CHIDAMOYO, Zimbabwe  People lined up on the veranda of the American mission hospital here from miles around to barter for doctor visits and medicines, clutching scrawny chickens, squirming goats and buckets of maize. But mostly, they arrived with sacks of peanuts on their heads.

The hospital’s cavernous chapel is now filled with what looks like a giant sand dune of unshelled nuts. The hospital makes them into peanut butter that is mixed into patients’ breakfast porridge, spread on teatime snacks and melted into vegetables at dinnertime.

“We literally are providing medical services for peanuts!” exclaimed Kathy McCarty, a nurse from California who has run this rural hospital, 35 miles from the nearest tarred road, since 1981.

The hospital, along with countless Zimbabweans, turned to barter in earnest in 2008 when inflation peaked at what the International Monetary Fund estimates was an astonishing 500 billion percent, wiping out life savings, making even trillion-dollar notes worthless and propelling the health and education systems into a vertiginous collapse.