Charlene Smith
Over one weekend recently 80% of patients admitted to Johannesburg hospital were HIV-positive. Sixty per cent of the hospital’s paediatric admissions are HIV-infected and at least half of all patients are HIV-positive.
The hospital is ill-equipped to deal with the crisis, seriously lacking in both medical staff and drugs.
In a letter to the Gauteng standing committee on health last week, Aids clinic director Dr Clive Evian described the situation at the hospital: “[It] is frankly a disgrace and suggests that the authorities do not care much for people with HIV.” Evian says that if the situation is not remedied, “the clinic will close in the near future”.
The Johannesburg hospital dispensary frequently runs out of vital drugs. In the first weeks of May, there were no supplies of key antibiotics: amphycyllin for pneumonia; rocephin and claforan (broad-spectrum antibiotics useful in respiratory infections); mistpotchlor; bactrim and mycostatin oral suspension supplies which are critical to treat diarrhoea and oral thrush.
Thirty to 50 new patients test positive for HIV each day at Johannesburg hospital, and there is no budget for the HIV clinic, which operates for only four hours once a week, with only two doctors.
Despite its shortcomings, Johannesburg hospital is nirvana when compared to most other hospitals and clinics.
Matron Nomvula Silwane Kwadjo, who heads the women’s health unit at Cecilia Makiwane hospital in Mdantsane, East London, recently took two weeks’ stress leave. “The hospital has been inundated by HIV-positive mothers desperate to prevent transmission of the virus to their babies, but HIV test kits and nevirapine for the mothers haven’t arrived. It is very hard to turn all these desperate women away.”
The hospitals selected for pilot studies to prevent mother-to-child transmission have yet to receive the necessary HIV-test kits or medication to enable them to begin the programme that was due to begin on March 1. Ten months ago the government instructed hospitals to wait for a Cabinet decision, which is still pending.
Of the two hospitals and 27 clinics in Elliott, Transkei, only two have oxygen. At the Port St Johns clinic, nurses only have Panado and gentian violet to dispense typical for many rural areas.
The clinic at Rietfontein near Ohrigstad has incubators and state-of-the-art equipment but no electricity or running water. It serves 90 000 people in 19 villages and consistently runs out of medicines. Last week its stores carried a handful of vitamin B, Panado, a few anti-malaria drugs, one antibiotic, gentian violet and 300 condoms.
At Murchison hospital in Port Shepstone, a survey carried out last November showed that 40% of pregnant women under the age of 20 were HIV-positive. The hospital reports an inability to get hold of Diflucan (for thrush) and Anphotercin B for cryptococcal meningitis all HIV related.
A representative for the South Coast hospice said: “Fluconozale [given free by Pfizer] won’t touch sides because infection is so rampant.”
The paediatric ward at busy Tintswalo hospital in Acornhoek, Northern Province the main hospital in a busy urbanising hub has 45 beds crammed together with two doctors and four sisters. Most babies are HIV infected. There is a shortage of intravenous lines and blood, and only two oxygen containers although 90% of the cases, according to Dr Brandon Casserly, are respiratory related.
Dr Francois Venter, a volunteer at the Johannesburg hospital HIV clinic, said many patients are “ill or very frail and need a bed” which is not available. The clinic shares space with the transplant clinic, which is a problem, because many HIV patients have tuberculosis, which is airborne and would be lethal to a transplant patient.
Medical staff and NGOs complain that offers of voluntary help to the hospital from professionals “are spurned”.
But the over-extended hospital has a problem: the better the treatment it gives, the more patients it will attract, according to superintendent Warwick Sive.
Sive, at a closed-door briefing with Democratic Alliance leader Tony Leon last week, said 64% of patients at Johannesburg hospital “should be at other institutions. Even if huge resources were pumped into this hospital it would not resolve the crisis; money has to be spread to other areas.” He said patients came to the hospital because there were not enough drugs elsewhere, and “patients say if you fall out of the bed at Johannesburg hospital nurses will pick you up”.
He said flows of patients from outside South Africa are “a huge problem. They get treated as if they are South Africans; no one is turned away.” He and superintendent Dr Saggie Pillay admitted South Africa is the only country in the world that treats foreigners free. Pillay said foreign countries do not reimburse the hospital charges.
