Khadija Magardie
A series of interviews published in the 2001 South African Health Review underscore concerns that doctors and nurses in public hospitals and clinics are among the major culprits discriminating against people with HIV.
Published annually by the Health Systems Trust, the review is the most comprehensive overview of issues affecting the health-care sector.
Being tested without consent, broken confidentiality with HIV test results and callous treatment were some of the complaints levelled by HIV positive patients against public health workers and reported in the review.
One patient’s experience is narrated: “I found a certain doctor. He asked me what was wrong and I told him that I was not shocked or had a headache or something, maybe it was the symptoms because I was HIV positive. He said to me I am going to die a terrible death. I have sinned. I have to pray to God for forgiveness because I was sleeping around
“I was very angry because I did not expect that from a doctor, a professional doctor, how can? (sic)”
The results of interviews conducted with groups of HIV-positive patients are contained in a chapter entitled “Voices of Service Users”, by Precious Modiba, Lucy Gilson and Helen Schneider of the University of the Witwatersrand’s Centre for Health Policy. Although cautioning that the negative experiences were by no means universal, the authors noted that several of the interviewees reported negative experiences at the hands of health-care workers either at government hospitals, general clinics or specialised HIV clinics.
The most common problem was broken confidentiality. Several interviewees explained how either the conditions at the facility did not allow privacy such as doors left open during consultations or patients were treated rudely. One related how, on admittance to hospital, a nurse read her clinical notes and, discovering the woman was HIV positive, shouted: “Shoo! You HIV positive Aids!” in the presence of other people.
According to another patient, the nurses gossiped about her and her HIV status, which she felt was abusive. “When you go to the clinic, you will see sisters nudging at each other talking about you. They speak with their eyes.”
The findings of the review come in the wake of a recent ruling by the Health Professions Council and South African Medical Association that doctors can no longer disclose the nature of an illness on a sick certificate which has been welcomed by organisations lobbying for the rights of people with HIV/Aids.
In terms of the ruling, a doctor may only indicate a description of the illness with the patient’s permission. If refused, the doctor should only indicate that “the patient is not fit for work”.
Sister Sue Roberts, who coordinates the HIV clinic at Helen Joseph Hospital in Johannesburg, says people who come to the clinic regularly complain that their right to privacy has been breached. Roberts says the stigma surrounding HIV/Aids is so great that, in some instances, patients do not even want the name or number of the ward where they were treated disclosed on a hospital card.
She says because many patients find it difficult to disclose the nature of their illness to even their families, it is “vital” that confidentiality is respected.
“It’s not up to us to decide who a person discloses to; it’s not our decision to make,” she says.
Medical exodus worsening
Despite the introduction in 1997 by then minister of health, Nkosazana Dlamini-Zuma, of compulsory community service for newly qualified doctors, there are still too few medical personnel for patients in government health facilities, writes Khadija Magardie.
According to the 2001 South African Health Review, the public health sector’s doctor-patient ratio has thinned since 2000. There were 19,8 medical practitioners per 100000 of the population in 2001, compared to 21,9 in 2000. For professional nurses the ratio has also shrunk from 120,3 in 2000 to 111,9 in 2001.
The health review notes that the scheme of community service doctors replacing skilled foreign doctors, especially in rural areas, “is not working”, primarily because “often, community service doctors require so much time and supervision that they can do little to relieve the workload”.
A senior hospital manager is quoted as saying: “To think that a junior doctor who is still shaking when he’s called to theatre or at nights, after nine months can replace a doctor who has been working for 37 years …”
Competitive salaries, better working conditions and other increments have been cited as reasons behind the exodus of skilled medical personnel to either the private sector or to take up lucrative postings abroad.
The review also notes, in a chapter on the experiences of hospital superintendents and managers, that the restrictions placed on the use of foreign doctors in government hospitals are proving a frustration for hospital managers “because foreign doctors form a large recruitment pool”.
Issues such as insecure contracts and problems in getting contracts reviewed were cited as obstacles in securing the services of skilled foreign doctors to work in government health facilities.