulu tribal phrase: ‘men who try to get something from nothing’ this group of Zimbabwe men travel to South Africa in a desperate attempt to find gold and to provide for their struggling families back in Zimbabwe. While the activity is illegal, the seriousness of their ‘illegal’ activity is certainly unequitable to the illegal activity of Zimbabwe’s 92-year-old president, Robert Mugabe.

Robert Mugabe took office in 1980 after a brutal civil war and was at first proclaimed as a leader who could positively impact Zimbabwe. Yet after nearing the end of his seventh-term in office, he is considered by the west as a leader of a regime that has invoked economic and political oppression on its people.

In 2009, Zimbabwe was infamously known for their massive hyper-inflated currency, which at one time hit over 231 million percent from a combination of a 50% shrinking economy, poor crops and public corruption in the midst of a political rebellion against Mugabe. In order to save Zimbabwe from utter economic destruction, Zimbabwe changed currencies and adapted the U.S. dollar for greater protection from internal insecurities.

Since 2016, rough estimates have placed Zimbabwe’s unemployment rate at 90%. With a failing agriculture and industry economy, Zimbabwe has had to increasingly rely on imports for products. As the economy is beginning to look similar to the one in 2008, the government has taken extra precautions in preserving the quantity of U.S. dollars in the treasury. This has resulted in the freezing of payments to many government workers such as teachers and civil servants and has also caused an increased amount of public demonstrations of unrest.

Yet, in order to combat activism on the streets, a local NGO has estimated that over 654 cases of political violence has come from government security officials, including police, military, and a secret service unit just from 2016 alone.  Reports have found that detainees have had to face sexual violence, were injected with mysterious substances and were hung over large pots of sulphuric acid to discourage them from more activism.

These troubling reports have certainly not helped Mr.Mugabe’s case in pressing the IMF for economic relief as the IMF has been reluctant in even providing support without any change in Zimbabwe’s governmental structure, especially the fact that 97% of all government spending is used to pay the governmental workforce. Zimbabwe has refused to make any spending cuts.

As a desperate-last ditch effort, President Mugabe on November 28 ordered to print a new currency, a Zimbabwean currency that looks almost identical to the note used during Zimbabwe’s hyper-inflated period in 2008-2009. Orders were then given to stock ATMs in millions of the new $2 and $5 note with the hopes that only larger bulk import purchases would need US Dollars for a transaction. The switch to Zimbabwean currency has caused civil anxiety and many people have rushed to banks to withdraw as many US dollars as possible resulting in long lines and unrest.

Many economists worry that Zimbabwe’s turn to an insulating currency will be highly detrimental to Zimbabwe’s economic health as foreign demand for the currency will be next to nothing.

For months the imminent disaster has led many Zimbabwean people to turn to plastic payment, either from debit card machines or services on a mobile phone. Services such as gambling, supermarket purchases and even donations to churches has been adapted to a plastic transaction as money has been so scarce. In rural villages where technology is not as prevalent, transactions have been left to bartering.

This vacuum of money has provided a perfect opportunity for a growth in inequality as only the wealthy has been able to open debit accounts. The poor are left to struggle without the basic tool to trade, money, and are forced to buy cell phones for access to a mobile banking service from individuals who realize the opportunity to make massive profits out of people’s desperations.

For example, take village trader, Fambai Mudzaniri who has been consistently making 500 dollars a month from the shortage. He goes into the town and buys $13 dollar phones and resells them to poor villagers for a goat or a few chickens. He then takes the livestock and sells them to restaurants for $50 dollars each.

Unfortunately, the troubling economic conditions and corrupt government will be unable to provide for the eventual widening of the inequity of Zimbabwe and the increased amount of civil unrest from droughts, a lack of food and opportunity. Fortunately, though, Robert Mugube is currently the world’s oldest leader and even though he is looking for ‘re-election’ in 2018, he has even acknowledged his own death in 2016 with the public statement: “Yes, I was dead-I resurrected.” Hopefully within the next decade Zimbabwe will resurrect too.

