The impact of HIV/Aids on Rustenburg Provincial Hospital has been enormous. Well over half of all patients display the symptoms of Aids and two-thirds of those tested for the virus last year were HIV-positive. Tuberculosis and pneumonia, both closely associated with HIV, are the most common illnesses.
Situated in the heart of North West mining territory, the 352bed hospital is almost always full to capacity, admitting more than 2Â 000 patients and treating more than 8Â 300 outÂpatients each month.
Catherine Monamodi, sister in charge of the 30-bed female medical ward, says there are always patients waiting for beds. “Once a patient is discharged or transferred, that bed already has a new patient,” says Monamodi. “You know, because of this mine, because of HIV, most of our patients are very sick.”
The hospital was the first site in the region to offer antiretroviral treatment in April 2004. It is now monitoring more than 6Â 000 HIV-positive patients, 3Â 300 of whom are on antiretrovirals.
The programme offers HIV counselling, treatment readiness training and antiretrovirals. It also has a prevention of mother-to-child HIV transmission programme and nutritional training. It also offers antiretrovirals to rape survivors and support services for patients with TB and other opportunistic infections.
Sister Rebecca Diphoko, assistant director of the comprehensive Aids programme, says about 60 new patients come to the clinic every day.
“Patients who are stable and have been on treatment for six months and above, and who can supervise themselves in terms of taking the treatment, we down-refer to the clinics. The clinics supervise and monitor them for six months so that we get relief. They come back to us after six months for review.
“The down-referral is a major achievement for us. We started it two months ago, but we’ve already referred 220 patients to the clinics. We are already seeing its fruit because, by 7am, the clinic is already full, but at least now we can breathe.”
Budgetary constraints are a problem as the programme only has money for salaries, not for equipment or training.
Despite the challenges, Diphoko is positive and morale is boosted by the patients themselves. “On a daily basis you hear a patient saying: ‘You know, I was dying. I was bed-ridden. My muscles were wasted, but look at me right now. I’ve improved. I can walk. I can do whatever for myself. I’m back to work.’ That encourages you to come to work. At least you are saving a life on a daily basis.”
While the programme is going well, it has put a heavy burden on the pharmacy department, which has to dispense the antiretrovirals.
“We are experiencing larger and larger numbers of patients because of the HIV programme,” says Wilheminah Lekganyane, the pharmacy manager. “We are now starting to refer-down to clinics, which are nearer the patients’ homes, but it’s still a burden on the hospital.”
Pharmacy stock controller Farana Cassiem says the pharmacy dispenses to about 350 outpatients every day, and that four or five pharmacists on duty every day dish out between 2Â 500 and 3Â 000 items.
“The pharmacy is officially closed after 4pm, but at the outpatients department, if there are patients waiting there, we wait until we have dispensed medication to all the patients before we close the doors — and it can be as late as 8pm,” says Cassiem.