KwaZulu’s health service is sick

Nurses living in disused barns and pregnant women sleeping in makeshift beds on cold cement floors in kwaZulu’s St Benedictine Hospital are the outward signs of a crisis in the homeland’s health services. St Benedictine Hospital, which serves 150 000 people, is a reflection of the homeland health system: a lack of funds, too few doctors for too many patients and inadequately equipped clinics.

Last week The Weekly Mail gained a first­-hand impression of these conditions. The wards are grim and crowded. They have no partitions and treatment takes place in full view of other patients. In the women’s ward, the isolation section has no curtains and the sun streams in on patients who have contagious diseases.

The children’s intensive care unit has only three beds and one incubator. Women who are about to go into labour are accommodated in a sluice room on makeshift beds on a cold cement floor. The hospital ‘s casualty waiting room com­prises a crude outside shelter with no walls or proper seating. 

Qualified nurses working at the hospital live in disused barns about 500m from the hospital. Each nurse uses a section of the shed. The accommodation has no electricity. They get their water from an outside tap and cook on paraffin stoves. Nurses complain about transport at the hos­pital and the clinics.There are not enough ambulances or ambu­lance drivers and often drivers work double shifts. 

Dr Daryl Hackland, secretary of health for kwaZulu, says the kwaZulu Health Department is “aware of the problem”. He says a report at the end of June noted that half the ambulances at St Benedictine were not work­ing but also also pointed out that at other hospi­tals, 80 percent of the ambulances were on the road. 

On the night The Weekly Mail visited St Benedictine, a driver who had been working all day was going to Durban at 4am. Drivers have no first aid training and the ambulances are sometimes not even equipped with regu­latory oxygen tanks. The only times that nurses accompany the ambulances are when women are in labour.

Hackland explains that kwaZulu does not provide a paramedic ambulance service. All that is provided, be says, is a “patient trans­port system”. He admits that the health system has prob­lems and says that “funds have been limited for some years, especially for the expansion required”.

Dr Effie Schultz , who has worked at the hospital for a year, told The Weekly Mail that she had recently sent a letter of complaint to the Department of Health, objecting to conditions at the hospital. The department is. investigating her complaints. She explains that one of the projects she has been assigned was to start a chronic dis­eases clinic – but all she was given was a tiny, ill-equipped room.”This is not a clinic,” she says, pointing to the one bed, the tatty curtain and the kitchen table from which her nurse works. 

Schultz points out the shortage of qualified pharmacists in kwaZulu; thus dispensaries are often in charge of pharmacy assistants. But, she says, “at St Benedictine this doesn’t work”. Without supervision, crucial medicines like asthma inhalers and chronic disease treatment is often out of stock. But Hackland says the kwaZulu Pharma­ceutical Services regularly visits the hospi­tals to oversee the work of the pharmaceuti­cal assistant. He also says a doctor is responsible for the dispensary. 

However, in a study in kwaZulu last year, it was found that of all the immunised chil­dren, only half had the necessary antibodies in their systems and were contracting diseas­es they had been immunised against. Health­ workers at St Benedictine say that vaccines are not properly stored because the fridges and fridge thermometers are often out of order.

Nurses at St Benedictine sent a letter of complaint about their living and working conditions to the kwaZulu Nursing Board. Some of their complaints have been attended to, but their living conditions remain the same.Hackland describes the accommodation crisis as a “critical situation”, but adds that the department cannot provide accommodation for all its nurses. The hospital is investigating housing projects for its staff, as part of its ongoing up­grading programmes. But these, he admits, are in their infant stages.The poor conditions extend to eight clinics served by the St Benedictine Hospital.

The kwaZulu health model, based on a net­ work of primary health care clinics, is a good one, according to Dr Khorshed Ginwalla of the Department of Community Health at the University of Natal. The clinics are serviced by district and regional hospitals like St Ben­edictine.

“The clinics should be accessible,affordable and appropriate and they should take health care to the community,” says Ginwalla. “But there are not enough of them”. St Benedictine services eight such clinics. But the full potential of these clinics is not being exploited, complain health workers. Doctors’ visits to the clinic are sporadic and the nurses are not supervised regularly. Be­ cause they are not all primary health care nurses, who are more qualified than senior nurses, regular supervision and training is essential.

But only two primary health care nurses service the eight clinics, alleges Schultz. At the farthest clinic, Usuthu, there were bats in the roof. After Schultz complained, the roof was repaired – but the workmen forgot to replace the ceiling board, leaving a gaping hole in the ceiling. Nurses complain that dirt falls onto the patients.

None of the clinics have electricity – some have solar panels but non of these work. And the clinics’ telephones often do not work. Nurses need to remain in constant contact with the hospital to get medical ad­ vice and to call ambulances.

With no means of calling ambulances, nurses often are forced to pay exorbitant fares for private taxis to take patients to the hospital. This highlights the biggest problem of the clinics: a lack of funds. From a health budget of R290-million, the kwaZulu Health De­partment will spend only R54-million on its clinics in 1991. In 1982, the Johannesburg General Hospital alone cost R60-million to run.

Nevertheless, amid all the dereliction at the St Benedictine, the nurses have mounted a valiant effort to run a preventative health pro­gramme with minimal resources.

Healthworkers proudly show off photographs of a successful breast-feeding festival they hosted at one of the clinics last year. With bright posters on Aids, contraception and anti-smoking, there is no shortage of good intentions at St Benedictine.

Mental Hospitals – the TAP replies

Senior Transvaal Provincial Adminis­tration officials on Friday met The Weekly Mail to give their side to the newspaper’s expose of conditions In the racially seg­regated psychiatric hospitals, Sterkfonte­in and Weskoppies. 

“l will certainly not say all you have writ­ten about the hospitals is untrue,” MEC Fanie Ferreira said, “but you must under­ stand that there has been too little time for us to change the apartheid policy.” Management of these hospitals had only been handed over to TPA in 1988 and integration had to be carefully planned, he explained. Ferreira said the TPA was working on a programme programme for in­tegration but did not elaborate. However, nurses are not Involved in the planning.

Another problem, Ferreira said, was the lack of TPA funds for mental health. The officials denied one of the strongest allegations made by many health workers, that black patients receive no psychotherapy at all. 

This article originally appeared in the Weekly Mail

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