Natalspruit Hospital, Gauteng
Natalspruit Hospital’s wards used to resemble a battlefield as health workers treated those wounded in political battles on the East Rand in the 1980s. Now an overwhelming number of Aids patients have quietly replaced those with gunshot and stab wounds, and there are signs that the quality of care is deteriorating as healthcare workers battle to cope.
The shacks surrounding the 784bed Katlehong hospital are a visible reminder that most of the patients are from impoverished households.
“Sorry, sorry, sorry,” urges a nurse as she pushes a trolley with a body under a sheet down a passage leading from the men’s medical ward.
“You see? There’s already a death,” whispers Sister Rosinah Serote, a motherly figure who has been head of nursing at the hospital for the past five years. It’s the first death for the day in Ward 16. The previous day, there were seven deaths in the medical wards.
“It does overwhelm us because, really, they are sick. They need to be cared for all the time. They are totally dependent on us because most of them can hardly walk. They can hardly feed themselves. They can hardly wash themselves, so we have to wash them. We have to take care of them full time,” explains Nombulelo Mabhija, the sister in charge of the 38-bed men’s ward. Shrugging her shoulders, she adds: “We cope. Sometimes we are overwhelmed, but we have to be there for the patients.”
Dr George Abraham, acting senior clinical manager of the hospital, believes the issues are straightforward: “Number one, our number of patients with HIV-related diseases have increased. Number two, we have been losing staff on a regular basis due to HIV. You’ll find that, on a monthly basis, we lose one to two people because of HIV.”
Abraham, who has worked at Natalspruit for the past 12 years, believes the hospital staff are no different from the community they serve. “I think the main thing is stigma. If I know I’m HIV [positive] I try to hide it until it’s very, very late. It’s a matter of stigma — whether I’m a healthcare worker or not,” he says. “We used to admit between 10 and 15 medical patients on a daily basis. Now that number has gone up to 40 to 50 patients a day — and most of these patients have HIV-related complications.”
Serote says more than 80% of admissions to the hospital’s medical wards are HIV-related. In addition to the pressure to find beds for them all, she has also been forced to deploy staff from other wards to dispense antiretrovirals in the HIV clinic. “We had to remove one paediatric ward and make it a step-down [lower-care ward]. And we had to take one female orthopaedic ward and make it a female medical ward. And we had to push orthopaedics somewhere else,” she sighs.
Serote warns that if the HIV epidemic continues to grow in their community, there will be no beds available for patients with any other condition. “It’ll mean we will turn patients away.”
In a separate building away from the main hospital the outpatients HIV clinic, Faranani (a Tshivenda word meaning “join hands and work together”), is teeming with patients waiting for their turn to see the pharmacist.
Ingrid Linder is the sole pharmacist at Faranani. “Often we have to be fast in our dispensing mechanisms and sometimes patients don’t get the best quality out of our service. We are pushed for time.”
At best Linder spends five minutes with each patient, which is not ideal. By 11am she has usually seen about 40 patients and more than 50 are still waiting.
“That’s not how I want it to be, because pharmacy is a complicated issue. It’s medicine. There are some finer details that you sometimes have to take the time to explain to your patient. But you always have that burning issue at the back of your head: time factor, time factor. Other people are waiting as well. Hurry up. Be fast. Be quick,” she says.
Of the 20Â 000 patients who have been seen at Faranani, only 1Â 000 are on antiretrovirals, a fact that Serote attributes to the clinic only having one pharmacist.
Abraham is blunt: “We are going to reach a stage when we won’t be able to cope unless we have enough resources. This year we might see up to 30Â 000 patients. You need space, you need manpower, you need money, social services. It’s an all-inclusive problem.”
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