/ 1 November 2013

Comment: Violent strike compromised medical care

Fanning the flames: Striking farmworkers are said to have targeted those trying to help the sick and injured.
Fanning the flames: Striking farmworkers are said to have targeted those trying to help the sick and injured. (David Harrison)

We feel that the findings of the research conducted by the People's Health Movement (PHM) are not an accurate reflection of the efforts that were made by the Western Cape government health department to maintain access to health services in the areas affected by last year's farmworkers' strike.

The need to close clinics due to protest action was completely unexpected. Never before have protesters threatened the safety of health workers and patients during a strike, or vandalised facilities. 

Clinic closure is not taken lightly. However, if staff or patient safety is threatened, services will be closed. The department cannot knowingly place staff in an unsafe situation.

It is interesting to read in PHM's report that one farmworker stated the "clinic was closed for three weeks". Clinics were closed on and off, the longest consecutive period being three days ( January 14 to 16). Only the De Doorns clinic, at the epicentre of the strike, was closed for longer than a day. Facilities in the other affected towns were closed for shorter periods. 

On many occasions in the initial phase of the protest staff simply closed the gates and locked the clinic doors, while keeping a facility operational, thus offering themselves and patients some form of safety. On a few occasions clinics were closed due to the logistical inability of patients and staff to get to the clinic. 

This was mostly due to rocks strewn on the roads and other physical barriers that prevented passage. 

De Doorns clinic closure 
The decision to close the De Doorns clinic on January 14, 15 and 16 was taken because of protesters throwing rocks at the vehicles of staff. An ambulance was also stoned and vandalised. But even so, emergency teams continued working, although they moved their base to the police station.

Despite threats made by protesters, including that the homes and children of staff would be targeted, the De Doorns clinic was re-opened within an hour of an agreement made on January 17 between government officials and community leaders that community members would assist in keeping the clinic, its staff and patients safe from protesters. 

Constitutionally, the department is required to offer, without interruption, emergency medical services. Throughout the protest, these services were always provided, and it is our understanding that no patients were ever turned away. Large-scale messaging was done by radio and through community networks, informing the community that any person requiring medication should make use of the ambulance services at the De Doorns police station for safe access to Worcester Hospital, where it would be dispensed. 

Although we concede that the availability of chronic medication presented problems in December, in January these problems were diminished, as most patients requiring chronic medication had received medication for two months, as is the practice during the festive season.

Fear of arrest at hospitals
We believe that the notion that the police were "waiting for you at the hospital" germinated on the day that police officials and farmworkers were being simultaneously treated at Worcester and Ceres hospitals, which may have led to fear of incarceration. 

A further catalyst could have been that, at times, protesters blocked ambulances from accessing the wounded. Therefore, those requiring medical assistance had to go to a police station, where emergency medical teams were temporarily stationed. 

When no ambulance was available, the police transported patients to the closest facility. Police were not waiting for patients at any of them.

As far as can be ascertained by the department, no person with injuries related to the unrest was "handed over" to the police. Our patients' right to treatment remained the priority, irrespective of the cause of injury. A total of 73 patients with injuries directly related to the strikes were treated. 

It is unfortunate that two patients were arrested at Worcester Hospital, however, this should be discussed with the South African Police Service. We cannot comment on the services available from private farm clinics or on the behaviour of the police.  

The PHM survey does not address the affect the protest had on personnel at health facilities. Some staff at facilities in the De Doorns area were traumatised, which has led to ongoing, one-on-one and group debriefing sessions. One of our staff members stated during a group debriefing: "That man who was on TV throwing stones at the clinic told us he would kill us. He is one of our patients and next week we will need to care for him. It will be difficult because now I don't trust him."

It is also unfortunate that only 25 people were interviewed for the survey, as this is not a true cross-section of the community. It is also not indicated whether the interviewees were protesters or innocent bystanders.

Recommendations followed
Many of the recommendations given in the PHM report were followed during the strike and are usual practice when services are interrupted. These include the communication of alternative places to access healthcare; the deployment of staff to facilities that could receive extra patients; and the use of a health committee. 

Although only one of the clinics in the Cape winelands district has an active health committee, it finds it difficult to find people who are committed to serving on the committee.

The PHM research serves to refocus energy on instilling good relationships within the communities we serve. However, it is up to the community to ensure that facilities are able to continue delivering services, irrespective of the situation surrounding the facility.

Faiza Steyn is the director of ?communications at the Western Cape department of health. ?Last week's report on the PHM survey can be found at mg.co.za/health