Mpumalanga ‘€“ Turning the Corner

When Hussein Verachia was appointed head of the Mpumalanga health department in September 2003, he inherited what he refers to as a ‘€œdysfunctional department’€.

These are polite words to describe the notorious department that was regarded as incompetent and that mismanaged funds and manipulated tenders to benefit friends and family. Verachia’€™s predecessor, Riena Charles, has since been suspended from the provincial government. Charles and former MEC, Sibongile Manana, were moved to other departments following media exposés of massive fraud and corruption.

It is a time Verachia and his team would like to forget. Now radio advertisements extolling the virtues of the region’€™s public health services form part of an aggressive new campaign.

Dr Thapelo Mokola, CEO of Neslpruit’€™s Rob Ferreira and Themba, hospitals says the department’€™s agenda has moved from ‘€œthe confrontational to the developmental’€.

Political troubles aside, the largely rural province of three million inhabitants is faced with poverty, inadequate access to basic services and limited resources. Under spending of the provincial health budget was frequently reported, until September last year when a new MEC and head of department were appointed. From then up till March this year, the department’€™s expenditure rose from 33 to 93 percent.

According to Verachia, vacancies and low morale among staff were two pressing issues. Subsequently, up to 1 000 posts were advertised, 600 of which have been filled ‘€“ 130 of them with doctors.

This bodes well for the province’€™s primary health care package as the increase in the numbers of doctors has resulted in more sessions at clinics.

One of the health-care facilities to have benefited from the recruitment drive is Shongwe Hospital, situated in the rural Nkomazi district, 10kms from the Swaziland border and about 40kms from Mozambique. The district is home to about half a million people, but migration from the two poorer countries into the area, makes it difficult to estimate accurately.

Shongwe is situated amongst lush farmlands and exotic-sounding estates and trout farms. But there is nothing glamorous about the poor roads, lack of sanitation or proper water supply and high illiteracy levels that the people in nearby villages experience. Many work on the farms but even more are unemployed, Shongwe hospital’€™s medical manager Dr Jackie Mncina explains. Mcina first worked in the hospital in 1997 and 1998 and returned in October 2002.

‘€œI heard so many things about it after I left ‘€“ the shortage of doctors, one problem after another ‘€“ I had to come back.’€

The 350-bed hospital increased its complement of doctors from nine to 22 after September and there are now about 313 nurses. It is estimated that there is one doctor per 6 097 people and one professional nurse per 1 116 people in the entire province.

Attracting staff to a largely rural province such as this one, is a challenge, Mncina admitted, but for the team of young doctors who’€™ve chosen to stay on after completing their community service, or like Mncina and his deputy, have decided to return to the hospital, things are happening, in spite of difficulties.

‘€œThere’€™s a change in the air and we all feel it. At least now, things are in place and we have the right people for the job,’€ Mncina explained.

Mncina’€™s ‘€œdream team’€ last year created an HIV Clinic in response to the lack of proper care and support for HIV-positive patients. The clinic now operates twice a week and saw 75 new patients in April. It provides voluntary testing and counselling services and treats opportunistic infections.

Shongwe is one of six sites in the province that will be providing antiretroviral treatment. Dr Gillian Tarr, the site facilitator for the clinic, says what she and the rest of the staff members are most proud of is the growing demand for the clinic’€™s services.

Tarr attributes this to ‘€œa good referral system with the clinics’€ as well as strong links with the community.   The clinic has now started to identify patients to enrol on to its treatment programme.

‘€œWe are almost ready. We’€™ve been told that the drugs have arrived in the province,’€ she noted.

Meanwhile, the provincial health department claims that there are 165 operational VCT sites and 112 sites that offer Nevirapine for the prevention of mother-to-child transmission.

The programme has been running at Shongwe since September 2001, but the uptake is still low, Sister Jabulile Masuku who runs the PMTCT clinic, admitted.

Post-exposure prophylaxis for rape survivors has been a thorny issue in the province. Former MEC Sibongile Manana evicted rape activist group GRIP (Greater Nelspruit Rape Intervention Project) from the Rob Ferreira hospital when she discovered that ARVs were being dispensed to rape survivors. GRIP director, Barbara Kenyon, said the NGO had moved on and is now back operating from the hospital.

Although the province claims that there are 22 health-care facilities providing PEP, the system is ‘€œpatchy’€. Kenyon noted that GRIP is still not allowed to operate in some of the province’€™s hospitals. The NGO has the funds to complement health services, but the department has refused to engage in partnerships, Kenyon said.

Back in Shongwe, Mcina agrees that the role of NGOs and the community cannot be under-estimated. This, he said, was brought home to him during the region’€™s cholera outbreak earlier this year, where health promoters and NGOs were roped in to educate people about the disease.

‘€œCholera is a bug that will expose the lack of services. No toilets, people use the fields and the rivers, no water supply, people use those same rivers and ingest cholera,’€ said Dr Kobus Hugo, the Communicable Disease Control coordinator in Mpumalanga.

When the outbreak started in December last year, the CDC unit was operating in name only, as most of the posts had not been filled. But within three months, a new department had been formed and had to come up with a plan to control the disease in the province. Now, almost six months later, the disease has been ‘€œnearly contained’€, Hugo observed.

There is also a sense throughout the province that no health programme can really succeed without the involvement of traditional healers.

Two traditional healers have been invited to visit the hospital’€™s HIV clinic and GRIP has also run workshops for traditional healers, enlisting their support in caring for rape survivors.

But Gogo Kaizer Gumede-Maebele, a warm but imposing traditional healer who sits on the Mpumalanga AIDS Council and South Africa National AIDS Council, is tired of what she terms ‘€œtoken’€ workshops that patronisingly claim to involve traditional healers.

She has spent many years trying to ensure that her profession gets the respect it deserves and won’€™t quit until traditional healers have been fully integrated into the country’€™s health system.

‘€œTraditional healers are a part of our culture, you cannot run away from it,’€ she insisted.

Dr Mokola, Rob Ferreira and Themba’€™s CEO, sums up the changes sweeping Mpumalanga’€™s public health sector:   ‘€œWe are in a new era. We are now here to serve the community, not ourselves, and all systems are in place to do this.’€

Mpumalanga Stats

  • Population (2001): 3 million (7% of SA)
  • Unemployment:  29.8 (2002)
  • Water: Only 27.6% of households have piped water inside
  • Sanitation: 3.5% of households had no toilet
  • Infant Mortality Rate (2002): 59 per 1,000 live births
  • Stunting: 25.4% (Age 1-9 years)
  • Antenatal HIV prevalence: 29.2%
  • Reported cases of malaria: 293.1 per 100,000 (highest in the country)
  • Health expenditure per capita: R554 (2001/02)

E-mail Kanya Ndaki


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