Peace Deals and Populism in Colombia

By Adithya Sivakumar

2016, regardless of its flaws, was a reactionary year. However, the interesting component of decisions made throughout this cycle has been that populism, not necessarily politicians, have fueled these choices. From Trump to Brexit, voters have signalled a wakeup call to the establishment, letting them know their voices are loud and present. Colombia, a nation in the upper region of South America, was one of the countries to fall victim to the incendiary political forces of this wild year, where a peace deal between the country and an rebel group was put up to the scrutiny of the nation’s voters, leading to a surprising result.

Created in response to perceived government neglect, the Revolutionary Armed Forces of Colombia (FARC) was first a group that protected rural communities from government attacks, but soon developed into a group that participated in kidnapping and drug trafficking to pay for their expenses. Despite a peace deal in the 1980’s, conflict between the government and FARC continued, with major crackdowns by the government and renewed attacks by the group leading to further violence. After years of war between the Colombian government and FARC, both sides finally sat down and hammered out a peace agreement earlier this year, under the watchful eyes of various other countries and organizations, including the Roman Catholic Church and Cuba.

For the peace agreement to be put into effect, however, the Colombian people needed to ratify it. In Colombia, just like other nations around the globe, a choice with wide-ranging implications was to be made by its population.To an outsider, the decision may seem simple. Peace seems the safest way to proceed, and could heal the divide caused by years of war. It seems like a no-brainer, right?

The Colombian people, however, did not think so.

In a decision that shocked the world, the peace deal was rejected in a razor-thin margin, with 50.2% saying “No” to ratifying the peace deal. Despite backing from the Prime Minister of Colombia and various members of the United Nations, the deal failed to be enacted by less than 54,000 votes. The voting turnout was low, which may have contributed to the decision, but many were confused as to why this rejection had occurred in the first place. Were those who voted against the deal less willing to compromise with FARC, or less affected by the conflict than those who voted yes to the deal? Or, as seen with Brexit and Trump’s win in the United States, was this simply a rejection of the establishment’s position on a certain position?

Turns out, it was a mixture of some of these factors. Many who voted “no” did not necessarily reject peace, but rather rejected some of the terms laid out in the deal, which were viewed as too lenient in some views. For example, provisions that allowed those who confessed to war crimes more lenient sentences and gave a monthly stipend to demobilized rebels were seen as too much for some citizens. Additionally, these voters may have been distrustful of FARC due to its violation of ceasefires in the past. Alvaro Uribe, the primary opponent of the peace deal and also a President of Colombia during a crackdown on FARC, insisted that he wanted peace, but wanted, among other stipulations, that those convicted of crimes were to be barred from political office and FARC leaders spend time in prison.

However, unlike many populist movements around the world, the decision in Colombia was unique in that it demonstrated a urban-rural divide in terms of the vote. Urban areas, which had been shielded by the conflict, primarily voted no, while rural areas, who were experiencing the brunt of the conflict, voted yes. Therefore, the vote did not seem strictly defined by populist sentiment, but rather various other factors that may in fact indicate an elitist sentiment among those who voted no.
With these factors in mind, both the Colombian government and FARC sat back down at the negotiating table to create another settlement, one that would take the concerns of the voters into consideration. More severe restrictions were imposed on rebel movements, while rebels would also be required to reveal drug-trafficking routes to the government. After these changes were sown into the deal, the Colombian Congress approved the deal unanimously, bypassing the will of the voters and leading to a new peace in the Colombian nation. Although the deal was approved, the nation will have to deal with the lasting after-effects from the war, in which more than 260,000 have died, at 79,000 have gone missing, 30,000 have been kidnapped, and 7 million have been displaced. The new outcome gives a wider berth for hope in Colombia’s future, and it is up to the government, FARC, and the people of Colombia to actively participate in the next steps of the reconciliation process in the region’s longest-running conflict.

