By Bigboy Madzivanzira
Harare – In our clinics and WhatsApp family groups, a new health challenge is emerging as Zimbabwe’s population ages. It is no longer only about a broken hip. Families are asking: What do we do when Gogo aged 92 refuses hip surgery? What when Sekuru aged 85 refuses brain tumour operation? What when a stroke patient is told a blood clot must be removed and patient says ‘handidi’ — I do not want it?
At Health Promotion Clinic Trust Community Based Rehabilitation we are seeing this pattern across all surgical specialties – orthopaedics, neurosurgery, and general surgery.
1. THREE COMMON SCENARIOS
a) Orthopaedic: Neck of Femur Fracture / POP
After a simple fall at home, an elderly person breaks the hip. The bone breaks just below the ball joint. Surgeons recommend fixing with metal or replacing the head (hemiarthroplasty). Without surgery, the patient faces long bed rest, severe pain on movement, pressure sores, chest infections and blood clots. With surgery, pain is relieved quickly and early sitting and walking with a frame is possible within 24-48 hours.
b) Neurosurgical: Brain Tumour in Old Age
An elderly patient is diagnosed with a brain tumour – meningioma, glioma – causing headaches, weakness, confusion or seizures. The neurosurgeon explains surgery can remove the tumour and relieve pressure. But families fear: “Will he survive brain surgery at 85? Will he become a vegetable?”
c) Neurosurgical: Stroke and Blood Clot on the Brain
After a stroke, or after a fall while on blood thinners, an elderly patient develops a blood clot on the brain – chronic subdural haematoma or intracerebral bleed. The patient becomes drowsy, weak on one side. Doctors advise burr-hole drainage or craniotomy to remove the clot.
2. WHY ELDERLY PATIENTS REFUSE
– Fear of anaesthesia and not waking up
– Fear of being a burden after surgery
– Cultural and spiritual beliefs – “at my age I should not be cut, Ndapedza hangu”
– Desire for peaceful natural death
– Lack of clear information in Shona / Ndebele / English
– Past bad hospital experiences
Refusal is not ignorance. It is often a considered value judgment.
3. WHAT DOES LAW AND ETHICS SAY?
Every adult patient in Zimbabwe, if they have mental capacity, has the right to informed consent and informed refusal under the Patients’ Charter and health professionals’ ethics.
Capacity means: Does the patient understand the condition, the proposed operation, the risks of operating, the risks of NOT operating, and can they communicate a decision? Age alone does NOT remove capacity. A 92-year-old can have full capacity. Delirium from pain, medication, or severe dementia can temporarily affect capacity and needs assessment by the team.
Doctors must not force. Families must not force. Refusal must be documented and a supportive care plan made.
4. BEST PRACTICE: MULTIDISCIPLINARY TEAM
Best practice is not one surgeon telling the family “she needs surgery”. It is an orthogeriatric / neuro-geriatric approach:
– Physician / Geriatric assessment: Is heart, lungs, kidneys fit for anaesthesia? What is frailty level?
– Orthopaedic / Neurosurgical assessment: Benefits vs risks of surgery vs non-surgery
– Anaesthetist assessment: Anaesthetic risk at 85-95 years
– Rehabilitation assessment: As a Medical Rehabilitation Practitioner, I explain what rehab looks like in both pathways. If operated, rehab is early physiotherapy, breathing exercises, early sitting, walking with frame. If not operated, rehab is palliative – positioning every 2 hours, pressure area care, chest physiotherapy, swallowing care, family training on home nursing.
– Family Conference: Let the patient speak FIRST. Use Shona / Ndebele / English as needed. Include diaspora via video call. One spokesperson to talk to doctors.
5. HEALTH PROMOTION CALL FOR ZIMBABWE
Zimbabwe needs:
1) Public education on advance care directives – elderly should discuss wishes early while well.
2) Strengthening orthogeriatric and neuro-geriatric teams at Parirenyatwa, Sally Mugabe, Mpilo and private hospitals.
3) Integration of palliative care – even when surgery is refused, pain relief, dignity, spiritual support and pressure sore prevention must continue.
4) Support for families to manage conflict – one chairperson, one treasurer for contributions, no insults on WhatsApp.
The truth is not “always operate” or “never operate”. The truth is a respectful, informed, patient-centred process that preserves family unity, whether it is a hip, a brain tumour, or a stroke blood clot.
ABOUT THE AUTHOR:
Bigboy Madzivanzira is a multi-faceted Medical Rehabilitation Practitioner registered with the Medical Rehabilitation Practitioners Council of Zimbabwe (MRPCZ), a Health Promotion Practitioner registered with the Allied Health Practitioners Council of Zimbabwe (AHPCZ), a Family Therapist and a Freelance Journalist accredited by the Zimbabwe Media Commission (ZMC).
He is the Founder of Health Promotion Clinic Trust, where he provides community-based medical rehabilitation, disability inclusion support, family therapy, health education and counselling.
With experience spanning clinical rehabilitation, community health, humanitarian work and media, he writes on health systems strengthening, disability inclusion, geriatric care, non-communicable diseases, health promotion, and ethical issues in patient care.
He can be contacted on 0773 367 913 or healthpromotionclinic@gmail.com