Long-distance doctoring

Sister Pierrette Rossouw’s smile turns to a mock frown when she explains how she has ended up in the small Northern Cape dorp of Garies.

“You know, they say that when you come to Garies you cry, but when you have to leave you cry again,” she says with a chuckle.

Sister Roussouw has worked at the Garies clinic for 11 years. Her nurse’s shoes are well worn, an indication of the many hours she has spent on her feet. Garies, about 240km from the Namibian border, is a welcome stop on the long, dry trek from Cape Town to Namibia. The dorp’s main features are a run-down hotel, a new police station and a farmers’ cooperative.

The Northern Cape is not for the faint-hearted. The landscape is harsh, distances between towns are vast and temperatures range from 40 degrees Celsius in the day to below freezing at night. The province comprises almost 30% of South Africa’s land mass, but is home to just 900 000 people. Employment in the region is scarce, with only a few jobs on offer at farms and granite mines.

But those who have settled in the province’s many one-horse towns are determined to stay, and many professionals, especially health workers, are returning to their place of birth after completing their tertiary education.

About 70% of residents live in urban areas, and towns experience a constant influx from rural areas, as workers on farms flock to small urban centres where health services and schools are more accessible.

Rossouw and her colleague, Zinnie de Klerk, see an average of 57 patients a day on their rounds in the mobile clinic and the remote villages they visit.

The primary causes of death in the region are respiratory and cardiovascular disease and tuberculosis.

“We have about 24 tuberculosis patients at any one time,” says Rossouw, adding diabetes and high blood pressure to the list of common ailments.

As with other clinics in the province, Garies focuses on primary health care and aims to reduce the number of referrals to hospitals.

“Recent calculations showed that of 974 patients we saw in Garies clinic, the doctor [who visits every day] only saw 94 and most were for chronic medication prescriptions,” she says proudly.

The province has a high number of teenage pregnancies — with almost one in five women aged between 15 and 19 becoming pregnant.

To address the challenges faced by young adults, two youth centres have been opened in Kimberley and Upington to provide relationship counselling and education on safer sex, contraceptives, treatment of sexually transmitted infections and termination of pregnancy services.

Because of the distances between towns and referral centres, transporting patients to health centres for specialist services is a major challenge.

“We refer many patients to Springbok, but we refer as far away as Kimberley [800km] or Bloemfontein [975km],” says Sister Riana de Waal of the Pofadder clinic.

“A big problem is that there is not always a staff member to accompany the patient. Sometimes, in emergencies, we have to use the flying ambulance service [operated by the Red Cross],” she says.

Ambulances in the Northern Cape travel about 13-million kilometres a year, transporting about 150 000 patients.

The past financial year saw average provincial expenditure on health increase by almost 11%. The per capita spending on health in the province is budgeted at R1 042, placing it among the top five provinces in this regard.

The introduction of community service has also, for the first time, seen a permanent doctor located in Pofadder and other small towns to serve the clinics and community hospitals. Specialists are flown into Springbok from Kimberley and Bloemfontein every five weeks.

Health workers agree that the disturbingly high level of alcohol and drug abuse in the province requires urgent psycho-social intervention.

“We try to do the best we can, but even if we are able to stabilise the patients, they return to the socio-economic conditions that cause many of their problems in the first place,” says Stanley Basson, a nurse in Pofadder.

Substance abuse has resulted in almost 30% of all children in the province displaying signs of stunted growth, and De Aar has one of the highest foetal alcohol syndrome rates in the world.

For a full version of this story visit www.health-e.org.za

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