LEADER’S ANALYSIS Mark Heywood, Executive Director, Section 27
This report is about rights and wrongs. The unnecessary death of one-year old baby Ikho is wrong. The suffering of Lindeka Gxala and the gross violations of her dignity and privacy are wrong.
The health care workers and patients who bravely have decided to report their stories have opened a window that allows you to see not only their suffering but also part of a much bigger picture of pain and indignity.
The report bears witness to, and provides an analysis of, the collapse of a provincial public health system on which over six million people depend. For over a decade this collapse has been overlooked, nay permitted, by a succession of politicians at both a provincial and national level who have abused public trust and become more interested in using their elected positions to line their own pockets, than to advance the public interest.
This is no polemical exaggeration for, as Daygan Eagar (p19) explains, an investigation by the Special Investigation Unit (SIU) has found that over an 18 month period R800m was stolen by public officials. As far as we know, no-one is in prison for this grand theft.
There are no excuses for what is described in the pages that follow. The crisis of the health system is not an apartheid-legacy, but a democratic failure. It is a crisis of management and political oversight. It is a crisis of the Constitutional promise. We say this because we know that there are financial and human resources available to provide health care in the Eastern Cape; there are committed nurses, doctors, community health care workers as well as other people who want to be trained to work in hospitals and clinics; there are systems which can be made to work to effectively distribute medicines, X-ray machines and other essentials to clinics.
This is the story of a political failure.
But it is not all a tale of gloom. The mere existence of this report bears witness to the fact that many health workers and ordinary people in the Eastern Cape have decided enough is enough. In the words of Anele Yawa (p10), the TAC’s Provincial Chairperson, “It has to stop.” In this respect, this report is not a mere journalistic exposé, but part of a social mobilisation for the right to health that will only end when the problems it describes have been reversed.
But how can problems of such enormity be overcome?
As we all know, Nelson Mandela hails from Qunu, a town in the OR Tambo health district of the Eastern Cape, an area in which the blight of apartheid-inherited inequality in health care has tragically deepened. Fortunately because of Nelson Mandela, and other visionary leaders like Chris Hani, Oliver “OR” Tambo, Govan Mbeki who also originate from villages and towns in the Eastern Cape, South Africans have a Constitution to which they can turn when their fundamental rights are being violated, or as a means to have the government ordered to take measures to realise the rights for which they struggled. We plan to do this.
The fundamental right that bleeds from the heart of this report is found in section 27 of the Constitution; it is the right of “everyone to have access to health care services” and the duty on the government to “progressively realise” this right.
The overarching wrong, as described by Dr Trudy Thomas, the “first democratic MEC for Health in the Eastern Cape, is that for the last 15 years there has been a deterioration of health services in the Eastern Cape – the exact opposite of what the Constitution requires.
This has to stop and the people must have a remedy for this disaster.
The Eastern Cape Health Crisis Action Coalition (ECHCAC) was established in May 2013 for this purpose alone. It will campaign for justice for people like Baby Ikho and Lindeka Gxala; it will campaign to end corruption with impunity; it will campaign for the dignified employment of health care workers and the filling of vacant positions; it will campaign to ensure that democratic and effective clinic committees and hospital boards are established; and it will campaign for a plan, timetable and resources to turn around the crisis we describe. If you want to join or support the ECHCAC contact us at [email protected] or via www.ECHealthCrisis.org
CITIZENS’ REPORT Of Dignity and Death
The story of Lindeka Gxala, a 33-year-old woman, who lost her baby when she was seven months pregnant, is a tough read.
Sadly and horrifically the story does not end with her loss, as she is forced to endure a painful and undignifed abortion.
A receptionist at Mdumbi Backpackers in the breathtakingly beautiful Mankosi area, Gxala’s tale starts at Pilani Clinic, where she was told in February 2013 that she was pregnant with her first baby.
‘I was early in my pregnancy with my first child when I first walked to the clinic 10 km from my home,’ says Gxala. She waited the entire day to be seen at the busy clinic, which is run by a single nurse and an assistant.
Between February and May, Gxala made six visits to the clinic and only got to see the nurses on two occasions. On her sixth attempt, she says, ‘I was six months’ pregnant and I took the day off work to walk to the clinic. The nurse was again too busy to see me. My friend and I decided instead to go to Nelson Mandela Academic Hospital in Mthatha.
‘The nurses at Pilani are kind and well regarded in the community. I can even call one of them on the phone if I have a serious problem, but they are simply too busy to attend to all the patients.’
When Gxala visited the hospital in Mthatha she learned that her unborn baby was dead. It was June 11 2013 and she was seven months’ pregnant.
‘The doctor assured me that there would be no pain when they removed her from me, and I was admitted and placed in a ward the following day.’ There weren’t enough beds and Gxala was forced to share a bed with another woman, who was already in labour.
‘She was bleeding. The nurses told her to be still, but when the pain came she would thrash and the blood would spill onto the floor. She bled heavily and her blood pooled on the floor,’ says Gxala.
Several hours later, the nurses provided Gxala with two tablets. It was never explained to her that these tablets would cause her to abort: ‘I am not sure what the tablets were or what they were for.’ Six hours after taking the drugs Gxala was still waiting for something to happen.
‘The nurses gave me two more tablets. I became very thirsty and stood up to search for water. I went to the sink and it was full of vomit, I could not drink from it. The vomit blocked the sink and it could not drain.
‘They brought me dinner, mincemeat and bread or rice, but I could not eat it because the place was filthy.
“It was deep, sharp pain. I felt something come out of me. I stood up and searched in the darkness for a nurse. The nurses ordered me to walkaround.” Lindeka Gxala
There was blood all around me and people vomiting and the room was filled with the stench of blood and the vomit.’
