Letter from Zambia
by Mark Lynasp
The Nation magazine, Feb. 14, 2000
The problem with taking a blood sample for your malaria test
is that the cockroaches may eat it in the night," announced
the nurse. "Ants are an even worse problem. The place is
infested with them." Siavonga Hospital, on the shores of
Lake Karibe in southern Zambia, is suffering. "We have to
put patients with TB in the same room as women who are giving
birth," says one of the four Cuban doctors who battle to
run the place. They also have to charge fees for their healthcare,
and patients have to provide their own medicines, syringes and
clean needles. What if they can't afford to pay? The doctor shrugs.
"What do you think? They die."
People are dying. Quietly, but in huge numbers, all over Zambia,
lives are being wasted. Wasted not because of some accident of
nature but as a direct result of economic policies imposed by
faceless Western planners. For more than twenty years now the
World Bank and the International Monetary Fund have been forcing
"structural adjustment programs," or SAPs, on the bankrupt
countries of Africa. Trapped between a near-religious belief in
economic neoliberalism and the US-driven interests of big business,
these two institutions are blind to the havoc they are causing.
Almost every country on the continent has succumbed to their prescription.
Across Africa, the vultures are circling.
The World Bank has claimed that Zambia's reformed healthcare
system is a model for the rest of Africa. "It's true that
there are no queues," says Dickson Jere, a freelance journalist
formerly with the Zambia Post, an independent daily. "But
that's because people are simply dying at home."
They're called BIDs-"brought in dead." At the casualty
ward in Lusaka's University Teaching Hospital (UTH), they are
increasingly common phenomena, especially among children. "If
you want to see the impact of structural adjustment on Zambia,"
Emily Sikazwe, director of the antipoverty group Women for Change,
told me, "Go to UTH."
I went to UTH. It is Lusaka's biggest hospital, where those
who can't afford private healthcare end up. In a packed ward near
the main entrance a man writhed in bed. "I'm dying,"
he moaned, while his wife stood helplessly by his side. Emaciated
figures shivered under sparse bedclothes. Families crowded around
beds or sat on the floor, bringing food to the sick to supplement
the meager hospital rations of beans and maize meal. In another
ward a preacher harangued a dying woman, whose family stood around
with heads bowed. As he waved his Bible, she struggled to move
her lips to acknowledge him.
Enter the children's ward and the smell hits you like a wall.
A musty, medicinal odor-the smell of sickness and death. Rows
of children lie on small beds, slowly passing away from preventable
diseases like TB, malaria and pneumonia. On the other side of
the building is a cleaner, neater ward, where half the beds stand
empty. This is the fee-paying section, where families who can
pay a 100,000-kwacha ($36) deposit can buy a slightly better chance
of life. In World Bank language, this is "user-responsive
healthcare."
Don't just go to UTH. Go also to Misisi or to any of the twenty
or so shanty "compounds" that ring Lusaka. In Misisi,
barely a kilometer from Lusaka's town center, Masauso Phiri stands
outside the windowless concrete shed that is his house. Next door
an old man nearly died of starvation-luckily, he was saved by
the return of his son from the Copper Belt, where he worked in
the mines. That's not unusual. People are dying of starvation
in Misisi. But they do so quietly, wasting away in their houses,
too ashamed to venture out. Things were not always like this.
Phiri, like many of his neighbors, has heard of structural
adjustment. It was because of the SAP that he lost his job as
a security guard. It was because of the SAP that he lost a child-a
3-year-old boy, who died of pneumonia in 1996. "I know it
is meant to put the economy on the right track, but to me it seems
to make us suffer," he says. "We can't eat policies."
He looks at the ground. "I don't have any hope. I don't have
any money, so I can't think of any future. My future is doomed."
Only one in five people in Misisi is employed. The unemployed
are part of an army of jobless, created when economists from the
World Bank and IMF decided that Zambia's public sector was "bloated"
and that companies would benefit from the tonic of privatization
and an opening of markets to international competition. The Zambian
government boasts that it has the speediest privatization program
in Africa. But half the companies sold out of the state sector
are now bankrupt. More than 60,000 people have lost their jobs
as a direct result of the economic liberalization program introduced
after 1991. With many mouths dependent on one breadwinner, this
has thrown an estimated 420,000 into destitution.
In their desperation, people turn on one another crime is
soaring in the compounds around Lusaka. I attended the funeral
j of one old woman, shot in her house by bandits as she tried
to prevent them from entering. In the darkness outside her house,
male friends and relatives sit around the fire in quiet contemplation.
They will spend the night there, in the cold, just sitting, talking
and remembering. Inside the house women wail. The robbers took
nothing. The old woman had nothing to take.
"SAPs cause poverty," says Women for Change's Sikazwe.
"And poverty has a woman's face." Women shoulder the
main burden of providing for families, and girls are the first
to be withdrawn from school when a father loses his job. Women
like Esnart Banda, a widow with five children, who makes about
2,000 kwacha (72 cents) a day selling vegetables in a market near
Misisi. Most days she can afford only one meal for her children,
even though the youngest is suffering from TB. Her kids join 40
percent of Zambia's children in suffering from chronic undernutrition.
