Conversation with…Tinashe Goronga, Junior Doctor in Zimbabwe

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Tinashe is a 29-year-old doctor at Binga District Hospital. He trained at the University of Zimbabwe and obtained his medical degree in 2016.

He has an interest in human rights including sexual rights and gender equality and serves on the board of The Sexual Rights Centre, a Bulawayo-based organisation that works with sex workers and sexual minorities. He is associated with the Social Medicine Consortium, a collective that fights for health equity with social medicine at its core. He serves on the global leadership of the SMC Global Campaign against racism.

Outside of the clinic, he is a member of the Wildlife and Environment Zimbabwe Matebeleland Branch. He’s also a member of East Africa Rising, a collective of young professionals interested in pan-Africanism and development of the continent.

You qualified nearly 3 years ago. Is medicine anything like you thought it would be?

To be honest I didn’t have very high expectations of life after medical school. I thought it would be much easier than it is though, with less pressure and a bit more respect. I thought there’d be less studying, you’d know everything and could solve all problems. I guess it depends on the context in which you work.

I realised I didn’t know as much as I thought I knew! It’s one thing passing an exam but another thing working on the ground and having to solve real problems, especially after being in a system where it was about cramming the knowledge in and not necessarily applying it. Few patients come in with textbook symptoms. You must apply the knowledge, search and work things out.

What was most surprising for you?

I was surprised at how much work I had to put in after graduation. I still had to read just as much as I did to keep up with what’s happening and trying to discover what I was passionate about now that I was in the big, wide world.

It was like starting all over again to be honest!

Tell us about your current job?  

I work as a general medical officer, which is like a general practitioner, at a district hospital in a rural part of the country. Basically, I see all the cases that come in and have to decide if someone needs specialist care or if I can manage them as a general practitioner. I also work in surrounding clinics and do some administrative work mostlyaround planning.

What’s a typical day for you?

I get to the hospital around 8am then do my ward round checking on my new and old patients. Then I go to theatre and do minor procedures and if there is an elective caesarean case then I would do that. After theatre, I go to the out-patients department to review patients who need check-ups. I then wait for emergencies after that.

So, because of the staffing issue at my hospital, usually most of the time I’m the only doctor around so I end up having to cover everything meaning I’m on duty 24/7.

There are no fixed hours really. Some days I can finish duties at lunchtime then it’s just emergencies after that. Other days I might finish my duties at 6pm before I can even start on emergencies.

You obviously love what you do? What else keeps you going?

That’s a difficult one. What keeps me going is my interest in public health and in understanding and learning from my community. The struggles that people in this part of the country face challenge me to find ways to solve them. Sometimes there are moments that are really rewarding – like when you attend to a patient and they get better and you forget about them. Then you bump into them at the shops and they come up to you and tell you how much you helped them. Those moments of gratification sort of keep you going when things are hard, or you are about to burn out.

How did you get involved in these social care initiatives that you’re a part of?

I’ve always had diverse interests but was a bit disappointed in medical school as I had to give some of them up. I was always interested in human rights and environmental conservation; I served on a committee for wild-life conservation before.

In my 4th year or med school, I went for an elective course on social medicine in Uganda where we looked beyond the biological basis of disease. That turned out to be the most exciting part of my educational career up to that point and I knew this was for me.

The following year the Social Medicine Consortium was formed and that allowed me to remain plugged in and find opportunities where I could make a difference. One was the opportunity to serve on the board of an organisation that worked with sex workers and sexual minorities and I took it up because of my interest in human rights. Now with the SMC we are doing a lot of projects one of which is the global campaign against racism. These are some of the things that have kept me going and allowed me to balance my interests in clinical and non-clinical things that indirectly affect health.

We don’t see African men get involved in such initiatives. Is it really that they’re not interested or that we don’t see enough of them. Is it a stereotype? Is it generational? Help us understand!

Phew! Well yes…that’s very true that when you go into some spaces you don’t see a lot of guys involved especially when it comes to gender issues. When you start talking about gender issues, one thing that I’ve noticed is that it annoys a lot of my friends, my male friends – and even environmental issues. So, I guess a lot of it stems from socialisation in terms of how we are brought up. I don’t blame them in a way because I have seen many situations where you hear people imply to someone that they can’t do this because that’s not what’s expected of men.