The woman who was sharing a bed with Gxala warned her to get blankets before sunset, as the hospital would not be providing her with any.
‘She was correct – the hospital did not provide me with a blanket.’ A friend borrowed two blankets for Gxala. ‘It was cold that night and I was glad for the blankets.’
Gxala recalls there being no electricity in the ward until one or two in the morning. ‘When it became dark, the nurses attended to the women and delivered the babies by the light of their cell phones.’
Around midnight, 12 hours after taking the first tablets, Gxala experienced severe pain and cramps in her lower body.
‘It was deep, sharp pain. I felt something come out of me. I stood up and searched in the darkness for a nurse. The nurses ordered me to walk around. I tried to tell them that something was coming out of me. They told me to walk around more. I kept telling them about the pain. By then my dead child had come out feet first and the head was stuck inside me. The baby hung from me as I walked around the ward and tried to plead with the nurses, to beg them for relief from the pain.
‘I was still walking around when I collapsed from the pain. The nurses then removed another patient from her bed and put me in the bed. I stayed there until six in the morning without anyone helping me. I was in terrible pain the whole time.’
The nurses eventually took Gxala to the theatre. ‘The nurses looked at my hospital card and commented that they had failed to give me an injectable anaesthetic for pain. I still do not know whether they had forgotten, or did not have the injection. Without giving me painkillers they then removed the dead baby while I was conscious. The pain was terrible. They eventually gave me something for the pain, but I had felt everything. I cried the whole time.’
Lindeka Gxala was sent home the same day.
Her story speaks of a health system that fails its patients, and of some health workers who have no respect for them, leaving them stripped of their dignity.
CITIZENS’ REPORT Operating in the Dark
Sister Ethel Mhlekwa of Kotyana Clinic is not asking for much. “Access to basic services such as electricity and water would go a long way to enabling us to meet standards which we should adhere to in the interests of our patients,” says Mhlekwa.
A professional nurse, Mhlekwa is also the acting Operational Manager, an extra responsibility for which she is not compensated.
A nurse for the past 27 years, Mhlekwa arrived at Kotyana Clinic in 2009 although it was only officially opened a year later. She has been acting manager since it opened.
Although there are many problems at the clinic, there are four big challenges:
the absence of electricity; | |||||
staffing; | |||||
staff accommodation; and | |||||
the unavailability of water. | |||||
The clinic has solar panels, but they have not worked for approximately three years. This means the nurses rely on a gas fridge in the nurses’ accommodation to store vaccines and the supply of gas is erratic and unreliable. In summer, the refrigerator is not sufficiently cold and in winter it gets too cold. The nurses also use the refrigerator to store their food.
No electricity presents huge challenges in emergencies after sunset. Recently, a baby was born at home and brought to the clinic in the evening. Mhlekwa had to check on the health of the mother and the baby by the light of a paraffin lamp. “It is not possible to perform this service properly under these conditions,” she says.
As another example, in an emergency situation when a patient requires sutures in the evening, the nurses cannot attend to the patient because of the lack of light. They have to send the patient to Zithulele Hospital, which is approximately 10 kilometres from the clinic, but there is not an ambulance available and the patient has to hire a car, which is expensive.
Similarly, mothers in labour are sent to Zithulele Hospital when it is dark.
There is also no telephone, fax machine or computer at the clinic. The only means of communication is their personal cell phones. They charge their cell phones by turning on a car and using the car battery.
Nurses are also not keen to work at the Clinic because they know that the accommodation does not have electricity.
Kotyana has only two professional nurses, one nursing assistant, two lay counsellors and five community health workers (who are based at and report to the clinic but work in the community). The nursing assistant is furthering her studies this year and is away. This leaves the Clinic with just two nursing staff. They see between 1 200 and 1 500 patients every month and have serious difficulties providing care to patients due to the shortages of staff, working until after dark.
There is also no cleaner or caretaker appointed for the clinic. This means that the community health workers have to assist with the cleaning even though they are not paid to do so.
The grass around the clinic has not been mowed and there is no lawnmower.
When Mhlekwa applied for the post of Operational Manager in 2011 she was later told that the posts had been frozen and she could not be appointed to the position.
There are only three small rooms at the Clinic for staff accommodation. When the Clinic was opened, officials of the Eastern Cape Department of Health promised that a building near the Clinic would be renovated to provide more staff accommodation. This has never happened.
The clinic has five rainwater tanks. Three of the tanks are currently empty and the other two tanks are not full. The clinic has in the past run out of water when there is not enough rain.
There is a dam close to the clinic and there are pipes that run from the dam to provide the community around the clinic with water but the government has not installed pipes to get the water to the Clinic.
The lack of water is a problem for a number of reasons. It makes cleaning the Clinic difficult, limits the water available for patients to drink while waiting to receive services and limits the water available to nurses to wash their hands.
“We speak about infection control, but speaking is all we can really do. We cannot possibly practise it properly,” says Mhlekwa.
The clinic orders medicine twice a month. The order is physically taken to the supervisor at Xhora office who then puts in a larger order and distributes the medication received to facilities. Nurses have to go in their own car or by taxi to the supervisor and pay for this out of their own money. This takes several hours and costs around R200 in a car or R60 by taxi.
Note
This is the introduction and two reports from this publication. The full publication can be found at: http://www.section27.org.za/wp-content/uploads/2013/09/SECTION27-report-redacted.pdf Reprinted with kind permission of the Treatment Action Campaign and Section 27.
“We speak about infection control, but speaking is all we can really do. We cannot possibly practice it properly.” Sister Ethel Mhlekwa
