South Africa’s free antenatal care is delivering – literally
Khadija Magardie
It’s 4.15pm in the labour ward at Johannesburg hospital, fondly known as “the Gen”, and staff have just delivered their eighth baby for the day. At the front desk, midwife sister Pretty Dubazana is talking to a patient. Her shift should have ended in the early afternoon, but she’s staying until things quieten down. She admits sometimes she does not know what motivates her to work under such stressful conditions. “Other nurses have packed up to go to Saudi Arabia,” she laughs. “But not me.”
Booking clerk Mariki Maritz, who has worked at the hospital for 15 years, says, “If I had to fall pregnant, this is the only place I’d like to have my baby.”
In the neonatal unit, which cares for premature babies and those with respiratory problems, sister Sekhametsi Moahloli is looking after her 12 tiny, incubated charges. Because of staff shortages there are seldom more than two nurses in the unit to care for the infants who require hourly observations and medication.
Working hours are often unreasonable – few duty staff work their supposed 12-hour shift. The antenatal units are acutely short of everything, from linen to beds. Yet most midwives say they will never leave.
On the other side of town, the Women and Children hospital in Coronationville is just seeing its last trickle of patients. The doors of the antenatal clinic open at 6am, but the snaking queues outside the clinic doors start long before. Hundreds of women pass through the clinic’s doors daily.
The introduction of free antenatal care to pregnant women in 1994 placed a huge strain on public health sector resources. The unbelievably long queues bear testimony to the fact that six years down the line, the Department of Health has still not ironed out resource allocation for clinics.
A typical day at an antenatal clinic is like a day at the home affairs offices before election time. Women are shunted from queue to queue, to take a variety of urine and/or blood samples. Because there are so many of them, patients spend insufficient time with doctors or midwives. “Impersonal” antenatal care means that problem pregnancies often go undetected.
Staff say an unfair burden is placed on public health facilities, aggravated by pregnant women not adhering to zoning, which determines that residents of certain areas should receive antenatal care at the nearest hospital. Johannesburg hospital, which is a referral hospital in Parktown, sees patients from Soweto, the East and West Rand, and even from other provinces.
One patient, says sister Connie Ngobeni, who is in charge of the labour ward, came from KwaZulu-Natal, and insisted on delivering at the Gen. Many patients do not attend antenatal classes, leaving the staff with no medical record history when they go into labour. “We have to rely on guesswork,” says Ngobeni.
Johannesburg hospital is better equipped than other antenatal facilities. The labour ward’s seven delivery rooms are only for high-risk patients, such as those needing caesarean sections. The majority of admissions go to the midwives obstetrics unit, opened in 1998 to cope with more patients. The four resident midwives run the unit. Women who are healthy are discharged up to six hours after the birth, to make space for others.
Ngobeni acknowledges that there are serious shortcomings, but says the service has been a success. “We work very hard, so one should give recognition where it is due,” she says.
The quality of care at antenatal clinics around the country is of a considerably high standard. But staff and resource shortages result in women spending up to an entire day sitting in queues at clinics.
Some patients contribute towards staff frustrations – they still regard the absence of a doctor as a sign of inferior service. “There’s still the attitude that the midwives are not qualified enough,” says Dubazana.
Pregnancy Education Week, which starts on Monday, is a collaboration between business and the Department of Health. According to health professionals, the numbers of women dying from pregnancy-related hypertension, haemorrhaging and botched abortions could be drastically deduced by attendance at antenatal classes.
The tireless workers caring for unborn and newborn say they welcome any attempts to lighten their workload, but they will continue to bring new South Africans into the world. “In the private sector, you’re just a doctor’s assistant, but here, you do things yourself,” says Ngobeni.