Even in medical school, guys will opt for the surgical specialities as opposed to community medicine and public health and I think that’s based in some ways on expectations. Then there are gender stereotypes. The moment you start talking about women’s rights, the men look at you, wondering why you are talking about women’s rights and even start questioning your sexuality.

More women are comfortable talking about sexual rights and I guess because women gave been affected a lot more by issues of sexuality and sexual rights and have been victims by social construction, they easily take up these issues. As men, we have always enjoyed male privilege, so we are reluctant to get into these issues as that would mean breaking down systems that benefit us. So that’s my take on it.

What do you least like about what you do ?

What I like most, to be honest, is the travelling. I love travelling! It has exposed me to so much. I love interacting with people who are different to me. It’s boring to constantly be with people like you. I love the conversations that I have with all these great minds no matter where.

I also love the fact that I am doing work that can impact a community rather than just the individual

What do you least like about what you do?

I don’t like that whole sense of helplessness – especially as I myself have struggled with mild depression which can come with that feeling. I internalise a lot of things, so I often find myself feeling helpless a lot of the time –  when I cannot deliver what I know I can because the system doesn’t allow it. You feel powerless without the resources.  I really hate that feeling and often you carry it away from work to your family and friends.

I also end up taking time away from my family which is unhealthy. What happens is that when you have leave you end up using it to attend meetings or conferences meaning that is time not spent with family.

What are some of your other passions?

Art, books and theatre!

Can you share what vision you have for YOU and healthcare in Zimbabwe?

My personal vision really is aligned to social medicine. I’m very passionate about it as it integrates a lot of things – aspects of public health, human rights, environmental issues – a lot – and it offers an opportunity for a more sustainable approach to healthcare. That’s because you are dealing with structural causes that affect healthcare access and outcomes. So, I hope to remain in this field, teaching, contributing to medical education, policy reform and establishing systems. I see myself involved not only locally but on a national, regional and global level because we need more African voices in global health and initiatives that are led by us.

For Zimbabwe, my vision is for healthcare that is equitable especially with what I have seen in the rural areas. There are a lot of structures that need to be dismantled – some of them were inherited during the colonial times and they don’t work anymore. I want to see someone in Binga get the same care that someone in The Avenues or other private hospital gets. And for free. I believe in preferential options for the poor, the needy and the marginalised because these are the people in need.

What’s the mood in the medical community with the current state of the health system?

I can’t say we’re optimistic as things seem to be taking a downward turn. A lot of people are disgruntled and it’s not just doctors. A lot of attention is put on doctors but it’s all healthcare professionals that are frustrated. All of us cannot render basic care. In the lab, they can’t do the essential tests. Nurses can’t give even basic care as amongst lots of other reasons, the nurse-to-patient ratios are not met. Yet we have unemployed nurses…

We feel unappreciated and sadly a lot have and will leave the country. Honestly, it’s stressful. A lot of people are fatigued. Everyone has seen the video of the consultant who broke down on camera. A lot of people are like that – at the edge of a cliff. Keeping sane is tough because you are faced with hopeless eyes and you look back at them with your own hopeless eyes which is not what we trained to do. Seeing lives lost that could have been saved is devastating.

How do you think the current strike will change things? What do you think it will achieve?

The current strike is different though the grievances are the same. This time it has started with the senior consultants whereas before it was the junior doctors that went on strike. It has taken us juniors by surprise to see our seniors strike – it’s usually us that starts them. The reaction has been faster, maybe because they command more respect and also if they withdraw their skills the system will collapse in a day.

We hope this time we achieve more sustainable solutions because we are tired of having to go on strike. We don’t enjoy it. It’s stressful because you’re battling with your conscience, the ethics of it and the backlash from the community. We are definitely not comfortable striking, so we hope something meaningful comes out of it.

However, the real issues to change are the economy, the deprioritisation of health, the policies and structural blocks. Anything that doesn’t tackle these is just dealing with the symptoms and not the cause.

Tinashe, thanks so much for sharing your heartfelt thoughts. We are in awe of you and all healthcare professionals who have soldiered on to this point and know that you are appreciated and are supported!

Thank you! It’s an honour to be featured.

Really, we have so many great minds and I hope we can engage the government to come up with measures to relieve the pain we’re all feeling right now.

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