Sive said that at Helen Joseph hospital a foreign patient recently brought a court action “to get pushed to the top of the dialysis queue [there is not sufficient dialysis capability for South African patients either], but the court said he had to get into the queue. They made no ruling on the entitlement of a foreigner to free medical care in South Africa.”
Ten per cent of patients at Johannesburg hospital’s HIV clinic are on anti-retrovirals, which they buy for themselves at a cost of R600 to R800 a month.
As for pregnant women, staff at the maternity section say that for the past year or more they have recommended that mothers spend R40 to buy Nevirapine for themselves and their babies to prevent HIV “and all of them do”, one senior nurse said.
@Poverty projects under threat
Mail & Guardian reporter
This month more than 50 unemployed youths were forced to return to the poverty-stricken Refilwe township near Cullinan, while the government is dilly-dallying about how to spend R889 600 earmarked for a project that was meant to alleviate poverty in the area.
In spite of the fact that the Refilwe/Bronkhorstpruit area has been identified as one of the poverty pockets in Gauteng, the Department of Social Services and Population Development has been unwilling to pay rentals to house the project.
According to Grace Finger of the department’s office in Bronkhorstpruit the project is under way and the service provider, Velela Tourism Training Academy, is still training Refilwe members in tourism.
“The project is at a standstill and we have already paid three months’ rent. That happened because we were given a wrong brief,” said Busi Radebe of Velela.
Radebe said the wrangle began when Velela was appointed as service provider and insisted on a cheque account being opened. Velela was not satisfied that, for the first two months, the R889 600 earmarked for the project was in a savings account and was therefore accessible in cash to anyone in the organisation.
“We had serious problems in accomplishing that [cheque account] because, after informing the bank of our decision, after seven days the money was still in the savings account and we were told that documents relating to the cheque account application were missing,” said Radebe.
It was also strange, according to Radebe, that the cheque account was opened after 6pm because the bank closed at 3.30pm.
However, according to Finger, all Gauteng poverty alleviation projects use cheque accounts. Finger said it was a mistake that the savings account was opened for Refilwe.
“I think government officials had other plans for the money because it is clear they are the ones who are creating confusion in this whole project and it is not the first time they did that,” said a Refilwe Tourism project representative.
According to the business plan that was submitted to the social services department before funds were approved, Refilwe Tourism project would run eight programmes. However, project members did not know about the business plan. “What we know is that our project has four programmes, out of which only one is operational,” said a Refilwe representative.
According to a document provided by the social services department, there are 386 projects and only seven were listed as having failed. In Cullinan alone six projects are described by the department as viable, while only two are functioning.
The All-In-One project in Vosloorus, on the other hand, listed third on the Gauteng list, closed last year with members vowing they did not know what happened to R150 000 that was allocated to their project. Members said they paid rent from the profit made and had to pay for their own transport and food.
In an affidavit a member of All-In-One claims that money was withdrawn to buy material to make curtains for social services officials. All-In-One members who sewed the curtains claim they were never paid.
In another affidavit, a member of Refilwe alleges that he was ordered by social services officials to move a fax machine and telephone from Refilwe to his home.
The social services department said MEC Angy Motshekga has ordered an intensive audit of all poverty projects in Gauteng and that the report would be made available in the near future.
However, Velela is still waiting for a response to a letter it wrote to Minister of Social Development Dr Zola Skweyiya after the collapse of All-In-One project. Velela was involved in the training of All-In-One officials.
The letter spelled out the modus operandi used in misapropriating government funds. The matter, however, has been referred to the director general of the Department of Social Development.
“It seems the poor will remain poor because the funds that are meant for their empowerment end up benefiting government officials,” said Radebe, who added that Velela was told that more than 40 projects have collapsed in Gauteng alone.
In a new twist, the social services department issued a statement saying it would “immediately” close all poverty-relief projects in Gauteng that have failed to meet envisaged objectives. The department said it will implement an exit strategy that would ensure “no family goes to bed without a meal. Our commitment to better the lives of our people remains unshakeable,” the statement says.