Attitude of health authorities in Musina At a recent one day open seminar on health issues hosted by the Musina municipality, health workers raised the issue of Zimbabweans. The general policy at Musina hospital seems to be that Zimbabweans should get health care, but that because they are not South African tax payers, they should pay more. Zimbabweans are charged R75 instead of the R25 that South Africans pay. However, the clinic is free, including to Zimbabweans. Nurses mentioned a concern about pregnant girls from Zimbabwe, who do not come to the health providers until their situation is desperate. Zimbabwean women in labour with complications suddenly appear at the hospital at the last minute, with no known medical history, and this means having to deal with an emergency situation. The nurses also mentioned the problem of Zimbabweans defaulting on their tuberculosis treatment, either because they move on and then reappear months later, or because they get deported in the middle of their treatment. In general, the Musina health care system appears sympathetic to and accommodating of Zimbabweans. We did not receive accounts of Zimbabweans being denied health care here, although they did report being afraid to go to a clinic without ID, or not having money to pay for what was needed. When these anecdotes and many others were summarised, they indicated the following general categories of experience in relation to health care, in Johannesburg in particular. • • • • • It is not always possible for a Zimbabwean, or any other foreigner, to walk into a clinic and be given health care. Potential patients are invariably asked for ID of some kind, and many asylum seekers do not have ID, and at this point, some have reported being denied health care. A few reported being called “makwerekwere” and ejected from clinics for producing Zimbabwean ID, or for saying they were Zimbabwean to explain why they did not have ID. A further barrier for some refugees is money. Some have reported receiving free medical care, and others have paid small – or large - sums for it. Others have reported failing to access health care because they cannot afford to pay for it, especially for specialist treatment. However, this is much the same in Zimbabwe: many Zimbabweans now fail to access health care for financial reasons. Some Zimbabweans avoid the public health system, because they are worried about the issue of being deported. Some have been fortunate enough to use private practitioners, either because they have relatives who pay for them, or through NGOs referring them. The Methodist Church in downtown Johannesburg provides an itinerant health care programme for vagrants living on the streets, some of whom are refugees from Zimbabwe and elsewhere. Every Wednesday night, as well as providing a hot meal at various feeding points in the city, this church also hands out small packs of over-thecounter medicines to those reporting general aches and pains. Anyone who appears seriously ill or in need of a proper medical consultation, is given a letter of referral on a letterhead, to general practitioner/s who are prepared to offer this service. In the light of all this anecdotal evidence, a questionnaire was devised and 111 Zimbabweans were interviewed.152 This is not a statistically significant sample, considering the numbers of Zimbabweans in Johannesburg, but gives some further insight into this important issue. 152 See Appendix Three, second questionnaire. 65