Harare, Zimbabwe – In December 2021, Setfree Mafukidze, his wife and four children moved to Somerset in the United Kingdom, joining a long list of health workers who have fled Zimbabwe to escape economic and political turmoil.
For four years, he had worked as the head nurse at the only clinic in Chivu, a town about 140km (90 miles) south of Harare.
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By his estimate, he cared for more than 10,000 people there. Despite earning only about $150 a month, he would often dip into his own pockets to pay his patients’ bills.
Once, a patient with meningitis needed $200 to buy lifesaving medication, a huge sum in a country where a third of the population live on no more than $1 a day. Neither the patient nor his mother had the funds, so Mafukidze appealed to well-to-do Zimbabweans in the diaspora to help. After they did, he drove back and forth to the capital, Harare, to get the drugs.
For Zimbabweans who saw people like Mafukidze as heroes, their departures are seen as a great loss.
“He would attend to people at any given time during emergencies and could make follow-ups at our homes,” said Tawanda Mabuwu, a Chivhu resident. “When my sister who was his patient died after he departed for the UK, he sent his wife with clothes for Christmas for the two orphans my sister left. He was just good, and we keep on losing our best.”
After Brexit in 2016 and COVID-19 four years later led to a shortage of skilled professionals in the UK, the country eased entry rules, leading to an increase in work visas issued to foreign health and social care workers.
From September 2022 to September 2023, 21,130 Zimbabweans were given visas to work in the UK, according to Home Office data. It was a 169 percent increase from the same period the year before, putting Zimbabwe among three countries – alongside Nigeria and India – with the largest number of citizens heading to the UK on this visa.
In November, the World Health Organization said the number of public sector health workers in Zimbabwe had been reduced by at least 4,600 since 2019 despite increased recruitment.
Five health workers told Al Jazeera they would jump at an opportunity to work abroad. Dozens of WhatsApp groups have been created with those who have left offering tips to members who are looking to leave or are in the process of doing so.
“Nurses in Zimbabwe are not paid well enough to stick around when an opportunity to leave arises. It’s all about remuneration. It’s all about conditions of service,” said Mafukidze, who decided to leave to give his children better opportunities and advance himself academically.
A healthcare worker who spoke on the condition of anonymity to Al Jazeera said he used to earn the equivalent of $150 per month but now gets 3,000 pounds ($3,782) per month after taxes.
Beyond pay, many healthcare workers in the African nation said they opted to migrate because of the general state of the healthcare sector. Health training schools are ill-equipped and have too few tutors. Hospitals lack functioning equipment and have inadequate drug supplies and poor working conditions.
The situation has been worsened by a deepening economic crisis that President Emmerson Mnangagwa has been unable to halt since toppling Robert Mugabe in November 2017 in a military coup.
“At the moment, there are shortages of staff, leading to burnout to those who are there. … The buildings are dilapidated. People need competitive salaries, and the issue of the economy must be addressed,” said Enock Dongo, president of the Zimbabwe Nurses Association.
Zimbabweans living in border towns are increasingly crossing to neighbouring South Africa and Zambia for healthcare. In 2022, an official in South Africa’s Limpopo province was caught on camera saying the country’s healthcare system was being overwhelmed by an influx of Zimbabwean patients.
Donald Mujiri, spokesperson for Zimbabwe’s Ministry of Health, did not respond to Al Jazeera’s questions about the continuing migration or the state of healthcare in Zimbabwe.
A continuing dilemma
Despite being separated by oceans, many health workers abroad still keep in touch with their former patients and become sad whenever they get news of a death.
“I’m emotionally attached because I know that when someone has to reach a person who is more than 10,000 miles (16,000km) away from them for that kind of assistance, it means there is a gap. There is definitely a gap,” said Mafukidze, who is in his 40s.
That continuing bond has now led to a personal dilemma for dozens of these emigrants watching helplessly as Zimbabwe’s healthcare system and economy continue to deteriorate: to remain in their new homes where their time and talents are better rewarded or return home to help the patients they left behind.
“I have had a long list of patients, people who believed in my services, who constantly reach out to me, … and I have constantly helped them over the phone, but I have always felt I was better off on the ground,” Mafukidze said. “Unfortunately along the way, some have been lost, and it gives me some sadness to say maybe if I was there, things could have been different. … That feeling grips me [like] I neglected people back home.”
He delivers consultations virtually by WhatsApp or calls, focusing on diabetes care after having lost his mother to the ailment when he was only 12 years old.
Another nurse who left for Somerset in 2019, Tapiwa Mujuru said he was attached to teenagers who were born HIV-positive while working at a Harare facility.
“I used to tell them that they were going to make it, … but when I told them I was leaving, I saw self-doubt in their eyes. To tell you the truth, I felt bad about leaving, but I had to leave. I feel better that we still talk on WhatsApp,” he said.
In one WhatsApp group with 48 health workers, there was a unanimous agreement that they would like to return home one day. In similar groups, the matter is being debated too.
In one such group, members said once they build houses in Zimbabwe and secure their future through investments and savings, they will return. But for now, they are staying away until the pay increases and working conditions improve.
The group’s members have other complaints. The list of patients at British public hospitals are longer than back in Zimbabwe. For instance, waiting times for general practitioner appointments often take three to six months. Some said they are still finding it tough adapting to the weather. Others feel homesick and crave the communality and social life back in Zimbabwe.
Some nurses also said they need a second job to get by. While they earn more, their bills have increased. But the skilled worker visa allows them to work only 20 extra hours at a second job, Mafukidze said, so finding one is tough.
Back in Zimbabwe, there are calls for them to start returning home to help rebuild.
Professor Solwayo Ngwenya, clinical director at Mpilo Hospital in Zimbabwe’s second-largest city, Bulawayo, once worked in the UK’s National Health Service. Six years after leaving for the UK, he retraced his footsteps and set up the 30-bed hospital he now heads.
“I had always wanted to return home, where I always felt I would do well and treat the local population. … I returned home in 2006 since I had accomplished what I had set out to achieve and for personal reasons,” he said.
He attributes his later achievements in life to returning to home soil and believes “home could be the best”.
Mafukidze is convinced that he and some of his peers abroad will return to Zimbabwe one day to help their compatriots.
“I know these people need me,” he said.
N.B. All dollar figures are in US dollars due to hyperinflation and the rapidly changing value of the Zimbabwe dollar.