Electronic Medical Record for Clinic Growth in Rural Guatemala

By Benjamin Li, MD/MBA expected 2018

Purpose: Describe the Primeros Pasos clinic and provide context for its current growth strategy: developing an electronic medical record system.

In 2004, a Vanderbilt medical student founded a non-profit primary care clinic to address health disparities in his home country, Guatemala. Like many developing countries, Guatemala struggled to provide access to health care throughout many parts of the country, especially rural areas. Located outside of Quetzaltenango (the second largest city in Guatemala), the Palajunoj Valley is an agricultural community of 18,000 inhabitants. Though situated in a beautiful landscape, it struggles with no access to clean water, heavy ash from the nearby active volcano (volcán Santa María), and poor education and nutrition. The Primeros Pasos Clinic provides care for this population.

Each year, Primeros Pasos has continued to grow through the collaboration of medical students, volunteers, and professionals. In its inception, the clinic served children from local schools. It expanded to include adult services in 2007, laboratory services in 2009, dental care in 2010, and a nutrition program for health and education in 2012. It is currently staffed with a clinic coordinator, a dentist, a pathologist, two Guatemalan physicians, six to eight rotating Guatemalan medical students, and a host of international medical volunteers who come and go throughout the year, usually one to three months at a time. It has established several partners, including local businesses, Spanish schools that provide education and lodging for volunteers, and global health alliances. The clinic treats four main conditions: intestinal parasites, respiratory illnesses, skin lesions, and malnutrition.

Like many developing clinics in poor regions, Primeros Pasos provides most of its care at low or no cost, so it relies heavily on outside funding. The clinic coordinator is responsible for applying for numerous outside grants throughout the year. In addition, each international volunteer is expected to fundraise $300 for the clinic. Vanderbilt Medical School organized a “Miss America” style event called the “Dr. Vanderbilt Pageant” to fundraise $2000 for the clinic in 2016. The clinic currently hopes to use this funding to acquire a new electronic medical record system (EMRS).

The new system, OpenMRS Software, is an open source EMRS platform commonly used to improve health care delivery in the developing world. It is designed to be adaptable for different sites, languages, and types of diseases. First implemented in Kenya and Rwanda in 2006, it is now used throughout the world.

As the clinic coordinator explained, this new system would open a whole new pathway for Primeros Pasos. Currently, the clinic operates with a handwritten paper/Microsoft Excel hybrid system in which patient records are kept in color-coded folders (pink for females, blue for males) stored alphabetically in three large filing cabinets in the clinic. The new system improves difficulties that range from illegible handwriting to providing unique patient identifiers (many people in the valley share identical names), and creates an organized way to streamline care, track patients, and collect information. Improving efficiency allows the clinic to see higher volumes of patients. This will encourage patients to return to the clinic for routine healthy check-ups, instead of just when they are ill.

On a significant note, the new EMRS opens avenues for greater funding. Many large grants require data and metrics to support program efficacy. Primeros Pasos will be able to use OpenMRS to collect, centralize, and report patient data (health demographics, diseases, treatment, outcomes, and more), allowing it to access this pool of funding. Furthermore, statistical reports can be used to evaluate and improve medical program design, approach, and policies to most effectively optimize patient care and outreach.

The steps towards this growth would not have been made possible without the interest and contribution of student volunteers and Global Health programs. Though short-term visits may appear to offer limited impact, Primeros Pasos is an example of a clinic that has benefited steadily through the years with continued support. A key component to its success has been establishing a long-term vision and a diverse board of members to oversee its growth and operations. Particular credit should be given to the clinic coordinator, who has been able to track the progress of the clinic, develop partnerships, spearhead finances, and update goals and initiatives while managing its volunteers. The clinic imparts a lasting impression on its volunteers, which serves as a testament of its collaborative success.