By Michael Gwarisa
He wears many hats. Dr. Efison Dhodho is currently the Knowledge Manager for the Zimbabwe College of Public Health Physicians, a dedicated researcher, and the Director for Strategic Information, Evaluation, Learning, and Information Technology Systems at the Organization for Public Health Interventions and Development (OPHID).
Born into a family of 13 as the fifth child, Dr. Dhodho recalls how his fragile health as a child necessitated moving to live with his mother, a rural nurse in Mwenezi District, while his siblings stayed with their father, a teacher.
I was such a sickling that I had to be moved to stay with my mother close to the clinic where I could at least get monthly injections of a very painful benzathine penicillin because of my frequent illnesses with pneumonia,” he recounted during an interview.
Dr. Dhodho attended Mwenezi Primary School, one of the few available schools in the area, and later proceeded to Mwenezi Government High School for his secondary education.
It was at Mwenezi High School that his dream of becoming a medical doctor took root. While in Form Three, he was tasked with managing the school’s mini-library, which contained a few assorted books. Among them, he discovered the University of Zimbabwe (UZ) prospectus, which became a source of inspiration.
“I read through and found this interesting book that talked about the University of Zimbabwe. I gravitated toward health and looked at the section that discussed medicine. That was the moment I realized I could actually become a doctor. My mother being a nurse also influenced me and the idea latched onto me.”
However, there was a setback. Admission to medical school required Mathematics, Physics, and Chemistry at both Ordinary and Advanced Levels. Unfortunately, his rural school only offered Co-Science, which was not recognized for medical school applications.
“At such a young age, I was quite crushed knowing that my dream could be jeopardized simply because my school didn’t offer the required science subjects. I remember writing two letters to the heads of Gokomere and St. Antony High Schools, which were renowned for sciences in Masvingo. I explained my situation and asked for an opportunity to be enrolled at their schools despite my circumstances, but I never got a response.”
Despite this challenge, two years later, he enrolled for A-Level studies at Gutu High School after excelling in his O-Level exams. Gutu High was known for excelling in literature and arts but fate intervened. The year Dr. Dhodho was due to begin his A-Levels, Gutu High introduced science subjects, and he seized the opportunity to pursue them.
In 1999, Dr. Dhodho enrolled at UZ for a Pharmacy degree program, despite having Medicine as his first choice. Around six weeks into the course, an instruction from then-President Robert Mugabe became his miracle as he ordered the University to enrol more medical students in order to address the doctors shortages in the country.
“I then received an invitation from the faculty of medicine which then indicated that I was being invited to move to medicine because of this announcement and because I had put medicine as my first choice,” he said.
The Journey Begins
Having spent much of his childhood with his mother, often staying up late as she finished work at the clinic, Dr. Dhodho developed a deep passion for helping rural communities. For him, the choice was clear: he would either become a medical doctor or a teacher in rural areas. Both options resonated deeply with him. After completing his medical studies, he began his housemanship, or medical internship, at Mpilo Hospital.
“Even though I so much wanted to work in rural areas, working at Mpilo Hospital gave me a semblance of the community I wanted to serve. Remember, Mpilo, though in Bulawayo, caters to rural Matebeleland. After two years, I was done with my housemanship. A pivotal moment came again for me to decide: Where do I go after my internship now?”
It was 2007, and Zimbabwe was grappling with extreme hyperinflation. Nearly half of Dr. Dhodho’s graduating class left the country, seeking opportunities in neighboring nations like Namibia, Lesotho, and Mozambique, where Zimbabwean doctors were in high demand. At one point, he even secured a job at Manica Provincial Hospital in Mozambique but ultimately decided to stay in Zimbabwe. He took up the role of District Medical Officer (DMO) for Binga under the Ministry of Health and Child Care (MoHCC).
“I had to make a decision. Remember, it was so tough, this was 2007. But I remembered my commitment to rural communities, and I decided to go to Binga. It was a huge decision. At that time, my salary was the equivalent of US$25, and sometimes it wasn’t even enough to travel to Binga to collect that salary. But I went nonetheless,” said Dr. Dhodho.
While in Binga, the district was selected by the National AIDS Council (NAC), supported by the Global Fund, as one of 22 districts providing Antiretroviral Therapy (ART) services. At the time, Binga was experiencing a rise in new HIV cases, and Dr. Dhodho took on the dual roles of DMO and ART doctor under the project, which lasted two years.
The Obstacles
Even though he enjoyed his work in Binga, his tenure had its share of challenges. The poor road network made most clinics inaccessible, especially during the rainy season. Communication was also a significant hurdle, as there was no reception for local mobile network operators. To contact the Ministry of Health head office, one had to rely on a Zambian line or the Save the Children Zimbabwe radio.
“While in Binga, I realised that even Mwenezi was more advanced. In Binga, there were only 11 clinics serving a population of 140,000 people. The furthest clinic was over 200 kilometers away. The hospital itself was near the lake by Binga Centre. It was an extremely low-resource setting, and that’s when I learned that you had to innovate, push boundaries, and think outside the box.”
Facing the HIV Crisis in Binga Head-On
Though Binga historically had one of the country’s lowest HIV prevalence rates, it experienced a surge in cases between 2009 and 2010. This was largely driven by the movement of people seeking employment opportunities outside the district, following the introduction of the US dollar during the inclusive government era.
When Dr. Dhodho arrived in Binga, only 15 people were on ART. At the time, patients could only access antiretrovirals (ARVs) if their CD4 count was below 200, due to the limited supply of ARVs across the country. Furthermore, ARVs were only dispensed at hospitals, meaning patients had to travel over 200 kilometers to Hwange for treatment.
“This meant only those who could afford the journey would access ARVs, while many others died of AIDS. The wards were full of patients. ARVs were coming into the country, but the challenge was how to deliver them to such a large population. There was no transport, sometimes we would get a vehicle, sometimes not,” he recalled.
The policy restricting ARVs to hospitals condemned many people in Zimbabwe to death, as they couldn’t afford transportation.
“I said to myself, this isn’t working, people are still dying. With my team, I decided to engage the community. I met with chiefs because HIV carried a lot of stigma. I told them, ‘We’re going to distribute ARVs in an unconventional way. But first, I need your support. To lead by example, I want you to be tested for HIV, and I’ll personally conduct the tests. The results will remain confidential.’ The chiefs agreed, and they were tested.”
The Breakthrough
This marked a turning point in the fight against HIV in Binga. Chiefs began mobilising their communities, using village heads and other traditional leaders to encourage people to get tested. Healthcare workers often arrived at clinics to find long queues of people waiting for HIV services.
“Within the first six months, we increased the number of people on ARVs from 15 to 1,200 across the district, with a loss-to-follow-up rate of less than 5%,” said Dr. Dhodho.
“That was unbelievable because, back then, many people were lost to follow-up due to the lack of phones. But in our case, it was different. ARVs were now available at local clinics, and chiefs had mobilised their communities. There was strong cohesion, making it easier to trace people through village heads.”
Sometimes, healthcare workers provided HIV services late into the night.
“We’d be there until 9:00 PM, using car lights to test people and start them on ART. Gradually, the hospital wards emptied, and deaths decreased significantly,” he added.
Dr. Dhodho’s work in Binga gained national and international recognition. He was invited to present at a SAfAIDS conference on how his team had managed to deliver ARVs so effectively in such a remote community.
