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. Since then, a power-sharing government has formed after years of decline under President Robert Mugabe, and the economy has stabilized. Zimbabwe abandoned its currency last year, replacing it with the American dollar, and inflation has fallen to a demure 3.6 percent. Teachers are back in their classrooms and nurses are back on their wards. But a recent U.N. report suggests how far Zimbabwe has to go. It is still poorer than any of the 183 countries the U.N. has income data for. It is also one of only three countries in the world to be worse off now on combined measures of health, education and income than it was 40 years ago, the U.N. found. 'It's very difficult to get this famous dollar that people are talking about,' said Esther Chirasasa, 30, who hiked 8 miles through the bush to the hospital for treatment of debilitating arthritis. Her son, Cain, 13, walked at her side carrying a sack of peanuts to pay for her care. Patients provide the crops they grow and the animals they raise -- food that feeds the thousands of patients who use the hospital -- and the hospital tends to their wounds, treats their illnesses and delivers their babies. Its two doctors and 15 nurses see about 6,000 patients a month and have put 2,000 people with AIDS on life-saving antiretroviral medicines. 