Drive for health in North West

Sister Jeanette Joubert has spent the past 23 years driving distances of up to 3 000km a month to reach patients in the harsh, dry conditions of the North West. It is no easy job providing basic health-care services in a province where 65% of the more than three million inhabitants live in rural areas.

“You’re a driver, a nurse, a social worker, and then if you’re really good, a mechanic, because you must be prepared to get stuck — these roads are terrible,” says Sister Pinky Motlhabane, a primary health-care nurse who has been with the Bophirima municipality health department for 10 years.

It is not unusual to drive 500km a day, to see only two patients. But today is “a lucky day” for Motlhabane. Her route is “relatively easy” as she will be travelling to nearby farms and sticking mostly to the tar road.

Driving out of Vryburg, her first stop is a farm outside Stella in the heart of Stellaland — the breadbasket of the North West province. Agriculture is the main source of employment in this area and clinics usually use the farms as a base for treating farm workers.

This farm with its fields of sunflowers is relatively easy to reach.

As the familiar white van appears at the workers’ compound, children rush to greet the nurse and her assistant. Their malnourished bodies bear witness to a serious problem in the region. Nutrition indicators are a cause for concern. In 1999 there was 24,9% stunting in children between the ages of one and nine — high compared with the national average of 21,6%.

The families here get by on an irregular supply of rations from the farm — up to five litres of milk a day and 50kg of mielie meal a month.

Teenage pregnancy rates in North West decreased slightly from 11% in 2001 to 9% in 2002, the effects are also more evident in communities with low literacy and employment rates.

Keaorata, also known as “Lovers”, is a 23-year old artist and volunteer at the Ganyesa clinic. He says teenagers here have few options: “Poverty is a way of life and all we do is go to taverns and drink, and then make babies.”

Margaret Mokgothu, HIV/Aids coordinator for the Ganyesa sub-district south of Vryburg, says farm workers have been neglected in HIV/Aids awareness programmes.

Mobile clinics have been equipped to provide voluntary counselling and testing (VCT), as well as nevirapine for the prevention of mother-to-child transmission (PMTCT). But the migration of farm workers to cities like Rustenburg has made follow-up of such services difficult.

The provincial health department had increased its PMTCT sites from two to 89 by the end of March 2003. “In theory, each and every clinic in each health district should be providing nevirapine,” says the provincial health minister Dr Molefi Sefularo.

In Taung, only four out of 23 clinics in the sub-district serving a population of 231 000 have PMTCT programmes and only 26 HIV-positive women have enrolled since last March. The VCT programme is doing only slightly better.

According to regional manager Gladys Crisp-Mokoto none of the three mobile health clinics have started voluntary counselling and testing and only 18 of its 23 clinics have “a well-functioning VCT service”. This, she explains, is due to a lack of training and capacity.

Those sites that are up and running, tested and counselled 583 people between October and December. A private company has been contracted to train up to 30 people in a year — a process that was “frustratingly slow”, she added.

Nevertheless, preparations for the roll-out of anti-retrovirals in the province are under way. The health minister points to the accreditation of Tshepong hospital in Klerksdorp as the first step in the province’s plans.

Taung District hospital — another anti-retroviral distribution site — is setting aside a 25-bed ward and has advertised posts for more staff.

There were only 11,5 doctors for every 100 000 people (one doctor for 8 695 people) living in the North West last year and the situation has not improved much.

Bophirima district manager Konrad Motlhabane is in charge of the country’s best-run rural health district — a title awarded to Motlhabane and his staff in 2003 for their efficient management of health services in the region. But all the awards in the world will not bring doctors and nurses to work here. Last year Motlhabane personally went to all nursing colleges in the region and “begged and pleaded with them to come and work here”.

The “lack of doctor manpower”, as Motlhabane puts it, has placed the burden of patient care on nurses. Margaret Mokgheti is the sister in charge of Morekwong clinic, about 130km outside Vryburg. The clinic is a 24-hour health centre that acts as a referral base for smaller clinics. They haven’t seen a doctor since November. — Health-e

North West facts and figures