It's worth pausing here to look at the figures. In 1980, under
the former socialist government of Kenneth Kaunda, the under 5
mortality rate was 162 deaths per 1,000 births. It's now 202 per
1,000. That means one in five children in Zambia dies before reaching
the age of 5. The average life expectancy has fallen from 54 in
the mid-eighties to 40 now. With the AIDS epidemic raging, this
can only get worse. Over the same period the primary school enrollment
rate has plummeted from 96 percent to 77 percent. Half a million
children are now out of school, out of a total national population
of only 9 million.
These last figures are not accidental. They reflect the results
of cuts in public spending and the introduction of school fees.
For example, whereas in 1991 the Zambian government spent about
$60 per primary school pupil, it now spends just $ 15. Cuts in
public spending-the slimming down of a "bloated" public,
. sector-are a central plank of structural adjustment, as promoted
by the World Bank and the IMF. In one of SAP's greatest ironies,
| the World Bank is now recasting itself as a "Knowledge
Bank"- even as it condemns millions of children across Africa
to a lifetime of ignorance and illiteracy.
"What if the IMF was to pack its bags and leave Zambia?
Do they imagine the situation would get worse for us?" asks
Sikazwe. "What would they say if we took them to the World
Court in The Hague and accused them of genocide?" How does)
she sum up the impact of structural adjustment on Zambia? "Devastating."
Half a world away in Washington, the architects of this human
disaster dine in comfort and seclusion, spending more on one meal
than Masauso Phiri's wife makes in a year of selling buns in their
shantytown. Although most World Bank staff work at its Washington
headquarters, those unlucky enough to be posted in the Third World
receive ample compensation for their misfortune. This includes
subsidized housing (complete with free furnishings), an extended
"assignment grant" of $25,000 and a "mobility premium"
to defray the cost of child education. Salaries are tax-free and
averaged $86,000 in 1995, according to a General Accounting Office
report to Congress. No "structural adjustment," then,
for this privileged coterie of bankers and policy analysts. Meanwhile,
in Africa a hidden genocide lays waste the continent.
"It's not right for a bank to run the whole world,"
says Fred M'membe, editor of the Zambia Post. "They do not
represent anybody other than the countries that control them.
What this means in practice is that the United States runs our
countries." He continues: "Look at any African country
today, and you'll find that the figures are swinging down. Education
standards are going down, health standards going down and infrastructure
is literally breaking up."
In the midst of this chaos, what remains of Africa's wealth
is being plundered. And this, argue many, is the real impetus
behind structural adjustment. "They say if you perform well,
there'll be a flow of foreign direct investment," says M'membe.
"Investment" like Shoprite Checkers, the South African
supermarket chain that is colonizing Zambia with the help of a
massive government tax rebate. Shoprite has ravaged the economies
of entire towns, undercutting local traders and putting out of
business stores run for generations by one family.
To make matters worse, Shoprite buys nothing locally. Taxfree
produce-even maize and potatoes-is trucked in from Zimbabwe and
South Africa. Meanwhile, Zambian maize rots in the fields, because
the farmers who grow it cannot find a market. Under the previous
government an agricultural marketing board was responsible for
collecting and distributing produce from the whole country. Under
structural adjustment, the private sector is left to do its worst.
But with the poor state of the country's roads, private traders
find it cheaper to import subsidized maize from the United States.
Some farmers are so desperate that they give their produce away
to Lusaka-based dealers, who promise to return with the earnings.
Of course, they never do.
The majority of privatized Zambian businesses have been sold
off into foreign ownership. In the case of Zambia Breweries-producers
of the country's famous Mosi (Victoria Falls) lager-South African
Breweries is now in charge. Zambia Consolidated Copper Mines-which
has acted as a mini-government in the country's Copper Belt region-is
now being sold off to a Canadian and Swiss consortium under pressure
from international lenders, who have refused to give Zambia balance-of-payments
support until the mines are privatized. Many more home-grown companies
have simply gone bankrupt or are struggling to survive.
"Africa can only develop with the participation of its
own people," says Emily Sikazwe. People-centered development
is a strategy to which the UN, NGOs and even the World Bank- which
sprinkles its publications with high-minded concepts- have signed
on. Meanwhile, organizing together into a Campaign Against Poverty,
Zambian NGOs are issuing a challenge to the World Bank and the
IMF to allow Africans to participate in deciding how their countries
are run.
If the neoliberal economists of the World Bank are interested
in heeding this call, they will have to leave their plush offices
in Washington. They'll have to go to Lusaka, to Nairobi and to
Harare. They'll have to go to Misisi, to UTH, and they'll have
to listen to what people there say.
Mark Lynas is editor of the international human rights and
development website www.oneworld.net. He also coordinates Corporate
Watch, an activist research group based in Oxford, England.
Africa watch